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Table 1 Definitions of the nine low value services

From: Exploring variation in low-value care: a multilevel modelling study

Service (recommendation source) Narrower low value care definition Broader low value care definition
Abdominal hysterectomy for benign disease (vs laparoscopic or vaginal) (Committee on Gynecologic Practice, 2009 [14]) Numerator: Denominator episodes involving hysterectomy with abdominal approach.
Denominator: Episodes involving women aged 18 and older having hysterectomy, with no codes for caesarean, cancer, endometriosis or pelvic peritoneal adhesions recorded in the episode.
Numerator: Episodes involving hysterectomy with abdominal approach.
Denominator: Episodes involving women aged 18 and older having hysterectomy, with no codes for caesarean or cancer recorded in the episode.
Arthroscopic lavage and debridement of knee for osteoarthritis or degenerative meniscal tears (CWUS, NICE) Numerator: Denominator episodes involving knee arthroscopy.
Denominator: Episodes involving people aged 55 or older with diagnosis of gonarthrosis or meniscal derangements and no diagnosis of ligament strain or damage or diagnosis of septic (pyogenic) arthritis recorded in the episode.
Numerator: Denominator episodes involving knee arthroscopy.
Denominator: Episodes involving people aged 18 or older with diagnosis of gonarthrosis or meniscal derangements and no diagnosis of ligament strain or damage or septic (pyogenic) arthritis recorded in the episode.
Carotid endarterectomy for asymptomatic high-risk patients with limited life expectancy (CWA, EVOLVE, CWC, CWUS) Numerator: Denominator episodes involving carotid endarterectomy.
Denominator: Episodes involving people aged 18 or older with diagnosis of occlusion and stenosis of carotid artery or procedure of carotid endarterectomy with no excluding diagnosis in the episode, and ASA code 4–5 or (age ≥ 75 and ASA 3), and not emergency care or admitted through emergency department.
Numerator: Denominator episodes involving carotid endarterectomy.
Denominator: Episodes involving people aged 18 or older with diagnosis of occlusion and stenosis of carotid artery or procedure of carotid endarterectomy with no excluding diagnosis in the episode, and ASA code 4–5 or age ≥ 75.
Colonoscopy for constipation in people < 50 years (CWC) Numerator: Denominator episodes involving colonoscopy.
Denominator: Episodes involving patients aged 18–49 with diagnosis of constipation, and no diagnoses of anaemia, weight loss, family or personal history of cancer of digestive system, or personal history of other diseases of the digestive system recorded in the previous 12 months.
Numerator: Denominator episodes involving colonoscopy.
Denominator: Episodes involving patients aged 18–49 with diagnosis of constipation, and no diagnoses of anaemia, weight loss, family or personal history of cancer of digestive system, or personal history of other diseases of the digestive system recorded in the episode.
Endoscopic retrograde cholangiopancreatography (ERCP) without cholangitis (Tenner et al., 2013 [15]; Working Group IAP/APA Acute Pancreatitis Guidelines, 2013 [16]; Nesvaderani et al., 2015 [17]) Numerator: Denominator episodes involving ERCP.
Denominator: Episodes involving patients aged 18 or older with diagnosis of calculus of bile duct or biliary acute pancreatitis, and no record of cholangitis and obstruction and not classed as emergency admission or admitted through the emergency department.
Numerator: Denominator episodes involving ERCP.
Denominator: Episodes involving patients aged 18 or older with diagnosis of calculus of bile duct or biliary acute pancreatitis, and no record of cholangitis and obstruction.
Endoscopy for dyspepsia for people < 55 years (CWC) Numerator: Denominator episodes involving endoscopy.
Denominator: Episodes involving patients aged 18–54 with diagnosis of dyspepsia, and no excluding diagnoses recorded in the previous 12 months.
Numerator: Denominator episodes involving endoscopy.
Denominator: Episodes involving patients aged 18–54 with diagnosis of dyspepsia, and no excluding diagnoses recorded in the episode.
Endovascular repair of infrarenal abdominal aortic aneurysm (CWC) Numerator: Denominator episodes involving endovascular repair of aneurysm.
Denominator: Episodes involving people aged 18 or older with diagnosis of abdominal aortic aneurysm, ASA score 4–5, or (age ≥ 75 and ASA 3), not emergency or admitted from emergency department.
Numerator: Denominator episodes involving endovascular repair of aneurysm.
Denominator: Episodes involving people aged 18 or older with diagnosis of abdominal aortic aneurysm, ASA score 4–5, or age ≥ 75.
Sentinel lymph node biopsy for melanoma in situ or T1a melanoma (EVOLVE, CWUS) Numerator: Denominator episodes involving sentinel lymph node biopsy.
Denominator: Episodes involving patients aged 18 or older with diagnosis of melanoma in situ or melanoma (morphology code M872–M879 /0–2) and no other cancer code recorded in the episode.
Numerator: Denominator episodes involving sentinel lymph node biopsy.
Denominator: Episodes involving patients aged 18 or older with diagnosis of melanoma in situ or melanoma (morphology code M872–M879 /0–3) and no other cancer code recorded in the episode.
Spinal fusion for low back pain (CWC) Numerator: Denominator episodes involving spinal fusion.
Denominator: Episodes involving patients aged 18 or older with diagnosis of low back pain with no mention of sciatica, spondylolisthesis or spinal deformity, or pain in legs recorded in the previous 12 months.
Numerator: Denominator episodes involving spinal fusion.
Denominator: Episodes involving patients aged 18 or older with diagnosis of low back pain or spinal stenosis with no mention of sciatica, spondylolisthesis or spinal deformity, or pain in legs recorded in the episode.
  1. Adapted from Badgery-Parker et al. (2018) Additional file 2: Table S1 [3].