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Questionable care: avoiding ineffective treatment

by Stephen Duckett and Peter Breadon


Far too many patients in some Australian hospitals get a treatment they should not receive, against all evidence that the treatment is unnecessary or does not work.

This report identifies five treatments that should not be given to certain types of patients. Yet this happened to nearly 6000 people – or 16 people a day – in 2010-11.

These treatments – which include treating osteoarthritis of the knee with an arthroscope, filling a backbone with cement to treat fractures and putting patients in a pressurised oxygen chamber when it will not improve their condition – can cause harm.

Some patients who had the treatments developed infections during their hospital stay or could have avoided the stress, cost, inconvenience and risk of a hospital stay altogether.

These treatments happen in only a minority of hospitals, but some of those hospitals provide them at 10 or 20 times the average rate, at great cost to patients and the community.

Australia needs a system to let these outlier hospitals know where they stand so that they can improve their care.

More thorough use of data that governments already possess could identify many more treatments that should be performed rarely or never on many patients.

There are reasons why clinicians sometimes choose inappropriate treatments. Evidence about treatments can be hard for clinicians to evaluate, access and use.

There is little systematic monitoring of where these treatments happen, and there are rarely major negative consequences for providing ineffective care. In fact, hospitals and clinicians get income for doing so.

This report explains how and why some patients get ineffective care and what governments should do to ensure that far fewer people get the wrong treatment.

If you are interested in replicating the analysis in this report, please register with Stephen Duckett [stephen.duckett@grattan.edu.au] to receive project and coding updates.

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