Identifying and acting on potentially inappropriate care
- 17 August 2015
- journal article
- Published by AMPCo in The Medical Journal of Australia
- Vol. 203 (4), 183
- https://doi.org/10.5694/mja15.00025
Abstract
To develop a model to measure potentially inappropriate care in Australian hospitals. Secondary analysis of computerised hospital discharge data for all Australian hospitals for the 2010-11 financial year. Hospital-specific incidence of selected diagnosis-procedure pairs identified as inappropriate in other literature. Five hospital procedures that are not supported by clinical evidence happened more than 100 times a week, on average. The most frequent of these do-not-do treatments was hyperbaric oxygen therapy for a range of specific conditions (4659 admissions in 2010-11). The rate of do-not-do procedures varied greatly, even among comparator hospitals that provided the procedure and that treated the relevant patient group. Among comparator hospitals, an average of 3.3% of patients with osteoarthritis of the knee received arthroscopic lavage and debridement of the knee (a do-not-do treatment), but four hospitals had rates of over 20%. There was also great variation in hospital-specific rates of procedures that should not be done routinely. Hospital-specific rates of do-not-do treatments vary greatly. Hospitals should be informed about their relative performance. Hospitals that have sustained, high rates of do-not-do treatments should be subject to external clinical review by expert peers.Keywords
This publication has 13 references indexed in Scilit:
- Forty years of unwarranted variation—And still countingHealth Policy, 2014
- A Decade of Reversal: An Analysis of 146 Contradicted Medical PracticesMayo Clinic Proceedings, 2013
- The Value of Low-Value ListsJAMA, 2013
- Over 150 potentially low‐value health care practices: an Australian studyThe Medical Journal of Australia, 2012
- Medical practice variations: what the literature tells us (or does not) about what are warranted and unwarranted variationsJournal of Evaluation in Clinical Practice, 2011
- Unwarranted Variation in Pediatric Medical CarePediatric Clinics of North America, 2009
- A Randomized Trial of Vertebroplasty for Osteoporotic Spinal FracturesThe New England Journal of Medicine, 2009
- A Randomized Trial of Vertebroplasty for Painful Osteoporotic Vertebral FracturesThe New England Journal of Medicine, 2009
- The Dog in the Night-time: Medical Practice Variations and Health PolicyPublished by Springer Science and Business Media LLC ,1990
- Small Area Variations in Health Care DeliveryScience, 1973