NEJM Catalyst Innovations in Care Delivery 2022; 0
Corinna Sorenson, PhD, MHSA, MPH, Mark Japinga, MPAff, and Hannah Crook
Published April 20, 2022
Summary
Despite a growing body of evidence documenting the problem of low-value care, our understanding of how to effectively reduce or eliminate it remains limited.
Through semistructured interviews with U.S. health care organizations with demonstrated experience and success in low-value care reduction, the authors sought to elucidate how different stakeholders across the system approach low-value care de-implementation in practice and the key strategies and actions used.
The analysis identified four key phases of low-value care de-implementation:
- plan and assemble,
- identify and assess,
- de-implement, and
- evaluate and disseminate.
De-implementation is an iterative, multiphased, multicomponent process marked by ongoing learning and feedback loops.
Each organization approached low-value care de-implementation with a strong orientation toward experimentation and continuous improvement and as a central tenet of a broader organizational mission to improve health and health care value.
To combat the complex drivers that facilitate and sustain low-value care provision, organizations adopted a range of strategies, resources, and tools to inform, implement, and drive their de-implementation efforts.
Such features included, but were not limited to,
- senior leadership support and aligning low-value care initiatives with unifying organizational values and priorities;
- physician leadership and empowerment;
- de-implementation infrastructure supports across people, data, and technology;
- education and engagement opportunities for providers, patients, and staff;
- data-driven techniques to measure and track low-value care, benchmark performance, and embed or link de-implementation targets within payment, network design, and care pathways; and
- ongoing relations with internal teams and external stakeholders and partners to disseminate and scale de-implementation best practices.
While health care organizations are complex and unique — with their own culture, workforce mix, resources, and priorities — these identified experiences and practices from organizations successful in de-implementation can inform and empower others across the health care landscape to act, innovate, and move the needle on systemwide low-value care reduction.
Originally published at https://catalyst.nejm.org on April 20, 2022.
