Low-value care: an evolutionary concept analysis

Abstract

Abstract Background: Low-value care is a significant contributor to health care waste and a threat to the viability and sustainability of health care systems. Low-value care has attracted increasing international attention in the last decade, but its precise conception remains elusive. Objective: To clarify the concept of low-value care. Methods: A systematic search was conducted of the Medline, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, Health Technology Assessment, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases from their inception to July 22, 2023 for articles written in English. Rodgers’ evolutionary method guided the narrative analysis. The attributes of low-value care, as well as its antecedents, consequences, and related terms were extracted and synthesized. Results: A total of 53 articles were included in this concept analysis. Defining attributes included being of little to no benefit or potentially harmful, not being cost-effective, occurring along a continuum, being relative, ignoring or disregarding patient wishes in certain circumstances, and involving multiple types of care. Low-value care antecedents were classified into 4 categories: demand-side factors, supply-side factors, social factors, and health care system factors, while consequences of low-value care were categorized into patient harms and health care system-related consequences. Conclusions: This in-depth analysis of attributes, antecedents, and consequences of low-value care promotes a better understanding of low-value care among health care providers, thus contributing to the identification and deimplementation of low-value care in practice and eventually contributing to reducing waste in health care spending and improving patient outcomes.