Low-value clinical practices in injury care

A scoping review and expert consultation survey

Lynne Moore, François Lauzier, Pier Alexandre Tardif, Khadidja Malloum Boukar, Imen Farhat, Patrick Archambault, Éric Mercier, François Lamontagne, Michael Chassé, Henry T. Stelfox, Simon Berthelot, Belinda Gabbe, Fiona Lecky, Natalie Yanchar, Howard Champion, John Kortbeek, Peter Cameron, Paule Lessard Bonaventure, Jérôme Paquet, Catherine Truchon & 2 others Alexis F. Turgeon, on behalf of the Canadian Traumatic brain injury Research Consortium

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

BACKGROUND Tests and treatments that are not supported by evidence and could expose patients to unnecessary harm, referred to here as low-value clinical practices, consume up to 30% of health care resources. Choosing Wisely and other organizations have published lists of clinical practices to be avoided. However, few apply to injury and most are based uniquely on expert consensus. We aimed to identify low-value clinical practices in acute injury care. METHODS We conducted a scoping review targeting articles, reviews and guidelines that identified low-value clinical practices specific to injury populations. Thirty-six experts rated clinical practices on a five-point Likert scale from clearly low value to clearly beneficial. Clinical practices reported as low value by at least one level I, II, or III study and considered clearly or potentially low-value by at least 75% of experts were retained as candidates for low-value injury care. RESULTS Of 50,695 citations, 815 studies were included and led to the identification of 150 clinical practices. Of these, 63 were considered candidates for low-value injury care; 33 in the emergency room, 9 in trauma surgery, 15 in the intensive care unit, and 5 in orthopedics. We also identified 87 "gray zone" practices, which did not meet our criteria for low-value care. CONCLUSION We identified 63 low-value clinical practices in acute injury care that are supported by empirical evidence and expert opinion. Conditional on future research, they represent potential targets for guidelines, overuse metrics and de-implementation interventions. We also identified 87 "gray zone" practices, which may be interesting targets for value-based decision-making. Our study represents an important step toward the deimplementation of low-value clinical practices in injury care. LEVEL OF EVIDENCE Systematic Review, Level IV.

Original languageEnglish
Pages (from-to)983-993
Number of pages11
JournalThe Journal of Trauma and Acute Care Surgery
Volume86
Issue number6
DOIs
Publication statusPublished - Jun 2019

Keywords

  • expert survey
  • Low-value care
  • scoping review
  • trauma systems

Cite this

Moore, L., Lauzier, F., Tardif, P. A., Boukar, K. M., Farhat, I., Archambault, P., ... on behalf of the Canadian Traumatic brain injury Research Consortium (2019). Low-value clinical practices in injury care: A scoping review and expert consultation survey. The Journal of Trauma and Acute Care Surgery, 86(6), 983-993. https://doi.org/10.1097/TA.0000000000002246
Moore, Lynne ; Lauzier, François ; Tardif, Pier Alexandre ; Boukar, Khadidja Malloum ; Farhat, Imen ; Archambault, Patrick ; Mercier, Éric ; Lamontagne, François ; Chassé, Michael ; Stelfox, Henry T. ; Berthelot, Simon ; Gabbe, Belinda ; Lecky, Fiona ; Yanchar, Natalie ; Champion, Howard ; Kortbeek, John ; Cameron, Peter ; Bonaventure, Paule Lessard ; Paquet, Jérôme ; Truchon, Catherine ; Turgeon, Alexis F. ; on behalf of the Canadian Traumatic brain injury Research Consortium. / Low-value clinical practices in injury care : A scoping review and expert consultation survey. In: The Journal of Trauma and Acute Care Surgery. 2019 ; Vol. 86, No. 6. pp. 983-993.
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title = "Low-value clinical practices in injury care: A scoping review and expert consultation survey",
abstract = "BACKGROUND Tests and treatments that are not supported by evidence and could expose patients to unnecessary harm, referred to here as low-value clinical practices, consume up to 30{\%} of health care resources. Choosing Wisely and other organizations have published lists of clinical practices to be avoided. However, few apply to injury and most are based uniquely on expert consensus. We aimed to identify low-value clinical practices in acute injury care. METHODS We conducted a scoping review targeting articles, reviews and guidelines that identified low-value clinical practices specific to injury populations. Thirty-six experts rated clinical practices on a five-point Likert scale from clearly low value to clearly beneficial. Clinical practices reported as low value by at least one level I, II, or III study and considered clearly or potentially low-value by at least 75{\%} of experts were retained as candidates for low-value injury care. RESULTS Of 50,695 citations, 815 studies were included and led to the identification of 150 clinical practices. Of these, 63 were considered candidates for low-value injury care; 33 in the emergency room, 9 in trauma surgery, 15 in the intensive care unit, and 5 in orthopedics. We also identified 87 {"}gray zone{"} practices, which did not meet our criteria for low-value care. CONCLUSION We identified 63 low-value clinical practices in acute injury care that are supported by empirical evidence and expert opinion. Conditional on future research, they represent potential targets for guidelines, overuse metrics and de-implementation interventions. We also identified 87 {"}gray zone{"} practices, which may be interesting targets for value-based decision-making. Our study represents an important step toward the deimplementation of low-value clinical practices in injury care. LEVEL OF EVIDENCE Systematic Review, Level IV.",
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Moore, L, Lauzier, F, Tardif, PA, Boukar, KM, Farhat, I, Archambault, P, Mercier, É, Lamontagne, F, Chassé, M, Stelfox, HT, Berthelot, S, Gabbe, B, Lecky, F, Yanchar, N, Champion, H, Kortbeek, J, Cameron, P, Bonaventure, PL, Paquet, J, Truchon, C, Turgeon, AF & on behalf of the Canadian Traumatic brain injury Research Consortium 2019, 'Low-value clinical practices in injury care: A scoping review and expert consultation survey', The Journal of Trauma and Acute Care Surgery, vol. 86, no. 6, pp. 983-993. https://doi.org/10.1097/TA.0000000000002246

Low-value clinical practices in injury care : A scoping review and expert consultation survey. / Moore, Lynne; Lauzier, François; Tardif, Pier Alexandre; Boukar, Khadidja Malloum; Farhat, Imen; Archambault, Patrick; Mercier, Éric; Lamontagne, François; Chassé, Michael; Stelfox, Henry T.; Berthelot, Simon; Gabbe, Belinda; Lecky, Fiona; Yanchar, Natalie; Champion, Howard; Kortbeek, John; Cameron, Peter; Bonaventure, Paule Lessard; Paquet, Jérôme; Truchon, Catherine; Turgeon, Alexis F.; on behalf of the Canadian Traumatic brain injury Research Consortium.

In: The Journal of Trauma and Acute Care Surgery, Vol. 86, No. 6, 06.2019, p. 983-993.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Low-value clinical practices in injury care

T2 - A scoping review and expert consultation survey

AU - Moore, Lynne

AU - Lauzier, François

AU - Tardif, Pier Alexandre

AU - Boukar, Khadidja Malloum

AU - Farhat, Imen

AU - Archambault, Patrick

AU - Mercier, Éric

AU - Lamontagne, François

AU - Chassé, Michael

AU - Stelfox, Henry T.

AU - Berthelot, Simon

AU - Gabbe, Belinda

AU - Lecky, Fiona

AU - Yanchar, Natalie

AU - Champion, Howard

AU - Kortbeek, John

AU - Cameron, Peter

AU - Bonaventure, Paule Lessard

AU - Paquet, Jérôme

AU - Truchon, Catherine

AU - Turgeon, Alexis F.

AU - on behalf of the Canadian Traumatic brain injury Research Consortium

PY - 2019/6

Y1 - 2019/6

N2 - BACKGROUND Tests and treatments that are not supported by evidence and could expose patients to unnecessary harm, referred to here as low-value clinical practices, consume up to 30% of health care resources. Choosing Wisely and other organizations have published lists of clinical practices to be avoided. However, few apply to injury and most are based uniquely on expert consensus. We aimed to identify low-value clinical practices in acute injury care. METHODS We conducted a scoping review targeting articles, reviews and guidelines that identified low-value clinical practices specific to injury populations. Thirty-six experts rated clinical practices on a five-point Likert scale from clearly low value to clearly beneficial. Clinical practices reported as low value by at least one level I, II, or III study and considered clearly or potentially low-value by at least 75% of experts were retained as candidates for low-value injury care. RESULTS Of 50,695 citations, 815 studies were included and led to the identification of 150 clinical practices. Of these, 63 were considered candidates for low-value injury care; 33 in the emergency room, 9 in trauma surgery, 15 in the intensive care unit, and 5 in orthopedics. We also identified 87 "gray zone" practices, which did not meet our criteria for low-value care. CONCLUSION We identified 63 low-value clinical practices in acute injury care that are supported by empirical evidence and expert opinion. Conditional on future research, they represent potential targets for guidelines, overuse metrics and de-implementation interventions. We also identified 87 "gray zone" practices, which may be interesting targets for value-based decision-making. Our study represents an important step toward the deimplementation of low-value clinical practices in injury care. LEVEL OF EVIDENCE Systematic Review, Level IV.

AB - BACKGROUND Tests and treatments that are not supported by evidence and could expose patients to unnecessary harm, referred to here as low-value clinical practices, consume up to 30% of health care resources. Choosing Wisely and other organizations have published lists of clinical practices to be avoided. However, few apply to injury and most are based uniquely on expert consensus. We aimed to identify low-value clinical practices in acute injury care. METHODS We conducted a scoping review targeting articles, reviews and guidelines that identified low-value clinical practices specific to injury populations. Thirty-six experts rated clinical practices on a five-point Likert scale from clearly low value to clearly beneficial. Clinical practices reported as low value by at least one level I, II, or III study and considered clearly or potentially low-value by at least 75% of experts were retained as candidates for low-value injury care. RESULTS Of 50,695 citations, 815 studies were included and led to the identification of 150 clinical practices. Of these, 63 were considered candidates for low-value injury care; 33 in the emergency room, 9 in trauma surgery, 15 in the intensive care unit, and 5 in orthopedics. We also identified 87 "gray zone" practices, which did not meet our criteria for low-value care. CONCLUSION We identified 63 low-value clinical practices in acute injury care that are supported by empirical evidence and expert opinion. Conditional on future research, they represent potential targets for guidelines, overuse metrics and de-implementation interventions. We also identified 87 "gray zone" practices, which may be interesting targets for value-based decision-making. Our study represents an important step toward the deimplementation of low-value clinical practices in injury care. LEVEL OF EVIDENCE Systematic Review, Level IV.

KW - expert survey

KW - Low-value care

KW - scoping review

KW - trauma systems

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U2 - 10.1097/TA.0000000000002246

DO - 10.1097/TA.0000000000002246

M3 - Review Article

VL - 86

SP - 983

EP - 993

JO - The Journal of Trauma and Acute Care Surgery

JF - The Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 6

ER -