Starfield V
This Year's Summit
Dr. Barbara Starfield’s work demonstrated that countries with primary care-oriented health systems have better population health outcomes, higher quality care, greater health equity, and lower costs.
The Starfield Summit is an ongoing series of meetings that provide an opportunity for conversation among a diverse group of leaders in primary care research and policy. The Summits are intended to galvanize participants, generate important discussion, and enable research and policy agenda-setting in support of primary care function as an essential catalyst in health system reform.
Process
Sessions
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Setting the Context
The primary focus of Virtual Session 1 was to set the context for the Summit by framing LVC in the context of payment reform. In this section we review results from two expert presentations and a subsequent group discussion by the Advisory Committee members.
2. Exploring the Options
The next objective was to review current LVC recommendations with the aid of specific criteria for evaluating LVC measures. A set of criteria (and related considerations) was developed by engaging the Advisory Committee in a survey process prior to Virtual Session 2, and a discussion process that continued throughout the Summit. The Advisory Committee then proceeded to review sources of existing LVC recommendations with these criteria in mind.
3. Drivers, Levers, and Stakeholders
Our original objective for Session 3 was to identify via consensus a core set of measures that matter for reducing LVC in primary care settings. With wisdom gained from the Advisory Committee Members participating in Sessions 1 and 2, it became apparent that an authentic approach to reducing low-value care should go deeper than identifying a set of low-value care measures from Choosing Wisely, the USPSTF, or some other ready source. With this context in mind, the planning team invited Advisory Committee members to share their insights about system drivers, levers, and stakeholders via a pre-meeting survey and facilitated discussion.
4. From Insights to Action
In the first three Virtual Sessions, the Advisory Committee framed LVC in the context of overall payment reform; developed criteria for reviewing existing LVC measures; and engaged in extensive discussion about feasibility concerns related to implementing existing recommendations from Choosing Wisely and the USPSTF. In noting the implementation concerns, the conclusion was not that the existing sources could not be used at all, but that careful vetting would be required to select recommendations that are evidence-based and feasible for implementation. It was recommended that the group advance both a No Value List and a Research and Development Agenda
Supporting Slides
No Value Care List Recommendations
No Value Care List with Advisory Committee Recommendations
R&D Agenda for Reducing Low Value Care
Selected Abstracts
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Barreto TW, Chung Y, Wingrove P, Young RA, Petterson S, Bazemore A, Liaw W. Primary Care Physician Characteristics Associated with Low Value Care Spending. J Am Board Fam Med. 2019 Mar-Apr;32(2):218-225. doi: 10.3122/jabfm.2019.02.180111. PMID: 30850458. https://pubmed.ncbi.nlm.nih.gov/30850458/
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Bouck Z, Ferguson J, Ivers NM, Kerr EA, Shojania KG, Kim M, Cram P, Pendrith C, Mecredy GC, Glazier RH, Tepper J, Austin PC, Martin D, Levinson W, Bhatia RS. Physician Characteristics Associated With Ordering 4 Low-Value Screening Tests in Primary Care. JAMA Netw Open. 2018 Oct 5;1(6):e183506. doi: 10.1001/jamanetworkopen.2018.3506. PMID: 30646242; PMCID: PMC6324437. https://pubmed.ncbi.nlm.nih.gov/30646242/
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Buist DS, Chang E, Handley M, Pardee R, Gundersen G, Cheadle A, Reid RJ. Primary Care Clinicians’ Perspectives on Reducing Low-Value Care in an Integrated Delivery System. Perm J. 2016 Winter;20(1):41-6. doi: 10.7812/TPP/15-086. Epub 2015 Nov 2. PMID: 26562308; PMCID: PMC4732793. https://pubmed.ncbi.nlm.nih.gov/26562308/
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Ganguli I, Morden NE, Yang CW, Crawford M, Colla CH. Low-Value Care at the Actionable Level of Individual Health Systems. JAMA Intern Med. 2021 Nov 1;181(11):1490-1500. doi: 10.1001/jamainternmed.2021.5531. PMID: 34570170; PMCID: PMC8477305. https://pubmed.ncbi.nlm.nih.gov/34570170/
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Rockwell MS, Michaels KC, Epling JW. Does de-implementation of low-value care impact the patient-clinician relationship? A mixed methods study. BMC Health Serv Res. 2022 Jan 6;22(1):37. doi: 10.1186/s12913-021-07345-9. PMID: 34991573; PMCID: PMC8733793. https://pubmed.ncbi.nlm.nih.gov/34991573/
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Schwartz AL, Jena AB, Zaslavsky AM, McWilliams JM. Analysis of Physician Variation in Provision of Low-Value Services. JAMA Intern Med. 2019 Jan 1;179(1):16-25. doi: 10.1001/jamainternmed.2018.5086. PMID: 30508010; PMCID: PMC6583417. https://pubmed.ncbi.nlm.nih.gov/30508010/