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Reducing ineffective practice: challenges in identifying low-value health care using Cochrane systematic reviews
Sarah Garner1, Mary Docherty, John Somner
1National Institute for Health and Clinical Excellence, London. sarah.garner@nice.org.uk
Journal of Health Services Research & Policy
|February 9, 2013
Summary
Identifying low-value healthcare practices is challenging but necessary for budget management. Cochrane Reviews can help identify these practices to support disinvestment decisions, though context-specific analysis is crucial.
Area of Science:
- Health Services Research
- Evidence-Based Medicine
Background:
- Identifying and reducing low-value healthcare practices is crucial for improving efficiency and managing health budgets.
- Centralized lists of low-value practices are controversial; opponents advocate for better targeting and implementation of treatment thresholds.
- The use of low-value practices remains a significant challenge in healthcare systems globally.
Purpose of the Study:
- To utilize Cochrane Reviews to identify potentially low-value healthcare practices.
- To support local disinvestment decisions by providing evidence on uncertain or ineffective interventions.
- To explore the feasibility of using systematic reviews for identifying practices for disinvestment.
Main Methods:
- Systematic screening of new or updated Cochrane Reviews.
- Inclusion criteria focused on reviews concluding uncertain effectiveness, ineffectiveness, or harm.
- Reviews were processed through the National Institute for Health and Clinical Excellence (NICE) Quality and Productivity topics.
Main Results:
- Over a six-month period, 65 Cochrane Reviews were processed.
- 28 reviews identified potentially low-value practices relevant to the UK context.
- The primary reason for identifying practices as low-value was a lack of randomized evidence of effectiveness.
Conclusions:
- Cochrane Reviews show potential for identifying low-value healthcare practices to aid disinvestment.
- Reinterpretation for the UK context and further analysis are necessary for practical implementation.
- Systematic reviews require adaptation to effectively support local healthcare budget management decisions.
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