Table 3

Framework for classifying low-value clinical practices

Type of process
Type of overuseAdmission, transferConsultationScreeningDiagnosticMonitoringTherapeutic
Inappropriate for a specified clinical indication*
Inappropriate for clinical indication in
a specific population†
Excessive service intensity or sophistication given expected clinical benefit‡
Excessive frequency of service given expected clinical benefit§
  • *Specific clinical situations or indications for which a service is considered inappropriate or of questionable clinical value (eg, antibiotics for acute bronchitis).

  • †Services that may be appropriate for a specific population, such as a high-risk population, but is inappropriate or of negligible clinical benefit when applied to other, particularly lower-risk populations (eg, cardiac stress imaging for initial detection and risk assessment in asymptomatic, low coronary heart disease risk individuals).

  • ‡More expensive or intensive services with marginal clinical benefits when less expensive or less intensive, but equally effective alternatives, are available (eg, combined, with and without contrast, abdominal CT scans when only one scan is necessary).

  • §Repeating tests too frequently when the probability of observing clinically important change is low and can increase costs and patient exposure to risks unnecessarily (eg, frequency of follow-up or monitoring).

  • Source, Chan et al.20