Linking Low-Value Care Lists and
Administrative Data to Prioritize
Health Technologies for Reassessment
Lesley Soril, MSc (PhD Candidate)
HTA Unit, O’Brien Institute for Public Health
Department of Community Health Sciences, University of Calgary
CADTH Symposium – April 16, 2018
Disclosure
I have no actual or potential conflict of interest
in relation to this topic or presentation.
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The value of ‘low value’ care lists
“Do not do”
recommendations
> 150 low value
technologies
in Australian MBS
Unnecessary
tests and
treatments
To develop and implement a systematic
process, leveraging published low value
care lists, to identify and prioritize
candidates for reassessment
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STUDY OBJECTIVE
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Rapid-review
Environmental
scan
Clinical experts
Health system
decision-makers
Pilot test in BC
with BC MoH
Refining process
in Alberta
Approach
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Key process attributes
Data-driven
Routine & replicable
Stakeholder collaboration
Actionable
High return on investment
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• In-hospital admissions
• Physician claims
• Laboratory data
ADMINISTRATIVE HEALTH DATA
?
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Compile
Review + Coding
Frequencies + Costs
Rank + Prioritize
Review + Dissemination
5-step
process
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Compiled published low value
care recommendations
— Choosing Wisely Canada
(n=176)
— NICE “do not do”
recommendations (n=1000)
— Low value technologies in
Australian MBS (n=174)
#1 Compile
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#2 Review + Coding
Recommendations were
reviewed and excluded if:
— Drug technology
— Not publicly-funded
— Clinically “nuanced”: language or
qualifiers not identified in
administrative data*
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*Examples of “nuanced”
language:
— “asymptomatic”
— “uncomplicated symptoms”
— “unless red flags are present”
— “without alarm symptoms”
— “low-risk”
— “high-risk”
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Recommendations were
reviewed and excluded if:
— Drug technology
— Not publicly-funded
— Clinically “nuanced”: language or
qualifiers not identified in
administrative data*
Included recommendations
were coded using appropriate
coding system
#2 Review + Coding
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“Do not offer pulmonary artery catheterization to people with acute heart failure”
ICD-10 CCI: 2.IM.28.^^ (Pressure measurement, pulmonary artery)Includes: Catheterization, Swan GanzMonitoring, blood pressure, pulmonary arteryMonitoring, pulmonary wedgeRight cardiac catheterization
ICD-10-CA: I50.0 (Congestive heart failure)150.1 (Left ventricular failure)150.9 (Heart failure, unspecified)
ICD-9-CM: 428.0 (Congestive heart failure)428.1 (Left heart failure)428.9 (Unspecified)
Fee Codes: 49.95 (Right cardiac catheterization)49.95A (Right cardiac catheterization with fluoroscopy)
In-h
osp
ital
Cla
ims
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Query administrative data:
— Discharge abstract database
(DAD)
— Physician claims
— Laboratory data
Outcomes of interest:
— Total frequencies and costs
per year (over past 5 FYs)
#3 Frequency + Costs
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Results ranked by total claims
and hospital costs per FY
Prioritization filter: high
budgetary impact
— Composite measure of high
cost and volume
— Operationalized as total costs
> $1M in a FY
#4 Rank + Prioritize
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Prioritized technologies
reviewed by expert advisory
committee
— In-person meeting
— Ad-hoc with individual
clinical stakeholders
Documented and
disseminated to BC MoH and
health authority stakeholders
for consideration
#5 Review +
Disseminate
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Pilot
testing in
British
Columbia
Choosing Wisely
Recommendations
N=176
NICE’s Do Not Do
List
N=1000
Australian MBS
Low Value List
N=174
Technologies for
Review & Coding
N=1350
Technologies to
Query in Databases
N=74
Excluded Technologies
N=1276Drug Technology
Clinically Nuanced**
Not publicly financed
No ICD codes available
Duplicate
Technologies with Identified
Frequencies and Costs
N=32
Zero frequency N=42
High Budgetary ImpactFilter:
Claims and hospital expenditures
exceed $1M in a FY
Expert Stakeholder
Review and Feedback
Draft Prioritized List of Candidate
Technologies for Reassessment
N=9
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Conclusions
Systematic process to identify and prioritize low
value technologies at a population-level
Demonstrates feasibility and strength of using local
administrative data assets for reassessment
Adopted and operationalized by BC MoH
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Success dependent on strong
health system leadership
Necessity of broad health
system partnerships
Data as the process backbone
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Next steps: Alberta testing
Considerations & Limitations Solutions for Alberta testing
Recommendations excluded due to
clinically “nuanced” language
Collaboration with Alberta’s Strategic
Clinical Networks
Only examined non-drug technologies Collaboration with Alberta Health’s
Pharmaceutical Portfolio
Data infrastructure is context-
dependent
Responsive to Alberta data assets and
holdings
Research Team: (*co-lead)
Dr. Fiona Clement*
Dr. Craig Mitton*
Dr. Stirling Bryan*
Brayan Seixas
Acknowledgements
Partners:
[email protected]: @lsoril
Funders:
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