Low-value procedures have been in the crosshairs for years for the resources they waste. New research further supports the idea that they may also cause more harm than good for the patients they’re supposed to help.
That's because low-value procedures raise the risks patients may experience problems such as unnecessary discomfort or dangerous hospital-acquired complications, according to study results published in JAMA Internal Medicine.
A group of Australian researchers looked at admissions data from 225 public hospitals in New South Wales from 2014 through 2017. To calculate value, they looked at cost as well as whether an unnecessary procedure simply fails to add to a patient’s quality of care or actually detracts from care quality and whether it makes a significant difference in terms of the overall value of the procedure from a broader perspective.
Building on previous research that demonstrated the cost of low-value care, the researchers chose seven procedures often used inappropriately and attempted to measure any patient harm caused.
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Depending on the procedure, the percentage of hospital-acquired complications ranged from 0.1% to 15%.
The procedures at the low end of that range included unnecessary endoscopies, colonoscopies and knee arthroscopies, which the authors also identify as relatively safe procedures. Nevertheless, as they point out, these procedures do involve patient discomfort.
At the other end of the spectrum, the team found that the risk of complications outweighed any potential benefit the patient might gain from treatment. For example, treating stenosis or a nonproblematic aneurysm with a carotid endarterectomy or endovascular aortic repair (EVAR) showed relatively high rates of hospital-acquired complications, including cardiac complications, infection, and delirium.
Among all procedures, healthcare-associated infections represented the most common complication, with the highest rates for unnecessary renal artery angioplasties and EVAR.
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Historically, initiatives such as Choosing Wisely have targeted low-value procedures mainly because of the way they add to systemwide healthcare costs. The link between incentives to provide low-value procedures and fee-for-service payment methodologies has been straightforward enough to suggest trimming unnecessary care amounted to low-hanging fruit in the move toward more value-based care provision.
The study correlated the occurrence of hospital-acquired complications with longer admissions, representing both an increase in the cost of care for the affected patients, as well as an unnecessarily increased use of healthcare resources that presumably could be put to use serving patients in greater need of care.
The potential significance of these downstream effects suggests this study only scratches the surface in terms of the true total cost of low-value procedures, researchers said in the study. In addition to the cost of unnecessarily prolonged admissions, the authors see additional potential areas of harm in potential psychological and psychosocial effects on patients.
“The full burden of low-value care for patients and the healthcare system is yet to be quantified,” they wrote.