Objectives Reducing low-value care and improving healthcare’s climate readiness are critical factors to improve the sustainability and resilience of health systems across the globe. By definition, low-value care generates carbon emissions, waste and pollution without improving patient or population health. Thirty percent of clinical care has been deemed low- or no value and as much as 80% of healthcare carbon emissions arise from clinical care. Little is known about the knowledge, research, interventions and practice change being developed on the co-benefits of reducing low-value care and reducing the environmental impacts of care. The objective of this study was to advance the field by developing foundational knowledge, through a literature analysis (scoping review & bibliometric analysis) and research agenda synthesis, of key aspects of co-benefits research and practice change.

Methods We identified, collected and synthesized data from research and practice change publications on reducing low-value care and improving the climate resilience and sustainability of health systems. Four databases, Medline, Embase, Scopus and CINAHL, were searched from inception to January 2023. We followed scoping review methodology to collect and analyze the data. The database searches identified 1794 unique articles for title and abstract screening; 264 articles moved to full-text review. For the bibliometric analysis of the included articles, we analyzed authors, organizations topics, collaborations, citations and journals. Biblioshiny, additional R-based applications, and Microsoft Excel were used for publication, co-authorship and co-word analyses.

Results Seventy six articles published 2013-2022 met inclusion criteria, with over 75% of the articles published since 2020. Thirty percent of the articles were empirical studies with the remainder being commentary, editorials or opinion. A quarter of the articles focused equally on the importance of reducing low-value care and improving environmental impact of healthcare; 60% of articles focused on reducing the environmental impact of care; 15% focused on reducing low-value care. The majority of articles focused on healthcare generally (32%), with the remainder focused on practices such as laboratory testing (17%), and surgery and anesthesia (15%). The majority of articles were written by multi-national teams, with first authors predominantly from Australia (42%), UK (23%) and USA (20%). The bibliometric analysis revealed distinct and geographically specific collaborations, in addition to a number of nation-spanning research groups. Reported research and practice priorities included a need for increased resource stewardship, standards, metrics and provider education. The lack of evidence, data, leadership and cohesive strategy were reported as challenges in the field. Directions for future research and practice included increasing transparency on environmental impacts and patient education and communication.

Conclusions This work provides foundational knowledge to advance understanding on the co-benefits of reducing low-value care and improving environmental sustainability. This literature synthesis mobilizes existing knowledge on co-benefits research and practice to support the development of solution to address low-value care and the climate resilience and sustainability of health systems. Next steps include consensus meeting to develop a shared research agenda and community of practice.