Selecting indicators for the measurement of low-value care using German claims data: A three-round modified Delphi panel

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 medic...

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Published in:	PloS one Vol. 20; no. 2; p. e0314864
Main Authors:	Pioch, Carolina, Neubert, Anne, Dammertz, Lotte, Ermann, Hanna, Hildebrandt, Meik, Ihle, Peter, Nothacker, Monika, Schneider, Udo, Swart, Enno, Busse, Reinhard, Vogt, Verena
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 18.02.2025 Public Library of Science (PLoS)
Subjects:	Analysis Biology and Life Sciences Cancer Chemotherapy Delivery of Health Care - standards Delphi method Delphi Technique Germany Health care Health care expenditures Health care policy Health care rationing Health insurance Health services Humans Indicators Medical care, Cost of Medicine and Health Sciences Methods Patient outcomes Patients Quality Indicators, Health Care Questionnaires R&D Research & development Research and Analysis Methods Germany Australia United States > US
ISSN:	1932-6203, 1932-6203
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Abstract	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.
AbstractList	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.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. 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.
Audience	Academic
Author	Dammertz, Lotte Nothacker, Monika Swart, Enno Ihle, Peter Busse, Reinhard Ermann, Hanna Vogt, Verena Schneider, Udo Pioch, Carolina Neubert, Anne Hildebrandt, Meik
AuthorAffiliation	4 PMV Research Group at the Department of Psychiatry and Psychotherapy for Children and Young Adults, University Hospital Cologne, Cologne, Germany 5 Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany, Berlin, Germany 2 Department of Orthopaedics and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany IST: Universidade de Lisboa Instituto Superior Tecnico, PORTUGAL 1 Department of Health Care Management, Technical University of Berlin, Berlin, Germany 8 Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany 6 Techniker Krankenkasse, Hamburg, Germany 3 Department of Epidemiology and Health Care Atlas, Central Research Institute for Ambulatory Health Care in Germany, Berlin, Germany 7 Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
AuthorAffiliation_xml	– name: 4 PMV Research Group at the Department of Psychiatry and Psychotherapy for Children and Young Adults, University Hospital Cologne, Cologne, Germany – name: 1 Department of Health Care Management, Technical University of Berlin, Berlin, Germany – name: 2 Department of Orthopaedics and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany – name: IST: Universidade de Lisboa Instituto Superior Tecnico, PORTUGAL – name: 7 Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany – name: 5 Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany, Berlin, Germany – name: 6 Techniker Krankenkasse, Hamburg, Germany – name: 3 Department of Epidemiology and Health Care Atlas, Central Research Institute for Ambulatory Health Care in Germany, Berlin, Germany – name: 8 Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/39964962$$D View this record in MEDLINE/PubMed
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SubjectTerms	Analysis Biology and Life Sciences Cancer Chemotherapy Delivery of Health Care - standards Delphi method Delphi Technique Germany Health care Health care expenditures Health care policy Health care rationing Health insurance Health services Humans Indicators Medical care, Cost of Medicine and Health Sciences Methods Patient outcomes Patients Quality Indicators, Health Care Questionnaires R&D Research & development Research and Analysis Methods
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Title	Selecting indicators for the measurement of low-value care using German claims data: A three-round modified Delphi panel
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