Public and private payers are widely using performance measures to assess the use of low-value interventions, such as imaging for patients with uncomplicated low back pain, and using the results for public reporting and pay-for-performance, say authors of a position paper written on behalf of the American College of Physicians Performance Measurement Committee and published October 30 in Annuals of Internal Medicine.

The paper gives an overview of performance measures that target low-value services in order to help physicians understand the strengths and limitations of these measures, provides specific examples of measures that assess the use of low-value services, and discusses how these measures can be used in clinical practice and policy.

The discussion includes 2 categories of low-value  interventions: (1) those for which the harms probably exceed the benefits (eg, performing colorectal cancer screening for patients older than age 85 years) and (2) those that may provide benefits but for which a quantitative assessment of their benefits and costs by a multistakeholder group (patients, clinicians, and policymakers) suggests that the tradeoff between health benefits and expenditures is undesirable (eg, screening for cervical cancer in low-risk women aged 65 years or older and in women who have had a total hysterectomy for benign disease).

"Ideally, performance measures should be based on rigorous study designs (for example, randomized controlled trials) that assessed the benefits, risks, and costs of interventions," say the authors. However, to develop performance measures for low-value services, they suggest that researchers "will probably need to use data from different types of research design and methods, including subgroup analyses from clinical trials, cohort studies, cost–benefit analyses, and cost-effectiveness analyses."

"Just as with other performance measures, those for low-value services can be used in a variety of ways to improve quality and health care value," they add. 

Read more about the American College of Physicians' (ACP) high-value care initiative that aims to help physicians and patients understand the benefits, harms, and costs of interventions, and determine whether services provide good value. Go to the February 2011 issue of Annuals of Internal Medicine for free full text of ACP's clinical guideline for diagnostic imaging for patients with low back pain. The guideline calls for diagnostic imaging only if patients have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition.