Evidence is not enough: health technology reassessment to de-implement low-value care

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cris.lastimport.scopus2025-04-04T03:14:44Z
dc.abstract.enBackground: 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. Methods: 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. Results: 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. Conclusions: 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.
dc.affiliationInstytut Psychologii
dc.contributor.authorIngvarsson, Sara
dc.contributor.authorHasson, Henna
dc.contributor.authorvon Thiele Schwarz, Ulrica
dc.contributor.authorNilsen, Per
dc.contributor.authorRoczniewska, Marta
dc.contributor.authorAugustsson, Hanna
dc.date.access2024-12-03
dc.date.accessioned2024-12-04T09:33:17Z
dc.date.available2024-12-04T09:33:17Z
dc.date.created2024-11-10
dc.date.issued2024-12-03
dc.description.abstract<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>This study is a qualitative interview study with representatives from health technology assessment agencies (<jats:italic>n</jats:italic> = 16) that support the regional health care organizations in Sweden and with representatives from the health care organizations (<jats:italic>n</jats:italic> = 7). Interviews were analysed with qualitative content analysis.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec>
dc.description.accesstimeat_publication
dc.description.grantnumber2018-01557
dc.description.issue159
dc.description.physical1-12
dc.description.versionfinal_published
dc.description.volume22
dc.identifier.doi10.1186/s12961-024-01249-w
dc.identifier.issn1478-4505
dc.identifier.urihttps://share.swps.edu.pl/handle/swps/1138
dc.identifier.weblinkhttps://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-024-01249-w
dc.languageen
dc.pbn.affiliationpsychologia
dc.rightsCC-BY-NC-ND
dc.rights.questionYes_rights
dc.share.articleOPEN_JOURNAL
dc.subject.enLow-value care
dc.subject.enDe-implementation
dc.subject.enHealth technology assessment
dc.subject.enHealth policy
dc.subject.enOveruse
dc.subject.enDisinvestment
dc.subject.enHealth care governance
dc.swps.sciencecloudsend
dc.titleEvidence is not enough: health technology reassessment to de-implement low-value care
dc.title.journalHealth Research Policy and Systems
dc.typeJournalArticle
dspace.entity.typeArticle