Ingvarsson Sara, Hasson Henna, von Thiele Schwarz Ulrica, Nilsen Per, Roczniewska Marta, Augustsson Hanna
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Health Res Policy Syst. 2024 Dec 3;22(1):159. doi: 10.1186/s12961-024-01249-w.
The use of low-value care (LVC) is a persistent challenge in health care. Health technology reassessment (HTR) assesses the effects of technologies currently used in the health care system to guide optimal use of these technologies. Consequently, HTR holds promises for identifying and reducing, i.e., de-implementing, the use of LVC. There is limited research on how HTR is executed to support the de-implementation of LVC and whether and how HTR outcomes are translated into practical application. The aim of this study is to investigate how HTR is conducted to facilitate de-implementation of LVC and to investigate how the results of HTR are received and acted on in health care settings.
This study is a qualitative interview study with representatives from health technology assessment agencies (n = 16) that support the regional health care organizations in Sweden and with representatives from the health care organizations (n = 7). Interviews were analysed with qualitative content analysis.
We identified three overarching categories for how HTR facilitates de-implementation of LVC and how the results are received and acted on in health care settings: (1) involving key stakeholders to facilitate de-implementation of LVC in identifying potential LVC practices, having criteria for accepting HTR targets, ascertaining high-quality reports and disseminating the reports; (2) actions taken by health care organization to de-implement LVC by priority setting and decision-making, networking between health care organizations and monitoring changes in the use of LVC practices; and (3) sustaining use of LVC by not questioning continued use, continued funding of LVC and by creating opinion against de-implementation.
Evidence is not enough to achieve de-implementation of LVC. This has made health technology assessment agencies and health care organizations widen the scope of HTR to encompass strategies to facilitate de-implementation, including involving key stakeholders in the HTR process and taking actions to support de-implementation. Despite these efforts, there can still be resistance to de-implementation of LVC in passive forms, involving continued use of the practice and more active resistance such as continued funding and opinion-making opposing de-implementation. Knowledge from implementation and de-implementation research can offer guidance in how to support the execution phase of HTR.
低价值医疗（LVC）的使用是医疗保健领域长期存在的挑战。卫生技术重新评估（HTR）评估医疗保健系统中当前使用的技术的效果，以指导这些技术的优化使用。因此，HTR有望识别并减少（即取消实施）LVC的使用。关于如何执行HTR以支持取消实施LVC以及HTR结果是否以及如何转化为实际应用的研究有限。本研究的目的是调查如何进行HTR以促进LVC的取消实施，并调查HTR结果在医疗保健环境中是如何被接受和付诸行动的。
本研究是一项定性访谈研究，访谈对象包括支持瑞典地区医疗保健组织的卫生技术评估机构的代表（n = 16）和医疗保健组织的代表（n = 7）。采用定性内容分析法对访谈进行分析。
我们确定了三个总体类别，涉及HTR如何促进LVC的取消实施以及结果在医疗保健环境中是如何被接受和付诸行动的：（1）让关键利益相关者参与，以促进在识别潜在LVC实践、接受HTR目标的标准、确定高质量报告以及传播报告方面取消实施LVC；（2）医疗保健组织采取行动，通过优先排序和决策、医疗保健组织之间的联网以及监测LVC实践使用情况的变化来取消实施LVC；（3）通过不质疑持续使用、持续为LVC提供资金以及制造反对取消实施的舆论来维持LVC的使用。
证据不足以实现LVC的取消实施。这使得卫生技术评估机构和医疗保健组织扩大了HTR的范围，以纳入促进取消实施的策略，包括让关键利益相关者参与HTR过程并采取行动支持取消实施。尽管做出了这些努力，但仍然可能存在对LVC取消实施的被动抵制形式，包括继续使用该实践，以及更积极的抵制，如继续提供资金和制造反对取消实施的舆论。实施和取消实施研究的知识可为如何支持HTR的执行阶段提供指导。
