Identifying and addressing low-value care in health and care systems

Expected Outcome

This topic aims at supporting activities that are enabling or contributing to one or several expected impacts of destination “Ensuring equal access to innovative, sustainable, and high-quality healthcare”. To that end, proposals under this topic should aim to deliver results that are directed at, tailored towards and contributing to all the following expected outcomes:

• Healthcare providers and policymakers make use of evidence-based indicators and methodologies to identify low-value care[1] practices, as well as opportunities for improvement and tools to monitor such improvements.
• Healthcare professionals are equipped with the knowledge and tools to implement guidelines for reducing or discontinuing low-value care activities and maintaining effective and patient-centred practices that ensure quality of care.
• Patients and citizens benefit from more effective healthcare, by understanding and endorsing measures that reduce low-value care, recognising the potential to achieve higher-quality healthcare and better health outcomes overall.
• Health and care systems benefit from a reduction of low-value care practices, which enables enhanced patient safety and quality of care, while contributing to their efficiency as well as fiscal and environmental sustainability.
• Healthcare organisations can, by identifying low-value care practices, reallocate valuable healthcare resources to other areas of need.

Scope

Low-value care, as defined in the footnote, can have widespread negative consequences for patients, caregivers, healthcare professionals, the health and care system, and the broader environment. A 2017 OECD report[2] estimated that “wasteful healthcare spending is common” and that “up to one-fifth of healthcare spending could be redirected towards better uses”. Low-value care represents a significant challenge, contributing to waste, costs, misuse of resources, and inefficiencies. Addressing low-value care can free up and allow reallocation of valuable healthcare resources to other areas of need, thereby maximising health outcomes, improving health and care systems resilience, and reducing their environmental impact. In this context, a recent report[3] by the Expert Group on Health Systems Performance Assessment (HSPA)[4] establishes the methodological basis and metrics to identify, measure and reduce low-value care.

Research activities under this topic should adopt a patient-centred approach that considers the needs and preferences of patients and citizens. They should promote socially acceptable solutions, taking into account relevant ethical, social and legal aspects and foster dialogue and collaboration between policymakers, healthcare providers, healthcare professionals, and patients/citizens. Proposals should engage citizens and civil society organisations in the development of their actions to ensure acceptability of solutions. By doing so the projects will contribute to better use of healthcare resources -including time and personnel- in ways that significantly improve patient outcomes and alleviate the increasing burden on healthcare professionals and health systems. Implementation research and multidisciplinary approaches should be considered to foster adoption and ensure effective interventions and long-term sustainability.

Proposed activities may[5] include clinical studies[6] to provide evidence on the value of any interventions or processes and, therefore, facilitate justified removal of any type of low value care. Proposed activities may also include data models, digital and artificial intelligence-based analysis, models and/or tools to identify and/or address low-value care. Proposed activities may examine the design and impact of healthcare payment systems, that could unintentionally incentivise low-value care and evaluate alternative financing models that better align incentives with patient outcomes and high-value care. Proposed activities may also facilitate or implement collaboration among registries (disease registries such as cancer registries, primary healthcare visits registries, prescription and drug purchase registries, reimbursement and medical devices registries, screening databases, socio-economic and census databases, etc.) across regions or countries, to enable or improve the assessment and comparison of different levels of care and their value to patients. Additionally, activities that facilitate learning and best practice transfers between countries or regions may also be considered as element of the proposal (for instance, to leverage best practice-sharing initiatives from international platforms such as the Knowledge Hub of the co-funded European Partnership on Transforming Health and Care Systems[7] or any other relevant European or global initiatives). Additionally, proposals may include or support international comparisons of low-value care practices and strategies for their reduction across countries, if and where deemed valuable.

Research actions should address all the following objectives:

• Develop a deeper understanding of how low-value care can be identified and measured throughout the healthcare process, including testing related indicators and producing evidence-based methodologies that enable the pursuit of improved efficiency and quality of care.
• Identify instances of overuse, misuse, underuse and unwarranted variation in specific healthcare contexts across different stages of the healthcare process. This analysis should provide actionable insights for policymakers, healthcare providers and healthcare professionals to evaluate the potential of possible strategies for reducing low-value care, allowing for more informed decision-making and improved care practices.
• Develop and/or pilot innovative strategies for effective reduction of low-value care in specific settings across the care pathway. These pilots should demonstrate scalability and transferability across diverse health and care systems in Europe.

Proposals should consider how gender norms and roles influence utilisation patterns, ensuring that strategies to reduce low-value care do not inadvertently exacerbate existing gender and social inequalities in healthcare access and outcomes. In addition, attention should be paid to intersectional factors that may further affect healthcare access and outcomes. If handling data and indicators, sex- and gender-disaggregated data should be collected and analysed, incorporating intersectional factors where feasible.

Proposals should consider the work and output of any EU level initiatives (e.g. the Expert Group on Health Systems Performance Assessment, the co-funded European Partnership on Transforming Health and Care Systems, relevant projects or Joint Actions funded under the EU4Health Programme (2021-2027)[8] and under EU Research & Innovation Framework Programmes, etc.) or other international initiatives (e.g. the 2017 OECD report mentioned above) in this area.

Applicants envisaging[5] to include clinical studies[6] should provide details of their clinical studies in the dedicated annex using the template provided in the submission system.

[1] Definition of low-value care from the Report by the Expert Group on Health Systems Performance Assessment: “From a health system perspective, low-value care encompasses overuse, misuse and underuse of healthcare services (for example, prevention, diagnostics, treatment, medication). Overuse and/or misuse comprise the delivery of harmful, ineffective, inappropriate, or not cost-effective healthcare services. Underuse refers to healthcare services not provided or used despite being necessary. Low-value care can lead to negative consequences for patients, their caregivers, the healthcare workforce, the health system as a whole and the wider environment.”

[2] OECD (2017), Tackling Wasteful Spending on Health, OECD Publishing, Paris. http://dx.doi.org/10.1787/9789264266414-en

[3] Report by the Expert Group on Health Systems Performance Assessment: “Identifying, Measuring And Reducing Low-Value Care In The Context Of Health System Performance Assessment”. https://health.ec.europa.eu/publications/identifying-measuring-and-reducing-low-value-care-context-health-system-performance-assessment_en

[4] https://health.ec.europa.eu/health-systems-performance-assessment_en

[5] Some proposals may not need to conduct clinical studies to achieve the objectives.

[6] Please note that the definition of clinical studies (see introduction to this Work Programme part) is broad and it is recommended that you review it thoroughly before submitting your application.

[7] https://cordis.europa.eu/project/id/101095654, https://www.thcspartnership.eu

[8] https://commission.europa.eu/funding-tenders/find-funding/eu-funding-programmes/eu4health_en

[9] Some proposals may not need to conduct clinical studies to achieve the objectives.

[10] Please note that the definition of clinical studies (see introduction to this Work Programme part) is broad and it is recommended that you review it thoroughly before submitting your application.