Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm, Sweden.
Health Res Policy Syst. 2022 Sep 1;20(1):92. doi: 10.1186/s12961-022-00895-2.
The de-implementation of low-value care (LVC) is important to improving patient and population health, minimizing patient harm and reducing resource waste. However, there is limited knowledge about how the de-implementation of LVC is governed and what challenges might be involved. In this study, we aimed to (1) identify key stakeholders' activities in relation to de-implementing LVC in Sweden at the national governance level and (2) identify challenges involved in the national governance of the de-implementation of LVC.
We used a purposeful sampling strategy to identify stakeholders in Sweden having a potential role in governing the de-implementation of LVC at a national level. Twelve informants from nine stakeholder agencies/organizations were recruited using snowball sampling. Semi-structured interviews were conducted, transcribed and analysed using inductive thematic analysis.
Four potential activities for governing the de-implementation of LVC at a national level were identified: recommendations, health technology assessment, control over pharmaceutical products and a national system for knowledge management. Challenges involved included various vested interests that result in the maintenance of LVC and a low overall priority of working with the de-implementation of LVC compared with the implementation of new evidence. Ambiguous evidence made it difficult to clearly determine whether a practice was LVC. Unclear roles, where none of the stakeholders perceived that they had a formal mandate to govern the de-implementation of LVC, further contributed to the challenges involved in governing that de-implementation.
Various activities were performed to govern the de-implementation of LVC at a national level in Sweden; however, these were limited and had a lower priority relative to the implementation of new methods. Challenges involved relate to unfavourable change incentives, ambiguous evidence, and unclear roles to govern the de-implementation of LVC. Addressing these challenges could make the national-level governance of de-implementation more systematic and thereby help create favourable conditions for reducing LVC in healthcare.
淘汰低价值医疗（LVC）对于改善患者和人群健康、最大限度减少患者伤害和减少资源浪费非常重要。然而，对于淘汰 LVC 的治理方式以及可能涉及的挑战，我们知之甚少。在这项研究中，我们旨在：（1）确定在瑞典国家治理层面上与淘汰 LVC 相关的关键利益相关者的活动；（2）确定在国家层面上淘汰 LVC 的治理所涉及的挑战。
我们使用有针对性的抽样策略来确定瑞典的利益相关者，他们在国家层面上有潜力参与淘汰 LVC 的治理。通过滚雪球抽样法招募了来自九个利益相关者机构/组织的 12 名受访者。对他们进行半结构化访谈，转录并使用归纳主题分析进行分析。
确定了四项在国家层面上治理淘汰 LVC 的潜在活动：建议、卫生技术评估、对药品的控制以及国家知识管理系统。所涉及的挑战包括各种既得利益，这些利益导致 LVC 的维持，以及与实施新证据相比，对淘汰 LVC 的工作的总体优先级较低。证据不明确，使得难以明确确定某项实践是否为 LVC。角色不明确，没有一个利益相关者认为他们有正式授权来治理淘汰 LVC，这进一步增加了治理淘汰 LVC 的挑战。
在瑞典，有各种活动在国家层面上被用来治理淘汰 LVC；然而，这些活动是有限的，与实施新方法相比，优先级较低。所涉及的挑战与不利的变革激励、证据不明确以及治理淘汰 LVC 的角色不明确有关。解决这些挑战可以使淘汰 LVC 的国家层面治理更加系统，从而有助于为减少医疗保健中的 LVC 创造有利条件。
