Assessing low-value care practices in the Netherlands
This recently published study looked at general practice and hospital routinely collected data in order to understand the volume and variation of selected low-value care practices. The analysis used billing claims from health care providers for 3.5 million Dutch inhabitants.
Three low-value practices were looked at: general practice ordering of imaging for low-back pain in the absence of red flags; hospitals that screened patients over 75 years for colorectal cancer; and hospitals that diagnosed varices with doppler or plethysmography.
The study showed there was a lot of variation in practice between providers. While many providers did not order these low-value tests, a minority ordered a substantial number.
This study reinforces the value of using routinely collected data to measure low-value practices and identifying variation in care as a tool for prioritising investigations to be targeted.
Choosing Wisely New Zealand recommendations are that imaging should not be used for diagnosing non-specific acute low back pain in the absence of red flags, nor should back imaging be part of routine medical examinations.
The full text is open access at https://doi.org/10.1093/eurpub/ckz245. The reference is Kool RB, et al. Assessing volume and variation of low-value care practices in the Netherlands, European Journal of Public Health, 17 Jan 2020, ckz245.