Waste, and how do we combat it? It’s a challenge facing all industries but nowhere more so than healthcare. Worldwide, waste is recognised as one of the biggest threats to future healthcare security.
The Partnership Centre has three research streams and today we’d like to introduce you to Stream 2: Reducing Waste and Low-value Care
Who leads this research?
Research Area 2.1: Impact of different Sources of Health Care Waste
Research Leads – Professors Paul Glasziou, Rachelle Buchbinder and Jon Karnon
Research Area 2.2: Lower Cost Delivery of Effective and Appropriate Services
Research Lead – Professors Rachelle Buchbinder and Paul Glasziou
What is waste?
Waste in healthcare is the delivery of care or services that do not benefit, or might even harm, patients. The consequence of waste in healthcare is not just harm to patients who receive unnecessary care but also the opportunity cost to patients who may fail to receive the necessary care.
What do we want to achieve?
We would like to develop a clear and actionable understanding of the two major components of waste in Australia – overtreatment/overuse and sub-optimal care delivery or coordination – and enable the development of appropriate interventions to target the highest priority areas.
What we have achieved so far?
Research Area 2.1: Impact of different sources of healthcare waste
The team based at Bond University are currently completing a very complex systematic review on ‘overdiagnosis’ encompassing 6,500 articles and focussing on methods of estimation generically, as well as specific disease estimates. Next, they will be conducting a parallel process ‘possible solutions’ review prior to liaising with possible sites for conducting pilots.
As an example of overdiagnosis the team looked at recent recommendations by the American Heart Association to change the threshold for “hypertension” which could result in an additional 31 million people in the US, 6.7 million in the UK and 2.4 million Australians being told they have hypertension. They used the G-I-N checklist published in 2017 to analyse their proposal.
To help disseminate this work, we also posted a reader friendly version in the Conversation, which was picked up by other news media.
Professor Glasziou will deliver the opening plenary – Winding back overdiagnosis: where are the leverage points? – at the Too Much Medicine XXIX Paulo Foundation International Medical Symposium in Helsinki in August http://too-much-medicine.com/ and will also speak on healthcare sustainability to the Medical Deans Annual Conference at Bond University in September.
Professor Doust will speak on “Guidelines for modifying disease definitions” at the American Association of Clinical Chemists annual conference in Chicago in August.
Research Area 2.2: Lower cost delivery of effective and appropriate services
Based at Monash University, the research team have had a busy year working on a scoping review to gain insight into the current research evidence on alternative models of service delivery (e.g. care provided in the home instead of in hospital).
We need your help
The next step for the team is to prioritise the alternative delivery arrangements for further investigation. They are planning to seek input from key stakeholders and leaders in the field on the delivery arrangements considered to be of highest priority for closer investigation. They also need input on whether there are other promising alternative delivery arrangements, not already identified in the scoping review, which should be further explored. Through this work they hope to identify opportunities for system gain where effective and potentially lower cost alternatives exist.