Beyond Microsystem Fixes: Targeting National Drivers of Low-Value Care; Comment on “Key Factors that Promote Low-Value Care: Views of Experts From the United States, Canada, and the Netherlands”

Document Type : Commentary

Authors

1 Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

2 Division of General Internal Medicine, Sinai Health, Toronto, ON, Canada

3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

4 Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada

Abstract

Low-value care drivers and interventions are often focused on a microsystem (eg, clinic or inpatient ward) or within a health system. Identification of national drivers such as payment structure and medical culture of overuse can help identify regional approaches to reducing low-value care. However, these approaches in isolation are insufficient and require additional strategies. These can include policy and payment changes and adopting shared decision-making (SDM). SDM has the potential to move medical culture away from the ‘more is better’ paternalistic and physician-centric culture to one that actively engages patients as full partners in managing their care.

Keywords


  1. Verkerk EW, Van Dulmen SA, Born K, Gupta R, Westert GP, Kool RB. Key factors that promote low-value care: views of experts from the United States, Canada, and the Netherlands. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.53
  2. Montini T, Graham ID. "Entrenched practices and other biases": unpacking the historical, economic, professional, and social resistance to de-implementation. Implement Sci. 2015;10:24. doi:1186/s13012-015-0211-7
  3. Colla CH. Swimming against the current--what might work to reduce low-value care? N Engl J Med. 2014;371(14):1280-1283. doi:1056/NEJMp1404503
  4. Cliff BQ, Avanceña ALV, Hirth RA, Lee SD. The impact of Choosing Wisely interventions on low-value medical services: a systematic review. Milbank Q. 2021;99(4):1024-1058. doi:1111/1468-0009.12531
  5. Feng Y, Kristensen SR, Lorgelly P, et al. Pay for performance for specialised care in England: strengths and weaknesses. Health Policy. 2019;123(11):1036-1041. doi:1016/j.healthpol.2019.07.007
  6. Mathes T, Pieper D, Morche J, Polus S, Jaschinski T, Eikermann M. Pay for performance for hospitals. Cochrane Database Syst Rev. 2019;7(7):CD011156. doi:1002/14651858.CD011156.pub2
  7. Petersen LA, Woodard LD, Urech T, Daw C, Sookanan S. Does pay-for-performance improve the quality of health care? Ann Intern Med. 2006;145(4):265-272. doi:7326/0003-4819-145-4-200608150-00006
  8. Soucat A, Dale E, Mathauer I, Kutzin J. Pay-for-performance debate: not seeing the forest for the trees. Health Syst Reform. 2017;3(2):74-79. doi:1080/23288604.2017.1302902
  9. Schuur JD, Hsia RY, Burstin H, Schull MJ, Pines JM. Quality measurement in the emergency department: past and future. Health Aff (Millwood). 2013;32(12):2129-2138. doi:1377/hlthaff.2013.0730
  10. Joynt Maddox KE, Sen AP, Samson LW, Zuckerman RB, DeLew N, Epstein AM. Elements of program design in Medicare's value-based and alternative payment models: a narrative review. J Gen Intern Med. 2017;32(11):1249-1254. doi:1007/s11606-017-4125-8
  11. Zikmund-Fisher BJ, Kullgren JT, Fagerlin A, Klamerus ML, Bernstein SJ, Kerr EA. Perceived barriers to implementing individual Choosing Wisely® recommendations in two national surveys of primary care providers. J Gen Intern Med. 2017;32(2):210-217. doi:1007/s11606-016-3853-5
  12. Rothberg MB, Scherer L, Kashef MA, et al. The effect of information presentation on beliefs about the benefits of elective percutaneous coronary intervention. JAMA Intern Med. 2014;174(10):1623-1629. doi:1001/jamainternmed.2014.3331
  13. Stacey D, Légaré F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4(4):CD001431. doi:1002/14651858.CD001431.pub5
  14. Sypes EE, de Grood C, Whalen-Browne L, et al. Engaging patients in de-implementation interventions to reduce low-value clinical care: a systematic review and meta-analysis. BMC Med. 2020;18(1):116. doi:1186/s12916-020-01567-0
  15. Légaré F, Labrecque M, Cauchon M, Castel J, Turcotte S, Grimshaw J. Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial. CMAJ. 2012;184(13):E726-734. doi:1503/cmaj.120568
  16. Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database Syst Rev. 2015;2015(11):CD010907. doi:1002/14651858.CD010907.pub2
  17. Spatz ES, Krumholz HM, Moulton BW. Prime time for shared decision making. JAMA. 2017;317(13):1309-1310. doi:1001/jama.2017.0616
  18. Härter M, van der Weijden T, Elwyn G. Policy and practice developments in the implementation of shared decision making: an international perspective. Z Evid Fortbild Qual Gesundhwes. 2011;105(4):229-233. doi:1016/j.zefq.2011.04.018
Volume 11, Issue 9
September 2022
Pages 1971-1973
  • Receive Date: 12 January 2022
  • Revise Date: 12 July 2022
  • Accept Date: 19 July 2022
  • First Publish Date: 20 July 2022