HSRAANZ Webinar – Developing and applying measures of low-value care in New South Wales public hospitals


Presented by Tim Badgery-Parker, Research Fellow, The University of Sydney, Faculty of Medicine and Health, School of Public Health, Menzies Centre for Health Policy, Charles Perkins Centre

Tuesday 5 March at 11.30am Canberra, Melbourne, Sydney



Background: Low-value care is use of a test or treatment when the expected benefit to the patient does not outweigh the potential harms. Initiatives such as Choosing Wisely have drawn attention to the issue of low-value care, but we have little knowledge of how much low-value care occurs, where or why it occurs, or the consequences of low-value care for patients and the health system.

Methods: We reviewed recommendations from English-language Choosing Wisely lists, the UK National Institute of Health and Care Excellence (NICE) ‘do not do’ recommendations, and other publications and selected 27 recommendations where low-value care could reasonably be identified in the NSW hospital admissions data. We translated these recommendations into measures of low-value care based on variables in the data. We used these measures to estimate rates of low-value care in NSW public hospitals in 2016-17, trends from 2010-11 to 2016-17, and associated costs. We also examined hospital-acquired complications after 7 low-value procedures in 2014-17 to 2016-17.

Results: In 2016-17 there were 46,169 episodes involving any of these 27 procedures, and 5509 to 8855 (11.00% to 19.18%) were low-value according to our measures. These episodes were associated with total costs of $49.9 million to $99.3 million. Thirteen of the procedures accounted for only 1.1% of the low-value episodes. For the remaining 14 procedures, rates were decreasing for 7, showed no trend for 4, and were increasing for 3 in the period 2010-11 to 2016-17. The low-value care rates varied substantially between hospitals. Complication rates over 3 years for 7 low-value procedures ranged from 0.1% for endoscopy for dyspepsia to 15.0% for endovascular repair of abdominal aortic aneurysm in asymptomatic high-risk patients.

Conclusion: Measurable low-value care occurs in NSW public hospitals. Low-value procedures are associated with substantial financial costs to the health system and measurable harm to some patients.


Tim recently submitted his PhD in the Menzies Centre for Health Policy, The University of Sydney. His research focuses on measuring low value care, defined by Choosing Wisely, RACP EVOLVE, or similar recommendations, in the NSW public hospital system. Tim previously worked as a biostatistician in the Centre for Epidemiology and Evidence, NSW Ministry of Health, and then in the Cancer Epidemiology and Services Research Group and the Surgical Outcomes Research Centre in the Sydney School of Public Health.

Tim was the winner of the 2018  HSRAANZ Award for the Best Health Services and Policy Research Paper by a PhD Student.