Measuring the frequency and variation of unnecessary care across Canada

BMC Health Services Research

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[1] 0000 0001 2111 1357, grid.413300.5, Canadian Institute for Health Information, 1010 Sherbrooke Street West, Suite 602, H3A 2R7, Montreal, Quebec, Canada;0000 0001 2111 1357, grid.413300.5, Canadian Institute for Health Information, 4110 Yonge Street, Suite 300, M2P 2B7, Toronto, Ontario, Canada;0000 0001 2157 2938, grid.17063.33, Department of Medicine, University of Toronto – St Michael’s Hospital, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada;0000 0004 0474 0188, grid.417199.3, Department of Anesthesia, Women’s College Hospital, 76 Grenville Street, M5S 1B2, Toronto, Ontario, Canada;0000 0004 0474 0188, grid.417199.3, Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville Street, 6th Floor, M5S 1B2, Toronto, Ontario, Canada;0000 0004 1936 7697, grid.22072.35, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, Alberta, Canada;Choosing Wisely Canada, 250 Yonge Street, Room 648, M5G 1B1, Toronto, Ontario, Canada;

关键词: Choosing wisely;    Low-value;    Lower back pain;    Preoperative testing;    Mammography;   

DOI  :  10.1186/s12913-019-4277-9

来源: publisher

【 摘 要 】

BackgroundThrough the Choosing Wisely Canada (CWC) campaign, national medical specialty societies have released hundreds of recommendations against health care services that are unnecessary, i.e. present little to no benefit or cause avoidable harm. Despite growing interest in unnecessary care both within Canada and internationally, prior research has typically avoided taking a national or even multi-jurisdictional approach in measuring the extent of the issue. This study estimates use of three unnecessary services identified by CWC recommendations across multiple Canadian jurisdictions.MethodsTwo retrospective cohort studies were conducted using administrative health care data collected between fiscal years 2011/12 and 2012/13 to respectively quantify use of 1) diagnostic imaging (spinal X-ray, CT or MRI) among Albertan patients following a visit for lower back pain and 2) cardiac tests (electrocardiogram, chest X-ray, stress test, or transthoracic echocardiogram) prior to low-risk surgical procedures in Alberta, Saskatchewan, and Ontario. A cross-sectional study of the 2012 Canadian Community Health Survey was also conducted to estimate 3) the proportion of females aged 40–49 that reported having a routine mammogram in the past two years.ResultsUse of unnecessary care was relatively frequent across all three services and jurisdiction measured: 30.7% of Albertan patients had diagnostic imaging within six months of their initial visit for lower back pain; a cardiac test preceded 17.9 to 35.5% of low-risk surgical procedures across Alberta, Saskatchewan, and Ontario; and 22.2% of Canadian women aged 40–49 at average-risk for breast cancer reported having a routine screening mammogram in the past two years.ConclusionsThe use of potentially unnecessary care appears to be common in Canada. This investigation provides methodology to facilitate future measurement efforts that may incorporate additional jurisdictions and/or unnecessary services.

【 授权许可】

CC BY