Cargando…

What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies

BACKGROUND: Low-value care is healthcare leading to no or little clinical benefit for the patient. The best (combinations of) interventions to reduce low-value care are unclear. PURPOSE: To provide an overview of randomized controlled trials (RCTs) evaluating deimplementation strategies, to quantify...

Descripción completa

Detalles Bibliográficos
Autores principales: Heus, Pauline, van Dulmen, Simone A., Weenink, Jan-Willem, Naaktgeboren, Christiana A., Takada, Toshihiko, Verkerk, Eva W., Kamm, Isabelle, van der Laan, Maarten J., Hooft, Lotty, Kool, Rudolf B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10461725/
https://www.ncbi.nlm.nih.gov/pubmed/37428942
http://dx.doi.org/10.1097/JHQ.0000000000000392
_version_ 1785097901079265280
author Heus, Pauline
van Dulmen, Simone A.
Weenink, Jan-Willem
Naaktgeboren, Christiana A.
Takada, Toshihiko
Verkerk, Eva W.
Kamm, Isabelle
van der Laan, Maarten J.
Hooft, Lotty
Kool, Rudolf B.
author_facet Heus, Pauline
van Dulmen, Simone A.
Weenink, Jan-Willem
Naaktgeboren, Christiana A.
Takada, Toshihiko
Verkerk, Eva W.
Kamm, Isabelle
van der Laan, Maarten J.
Hooft, Lotty
Kool, Rudolf B.
author_sort Heus, Pauline
collection PubMed
description BACKGROUND: Low-value care is healthcare leading to no or little clinical benefit for the patient. The best (combinations of) interventions to reduce low-value care are unclear. PURPOSE: To provide an overview of randomized controlled trials (RCTs) evaluating deimplementation strategies, to quantify the effectiveness and describe different combinations of strategies. METHODS: Analysis of 121 RCTs (1990–2019) evaluating a strategy to reduce low-value care, identified by a systematic review. Deimplementation strategies were described and associations between strategy characteristics and effectiveness explored. RESULTS: Of 109 trials comparing deimplementation to usual care, 75 (69%) reported a significant reduction of low-value healthcare practices. Seventy-three trials included in a quantitative analysis showed a median relative reduction of 17% (IQR 7%–42%). The effectiveness of deimplementation strategies was not associated with the number and types of interventions applied. CONCLUSIONS AND IMPLICATIONS: Most deimplementation strategies achieved a considerable reduction of low-value care. We found no signs that a particular type or number of interventions works best for deimplementation. Future deimplementation studies should map relevant contextual factors, such as the workplace culture or economic factors. Interventions should be tailored to these factors and provide details regarding sustainability of the effect.
format Online
Article
Text
id pubmed-10461725
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Lippincott Williams & Wilkins
record_format MEDLINE/PubMed
spelling pubmed-104617252023-08-29 What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies Heus, Pauline van Dulmen, Simone A. Weenink, Jan-Willem Naaktgeboren, Christiana A. Takada, Toshihiko Verkerk, Eva W. Kamm, Isabelle van der Laan, Maarten J. Hooft, Lotty Kool, Rudolf B. J Healthc Qual Original Article BACKGROUND: Low-value care is healthcare leading to no or little clinical benefit for the patient. The best (combinations of) interventions to reduce low-value care are unclear. PURPOSE: To provide an overview of randomized controlled trials (RCTs) evaluating deimplementation strategies, to quantify the effectiveness and describe different combinations of strategies. METHODS: Analysis of 121 RCTs (1990–2019) evaluating a strategy to reduce low-value care, identified by a systematic review. Deimplementation strategies were described and associations between strategy characteristics and effectiveness explored. RESULTS: Of 109 trials comparing deimplementation to usual care, 75 (69%) reported a significant reduction of low-value healthcare practices. Seventy-three trials included in a quantitative analysis showed a median relative reduction of 17% (IQR 7%–42%). The effectiveness of deimplementation strategies was not associated with the number and types of interventions applied. CONCLUSIONS AND IMPLICATIONS: Most deimplementation strategies achieved a considerable reduction of low-value care. We found no signs that a particular type or number of interventions works best for deimplementation. Future deimplementation studies should map relevant contextual factors, such as the workplace culture or economic factors. Interventions should be tailored to these factors and provide details regarding sustainability of the effect. Lippincott Williams & Wilkins 2023 2023-06-29 /pmc/articles/PMC10461725/ /pubmed/37428942 http://dx.doi.org/10.1097/JHQ.0000000000000392 Text en © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the National Association for Healthcare Quality. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Heus, Pauline
van Dulmen, Simone A.
Weenink, Jan-Willem
Naaktgeboren, Christiana A.
Takada, Toshihiko
Verkerk, Eva W.
Kamm, Isabelle
van der Laan, Maarten J.
Hooft, Lotty
Kool, Rudolf B.
What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies
title What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies
title_full What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies
title_fullStr What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies
title_full_unstemmed What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies
title_short What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies
title_sort what are effective strategies to reduce low-value care? an analysis of 121 randomized deimplementation studies
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10461725/
https://www.ncbi.nlm.nih.gov/pubmed/37428942
http://dx.doi.org/10.1097/JHQ.0000000000000392
work_keys_str_mv AT heuspauline whatareeffectivestrategiestoreducelowvaluecareananalysisof121randomizeddeimplementationstudies
AT vandulmensimonea whatareeffectivestrategiestoreducelowvaluecareananalysisof121randomizeddeimplementationstudies
AT weeninkjanwillem whatareeffectivestrategiestoreducelowvaluecareananalysisof121randomizeddeimplementationstudies
AT naaktgeborenchristianaa whatareeffectivestrategiestoreducelowvaluecareananalysisof121randomizeddeimplementationstudies
AT takadatoshihiko whatareeffectivestrategiestoreducelowvaluecareananalysisof121randomizeddeimplementationstudies
AT verkerkevaw whatareeffectivestrategiestoreducelowvaluecareananalysisof121randomizeddeimplementationstudies
AT kammisabelle whatareeffectivestrategiestoreducelowvaluecareananalysisof121randomizeddeimplementationstudies
AT vanderlaanmaartenj whatareeffectivestrategiestoreducelowvaluecareananalysisof121randomizeddeimplementationstudies
AT hooftlotty whatareeffectivestrategiestoreducelowvaluecareananalysisof121randomizeddeimplementationstudies
AT koolrudolfb whatareeffectivestrategiestoreducelowvaluecareananalysisof121randomizeddeimplementationstudies