February 23, 2023

Low Value Care in Hospitalized Patients, a National Data Stream on Quality of care in Swiss University Hospitals

6th Call, NDS

Short Summary

As both the number of patients and the cost of acute care are expected to increase in the future, promoting the most efficient standard of care and avoiding healthcare waste is key for the Swiss health system. Quality of care can be studied with the concept of low-value care, which refers to clinical practices that add little to no benefit to the patient, and that can cause harm or unnecessary costs. For example, elderly hospitalized patients often experience stress and anxiety. To help them sleep, they are sometimes prescribed benzodiazepines, which should only be used under particular indications; as a result, chances of falls are increased. Another example involves taking a patient’s temperature or blood pressure at night, and thus disrupting the patient's sleep, while this might not be absolutely needed and/or better scheduling could avoid this. Quantifying and analyzing low-value care could lead to significant improvements of quality of care in Swiss hospitals.

Goals

The LUCID National Data Stream project aims at studying how Swiss clinical practice
and low-value care has evolved in the last decade. The project is creating a National
Data Stream aggregating relevant data from consenting patients that have been
hospitalized in one of five university hospitals across Switzerland: Zurich, Basel,
Bern, Lausanne and Geneva. This data includes existing hospital data and Patient
Reported Outcomes (PROs), the latter being health-related data provided directly by
patients about how they feel, function, or perceive their health and treatment. The
whole data is harmonized to feed a dedicated medical registry, and then used to
design and analyze precise numerical low-value care (LVC) indicators. This will make
it possible to study quantitatively how frequent different types of LVC are, and the
evolution of clinical practice in Swiss hospitals. By identifying factors leading to the
occurrence of low-value care, the ultimate goal of LUCID is to effectively identify
ways to improve healthcare processes.

Significance

Reducing low value care is a largely untapped opportunity to increase the value of health care at a given cost while simultaneously reducing patient’s harm and test/treatment overuse. LVCs are estimated to represent up to 20% of healthcare costs in Switzerland, corresponding to CHF 16 billions per year by the Organisation for Economic Cooperation and Development (OECD). And while LUCID focuses on hospitalized patients in medicine who represent the largest part of hospitalizations, the project’s infrastructure and processes are applicable for hospitalized patients from other specialties.

Background

The Choosing Wisely Initiative (www.choosingwisely.org), launched in 2012 by the American Board of Internal Medicine (ABIM) Foundation, contributed significantly to structure the concept of low-value care and to its visibility. Smarter Medicine, its Swiss counterpart (www.smartermedicine.ch) launched by the Swiss Society of General Internal Medicine (SSGIM), produced in 2016 a set of recommendations aiming at reducing low-value care practices. This initiative is recommended by the OECD. While reducing LVC is necessary for sustainable healthcare systems, there was until this project started no monitoring of LVC in Swiss hospitals. The burden and consequences of LVC, as well as the overall impact of the Choosing Wisely Initiative in Swiss hospitalized patients, remains largely unknown. An efficient method to translate value-based initiatives into practice is to promote data-driven benchmarking to uncover potential hospital variation in the provision of LVC and also to disseminate quality improvement interventions and report on improvements. So far, in Switzerland, such quality monitoring and improvement initiatives have been limited by the lack of a federated database able to detect LVC provision in hospitalized patients. Further, the treatment success from the point of view of the values, needs and preferences of patients have hardly been monitored so far in Swiss University hospitals.

NDS

Dr. Guillaume Obozinski

ETH Zurich

Co-Investigators

Marie Méan (CHUV), Christian Lovis (UniGE/HUG), Jean-Louis Raisaro (CHUV), Drahomir Aujesky (Inselspital), Stefano Bassetti (USB), Christophe Meier (USZ), Jerome Stirnemann (HUG), Alexander Leichtle (Inselspital), Carole Aubert (Inselspital), Florence Vallelian (USZ), Bram Stieltjes (USB), Oksana Riba Grognuz (EPFL), Florian Rüter (USB), Manuela Eicher (CHUV), Arnaud Chiolero (UniFr), Jérémie Despraz (CHUV)