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Reading: Measuring low-value care along the continuum of care; are they up to the task?


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Measuring low-value care along the continuum of care; are they up to the task?


Eline Frouke de Vries ,

Tilburg University, NL
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Jeroen N Struijs,

National Institute of Public Health and the Environment, NL
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Richard Heijink,

Dutch Healthcare Authority, NL
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Roy JP Hendrikx,

Tilburg University, NL
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Caroline A Baan

Tilburg University, NL
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Introduction: Reducing low-value care is a core component of health care reforms in many countries. A sound set of low-value care measures is needed in order to evaluate these reforms, to monitor low-value care use in general and in alternative payer-provider contracts. Our objective was to review the scientific literature on low-value care measurement, aiming to assess the scope along the continuum of care and the quality of current measures.

Methods: A systematic review was performed for the period 2010 - 2015. We assessed the scope of low-value care recommendations and measures by categorizing them according to the Classification of Health Care Functions. Additionally, we assessed the quality of the measures by 1) analysing their development process and the level of evidence underlying the measures, and 2) analysing the evidence regarding the validity of a selected subset of the measures.

Results: We obtained 115 low-value care measures, of which 87 were concentrated in the cure sector, 25 in prevention and 3 in long-term care. No measures were found in rehabilitative care and health promotion. We found 62 measures from articles that translated low-value care recommendations into measures, while 53 measures were previously developed by institutions as the National Quality Forum. Only three measures were assigned the highest level of evidence, as they were underpinned by both guidelines and literature evidence. Our search yielded no information on coding/criterion validity and construct validity for the included measures. Despite this, most measures were already used in practice.

Discussions and conclusions: This systematic review provides insight into the current state of low-value care measures. As low-value care utilization is present in all sectors along the care continuum, more attention is needed for the development of new measures. Additionally, more attention is needed for the evidential underpinning and quality of these measures. Clear information about the level of evidence and validity helps to identify measures that truly represent low-value care and are sufficiently qualified to fulfil their aims. This will contribute to creating and maintaining the support of all stakeholders who are aiming to improve value in health care.
How to Cite: Frouke de Vries E, Struijs JN, Heijink R, Hendrikx RJ, Baan CA. Measuring low-value care along the continuum of care; are they up to the task?. International Journal of Integrated Care. 2017;17(5):A130. DOI:
Published on 17 Oct 2017.


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