Key Features Underlying Low-Value Care Recommendations.

Area of Science:

• Health Services Research
• Medical Economics
• Clinical Practice Guidelines

Background:

• Low-value care, defined as medical services that provide little to no benefit to patients, remains a significant challenge in healthcare systems globally.
• Variations in recommendations aimed at reducing low-value care contribute to its persistence, necessitating a deeper understanding of these recommendations' characteristics.

Purpose of the Study:

• To analyze the key features of consensus Choosing Wisely recommendations.
• To identify opportunities for improving recommendations designed to reduce low-value care by examining their rationales, targeted services, and evidence bases.

Main Methods:

• A comprehensive analysis of a broad set of consensus Choosing Wisely recommendations was conducted.
• Three features were systematically described: underlying rationales (waste, harm, or both), types of services targeted, and types of supportive evidence used.

Main Results:

• A minority of recommendations cited waste (36%), harm (17%), or both (40%) as rationales; 7% lacked explicit rationales.
• Diagnostic imaging was the most frequently targeted service type (31%), whereas clinical referrals/consults were least targeted (1%).
• Clinical guidelines were the most common source of evidence, utilized by 50% of recommendations.

Conclusions:

• Current Choosing Wisely recommendations exhibit considerable variation in their rationales, service targets, and evidence.
• There are clear opportunities to enhance the design and content of these recommendations to more effectively deter low-value care.
• Strengthening these recommendations is crucial for bolstering efforts to reduce unnecessary medical services and improve healthcare value.