Article type
Abstract
Importance to patients and background: Health care practices lacking evidence for effectiveness or practices leading to more harm than benefit to patients (ie, low-value care (LVC) practices) are still being utilized. Reducing LVC can contribute to the quality of care while increasing the efficient use of resources. Moreover, it aligns with the sustainable development goals (SDGs) by promoting good health among citizens. However, the effectiveness of deimplementation strategies has not yet been systematically synthesized across different LVC practices.
Objectives: This overview of reviews aimed: i) to investigate the effectiveness of deimplementation initiatives (ie, combination of strategies) and discrete deimplementation strategies across different health care practices and ii) to report on characteristics of deimplementation initiatives (eg, development, duration) in systematic reviews (SRs).
Methods: We searched MEDLINE (Ovid), Epistemonikos.org, and Scopus (Elsevier) from 1 January 2010 to 17 April 2023 and applied further search strategies. Two reviewers independently screened abstracts and full texts against a priori–defined criteria, assessed the quality of SRs applying AMSTAR 2, and extracted prespecified data. We mapped the extracted deimplementation strategies against the Expert Recommendation for Implementing Change compilation of strategies. We synthesized the results narratively and created harvest plots to display the results.
Results: Out of 46 SRs, the majority focused on the reduction of drug treatments (eg, antibiotics, opioids, n = 27) or laboratory tests or diagnostic imaging (n = 12). Overall, 15 SRs revealed effective reductions in antibiotic and opioid utilization. The evidence for the reduction of antipsychotics, benzodiazepines, laboratory tests, and diagnostic imaging was less consistent. Deimplementation strategies related to adapting and tailoring to context, developing stakeholder interrelationships, and changing infrastructure and workflow led to consistent reductions of LVC. Applied theories, duration, and intensity of deimplementation initiatives were most often not reported. The taxonomy developed by the Cochrane Effective Practice and Organisation of Care Review Group was most frequently used (n = 6) to categorize strategies.
Conclusions: This review highlighted the effectiveness of certain deimplementation strategies that could be applied to other LVC practices and therefore contribute to the SDGs. To enhance the utilization of synthesized evidence by decision-makers, it is imperative to report sufficient details describing deimplementation strategies in a standardized manner.
Objectives: This overview of reviews aimed: i) to investigate the effectiveness of deimplementation initiatives (ie, combination of strategies) and discrete deimplementation strategies across different health care practices and ii) to report on characteristics of deimplementation initiatives (eg, development, duration) in systematic reviews (SRs).
Methods: We searched MEDLINE (Ovid), Epistemonikos.org, and Scopus (Elsevier) from 1 January 2010 to 17 April 2023 and applied further search strategies. Two reviewers independently screened abstracts and full texts against a priori–defined criteria, assessed the quality of SRs applying AMSTAR 2, and extracted prespecified data. We mapped the extracted deimplementation strategies against the Expert Recommendation for Implementing Change compilation of strategies. We synthesized the results narratively and created harvest plots to display the results.
Results: Out of 46 SRs, the majority focused on the reduction of drug treatments (eg, antibiotics, opioids, n = 27) or laboratory tests or diagnostic imaging (n = 12). Overall, 15 SRs revealed effective reductions in antibiotic and opioid utilization. The evidence for the reduction of antipsychotics, benzodiazepines, laboratory tests, and diagnostic imaging was less consistent. Deimplementation strategies related to adapting and tailoring to context, developing stakeholder interrelationships, and changing infrastructure and workflow led to consistent reductions of LVC. Applied theories, duration, and intensity of deimplementation initiatives were most often not reported. The taxonomy developed by the Cochrane Effective Practice and Organisation of Care Review Group was most frequently used (n = 6) to categorize strategies.
Conclusions: This review highlighted the effectiveness of certain deimplementation strategies that could be applied to other LVC practices and therefore contribute to the SDGs. To enhance the utilization of synthesized evidence by decision-makers, it is imperative to report sufficient details describing deimplementation strategies in a standardized manner.