Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems (Danube University Krems), Dr.-Karl-Dorrek Straße 30, 3500, Krems a.d. Donau, Austria.
Institute for Implementation Science in Health Care, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland.
Implement Sci. 2024 Aug 5;19(1):56. doi: 10.1186/s13012-024-01384-6.
Reducing low-value care (LVC) is crucial to improve the quality of patient care while increasing the efficient use of scarce healthcare resources. Recently, strategies to de-implement LVC have been mapped against the Expert Recommendation for Implementing Change (ERIC) compilation of strategies. However, such strategies' effectiveness across different healthcare practices has not been addressed. This overview of systematic reviews aimed to investigate the effectiveness of de-implementation initiatives and specific ERIC strategy clusters.
We searched MEDLINE (Ovid), Epistemonikos.org and Scopus (Elsevier) from 1 January 2010 to 17 April 2023 and used additional search strategies to identify relevant systematic reviews (SRs). Two reviewers independently screened abstracts and full texts against a priori-defined criteria, assessed the SR quality and extracted pre-specified data. We created harvest plots to display the results.
Of 46 included SRs, 27 focused on drug treatments, such as antibiotics or opioids, twelve on laboratory tests or diagnostic imaging and seven on other healthcare practices. In categorising de-implementation strategies, SR authors applied different techniques: creating self-developed strategies (n = 12), focussing on specific de-implementation strategies (n = 14) and using published taxonomies (n = 12). Overall, 15 SRs provided evidence for the effectiveness of de-implementation interventions to reduce antibiotic and opioid utilisation. Reduced utilisation, albeit inconsistently significant, was documented in the use of antipsychotics and benzodiazepines, as well as in laboratory tests and diagnostic imaging. Strategies within the adapt and tailor to context, develop stakeholder interrelationships, and change infrastructure and workflow ERIC clusters led to a consistent reduction in LVC practices.
De-implementation initiatives were effective in reducing medication usage, and inconsistent significant reductions were observed for LVC laboratory tests and imaging. Notably, de-implementation clusters such as change infrastructure and workflow and develop stakeholder interrelationships emerged as the most encouraging avenues. Additionally, we provided suggestions to enhance SR quality, emphasising adherence to guidelines for synthesising complex interventions, prioritising appropriateness of care outcomes, documenting the development process of de-implementation initiatives and ensuring consistent reporting of applied de-implementation strategies.
OSF Open Science Framework 5ruzw.
减少低价值医疗（LVC）对于提高患者护理质量和提高稀缺医疗资源的利用效率至关重要。最近，已经针对 Expert Recommendation for Implementing Change（ERIC）策略汇编制定了消除 LVC 的策略。然而，尚未解决这些策略在不同医疗实践中的有效性问题。本系统评价综述旨在调查消除策略的有效性和特定 ERIC 策略集群。
我们从 2010 年 1 月 1 日至 2023 年 4 月 17 日在 MEDLINE（Ovid）、Epistemonikos.org 和 Scopus（Elsevier）中进行了搜索，并使用了额外的搜索策略来确定相关的系统评价（SR）。两名审查员独立根据预先确定的标准筛选摘要和全文，评估 SR 质量并提取预定数据。我们创建了收获图来显示结果。
在 46 项纳入的 SR 中，有 27 项侧重于药物治疗，如抗生素或阿片类药物，12 项侧重于实验室检查或诊断成像，7 项侧重于其他医疗实践。在对消除策略进行分类时，SR 作者采用了不同的技术：创建自行开发的策略（n=12）、专注于特定的消除策略（n=14）和使用已发布的分类法（n=12）。总体而言，有 15 项 SR 提供了减少抗生素和阿片类药物使用的消除干预措施的有效性证据。减少抗精神病药和苯二氮䓬类药物以及实验室检查和诊断成像的使用量，尽管不一致，但具有显著意义。ERIC 集群中的适应和调整以适应环境、发展利益相关者关系以及改变基础设施和工作流程的策略导致 LVC 实践的一致减少。
消除措施在减少药物使用方面是有效的，对于 LVC 实验室检查和成像也观察到不一致的显著减少。值得注意的是，基础设施和工作流程的改变以及发展利益相关者关系等消除集群似乎是最有希望的途径。此外，我们提供了一些建议来提高 SR 的质量，强调遵循综合复杂干预措施的指南、优先考虑护理结果的适宜性、记录消除措施的开发过程以及确保一致报告应用的消除策略。
OSF 开放科学框架 5ruzw。
Zotero 插件
