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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...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Lippincott Williams & Wilkins
2023
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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 |
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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 |
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