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

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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 languageEnglish
Pages (from-to)261-271
Number of pages11
JournalJournal for healthcare quality : official publication of the National Association for Healthcare Quality
Volume45
Issue number5
Early online date29 Jun 2023
DOIs
Publication statusPublished - 1 Sept 2023

Keywords

  • deimplementation
  • low-value care
  • overuse
  • quality improvement
  • systematic review

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