In this section
Low value care is care that provides little or no benefit, may cause patient harm, or yields marginal benefits at a disproportionately high cost.
This problem of
low value, or unnecessary, care is gaining wide recognition through
professionally led initiatives such as the international Choosing Wisely
movement and the UK NICE “do not do” guidelines. These initiatives strive to
achieve clinician consensus on what constitutes low value care with the hope
that identifying low value care practices will catalyse efforts to reduce such
the Royal Australasian College of Physicians’ EVOLVE initiative has
identified a top five list of ‘do not do’ treatments in child health. These are,
do not routinely…
However, we do
not know what proportion of care provided to children in Australia is low value.
Determining to what extent such care exists, where it is occurring (i.e. in primary
or secondary care, in the public or private system, in emergency department
(ED) or inpatient care etc.), and how to reduce it is crucial to a sustainable
The RCH HSRU is supporting the work of the Choosing Wisely team at RCH to reduce low value care in the hospital setting.
The REMEDI project
co-designed, implemented and evaluated a targeted behaviour change intervention
to reduce unnecessary prescribing of infant reflux medications across four
hospitals in Victoria. Overall we found a decrease in the number of infants
prescribed reflux medication and an increase in clinician knowledge of
potential harms caused by reflux medications.
You can find out more about the REMEDI project, infant reflux and access our resources for parents and clinicians.
This systematic review examined
how best to reduce clinician ordering of unnecessary imaging and pathology
tests in children. We will use this information to identify effective
interventions to reduce unnecessary care at the RCH and hence reduce waste in
hospital funds. Based on preliminary findings, an effective intervention will
likely include a combination of staff education, audit & feedback on low
value care at the doctor level, and changes to systems or processes.
Two projects measured the
extent of unnecessary prescribing of anti-reflux medications and associated
factors. The first project is measured unnecessary prescribing across RCH inpatient, outpatient, and ED
settings. The second project measured this across community (GPs, paediatricians)
care in Australia, using Medicare Benefits Schedule (MBS) and Pharmaceutical
Benefits Scheme (PBS) data. This project also examined costs to the
Australian healthcare system associated with unnecessary use of these
medications in infants.
Dr Suzi Reiss won a prize for this work at the 2017 The Royal Children's Hospital Advanced Trainee Research Symposium.
Using MBS and PBS data, this
project looked at the number of children with asthma who received a likely
unnecessary chest x-ray across Australia. The project examined potential
costs to the Australian healthcare system that could be saved if this
unnecessary care stopped.
This project measured the
extent of unnecessary abdominal x-rays in children with non-specific abdominal
pain across inpatient, outpatient and ED settings at the RCH. The project
estimated the potential costs saved from reducing the number of X-rays, which have potential to cause harm through radiation to children.
Prof Hiscock is conducting related projects through the Health Services research group at MCRI. You can read more about these projects here.
National: RCH; MCRI; University of
Melbourne; Menzies Kids, University of Sydney (Prof
Natasha Nassar); RACP (Mr Jason Soon); Australian Institute of Health
Innovation, Macquarie University (Prof Andrew Georgiou); Safer Care Victoria.
International: USA - University of
Michigan, Child Health Evaluation and Research Center (Prof Gary Freed).
Medicare Benefits Schedule (MBS);
Pharmaceutical Benefits Scheme (PBS); The Royal Children’s Hospital (RCH;
The Royal Children's Hospital Foundation.