Dr. Michael Parchman (right) of the MacColl Center for Health Care Innovation at Group Health Research Institute (GHRI), Emmy Ganos (left) of the Robert Wood Johnson Foundation, and GHRI’s Dr. Diana Buist launch a new framework for reducing low-value care at the 2016 Academy Health Research Meeting.

Doing less of what harms and more of what helps: Tackling low-value care

By Dona Cutsogeorge, staff author and communications coordinator at the MacColl Center for Health Care Innovation at Group Health Research Institute

Most health care providers understand and support the idea of reducing unnecessary tests and treatments, or “low-value care.” Yet doing so calls for change, which is incredibly hard. It involves asking providers to not perform a procedure or order a test—and to talk with patients about why doing less or doing nothing is better than doing something.

Approaching the problem of low-value care starts with explaining and defining its specifics—what tests, which treatments, and so on—but the solution doesn’t end there. A new approach to de-implementation suggests that ownership of the issue at the provider and staff level is key.

Supporting Provider Engagement to Reduce Low-Value Care is an action-planning framework that identifies the necessary conditions for change at the provider and staff level across diverse health care settings. These definitions make it possible to begin conversations about overuse and its potential for patient harm.

A new roadmap
This framework was the product of a focused literature review and a scan of innovative approaches tried by leading health care organizations across the United States, along with input from a diverse group of stakeholders. It can be used as a roadmap—a guide to focus change efforts and provide all stakeholders with a common understanding of your de-implementation approach.

This new resource can direct providers, health system leaders, or members of community coalitions in beginning the change process of doing less of what harms and more of what helps patients.

4 steps to reducing low-value care right now
Here are four ways you can begin addressing low-value care in your practice:

  • Start discussing the issues outlined in the framework with leaders at all levels, as well as providers, staff, and patients.
  • Identify and engage providers, staff, and patients with a passion for avoiding all forms of patient harm caused by low-value care.
  • Use existing organizational committees or structures to create a workgroup to drive change.
  • Pick a relatively non-controversial low-value service for your first de-implementation project, learn how to measure it, and build trust and transparency as you go.

Access the full Supporting Provider Engagement framework to get started. This resource is publicly available and free of cost.

Funded by the Robert Wood Johnson Foundation and created by the MacColl Center for Health Care Innovation at Group Health Research Institute, the Supporting Provider Engagement Framework was formally introduced at the 2016 AcademyHealth Annual Research Meeting.

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