Low-value care in Australian public hospitals: prevalence and trends over time.

To examine 27 low-value procedures, as defined by international recommendations, in New South Wales public hospitals. Analysis of admitted patient data for financial years 2010-2011 to 2016-2017. Number and proportion of episodes identified as low value by two definitions (narrower and broader), associated costs and bed-days, and variation between hospitals in financial year 2016-2017; trends in numbers of low-value episodes from 2010-2011 to 2016-2017. For 27 procedures in 2016-2017, we identified 5079 (narrower definition) to 8855 (broader definition) episodes involving low-value care (11.00%-19.18% of all 46 169 episodes involving these services). These episodes were associated with total inpatient costs of $A49.9 million (narrower) to $A99.3 million (broader), which was 7.4% (narrower) to 14.7% (broader) of the total $A674.6 million costs for all episodes involving these procedures in 2016-2017, and involved 14 348 (narrower) to 29 705 (broader) bed-days. Half the procedures accounted for less than 2% of all low-value episodes identified; three of these had no low-value episodes in 2016-2017. The proportion of low-value care varied widely between hospitals. Of the 14 procedures accounting for most low-value care, seven showed decreasing trends from 2010-2011 to 2016-2017, while three (colonoscopy for constipation, endoscopy for dyspepsia, sentinel lymph node biopsy for melanoma in situ) showed increasing trends. Low-value care in this Australian public hospital setting is not common for most of the measured procedures, but colonoscopy for constipation, endoscopy for dyspepsia and sentinel lymph node biopys for melanoma in situ require further investigation and action to reverse increasing trends. The variation between procedures and hospitals may imply different drivers and potential remedies.

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Competing interests: TBP receives consulting fees and scholarship support from the Capital Markets Cooperative Research Centre and a University Postgraduate Award from the University of Sydney. KC receives personal fees from the Capital Markets Cooperative Research Centre and the Australian Federal Government via a Research Training Program Award and The University of Sydney. Prof Elshaug is a Board Member of the New South Wales Bureau of Health Information, receives salary support as the HCF Research Foundation Professorial Fellow, receives consulting/sitting fees from Cancer Australia, NPS MedicineWise (facilitator of Choosing Wisely Australia), the Australian Commission on Safety and Quality in Health Care (Atlas of Health Care Variation Advisory Group), the Queensland and Victoria Government Departments of Health, Private Healthcare Australia and the Australian Government Department of Health as an appointee to the MBS Review Taskforce. SAP, IAS, JB, SD, NO have no relevant disclosures.