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Acting on potentially inappropriate care

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Measuring inappropriate care should rely on evidence available at the time, with anomalous practices evaluated by clinical panels

Our recent MJA article1 and accompanying report2 set out a model for harnessing clinical expertise and government resources to address the issue of inappropriate care.

This model involves four steps. First, a credible, independent body would review clinical evidence to identify potentially inappropriate treatments. Second, the same body would monitor use of those treatments. Hospitals providing the treatments more frequently than the national average rate would be advised of that fact. Third, if a hospital’s abnormal practice persisted, they would face an external clinical review in which they could justify their practice to peers. Finally, if the reviewers found this justification unsatisfactory, only then might there be financial consequences.

It is hard to see how this cautious and clinician-led model is punitive, as Sherlock labels it.3 We do not recommend taking potentially inappropriate treatment options away from clinicians. Instead, we recommend monitoring their use and initiating clinician-led reviews of unusual practice patterns, recognising that even do-not-do treatments may be justified in some circumstances.

Our model recognises that health…