Levers for addressing medical underuse and overuse: achieving high-value health care

The Lancet

Volumn 390, Issue 10090, 2017, Pages 191-202

  Elshaug, Adam G ^a,b   Rosenthal, Meredith B ^c   Lavis, John N ^c,d   Brownlee, Shannon ^b,c   Schmidt, Harald ^e   Nagpal, Somil ^f   Littlejohns, Peter ^g   Srivastava, Divya ^h   Tunis, Sean ⁱ   Saini, Vikas ^b  

^a University of Sydney   (Australia)

^b Lown Cardiovascular Group   (United States)

^c HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^d MCMASTER UNIVERSITY   (Canada)

^e UNIVERSITY OF PENNSYLVANIA   (United States)

^f WORLD BANK   (United States)

^g KING'S COLLEGE LONDON   (United Kingdom)

^h LONDON SCHOOL OF ECONOMICS   (United Kingdom)

ⁱ Center for Medical Technology Policy   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

BIOMEDICAL TECHNOLOGY ASSESSMENT; COST EFFECTIVENESS ANALYSIS; HEALTH CARE ACCESS; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH CARE UTILIZATION; HEALTH INSURANCE; PRIORITY JOURNAL; REVIEW; COST BENEFIT ANALYSIS; HEALTH CARE DELIVERY; HEALTH SERVICE; HUMAN;

COST-BENEFIT ANALYSIS; DELIVERY OF HEALTH CARE; HEALTH SERVICES; HUMANS;

EID: 85016135746     PISSN: 01406736     EISSN: 1474547X     Source Type: Journal    
DOI: 10.1016/S0140-6736(16)32586-7     Document Type: Review

References (111)

1. Brownlee, S, Chalkidou, K, Doust, J, et al. Evidence of overuse of medical services around the world. Lancet, 2017 published online Jan 8. http://dx.doi.org/10.1016/S0140-6736(16)32585-5.
2. Glasziou, P, Straus, S, Brownlee, S, et al. Evidence for underuse of effective medical services around the world. Lancet, 2017 published online Jan 8. http://dx.doi.org/10.1016/S0140-6736(16)30946-1.
3. Saini, V, Garcia-Armesto, S, Klemperer, D, et al. Drivers of poor medical care. Lancet, 2017 published online Jan 8. http://dx.doi.org/10.1016/S0140-6736(16)30947-3.
4. Jarman, B, When managers rule. BMJ, 345, 2012, e8239.
5. Moriates, C, Shah, N, Creating an effective campaign for change: strategies for teaching value. JAMA Intern Med 174 (2014), 1693–1695.
6. Dickson, KE, Simen-Kapeu, A, Kinney, MV, et al. Every Newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. Lancet 384 (2014), 438–454.
7. Scott, IA, Duckett, SJ, In search of professional consensus in defining and reducing low-value care. Med J Aust 203 (2015), 179–181.
8. Waitzkin, H, To the editors and reply. MEDICC Rev 17 (2015), 5–8.
9. Schmidt, H, Gostin, LO, Emanuel, EJ, Public health, universal health coverage, and sustainable development goals: can they coexist?. Lancet 386 (2015), 928–930.
10. WHO. Universal health coverage. http://www.who.int/healthsystems/universal_health_coverage/en/, 2015 (accessed Dec 5, 2016).
11. Haynes, B, Can it work? Does it work? Is it worth it?. BMJ 319 (1999), 652–653.
12. Lown Institute. Declaration of principles of the Right Care Alliance. http://www.rightcaredeclaration.org/ (accessed Dec 5, 2016).
13. Institute Of Medicine of the National Academies. Essential health benefits: balancing coverage and cost, 2011, The National Academies Press, Washington DC.
14. Elshaug, AG, Watt, AM, Moss, JR, Hiller, JE, Policy perspectives on the obsolescence of health technologies in Canada. https://www.cadth.ca/media/pdf/Obsolescence%20of%20Health%20Technologies%20in%20Canada_Policy_Forum_e.pdf, 2009 (accessed Dec 5, 2016).
15. Giacomini, MK, The which-hunt: assembling health technologies for assessment and rationing. J Health Polit Policy Law 24 (1999), 715–758.
16. Garner, S, Littlejohns, P, Disinvestment from low value clinical interventions: NICEly done?. BMJ, 343, 2011, d4519.
17. Elshaug, AG, Watt, AM, Mundy, L, Willis, CD, Over 150 potentially low-value health care practices: an Australian study. Med J Aust 197 (2012), 556–560.
18. Levinson, W, Kallewaard, M, Bhatia, RS, Wolfson, D, Shortt, S, Kerr, EA, ‘Choosing Wisely’: a growing international campaign. BMJ Qual Saf 24 (2015), 167–174.
19. Elshaug, AG, Moss, JR, Littlejohns, P, Karnon, J, Merlin, TL, Hiller, JE, Identifying existing health care services that do not provide value for money. Med J Aust 190 (2009), 269–273.
20. Elshaug, AG, Hiller, JE, Tunis, SR, Moss, JR, Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Aust New Zealand Health Policy, 4, 2007, 23.
21. Elshaug, AG, Garber, AM, How CER could pay for itself—insights from vertebral fracture treatments. N Eng J Med 364 (2011), 1390–1393.
22. Chandra, A, Khullar, D, Lee, TH, Addressing the challenge of gray-zone medicine. N Engl J Med 372 (2015), 203–205.
23. Bhatia, RS, Austin, PC, Stukel, TA, et al. Outcomes in patients with heart failure treated in hospitals with varying admission rates: population-based cohort study. BMJ Qual Saf 23 (2014), 981–988.
24. Keyhani, S, Siu, AL, The underuse of overuse research. Health Serv Res 43 (2008), 1923–1930.
25. Lavis, JN, Wilson, MG, Grimshaw, JM, Evidence brief: optimizing clinical practice in Ontario based on data, evidence and guidelines. https://www.mcmasterhealthforum.org/docs/default-source/Product-Documents/evidence-briefs/clinical-practice-optimization-in-ontario_eb.pdf?sfvrsn=2, 2015 (accessed Dec 5, 2016).
26. Liang, BA, Mackey, T, Reforming direct-to-consumer advertising. Nat Biotechnol, 29, 2011, 397.
27. Frolich, A, Schiotz, ML, Strandberg-Larsen, M, et al. A retrospective analysis of health systems in Denmark and Kaiser Permanente. BMC Health Serv Res, 8, 2008, 252.
28. Garner, S, Docherty, M, Somner, J, et al. Reducing ineffective practice: challenges in identifying low-value health care using Cochrane systematic reviews. J Health Serv Res Policy 18 (2013), 6–12.
29. Miller, TD, Askew, JW, The first decade of appropriate use criteria: is the glass half empty or half full?. J Am Coll Cardiol 65 (2015), 774–776.
30. Doll, JA, Patel, MR, Self-regulation in the era of big data: appropriate use of appropriate use criteria. Ann Intern Med 162 (2015), 592–593.
31. Schwartz, AL, Landon, BE, Elshaug, AG, Chernew, ME, McWilliams, JM, Measuring low-value care in Medicare. JAMA Intern Med 174 (2014), 1067–1076.
32. Organisation for Economic Co-operation and Development. Geographic variations in health care: what do we know and what can be done to improve health system performance?. https://www.oecd.org/els/health-systems/FOCUS-on-Geographic-Variations-in-Health-Care.pdf, 2014 (accessed Dec 5, 2016).
33. Ivers, N, Jamtvedt, G, Flottorp, S, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev, 6, 2012 CD000259.
34. Collins, ED, Moore, CP, Clay, KF, et al. Can women with early-stage breast cancer make an informed decision for mastectomy?. J Clin Oncol 27 (2009), 519–525.
35. Hersch, J, Barratt, A, Jansen, J, et al. Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial. Lancet 385 (2015), 1642–1652.
36. Stacey, D, Bennett, CL, Barry, MJ, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev, 10, 2011 CD001431.
37. Katz, SJ, Hawley, S, The value of sharing treatment decision making with patients: expecting too much?. JAMA 310 (2013), 1559–1560.
38. The Ottawa Hosptial Research Institute. Patient decision aids. http://decisionaid.ohri.ca/ (accessed Dec 5, 2016).
39. MacKean, G, Noseworthy, T, Elshaug, AG, et al. Health technology reassessment: the art of the possible. Int J Technol Assess Health Care 29 (2013), 418–423.
40. Ginsburg, PB, Cost-utility of cataract surgery: the real issues. Ophthalmology, 120, 2013, 2366.
41. Tang, KL, Barnieh, L, Mann, B, et al. A systematic review of value-based insurance design in chronic diseases. Am J Manag Care 20 (2014), e229–e241.
42. Gibson, TB, Maclean, RJ, Chernew, ME, Fendrick, AM, Baigel, C, Value-based insurance design: benefits beyond cost and utilization. Am J Manag Care 21 (2015), 32–35.
43. Chernew, ME, Rosen, AB, Fendrick, AM, Value-based insurance design. Health Aff 26 (2007), w195–w203.
44. Parkinson, B, Sermet, C, Clement, F, et al. Disinvestment and value-based purchasing strategies for pharmaceuticals: an international review. PharmacoEconomics 33 (2015), 905–924.
45. Claxton, K, Palmer, S, Longworth, L, et al. A comprehensive algorithm for approval of health technologies with, without, or only in research: the key principles for informing coverage decisions. Value Health 19 (2016), 885–891.
46. Elshaug, AG, Moss, JR, Hiller, JE, Maddern, GJ, Upper airway surgery should not be first line treatment for obstructive sleep apnoea in adults. BMJ 336 (2008), 44–45.
47. Williams, I, Organizational readiness for innovation in health care: some lessons from the recent literature. Health Services Manage Res 24 (2011), 213–218.
48. Lavis, JN, Oxman, AD, Moynihan, R, Paulsen, EJ, Evidence-informed health policy 1-synthesis of findings from a multi-method study of organizations that support the use of research evidence. Implement Sci, 3, 2008, 53.
49. Song, Z, Rose, S, Safran, DG, Landon, BE, Day, MP, Chernew, ME, Changes in health care spending and quality 4 years into global payment. N Engl J Med 371 (2014), 1704–1714.
50. McWilliams, JM, Landon, BE, Chernew, ME, Zaslavsky, AM, Changes in patients' experiences in Medicare Accountable Care Organizations. N Engl J Med 371 (2014), 1715–1724.
51. Budryk, Z, Major teaching hospitals impose restrictions on low-volume surgeries. http://www.fiercehealthcare.com/healthcare/major-teaching-hospitals-impose-restrictions-low-volume-surgeries, 2015 (accessed Dec 5, 2016).
52. O'Mara-Eves, A, Brunton, G, McDaid, D, et al. Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Res 1 (2013), 1–548.
53. Arterburn, D, Wellman, R, Westbrook, E, et al. Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs. Health Aff 31 (2012), 2094–2104.
54. Katz, SJ, Treatment decision aids are unlikely to cut healthcare costs. BMJ, 348, 2014, g1172.
55. Kreis, J, Schmidt, H, Public engagement in health technology assessment and coverage decisions: a study of experiences in France, Germany, and the United Kingdom. J Health Polit Policy Law 38 (2013), 89–122.
56. Abelson, J, Blacksher, EA, Li, KK, Boesveld, SE, Goold, SD, Public deliberation in health policy and bioethics: mapping an emerging, interdisciplinary field. J Public Deliberation, 9, 2013, 5.
57. Institute of Medicine; Committee to Advise the Public Health Service on Clinical Practice Guidelines. Clinical practice guidelines: directions for a new program, 1990, National Academies Press, Washington DC.
58. Prior, M, Guerin, M, Grimmer-Somers, K, The effectiveness of clinical guideline implementation strategies—a synthesis of systematic review findings. J Eval Clin Pract 14 (2008), 888–897.
59. Hunt, TD, Ramanathan, SA, Hannaford, NA, et al. CareTrack Australia: assessing the appropriateness of adult healthcare: protocol for a retrospective medical record review. BMJ Open, 2, 2012, e000665.
60. Ivers, NM, Sales, A, Colquhoun, H, et al. No more ‘business as usual’ with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implement Sci, 9, 2014, 14.
61. Oxman, AD, Thomson, MA, Davis, DA, Haynes, RB, No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ 153 (1995), 1423–1431.
62. Grol, R, Grimshaw, J, From best evidence to best practice: effective implementation of change in patients' care. Lancet 362 (2003), 1225–1230.
63. Hughes, LD, McMurdo, ME, Guthrie, B, Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing 42 (2013), 62–69.
64. Tricoci, P, Allen, JM, Kramer, JM, Califf, RM, Smith, SC Jr, Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA 301 (2009), 831–841.
65. Lenzer, J, Hoffman, JR, Furberg, CD, Ioannidis, JP, Ensuring the integrity of clinical practice guidelines: a tool for protecting patients. BMJ, 347, 2013, f5535.
66. Norris, SL, Holmer, HK, Burda, BU, Ogden, LA, Fu, R, Conflict of interest policies for organizations producing a large number of clinical practice guidelines. PLoS One, 7, 2012, e37413.
67. Tunis, SR, Stryer, DB, Clancy, CM, Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA 290 (2003), 1624–1632.
68. Macleod, MR, Michie, S, Roberts, I, et al. Biomedical research: increasing value, reducing waste. Lancet 383 (2014), 101–104.
69. Chalmers, I, Bracken, MB, Djulbegovic, B, et al. How to increase value and reduce waste when research priorities are set. Lancet 383 (2014), 156–165.
70. Odierna, DH, Forsyth, SR, White, J, Bero, LA, The cycle of bias in health research: a framework and toolbox for critical appraisal training. Account Res 20 (2013), 127–141.
71. Moynihan, RN, Cooke, GP, Doust, JA, Bero, L, Hill, S, Glasziou, PP, Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States. PLoS Med, 10, 2013, e1001500.
72. Moraros, J, Lemstra, M, Nwankwo, C, Lean interventions in healthcare: do they actually work? A systematic literature review. Int J Qual Health Care 28 (2016), 150–165.
73. Moriates, C, Dohan, D, Spetz, J, Sawaya, GF, Defining competencies for education in health care value: recommendations from the University of California, San Francisco Center for Healthcare Value Training Initiative. Acad Med 90 (2014), 421–424.
74. Macinko, J, Starfield, B, Shi, L, The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Serv Res 38 (2003), 831–865.
75. Starfield, B, Shi, L, Macinko, J, Contribution of primary care to health systems and health. Milbank Q 83 (2005), 457–502.
76. Franks, P, Clancy, CM, Nutting, PA, Gatekeeping revisited—protecting patients from overtreatment. N Engl J Med 327 (1992), 424–429.
77. Horn, D, Koplan, K, Senese, M, Orav, EJ, Sequist, T, The impact of cost displays on primary care physician laboratory test ordering. J Gen Intern Med 29 (2014), 708–714.
78. Keyhani, S, Hebert, PL, Ross, JS, Federman, A, Zhu, CW, Siu, AL, Electronic health record components and the quality of care. Med Care 46 (2008), 1267–1272.
79. Squires, J, Sullivan, K, Eccles, M, Worswick, J, Grimshaw, J, Are multifaceted interventions more effective than single-component interventions in changing health-care professionals' behaviours? An overview of systematic reviews. Implement Sci, 9, 2014, 152.
80. Freedman, DB, Towards better test utilization—strategies to improve physician ordering and their impact on patient outcomes. EJIFCC 26 (2015), 15–30.
81. Georgiou, A, Williamson, M, Westbrook, JI, Ray, S, The impact of computerised physician order entry systems on pathology services: a systematic review. Int J Med Inform 76 (2007), 514–529.
82. Institute of Medicine. Delivering high-quality cancer care: charting a new course for a system in crisis, 2013, The National Academies Press, Washington DC.
83. Prasad, V, Cifu, A, Medical reversal: why we must raise the bar before adopting new technologies. Yale J Biol Med 84 (2011), 471–478.
84. Kramer, DB, Xu, S, Kesselheim, AS, How does medical device regulation perform in the United States and the European union? A systematic review. PLoS Med, 9, 2012, e1001276.
85. Lathyris, DN, Patsopoulos, NA, Salanti, G, Ioannidis, JPA, Industry sponsorship and selection of comparators in randomized clinical trials. Eur J Clin Invest 40 (2010), 172–182.
86. Flacco, ME, Manzoli, L, Boccia, S, et al. Head-to-head randomized trials are mostly industry sponsored and almost always favor the industry sponsor. J Clin Epidemiol 68 (2015), 811–820.
87. Wennberg, JE, Fisher, ES, Skinner, JS, Geography and the debate over Medicare reform. Health Aff (Millwood)(suppl web exclusives), 2002, W96–114.
88. Schoen, C, Osborn, R, Squires, D, Access, affordability, and insurance complexity are often worse in the United States compare to ten other countries. Health Aff 32 (2013), 2205–2215.
89. Lavis, JN, Røttingen, JA, Bosch-Capblanch, X, et al. Guidance for evidence-informed policies about health systems: linking guidance development to policy development. PLoS Med, 9, 2012, e1001186.
90. Kieslich, K, Bump, JB, Norheim, OF, Tantivess, S, Littlejohns, P, Accounting for technical, ethical, and political factors in priority setting. Health Systems & Reform 2 (2016), 51–60.
91. Paprica, PA, Culyer, AJ, Elshaug, AG, Peffer, J, Sandoval, GA, From talk to action: Policy stakeholders, appropriateness, and selective disinvestment. Int J Technol Assess Health Care 31 (2015), 236–240.
92. Australian Government Department of Health. Medicare benefits schedule review. http://www.health.gov.au/internet/main/publishing.nsf/content/mbsreviewtaskforce, 2016 (accessed June 27, 2016).
93. Chalkidou, K, Marten, R, Cutler, D, et al. Health technology assessment in universal health coverage. Lancet 382 (2013), e48–e49.
94. Center for Global Development. Priority-setting institutions for global health. http://www.cgdev.org/working-group/priority-setting-institutions-global-health (accessed Jan 16, 2016).
95. National Health Service England. Commissioning for value. Comprehensive data packs to support CCGs and NHS England in the regions. https://www.england.nhs.uk/resources/resources-for-ccgs/comm-for-value (accessed Dec 5, 2016).
96. Van Herck, P, De Smedt, D, Annemans, L, Remmen, R, Rosenthal, MB, Sermeus, W, Systematic review: effects, design choices, and context of pay-for-performance in health care. BMC Health Serv Res, 10, 2010, 247.
97. Cashin, C, Chi, YL, Smith, P, Borowitz, M, Thomson, S, Paying for performance in health care. Implications for health system performance and accountability, 2014, Open University Press, Maidenhead http://www.euro.who.int/__data/assets/pdf_file/0020/271073/Paying-for-Performance-in-Health-Care.pdf (accessed Dec 5, 2016).
98. Rosenthal, MB, Nonpayment for performance? Medicare's new reimbursement rule. N Engl J Med 357 (2007), 1573–1575.
99. Charlesworth, A, Davies, A, Dixon, J, Reforming payment for health care in Europe to achieve better value. http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/120823_reforming-payment-for-health-care-in-europev2.pdf, 2012 (accessed Dec 5, 2016).
100. Joynt, KE, Jha, AK, A path forward on Medicare readmissions. N Engl J Med 368 (2013), 1175–1177.
101. de Bakker, DH, Struijs, JN, Baan, CA, et al. Early results from adoption of bundled payment for diabetes care in the Netherlands show improvement in care coordination. Health Aff 31 (2012), 426–433.
102. National Institute for Health and Care Excellence International. Better decisions for better Health: priority-setting and health technology assessment for universal health coverage in India. http://www.idsihealth.org/wp-content/uploads/2015/04/Better-Decisions-for-Better-Health-Delhi-Final-Report.pdf, November 2014 (accessed Dec 7, 2016).
103. Schwartz, AL, Chernew, ME, Landon, BE, McWilliams, J, Changes in low-value services in year 1 of the medicare pioneer accountable care organization program. JAMA Int Med 175 (2015), 1815–1825.
104. Organisation for Economic Cooperation and Development. Better ways to pay for health care. http://www.oecd.org/els/health-systems/Better-ways-to-pay-for-health-care-FOCUS.pdf, June, 2016 (accessed Dec 5, 2016).
105. Weeks, WB, Rauh, SS, Wadsworth, EB, Weinstein, JN, The unintended consequences of bundled payments. Ann Intern Med 158 (2013), 62–64.
106. Hussey, PS, Wertheimer, S, Mehrotra, A, The association between health care quality and cost: a systematic review. Ann Intern Med 158 (2013), 27–34.
107. La Forgia, G, Nagpal, S, Government-sponsored health insurance in India: are you covered?, 2012, World Bank, Washington DC http://www.worldbank.org/en/news/feature/2012/10/11/government-sponsored-health-insurance-in-india-are-you-covered (accessed Dec 5, 2016).
108. Mechanic, RE, Altman, SH, McDonough, JE, The new era of payment reform, spending targets, and cost containment in Massachusetts: early lessons for the nation. Health Aff 31 (2012), 2334–2342.
109. Ginsburg, PB, Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment. Health Aff (Millwood) 31 (2012), 1977–1983.
110. Bismark, M, Paterson, R, No-fault compensation in New Zealand: harmonizing injury compensation, provider accountability, and patient safety. Health Aff 25 (2006), 278–283.
111. Machiavelli, N, The prince. P.F, 1910, Collier & Son, New York.