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

Tim Badgery-Parker,Sallie-Anne Pearson,Adam G Elshaug

doi:10.1186/s12913-020-05625-4

Tim Badgery-Parker, Sallie-Anne Pearson + Show 1 more

Open Access

https://doi.org/10.1186/s12913-020-05625-4

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Abstract

BackgroundRates 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.MethodsFor 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. We also used hierarchical clustering on the low-value procedures used and their rates at each hospital to try to identify groups of hospitals with higher or lower rates of low-value care across multiple procedures.ResultsSome hospital characteristics, such as hospital peer group and proportion of total episodes that involve the specific procedure, showed associations for some procedures, but none were consistent across all eight procedures. We clustered hospitals into five groups, but low-value care rates did not differ much between these groups.ConclusionAvailable hospital variables show little association with rates of low-value care and no patterns across different low-value procedures. We need to investigate factors within hospitals, such as clinician knowledge and beliefs about low-value care.

Highlights

Rates of low-value care vary between hospitals in New South Wales, Australia
Additional file 2 contains a summary of the hospital characteristics for each of the low-value procedures included in this study
Hospital characteristics associated with low-value care In general, the hospital characteristics available for this analysis showed little clear association with rates of lowvalue care, with no clear pattern across different lowvalue procedures (Fig. 1)

Summary

Introduction

Rates of low-value care vary between hospitals in New South Wales, Australia. Choosing Wisely [1] and similar movements have highlighted various tests and procedures that are low value and not expected to provide a net benefit in specific patient groups. The prevalence of low-value care varies by region [3, 6] and by hospital [10, 12]. In New South Wales, Australia’s most populous state, there is considerable interhospital variation in the prevalence of low-value care [10]. We used multilevel models to assess the contribution of Local Health District (LHD) and hospital of treatment and patient’s area of residence to the variation in low-value care prevalence [13]. Differences in policy could explain differences in low-value care prevalence.

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