Abstract 14471: Can Administrative Claims Data Accurately Identify Low-Value Pre-Operative Cardiovascular Testing?

Abstract

Background: Low-value care is defined as care where harms or costs outweigh the benefits. Low-value care services are often identified using administrative claims data, but the validity of claims-based measures may be limited due to the lack of clinical details. One example of a commonly-used claims-based measure of low-value care is pre-operative stress testing prior to low-risk surgery. Clinical practice guidelines recommend against routine testing since it provides no benefit, but testing may be clinically appropriate in patients with symptoms that warrant further investigation such as chest pain. AIM: To test the validity of a claims-based measure of low-value pre-operative stress testing against a gold standard of chart review. Methods: In this retrospective cohort study, we analyzed Medicare claims data linked to electronic health record data from a large accountable care organization. We applied a currently-used claims-based algorithm to identify patients who received a stress test within 60 days prior to a low-risk surgery (e.g., cataract surgery) in 2021. We then reviewed linked electronic health record data to assess the proportion of tests that were actually low-value or were misclassified (i.e., were clinically appropriate based on patient symptoms). Results: We identified 120 patients (median age 74, 50% female, 78% white) who underwent low-risk surgery and received a pre-operative stress test considered low-value by the claims algorithm. We excluded 35 patients who had insufficient data for chart review. Of the remaining 85patients, we found that 36 (42%) were confirmed low-value while 49 (58%) were actually clinically appropriate due to symptoms that prompted testing. The claims-based algorithm hada positive predictive value (PPV) of 42%. Conclusions: A commonly used claims-based measure for identifying low-value pre-operative CV testing misclassifies a substantial proportion of tests as low-value when they are clinically appropriate. This has significant implications for policy and practice, as it can erode trust in quality reporting systems and discourage clinically appropriate testing.