Pioch Carolina, Neubert Anne, Dammertz Lotte, Ermann Hanna, Hildebrandt Meik, Ihle Peter, Nothacker Monika, Schneider Udo, Swart Enno, Busse Reinhard, Vogt Verena
Department of Health Care Management, Technical University of Berlin, Berlin, Germany.
Department of Orthopaedics and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
PLoS One. 2025 Feb 18;20(2):e0314864. doi: 10.1371/journal.pone.0314864. eCollection 2025.
By reducing healthcare services that offer little benefit or potential harm to patients (low-value care), resources can be redirected towards more adequate treatments, improving healthcare efficiency and patient outcomes. This study aimed to systematically incorporate clinical expertise across medical disciplines through a Delphi process to establish indicators for measuring low-value care, ensuring their acceptance by medical societies, the broader medical community, and patients. We developed two versions (one with higher sensitivity and one with higher specificity) for almost each of the 42 indicators identified as potentially measurable in a previous systematic review. We conducted a three-round modified Delphi panel based on the RAND/UCLA appropriateness methodology, with 62 experts from 52 Scientific Medical Societies and professional organisations, and patient representatives. In round one, each indicator was rated for its ability to indicate low-value healthcare and its measurability in German claims data. This was followed by an online discussion in round two. The indicators were then modified based on expert feedback and re-assessed in round three. As a result, 24 indicators were deemed appropriate for measuring low-value care, covering areas such as pharmaceuticals, diagnostic tests, screening, and treatment. For example, one indicator identified patients with cancer who received chemotherapy in the last month of life. These indicators will help identify healthcare services that may require policy-level interventions to improve the quality of care. However, most low-value care indicators can only be measured in German claims data if documentation requirements for relevant information are expanded.
通过减少对患者益处不大或可能造成伤害的医疗服务（低价值医疗），资源可以重新导向更适当的治疗，提高医疗效率和患者治疗效果。本研究旨在通过德尔菲法系统整合各医学学科的临床专业知识，以建立衡量低价值医疗的指标，确保医学协会、广大医学界和患者能够接受这些指标。对于在先前的系统评价中确定为可能可测量的42项指标中的几乎每一项，我们都制定了两个版本（一个具有更高的敏感性，一个具有更高的特异性）。我们基于兰德/加州大学洛杉矶分校适宜性方法进行了三轮改进的德尔菲小组调查，有来自52个科学医学协会和专业组织的62名专家以及患者代表参与。在第一轮中，对每项指标指示低价值医疗的能力及其在德国理赔数据中的可测量性进行评分。随后在第二轮进行在线讨论。然后根据专家反馈对指标进行修改，并在第三轮中重新评估。结果，24项指标被认为适合用于衡量低价值医疗，涵盖药品、诊断测试、筛查和治疗等领域。例如，一项指标识别出在生命最后一个月接受化疗的癌症患者。这些指标将有助于识别可能需要政策层面干预以提高医疗质量的医疗服务。然而，如果扩大相关信息的记录要求，大多数低价值医疗指标才能在德国理赔数据中进行测量。
