Data research will help avoid ‘do-not-do’ treatments

The study of extensive healthcare data sets will help tackle the problem of identifying and tracking ‘do-not-do’ health treatments across Australia, writes actuary Sophie Dyson.

The Grattan Institute report released last week Questionable care: avoiding ineffective treatments identifies five treatments that should not be given to certain types of patients (do-not-do treatments) and three do-not-do-routinely treatments. The do-not-do list includes treating osteoarthritis of the knee with an arthroscope, filling vertebrae with cement to treat fractures and hyperbaric oxygen therapy. In addition to diverting resources away from effective patient care, these treatments represent unnecessary cost and inconvenience at best, and at worst, can cause serious harm to patients.

“Australia has extensive (but siloed) healthcare data sets and these could be put to better use.”

The five do-not-do treatments totalled 6,000 procedures in 2010-11. While a tiny proportion of the many millions of procedures delivered annually, among the patient group getting these procedures, the do-not-dos represented 4.5% of activity.  There is enormous variation between States, public vs private and individual hospitals in the rates of do-not-do procedures, with some hospitals delivering up to 10 to 20 times the average rate.

The report looks at only eight treatments, but there is a much longer list of do-not-do or do-not-do-routinely procedures to be addressed. To tackle the broader problem, the report recommends publishing clear guidance and lists of do-not-do treatments, tracking treatments and reporting on where they happen and using targeted interventions to reduce rates of ineffective care.

The use of healthcare data is a large component of the proposed solution. Australia has extensive (but siloed) healthcare data sets and these could be put to better use. Historically, access to healthcare data for research has been more highly restricted in Australia than some other countries, but the situation is improving.

The Capital Markets Cooperative Research Centre has over 35 PhD students in their health research stream (some of them actuaries), working on a range of data-related projects including effective care. The recently-launched Centre for Big Data Research in Health at University of New South Wales has over 20 PhD students.


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