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

Pauline Heus; Simone A van Dulmen; Jan-Willem Weenink; Christiana A Naaktgeboren; Toshihiko Takada; Eva W Verkerk; Isabelle Kamm; Maarten J van der Laan; Lotty Hooft; Rudolf B Kool

doi:10.1097/JHQ.0000000000000392

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

Pauline Heus, Simone A van Dulmen, Jan-Willem Weenink, Christiana A Naaktgeboren, Toshihiko Takada, Eva W Verkerk, Isabelle Kamm, Maarten J van der Laan, Lotty Hooft, Rudolf B Kool

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

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.

Original language	English
Pages (from-to)	261-271
Number of pages	11
Journal	Journal for healthcare quality : official publication of the National Association for Healthcare Quality
Volume	45
Issue number	5
Early online date	29 Jun 2023
DOIs	https://doi.org/10.1097/JHQ.0000000000000392
Publication status	Published - 1 Sept 2023

Keywords

deimplementation
low-value care
overuse
quality improvement
systematic review

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what_are_effective_strategies_to_reduce_low_value.2Final published version, 638 KBLicence: CC BY

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Heus, P., van Dulmen, S. A., Weenink, J.-W., Naaktgeboren, C. A., Takada, T., Verkerk, E. W., Kamm, I., van der Laan, M. J., Hooft, L., & Kool, R. B. (2023). What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies. Journal for healthcare quality : official publication of the National Association for Healthcare Quality, 45(5), 261-271. https://doi.org/10.1097/JHQ.0000000000000392

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abstract = "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.",

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Heus, P, van Dulmen, SA, Weenink, J-W, Naaktgeboren, CA, Takada, T, Verkerk, EW, Kamm, I, van der Laan, MJ, Hooft, L & Kool, RB 2023, 'What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies', Journal for healthcare quality : official publication of the National Association for Healthcare Quality, vol. 45, no. 5, pp. 261-271. https://doi.org/10.1097/JHQ.0000000000000392

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 et al.
In: Journal for healthcare quality : official publication of the National Association for Healthcare Quality, Vol. 45, No. 5, 01.09.2023, p. 261-271.

Research output: Contribution to journal › Article › Academic › peer-review

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T1 - What are Effective Strategies to Reduce Low-Value Care?

T2 - An Analysis of 121 Randomized Deimplementation Studies

AU - Heus, Pauline

AU - van Dulmen, Simone A

AU - Weenink, Jan-Willem

AU - Naaktgeboren, Christiana A

AU - Takada, Toshihiko

AU - Verkerk, Eva W

AU - Kamm, Isabelle

AU - van der Laan, Maarten J

AU - Hooft, Lotty

AU - Kool, Rudolf B

PY - 2023/9/1

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N2 - 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.

AB - 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.

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JO - Journal for healthcare quality : official publication of the National Association for Healthcare Quality

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Heus P, van Dulmen SA, Weenink JW, Naaktgeboren CA, Takada T, Verkerk EW et al. What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies. Journal for healthcare quality : official publication of the National Association for Healthcare Quality. 2023 Sept 1;45(5):261-271. Epub 2023 Jun 29. doi: 10.1097/JHQ.0000000000000392

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

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