PCR080: Utilization of 15 Low Value Services within Primary Care of a Southwest Virginia Health System in 2019
Michelle Rockwell, PhD, RD; John Epling, MD, MSEd; Kenan Michaels, BA; Kyle Russell; Beth Bortz, MPP
Michelle Rockwell, PhD, RD; John Epling, MD, MSEd; Kenan Michaels, BA; Kyle Russell; Beth Bortz, MPP
I do not understand how cervical and colorectal cancer screening are low-value items? These are the only two cancer screens that can be (or will soon to be) done by home based testing that will allow 80% or so of the population to not have to undergo an invasive exam.
I suspect that this is overuse of colonoscopy - repeat prior to indicated to begining earlier than guidelines? Similar to cervical cancer screening? Neat poster! Milliman is a bit of a black box to me. But hopefully this gives insight into waste.
@Diane, this is a great question. I wish we had had more room on the poster to define the services! Cervical and colorectal cancer screening are both high-value and low-value services. Based on Choosing Wisely criteria, these screenings are not indicated for all patients. For example, CRC screening that is more frequent than guidelines recommend (e.g., colonoscopy more frequently than 10 years, FIT more frequently than 1/year, etc.) or in patients older than recommended is classified as "wasteful" by the health waste calculator we used. Similar for cervical cancer screening: https://www.choosingwisely.org/clinician-lists/american-college-preventive-medicine-cervical-cancer-screening/. A barrier we've heard quite a lot to reducing the low-value versions of these services is concern about sending a mixed message regarding the high-value (and underutilized) instances of the service. And...how great that we're moving toward home-based non-invasive testing!
One of the other posters at NAPCRG noted that with COVID shutdown, less imaging was done for headaches - would be fascinating to see how telehealth might have impacted the prevalence of LVC. Great work.
Great work- I'd be interested to see how COVID affected the Vit D. With some of the press, I had a lot of patients asking for Vit D levels.
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Jack Westfall
jwestfall@aafp.org 11/20/2021Thanks for your terrific work on this research. Hope we can connect.