TY - JOUR
T1 - Prevalence and changes of low-value care at acute care hospitals
T2 - a multicentre observational study in Japan
AU - Miyawaki, Atsushi
AU - Ikesu, Ryo
AU - Tokuda, Yasuharu
AU - Goto, Rei
AU - Kobayashi, Yasuki
AU - Sano, Kazuaki
AU - Tsugawa, Yusuke
N1 - Funding Information:
AM was funded primarily by a grant from the Abe Fellowship Program administered by the Social Science Research Council in cooperatiion with and with funds provided by the Japan Foundation Center for Global Partnership (grant number is not applicable). Additional partial support was provided by the Japan Society for the Promotion of Science (20K18956). The findings and conclusions of this article are the sole responsibility of the authors and do not represent the official views of the research funders.
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/9/7
Y1 - 2022/9/7
N2 - Objectives We aimed to examine the use and factors associated with the provision of low-value care in Japan. Design A multicentre observational study. Setting Routinely collected claims data that include all inpatient and outpatient visits in 242 large acute care hospitals (accounting for approximately 11% of all acute hospitalisations in Japan). Participants 345 564 patients (median age (IQR): 62 (40-75) years; 182 938 (52.9%) women) seeking care at least once in the hospitals in the fiscal year 2019. Primary and secondary outcome measures We identified 33 low-value services, as defined by clinical evidence, and developed two versions of claims-based measures of low-value services with different sensitivity and specificity (broader and narrower definitions). We examined the number of low-value services, the proportion of patients receiving these services and the proportion of total healthcare spending incurred by these services in 2019. We also evaluated the 2015-2019 trends in the number of low-value services. Results Services identified by broader low-value care definition occurred in 7.5% of patients and accounted for 0.5% of overall annual healthcare spending. Services identified by narrower low-value care definition occurred in 4.9% of patients and constituted 0.2% of overall annual healthcare spending. Overall, there was no clear trend in the prevalence of low-value services between 2015 and 2019. When focusing on each of the 17 services accounting for more than 99% of all low-value services identified (narrower definition), 6 showed decreasing trends from 2015 to 2019, while 4 showed increasing trends. Hospital size and patients' age, sex and comorbidities were associated with the probability of receiving low-value service. Conclusions A substantial number of patients received low-value care in Japan. Several low-value services with high frequency, especially with increasing trends, require further investigation and policy interventions for better resource allocation.
AB - Objectives We aimed to examine the use and factors associated with the provision of low-value care in Japan. Design A multicentre observational study. Setting Routinely collected claims data that include all inpatient and outpatient visits in 242 large acute care hospitals (accounting for approximately 11% of all acute hospitalisations in Japan). Participants 345 564 patients (median age (IQR): 62 (40-75) years; 182 938 (52.9%) women) seeking care at least once in the hospitals in the fiscal year 2019. Primary and secondary outcome measures We identified 33 low-value services, as defined by clinical evidence, and developed two versions of claims-based measures of low-value services with different sensitivity and specificity (broader and narrower definitions). We examined the number of low-value services, the proportion of patients receiving these services and the proportion of total healthcare spending incurred by these services in 2019. We also evaluated the 2015-2019 trends in the number of low-value services. Results Services identified by broader low-value care definition occurred in 7.5% of patients and accounted for 0.5% of overall annual healthcare spending. Services identified by narrower low-value care definition occurred in 4.9% of patients and constituted 0.2% of overall annual healthcare spending. Overall, there was no clear trend in the prevalence of low-value services between 2015 and 2019. When focusing on each of the 17 services accounting for more than 99% of all low-value services identified (narrower definition), 6 showed decreasing trends from 2015 to 2019, while 4 showed increasing trends. Hospital size and patients' age, sex and comorbidities were associated with the probability of receiving low-value service. Conclusions A substantial number of patients received low-value care in Japan. Several low-value services with high frequency, especially with increasing trends, require further investigation and policy interventions for better resource allocation.
KW - Health & safety
KW - Health economics
KW - Health policy
KW - Quality in health care
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U2 - 10.1136/bmjopen-2022-063171
DO - 10.1136/bmjopen-2022-063171
M3 - Article
C2 - 36107742
AN - SCOPUS:85137921552
VL - 12
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 9
M1 - e063171
ER -
