7.4 Settings for low-value healthcare

Low-value care focuses on issues of quality and effectiveness of direct care to patients, clients, residents and other health service consumers. The context in which issues of low-value care might be identified come through an examination of direct services provided but also in a wider context that health and aged care organisations systemically and in relation to education, training and knowledge can also be in a position to enable value-care activities to take place. Low-value care can occur in various settings and situations in the health system and can be related to procedures and interventions, diagnostic testing and medication prescribing, and in end-of-life care related to issues of demonstrable meaningful benefit for terminally ill patients and residents. Low-value care can also be present in preventative services where there is a lack of evidence regarding activities related to communities and wider populations, such as unnecessary health screenings or interventions.

Direct and indirect drivers

Direct and indirect drivers enable low-value care and affect training, experience and culture of practice. This allows for variability in clinical decision-making and therefore in patient and client care delivery (Verkerk et al., 2022). A lack of consistent delivery guidelines, protocols and standards of practice (which could be affected by the sheer volume of knowledge and learning transfer that occurs within a health system and health practice) along with available time for practitioners to individually and collectively consider best practice is problematic.

Different funding allocation models can create financial incentives to act and provide care in certain ways, such as fee-for-service reimbursement that can overemphasise the volume of care provided to patients and clients rather than key issues of quality and value of care.

The legal framework of health services can cause situations where tests and interventions are requested in order to mitigate real or perceived legal liability in patient care. Poor or inadequate care coordination and weak use of available resources such as health informatics create fragmented care delivery.

Risk management

A number of risk management strategies can be used to deal with specific low-value care situations as well as the environments where low-value care might exist (Halligan et al., 2023). Strong and effective risk management involves the collaborative development of clinical guidelines to document issues, situations and drivers related to low-value care and to provide evidence and optimal practice guidelines for clinicians. Clinicians and system managers can use a range of decision support tools to measure achievement and compliance to standards, guidelines, protocols and best practice indicators in relation to low-value care identification and responsive action. The objective is to use contemporary information, knowledge and education strategies and approaches to provide support for the alignment of care with contemporary practice knowledge. Such strategies have potential and practical ability to reduce prevalence of low-value care and therefore improve quality of care and optimisation of the use of health resources.