New Report Highlights Recommendations to Reduce Low-Value Care Post-Pandemic

A new report from Choosing Wisely Canada (CWC) and CADTH looks ahead to post-pandemic health care in Canada. The report highlights consensus on evidence-based recommendations to reduce low-value care when health systems are ready to gradually resume the services and procedures that were put on hold due to COVID-19.

The joint report, Using Health Care Resources Wisely After the COVID-19 Pandemic: Recommendations to Reduce Low-Value Care, was published today in the Canadian Journal of Health Technologies and launched at CWC’s virtual national meeting.


“Low-value care” describes tests, treatments, or procedures that offer little clinical benefit to patients and can waste limited health system resources. The report highlights 19 existing Choosing Wisely Canada recommendations to help decision-makers avoid reintroducing low-value services in 7 clinical areas. The goal of the report is to help clinicians and policy makers ensure that limited health system resources are focused on providing necessary care and treatments that will improve the wellbeing of patients.

Recommendations in Key Clinical Areas

  • Primary care: Seven recommendations span primary care, including avoiding unnecessary rural transfers, annual exams, and screening and imaging tests  
  • Specialty care: Four recommendations address low-value procedures, including chronic dialysis, colonoscopy for constipation, cardiac imaging without high-risk markers, and knee MRIs
  • End-of-life care: Three recommendations emphasize the importance of advance care planning conversations for patients with serious illness and access to palliative care
  • Hospital care: Two recommendations address low-value routine investigations and pre-operative testing in hospital care
  • Long-term care: One recommendation addresses unnecessary hospital transfers from long-term care
  • Blood products: One recommendation addresses the overuse of red blood cells transfusion in hemodynamically stable critical care patients.

In an accompanying Viewpoint published in the same issue, Dr. Karen Born and Dr. Wendy Levinson emphasize how the CWC campaign recommendations have increased urgency in the COVID-19 era. The authors underscore that a sustained effort to use resources wisely and reduce low-value tests and treatments will position health care systems to effectively deliver high value tests, treatments and procedures, including restarting those that were postponed due to the pandemic.


About the Recommendations

Consensus of the recommendations were informed by a 10-member multidisciplinary panel of experts that included physicians, patient representatives, and health policy experts. The panel assessed and prioritized a curated shortlist of 45 existing evidence-based Choosing Wisely Canada recommendations. The final list consists of recommendations which had consensus from at least 80% of panel members and which all address services, tests, or procedures that are:

  • Common in clinical practice, may cause harm, and are resource intensive.
  • Associated with an area of need delayed by the pandemic or where there is an existing backlog.
  • Lead to potential strains on health care human resources and system capacity.
  • Aligned with categories of overuse identified and being measured by Choosing Wisely Canada and Canadian Institute for Health Information.

About Choosing Wisely Canada

Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in health care. One of its important functions is to help clinicians and patients engage in conversations that lead to smart and effective care choices. Choosing Wisely Canada is led by a team of clinicians and staff based at St. Michael’s Hospital (Toronto), the University of Toronto, and in collaboration with the Canadian Medical Association.


CADTH is an independent, not-for-profit agency funded by Canadian federal, provincial, and territorial governments (except Quebec) to provide credible, impartial advice and evidence-based information about the effectiveness of drugs and other health technologies to Canadian health care decision-makers.