Medicalresearch.com Interview with:
Alex Mainor, JD, MPH
Research Project Coordinator
The Dartmouth Institute for Health Policy and Clinical Practice
Lebanon, NH 03756
Carrie H. Colla, Alexander J. Mainor, Courtney Hargreaves, Thomas Sequist, Nancy Morden
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Waste in the healthcare system is an important concern to healthcare providers, patients, policymakers, and taxpayers, and is estimated to account for 30% of all healthcare costs. Low-value care can expose patients to unnecessary costs for little or no medical benefit, or to potential harm from unnecessary tests and procedures. In recent years, the concept of low-value care has gained wider acknowledgement and acceptance as a pressing concern for the healthcare system, and many interventions have been studied to reduce the use of this wasteful care. However, the landscape of these interventions has not been studied in a systematic and comprehensive way.
In this review, we found that interventions to reduce the use of wasteful medical care are often studied and published selectively. Findings suggest that interventions using clinical decision support, clinician education, patient education, and interventions combining elements from each have strong potential to reduce low-value care.
MedicalResearch.com: What should readers take away from your report?
Response: Multicomponent interventions targeting both patient and clinician behavior have the greatest potential to reduce the use of low-value care. Clinical decision support systems and provider performance feedback are also promising strategies, as well as provider education when paired with other intervention strategies. However, many widely used interventions, including popular payment mechanisms such as pay-for-performance and insurer restrictions, remain relatively under-studied in the reduction of low-value care.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Our review revealed little research on the effectiveness of provider report cards, pay-for-performance systems, insurer restrictions, and risk-sharing contracts to reduce the use of low-value care. Due to the broad and growing experimentation with these strategies, study of their potential impact should be a research priority.
MedicalResearch.com: Is there anything else you would like to add?
Response: It is important to note that reductions in low-value care do not necessarily translate to greater use of high-value care. In the future, it will be important to use higher quality, more comprehensive data from claims and electronic health records to accurately categorize value, and to facilitate experimentation and evaluation.
Carrie H. Colla, Alexander J. Mainor, Courtney Hargreaves, Thomas Sequist, and Nancy Morden
Interventions Aimed at Reducing Use of Low-Value Health Services: A Systematic ReviewMed Care Res Rev 1077558716656970, first published on July 8, 2016 doi:10.1177/1077558716656970
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