MedicalResearch.com Interview with:
Mr. Tim Badgery-Parker ELS, BSc(Hons), MBiostat
Research Fellow,Value in Health Care Division
Menzies Centre for Health Policy
MedicalResearch.com: What is the background for this study?
Response: This is part of a large program of work at the Menzies Centre for Health Policy on low-value care in the Australian health system. We have previously published rates of low-value care in public hospitals in Australia’s most populous state, New South Wales, and a report on rates in the Australian private health insurance population is due for publication shortly. We have also done similar analyses for other Australian state health systems.
This particular paper extends the basic measurement work to focus on what we call the ‘cascade’ effects. That is, looking beyond how much low-value care occurs to examine the consequence for patients and the health system of providing these low-value procedures.
MedicalResearch.com: What are the main findings?
Response: We looked at 7 procedures where the evidence is that certain patients will not benefit from the procedure, and examined whether patients who did receive these procedures suffered any of 16 hospital-acquired complications.
Rates of these complications ranged from 0.1% for fairly safe procedures like endoscopy to 15% for endovascular repair of abdominal aortic aneurysm in asymptomatic high-risk patients. Patients who suffered a complication had substantially longer length of stay. For example, patients who might expect an overnight stay for knee arthroscopy could suffer a complication and unexpectedly spend a week or more in hospital.
MedicalResearch.com: What should readers take away from your report?
Response: Patients admitted to hospital for procedures that are not likely to benefit them are suffering measurable physical harm. Low-value care is a patient safety issue, not just a matter of use of health resources. Patients who are offered these procedures need to ask about their individual expected benefits and potential harm.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We have only looked at a very limited number of complications in the same hospital episode. To understand the full burden of low-value care, we need to look at the full cascade, including all complications and consider later care in readmission following the procedure. There are also other domains of patient burden, such as financial burdens through out-of-pocket expenses and time off work for treatment and psychological burdens through stress and anxiety about the condition and treatment.
MedicalResearch.com: Is there anything else you would like to add?
Response: This work was funded through a partnership between the Capital Markets Cooperative Research Centre Health Market Quality program, the New South Wales Ministry of Health, and The University of Sydney.
Badgery-Parker T, Pearson S, Dunn S, Elshaug AG. Measuring Hospital-Acquired Complications Associated With Low-Value Care. JAMA Intern Med. Published online February 25, 2019. doi:10.1001/jamainternmed.2018.7464
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