Table 1

Frequency of low-value care (LVC) services in 242 acute care hospitals in the fiscal year 2019

Healthcare servicesNo of episodesNarrower definition
(high specificity)*
Broader definition
(high sensitivity)*
No (%) of LVC episodesNo of LVC episodes/1000†% of patients receiving LVCNo (%) of LVC episodesNo of LVC episodes/1000†% of patients receiving LVC
Antibiotics prescription60 3448159 (13.5)23.61.810 164 (16.8)29.42.2
Serum T3 level testing37 6208061 (21.4)23.30.88061 (21.4)23.30.8
Pregabalin prescription60 3887914 (13.1)22.90.435 736 (59.2)103.41.6
Spinal injection56594883 (86.3)14.10.44948 (87.4)14.30.4
Oral betamimetics prescription34253425 (100)9.90.23425 (100)9.90.2
Pulmonary function testing15 9203287 (20.6)9.50.93293 (20.7)9.30.9
Echocardiogram27 0171436 (5.3)4.20.41442 (5.3)4.20.4
Bone mineral density testing91571021 (11.1)3.00.35157 (56.3)14.91.3
Hypercoagulability testing2790474 (17.0)1.40.04508 (18.2)1.50.04
Intravenous betamimetics314247 (78.7)0.70.1247 (78.7)0.70.1
Stress testing4502160 (3.6)0.50.041760 (39.1)5.10.4
Breast MRI29096 (33.1)0.30.03103 (35.5)0.30.03
Intravenous sivelestat6666 (100)0.20.0266 (100)0.20.02
Traction therapy68363 (9.2)0.2<0.0174 (10.8)0.20.01
Spinal fusion37860 (15.9)0.20.0265 (17.2)0.20.02
Endoscopy in adults <55160458 (3.6)0.20.0260 (3.7)0.20.02
PTH testing625153 (0.8)0.20.0158 (0.9)0.20.01
Electroencephalography426640 (0.9)0.10.01117 (2.7)0.30.03
1,25-dihydroxyvitamin D testing47428 (5.9)0.10.0128 (5.9)0.10.01
Vertebroplasty6127 (44.3)0.10.0130 (49.2)0.10.01
IVC filters3026 (86.7)0.10.0126 (86.7)0.10.01
Endotoxin apheresis2525 (100)0.10.0125 (100)0.10.01
Artificial liver support2718 (66.7)0.10.0118 (66.7)0.10.01
PAC29512 (4.1)0.03<0.0112 (4.1)0.03<0.01
Arthroscopic surgery778 (10.4)0.02<0.0140 (51.9)0.10.01
Renal angioplasty76 (85.7)0.02<0.016 (85.7)0.02<0.01
PCI16602 (0.1)0.01<0.01151 (9.1)0.40.04
Intravenous anti-herpes drugs3381 (0.3)<0.01<0.012 (0.6)0.01<0.01
Surgery for VUR in children11 (100)<0.01<0.011 (100)<0.01<0.01
Tricyclic antidepressants prescription in children310 (0)009 (29.0)0.03<0.01
Carotid endarterectomy220 (0)006 (27.3)0.02<0.01
Nasolacrimal probe in infants0000000
Electroconvulsive therapy in children0000000
Total243 72239 657 (16.3)114.84.9‡75 638 (31.0)218.97.5‡
  • *We developed two versions of each measure: a narrower definition (higher specificity and less misclassification of inappropriate use) and a broader definition (higher sensitivity and greater capture of inappropriate use).

  • †Denominator is the number of patients seeking care at an analytic acute care hospital at least once in the fiscal year 2019 (note that the same individual might be double-counted if he or she visited a different hospital).

  • ‡Totals do not equal sums for the percentage of patients receiving each low-value service because some patients received multiple low-value services.

  • IVC, inferior vena cava; PAC, pulmonary artery catheterisation; PCI, percutaneous coronary intervention; PTH, parathyroid hormone; T3, triiodothyronine; VUR, vesicoureteral reflux.