for people ages 18 years and up (full criteria)
study started
estimated completion
Principal Investigator
by John N. Mafi, MD, MPH (ucla)



Low-value care is defined as patient care that provides no net benefit to patients in specific clinical scenarios, and it can cause patient harm. Prior research has documented high-rates of low-value care in Virginia, and this work has helped to inspire a Virginia government-sponsored quality improvement initiative to reduce low-value care. Funded by a $2.2 million Arnold Ventures grant, six large health systems in Virginia volunteered to partner with the Virginia Center for Health Innovation (VCHI) to reduce use of seven low-value health services (three preoperative testing measures, two cardiac screening measures, one diagnostic eye imaging measure, and one peripherally inserted central catheter [PICC] measure). These health systems include nearly 7,000 clinicians practicing across more than 1,000 sites. VCHI is implementing a step-wedge cluster-randomized physician peer-comparison feedback quality improvement intervention to reduce the use of these seven low-value services. VCHI will provide education, quality improvement training, and financial resources to each site, and VCHI will use the Milliman MedInsight Health Waste Calculator to create the peer comparison reports using the Virginia all payer claims database (APCD). Of note, the primary purpose of the initiative is to improve quality of care for Virginia residents and this initiative is not being done for research purposes, and step-wedge randomization is done to both ease logistical workload on VCHI and clarify impact of intervention (IRB exempt). Nevertheless, University of California, Los Angeles (UCLA) team plans to rigorously study and publish the impact of this intervention across the state of Virginia, which is why the UCLA team is preregistering the initiative. The UCLA team will use the Virginia APCD to evaluate the impact of the intervention. Because the APCD has a 1 year time-lag of data collection, the initial results of the impact of the intervention will not be available until August 2020 at the earliest.

Official Title

Eliminating Low-Value Care in Virginia: Six Large Health Systems Sign On


Chronic Kidney Diseases Eye Diseases Cardiac Disease Surgery Kidney Diseases Renal Insufficiency, Chronic Heart Diseases Multicomponent Physician Performance Peer-Comparison Feedback Intervention


You can join if…

Open to people ages 18 years and up

All adult patients (aged 18 or older) at each of the six health systems who are at risk for receiving low-value care across each of the seven measures.

  • For preoperative testing, eligible patients include those with a health system evaluation and management visits 30 days prior to low-risk surgery.
  • For eye imaging, eligible patients will be patients with evaluation and management visits with a health system ophthalmologist/optometrist.
  • For cardiac screening, eligible patients are patients with an ambulatory evaluation and management visit (all specialties).
  • For the PICC line measure, eligible patients would include hospitalized patients.

You CAN'T join if...

  • Patients under the age of 18.
  • Patients who do not meet the above criteria.
  • Patients who do not receive care at each of the six health systems.


  • University of California, Los Angeles
    Los Angeles California 90024 United States

Lead Scientist at University of California Health

  • John N. Mafi, MD, MPH (ucla)
    Associate Professor-in-Residence, Medicine. Authored (or co-authored) 35 research publications


in progress, not accepting new patients
Start Date
Completion Date
University of California, Los Angeles
Study Type
Expecting 1800000 study participants
Last Updated