Success factors for interventions to reduce low-value imaging. Six crucial lessons learned from a practical case study in Norway.

Background: Substantial overuse of health care services is identified and intensified efforts are incited to reduce low-value services in general and in imaging in particular.

Objective: To report crucial success factors for developing and implementing interventions to reduce specific low-value imaging examinations based on a case study in Norway.

Materials And Methods: Mixed methods design including one systematic review, one scoping review, implementation science, qualitative interviews, content analysis of stakeholders' input, and stakeholder deliberations.

Sources of specialist physician fee variation: Evidence from Australian health insurance claims data.

This study explores the variation in specialist physician fees and examines whether the variation can be attributed to patient risk factors, variation between physicians, medical specialties, or other factors. We use health insurance claims data from a large private health insurer in Australia. Although Australia has a publicly funded health system that provides universal health coverage, about 44 % of the population holds private health insurance.

Overcoming silos in health care systems through meso-level organisations - a case study of health reforms in New South Wales, Australia.

Fragmented care delivery is a barrier to improving health system performance worldwide. Investment in meso-level organisations is a potential strategy to improve health system integration, however, its effectiveness remains unclear. In this paper, we provide an overview of key international and Australian integrated care policies.

"It's not a one operation fits all": A qualitative study exploring fee setting and participation in price transparency initiatives amongst medical specialists in the Australian private healthcare sector.

The Australian government, through Medicare, defines the type of medical specialist services it covers and subsidizes, but it does not regulate prices. Specialists in private practice can charge more than the fee listed by Medicare depending on what they feel 'the market will bear'. This can sometimes result in high and unexpected out-of-pocket (OOP) payments for patients.

Health service research definition builder: An R Shiny application for exploring diagnosis codes associated with services reported in routinely collected health data.

Many administrative health data-based studies define patient cohorts using procedure and diagnosis codes. The impact these criteria have on a study's final cohort is not always transparent to co-investigators or other audiences if access to the research data is restricted. We developed a SAS and R Shiny interactive research support tool which generates and displays the diagnosis code summaries associated with a selected medical service or procedure.

Adverse Events and Hospital-Acquired Conditions Associated With Potential Low-Value Care in Medicare Beneficiaries.

Importance: There has been insufficient research on the patient harms and costs associated with potential low-value procedures in the US Medicare population.

Objective: To report the prevalence of adverse events associated with potential low-value procedures and the additional hospital length of stay (LOS) and costs.

Design Setting And Participants: This is a retrospective cohort study using Medicare fee-for-service claims between January 2016 to December 2018.

Patterns of specialist out-of-pocket costs for Australian Medicare services: implications for price transparency.

Objective To explore out-of-pocket (OOP) costs within specialties and individual specialists, and use of Medicare Benefits Schedule (MBS) data for potential price transparency initiatives. Methods We conducted a cross-sectional descriptive study of claims for a 10% random sample of Medicare enrolees for out-of-hospital MBS-billed subsequent and initial consultations between 1 January 2014 and 31 December 2014, specific to cardiologist, oncologist and ophthalmologists (with at least 10 patient visits in 2014). Our main outcomes were the number of locations per provider, number of unique OOP consultation costs per provider and provider-location, and the proportion of bulk-billed visits for these visits.

Developing a How-to-Guide for Health Technology Reassessment: "The HTR Playbook".

Background: To develop a knowledge translation (KT) tool that will provide guidance to stakeholders actively planning or considering implementation of a health technology reassessment (HTR) initiative.

Methods: The KT tool is an international and collaborative endeavour between HTR researchers in Canada, Australia, and the United Kingdom. Evidence from a meta-review of documented international HTR experiences and approaches provided the conceptual framing for the KT tool.

Rates of Low-Value Service in Australian Public Hospitals and the Association With Patient Insurance Status.

Importance: Low-value services have limited or no benefit to patients. Rates of low-value service in public hospitals may vary by patient insurance status, given that there may be different financial incentives for treatment of privately insured patients.

Objective: To assess the variation in rates of 5 low-value services performed in Australian public hospitals according to patient funding status (ie, private or public).

Assessment of Overuse of Medical Tests and Treatments at US Hospitals Using Medicare Claims.

Importance: Overuse of health care services exposes patients to unnecessary risk of harm and costs. Distinguishing patterns of overuse among hospitals requires hospital-level measures across multiple services.

Objective: To describe characteristics of hospitals associated with overuse of health care services in the US.

Utilization Rates of Pancreatectomy, Radical Prostatectomy, and Nephrectomy in New York, Ontario, and New South Wales, 2011 to 2018.

Importance: Few studies have compared surgical utilization between countries or how rates may differ according to patients' socioeconomic status.

Objective: To compare population-level utilization of 3 common nonemergent surgical procedures in New York State (US), Ontario (Canada), and New South Wales (Australia) and how utilization differs for residents of lower- and higher-income neighborhoods.

Design, Setting, And Participants: This cohort study included all adults aged 18 years and older who were hospitalized for pancreatectomy, radical prostatectomy, or nephrectomy between 2011 and 2016 in New York, between 2011 and 2018 in Ontario, and between 2013 and 2018 in New South Wales.

To Expand the Evidence Base About Harms from Tests and Treatments.

Rigorous evidence about the broad range of harms that might be experienced by a patient in the course of testing and treatment is sparse. We aimed to generate recommendations for how researchers might more comprehensively evaluate potential harms of healthcare interventions, to allow clinicians and patients to better include this evidence in clinical decision-making. We propose seven domains of harms of tests and treatments that are relevant to patients: (1) physical impairment, (2) psychological distress, (3) social disruption, (4) disruption in connection to healthcare, (5) labeling, (6) financial impact, and (7) treatment burden.

Hospital characteristics associated with low-value care in public hospitals in New South Wales, Australia.

Background: Rates of low-value care vary between hospitals in New South Wales, Australia. Understanding factors associated with this variation will help in understanding the drivers of low-value care and in planning initiatives to reduce low-value care.

Methods: For eight low-value procedures, we used Poisson regression of the number of low-value episodes at each hospital to assess the association between low-value care and hospital characteristics.

Estimating misclassification error in a binary performance indicator: case study of low value care in Australian hospitals.

Objective: Indicators based on hospital administrative data have potential for misclassification error, especially if they rely on clinical detail that may not be well recorded in the data. We applied an approach using modified logistic regression models to assess the misclassification (false-positive and false-negative) rates of low-value care indicators.

Design And Setting: We applied indicators involving 19 procedures to an extract from the New South Wales Admitted Patient Data Collection (1 January 2012 to 30 June 2015) to label episodes as low value.

Prevention of non-communicable disease: best buys, wasted buys, and contestable buys.

highlight the importance of local context in making decisions about implementing interventions for preventing non-communicable diseases

First steps towards price transparency: comparability of online out-of-pocket tools from Australian private health funds.

Objective The aims of this study were to compare and contrast the information three Australian private health insurance funds (HCF, Bupa and Medibank) have provided on their online out-of-pocket cost tools and to consider the implications this has for price transparency in Australia. Methods Website data were downloaded from HCF, Bupa and Medibank on 18 February 2019. The information and statistics provided on these pages were reviewed, and the procedures compared across funds if their pages had referred to the same Medicare Benefits Schedule (MBS) item(s).

Patterns of immediate breast reconstruction in New South Wales, Australia: a population-based study.

Background: The rate of immediate breast reconstruction (IBR) following mastectomy for breast cancer in Australia is low and varies between regions. To date, no previous Australian studies have examined IBR rates between all hospitals within a particular jurisdiction, despite hospitals being an important known contributor to variation in IBR rates in other countries.

Methods: We used cross-classified random-effects logistic regression models to examine the inter-hospital variation in IBR rates by using data on 7961 women who underwent therapeutic mastectomy procedures in New South Wales (NSW) between January 2012 and June 2015.

Care for low back pain: can health systems deliver?

Low back pain is the leading cause of years lived with disability globally. In 2018, an international working group called on the World Health Organization to increase attention on the burden of low back pain and the need to avoid excessively medical solutions. Indeed, major international clinical guidelines now recognize that many people with low back pain require little or no formal treatment.

Exploring variation in low-value care: a multilevel modelling study.

Background: Whether patients receive low-value hospital care (care that is not expected to provide a net benefit) may be influenced by unmeasured factors at the hospital they attend or the hospital's Local Health District (LHD), or the patients' areas of residence. Multilevel modelling presents a method to examine the effects of these different levels simultaneously and assess their relative importance to the outcome. Knowing which of these levels has the greatest contextual effects can help target further investigation or initiatives to reduce low-value care.

Measuring 21 low-value hospital procedures: claims analysis of Australian private health insurance data (2010-2014).

Objective: To examine the prevalence, costs and trends (2010-2014) for 21 low-value inpatient procedures in a privately insured Australian patient cohort.

Design: We developed indicators for 21 low-value procedures from evidence-based lists such as Choosing Wisely, and applied them to a claims data set of hospital admissions. We used narrow and broad indicators where multiple low-value procedure definitions exist.

Measuring Hospital-Acquired Complications Associated With Low-Value Care.

Importance: Studies of low-value care have focused on the prevalence of low-value care interventions but have rarely quantified downstream consequences of these interventions for patients or the health care system.

Objective: To measure immediate in-hospital harm associated with 7 low-value procedures.

Design, Setting, And Participants: A cohort study with a descriptive analysis using hospital admission data from 225 public hospitals in New South Wales, Australia, was conducted from July 1, 2014, to June 30, 2017.