Key Features Underlying Low-Value Care Recommendations

One potential reason that low-value care remains persistent is variation in recommendations created to deter it. A better understanding of key features, and how they differ across a range of recommendations, can offer insight about improvement opportunities. To address this knowledge gap, the authors described 3 features using a broad set of consensus Choosing Wisely recommendations: underlying rationales (ie, avoidance of waste and/or harm), types of services targeted, and types of supportive evidence used. The minority of recommendations were accompanied by rationales invoking waste (36%), harm (17%), and both (40%); 7% of recommendations were accompanied by no rationales. The most commonly targeted service type was diagnostic imaging (31%), while the least commonly targeted service type was clinical referrals/consults (1%). Most recommendations (50%) utilized guidelines as sources. These findings highlight several opportunities to modify low-value care recommendations in order to ultimately strengthen efforts to reduce low-value care.