Developing indicators for measuring low-value care: mapping Choosing Wisely recommendations to hospital data.

Area of Science:

• Health Services Research
• Health Economics
• Clinical Informatics

Background:

• Low-value health care, where harm or cost outweighs benefit, is a significant concern.
• Identifying and measuring low-value care is crucial for healthcare quality improvement.
• Choosing Wisely (CW) recommendations offer a basis for developing such measures.

Purpose of the Study:

• To develop indicators of low-value care.
• To adapt selected Choosing Wisely recommendations for measurement.
• To utilize routinely collected hospital claims data for indicator development.

Main Methods:

• Assessed 824 Choosing Wisely recommendations from four countries (US, Canada, Australia, UK).
• Selected recommendations based on measurability in administrative hospital claims data (setting, service record, indication, documentation).
• Developed low-value care indicators using 17 measurable recommendations (15 services), prior indicators, and clinical input for two hospital datasets.

Main Results:

• 17 Choosing Wisely recommendations (representing 15 distinct services) were identified as measurable in hospital claims data.
• Measurability criteria included service setting, recordability, indication mapping, and consistent documentation.
• Low-value care indicators were successfully developed for two hospital datasets.

Conclusions:

• It is feasible to develop indicators for low-value care using Choosing Wisely recommendations and hospital claims data.
• These indicators can be applied to administrative data for monitoring and quality improvement.
• The developed indicators provide a foundation for identifying and reducing low-value healthcare interventions.