HOW TO REDUCE OVERUSE IN HEALTHCARE Reduce low-value care with this practical guide Low-value care harms patients, overburdens healthcare professionals, threatens healthcare systems and damages the climate. How to Reduce Overuse in Healthcare: a practical guide is designed to provide practical guidance and tools for healthcare providers, their professional societies and policy makers developing programs to de-implement low-value or unnecessary care. This guide provides a five-step evidence and theory-based framework for developing and evaluating programs such as Choosing Wisely to reduce…mehr
Low-value care harms patients, overburdens healthcare professionals, threatens healthcare systems and damages the climate. How to Reduce Overuse in Healthcare: a practical guide is designed to provide practical guidance and tools for healthcare providers, their professional societies and policy makers developing programs to de-implement low-value or unnecessary care. This guide provides a five-step evidence and theory-based framework for developing and evaluating programs such as Choosing Wisely to reduce low-value care and improve patient outcomes.
How to Reduce Overuse in Healthcare: a practical guide readers will also find: _ An author team involved in the leading Choosing Wisely international network _ Detailed analysis of how to identify potential low-value care areas, select interventions and more _ Practical, real-world examples at the end of each chapter illustrating examples of overuse and de-implementation
How to Reduce Overuse in Healthcare: a practical guide describes the state of the art in de-implementation for healthcare professionals, healthcare administrators and policy makers looking to reduce low-value care in a more effective and evidence-based way.
Tijn Kool, MD PhD, is Full Professor Appropriate Care at the Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands. Andrea M. Patey, PhD, is Senior Research Associate in the Centre for Implementation Research in the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Canada. Simone van Dulmen, PhD, is Senior Researcher in Appropriate and Sustainable Healthcare at the Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands. Jeremy M. Grimshaw, MBChB, PhD, Senior Scientist in the Centre for Implementation Research in the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Canada.
Inhaltsangabe
Preface x
Chapter 1 Why Should We Reduce Medical Overuse? 1 Karen Born and Wendy Levinson
It Started with Quality Improvement 1
Then Came a Focus on Overuse 3
Overuse as a Global Healthcare Quality Concern 5
What Can Be Done to Address Overuse? 6
Choosing Wisely 7
What Can you Expect in the Following Chapters? 9
References 10
Chapter 2 Why Does Overuse Exist? 13 Tijn Kool, Simone van Dulmen, Andrea M. Patey, and Jeremy M. Grimshaw
A Multifactorial Challenge on Different Levels 13
Healthcare Professional Factors 14
Patient Factors 15
Preference for Acquiring Something 16
Clinical Care Context Factors 16
Absence of an Open Culture 17
Absence of Clear Leadership 17
Healthcare Organisation Factors 18
Insufficient Time 18
Lack of Coordination Amongst Healthcare Providers 19
Healthcare System Factors 19
Payment System that Rewards Volume 19
Influence of the Pharmaceutical and Medical Device Industry 20
Healthcare Insurance Policy 20
Key Points 20
References 21
Chapter 3 Why Is It So Hard to Change Behaviour and How Can We Influence It? 23 Jill J. Francis, Sanne Peters, Andrea M. Patey, Nicola McCleary, Leti van Bodegom- Vos, and Harriet Hiscock
The Challenge of Behaviour Change 24
Is The Behaviour a Routine? 24
Is The Behaviour Rewarding? 24
Do Habits or Routines Play a Role in Sustaining the Behaviour? 26
Four Crucial Questions to Address Before Working to Support Behaviour Change 28
Why Is It So Difficult to Change the Behaviour of Healthcare Professionals? 30
Designing Interventions to Change Behaviour 35
Summary 36
Sources of Information for Supporting Practice Change Among Healthcare Professionals 36
References 36
Chapter 4 How Can We Reduce Overuse: The Choosing Wisely De- Implementation Framework 41 Jeremy M. Grimshaw and Andrea M. Patey
Introduction 41
The Choosing Wisely De- Implementation Framework 44
Phase 0: Identification of Potential Areas of Low- Value Healthcare 44
Phase 1: Identification of Local Prioritiesfor the Implementation of Recommendations 45
Phase 2: Identification of Barriers and Enablers to Implementing Recommendations and Potential Interventions to Overcome These 46
Phase 3: Evaluation of the Implementation 48
Phase 4: Spread of Effective Implementation Programs 49
Key Points 50
References 51
Chapter 5 How Can You Engage Patients in De- Implementation Activities? 54 Stuart G. Nicholls, Brian Johnston, Barbara Sklar, and Holly Etchegary
What Is Patient Engagement and Why is it Relevant to De- Implementation? 54
Making a Patient Engagement Plan 56
The Level of Engagement 57
Area 1 - Patient Engagement in Agenda Setting and Prioritisation 61
Area 2 - Patient Engagement in the Design and Conduct of De- Implementation Activities 64
Area 3 - Patient Engagement in Spread 65
Important Considerations when Engaging Patients 66
Key Points 68
Sources of Information 69
General Resources 69
Planning Tools 69
Patient Engagement Methods 70
Evaluation Tools 70
References 70
Chapter 6 Identifying Potential Areas of Low- Value Healthcare- Phase 0 73 Moriah E. Ellen, Saritte M. Perlman, and Jeremy M. Grimshaw
Chapter 1 Why Should We Reduce Medical Overuse? 1 Karen Born and Wendy Levinson
It Started with Quality Improvement 1
Then Came a Focus on Overuse 3
Overuse as a Global Healthcare Quality Concern 5
What Can Be Done to Address Overuse? 6
Choosing Wisely 7
What Can you Expect in the Following Chapters? 9
References 10
Chapter 2 Why Does Overuse Exist? 13 Tijn Kool, Simone van Dulmen, Andrea M. Patey, and Jeremy M. Grimshaw
A Multifactorial Challenge on Different Levels 13
Healthcare Professional Factors 14
Patient Factors 15
Preference for Acquiring Something 16
Clinical Care Context Factors 16
Absence of an Open Culture 17
Absence of Clear Leadership 17
Healthcare Organisation Factors 18
Insufficient Time 18
Lack of Coordination Amongst Healthcare Providers 19
Healthcare System Factors 19
Payment System that Rewards Volume 19
Influence of the Pharmaceutical and Medical Device Industry 20
Healthcare Insurance Policy 20
Key Points 20
References 21
Chapter 3 Why Is It So Hard to Change Behaviour and How Can We Influence It? 23 Jill J. Francis, Sanne Peters, Andrea M. Patey, Nicola McCleary, Leti van Bodegom- Vos, and Harriet Hiscock
The Challenge of Behaviour Change 24
Is The Behaviour a Routine? 24
Is The Behaviour Rewarding? 24
Do Habits or Routines Play a Role in Sustaining the Behaviour? 26
Four Crucial Questions to Address Before Working to Support Behaviour Change 28
Why Is It So Difficult to Change the Behaviour of Healthcare Professionals? 30
Designing Interventions to Change Behaviour 35
Summary 36
Sources of Information for Supporting Practice Change Among Healthcare Professionals 36
References 36
Chapter 4 How Can We Reduce Overuse: The Choosing Wisely De- Implementation Framework 41 Jeremy M. Grimshaw and Andrea M. Patey
Introduction 41
The Choosing Wisely De- Implementation Framework 44
Phase 0: Identification of Potential Areas of Low- Value Healthcare 44
Phase 1: Identification of Local Prioritiesfor the Implementation of Recommendations 45
Phase 2: Identification of Barriers and Enablers to Implementing Recommendations and Potential Interventions to Overcome These 46
Phase 3: Evaluation of the Implementation 48
Phase 4: Spread of Effective Implementation Programs 49
Key Points 50
References 51
Chapter 5 How Can You Engage Patients in De- Implementation Activities? 54 Stuart G. Nicholls, Brian Johnston, Barbara Sklar, and Holly Etchegary
What Is Patient Engagement and Why is it Relevant to De- Implementation? 54
Making a Patient Engagement Plan 56
The Level of Engagement 57
Area 1 - Patient Engagement in Agenda Setting and Prioritisation 61
Area 2 - Patient Engagement in the Design and Conduct of De- Implementation Activities 64
Area 3 - Patient Engagement in Spread 65
Important Considerations when Engaging Patients 66
Key Points 68
Sources of Information 69
General Resources 69
Planning Tools 69
Patient Engagement Methods 70
Evaluation Tools 70
References 70
Chapter 6 Identifying Potential Areas of Low- Value Healthcare- Phase 0 73 Moriah E. Ellen, Saritte M. Perlman, and Jeremy M. Grimshaw
How to Identify Low- Value Care? 73
Resources to Identify Low- Value Care 75 &n
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