Table 1. Low-Value Service Measure Descriptions.
Category and key No. | Label | Description |
---|---|---|
Laboratory testing | ||
1a | Preoperative laboratory testing | Do not perform baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery |
2a | PSA testing | Do not perform PSA-based screening for prostate cancer in men older than 70 years |
3a | 25-Hydroxy vitamin D testing | Do not perform population-based screening for 25-hydroxy-vitamin D deficiency |
4 | Testing for chronic urticaria | Do not routinely do diagnostic testing in patients with chronic urticaria |
5a | Immunoglobulin G or E testing | Do not perform unproven diagnostic tests, such as immunoglobulin G testing or an indiscriminate battery of immunoglobulin E tests, in the evaluation of allergy |
6 | Bleeding time testing | Do not use bleeding time testing to guide patient care |
Imaging | ||
7a | Imaging for eye disease | Do not routinely order imaging tests for patients without symptoms or signs of significant eye disease |
8a | Short-interval repeat DEXA scan | Do not routinely repeat DEXA scans more often than once every 2 years |
9a | Imaging for headache | Do not perform imaging for uncomplicated headache |
10a | Carotid artery imaging for simple syncope | Do not perform imaging of the carotid arteries for simple syncope without other neurologic symptoms |
11a | Head imaging for syncope | Do not obtain brain imaging studies (CT scans or MRI) in the evaluation of simple syncope and a normal neurologic examination |
12a | Emergency department head CT scan for dizziness | Do not perform routine head CT scans for emergency department visits for dizziness |
13a | Imaging for low back pain | Do not perform imaging for low back pain within the first 6 weeks unless red flags are present |
14a | Head CT scan for sudden hearing loss | Do not order CT scan of the head or brain for sudden hearing loss |
15a | Imaging for uncomplicated acute rhinosinusitis | Do not routinely perform radiographic imaging for patients who meet diagnostic criteria for uncomplicated acute rhinosinusitis |
16 | MRI for rheumatoid arthritis | Do not perform MRI of the peripheral joints to routinely monitor inflammatory arthritis |
17 | Coronary artery calcium scoring for known CAD | Do not use coronary artery calcium scoring for patients with known CAD (including stents and bypass grafts) |
18 | DEXA scan in low-risk patients | Do not use DEXA screening for osteoporosis in women younger than 65 years or men younger than 70 years with no risk factors |
Cardiopulmonary and neurologic testing | ||
19a | Screening ECGs | Do not order annual ECGs or any other cardiac screening for low-risk patients without symptoms |
20a | Preoperative ECG, chest radiographs, or PFT | Do not perform ECGs, chest radiographs, or PFT in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery |
21a | EEG for headaches | Do not perform EEG for headaches |
22a | Cardiac stress testing | Do not perform stress cardiac imaging or advanced noninvasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present |
23 | PFT prior to cardiac surgery | Do not recommend PFT prior to cardiac surgery in the absence of respiratory symptoms |
24 | Preoperative echocardiography or cardiac stress testing | Do not perform baseline diagnostic cardiac testing or cardiac stress testing in asymptomatic stable patients with known cardiac disease undergoing low- or moderate-risk noncardiac surgery |
Procedures | ||
25a | Cervical cancer screening | Do not order unnecessary cervical cancer screening (Papanicolaou test and human papillomavirus test) in all women who have had adequate prior screening and are not otherwise at high risk for cervical cancer |
26a | Injection for low back pain | Do not provide outpatient epidural, facet, or trigger point spinal injections for low back pain |
27a | Repeat short-interval colorectal cancer screening | Do not order unnecessary screening for colorectal cancer in adults older than 50 years |
28a | Peripheral access placement without nephrology consultation in stage III-V CKD | Do not place peripherally inserted central catheters in patients with stage III-V CKD without consulting nephrology |
29 | Feeding tubes for patients with dementia | Do not recommend percutaneous feeding tubes for patients with advanced dementia |
30a | PCI for asymptomatic patients | Avoid PCI for stable, asymptomatic patients with normal or only mildly abnormal adequate stress test results |
31a | Vertebroplasty for osteoporotic fractures | Do not perform vertebroplasty for osteoporotic vertebral fractures |
32a | Coronary angiography in low-risk patients | Do not perform coronary angiography in patients without cardiac symptoms unless high-risk markers are present |
33 | Multiple palliative radiotherapy treatments for bone metastases | Do not recommend more than a single fraction of palliative radiotherapy for an uncomplicated painful bone metastasis |
34 | Renal artery revascularization | Do not perform revascularization without prior medical management for renal artery stenosis |
35 | Arthroscopic lavage and debridement for knee osteoarthritis | Do not perform an arthroscopic knee surgery for knee osteoarthritis |
Drugs | ||
36a | Antipsychotics for patients with dementia | Do not use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia |
37a | Opiates for acute disabling low back pain | Do not prescribe opiates for acute disabling low back pain before evaluation and a trial of other alternatives is considered |
38a | Antibiotics for acute upper respiratory tract and ear infections | Do not prescribe oral antibiotics for patients with upper respiratory tract or ear infection (acute sinusitis, viral respiratory illness, or acute otitis externa) |
39 | Antibiotics for adenoviral conjunctivitis | Do not order antibiotics for adenoviral conjunctivitis |
40 | Antidepressant monotherapy for bipolar disorder | Do not prescribe antidepressants as monotherapy for patients with bipolar I disorder |
41a | Two or more concurrent antipsychotic medications | Do not routinely prescribe 2 or more antipsychotic medications concurrently |
Abbreviations: ASA I or II, American Society of Anesthesiologists Physical Status Classification I or II; CAD, coronary artery disease; CKD, chronic kidney disease; CT, computed tomography; DEXA, dual-energy x-ray absorptiometry; ECG, electrocardiogram; EEG, electroencephalography; MRI, magnetic resonance imaging; PCI, percutaneous coronary intervention; PFT, pulmonary function testing; PSA, prostate-specific antigen.
Measures included in the main composite score. Measures with key numbers 8, 26, 29, 30, and 36 were not derived from the Milliman MedInsight Health Waste Calculator. Descriptions are adapted from Choosing Wisely and US Preventive Services Task Force recommendations.