Why Not? Persuading Clinicians to Reduce Overuse.

Area of Science:

• Health Services Research
• Medical Decision Making
• Healthcare Management

Background:

• Nonrecommended medical services contribute to excess healthcare costs and potential patient harm.
• Effective strategies for deimplementing low-value care are crucial for improving healthcare value.
• Understanding provider perspectives is key to successful deimplementation initiatives.

Purpose of the Study:

• To explore effective rationales for deimplementing nonrecommended medical services.
• To assess provider receptiveness to different arguments for practice change.
• To identify barriers to deimplementing low-value care.

Main Methods:

• Telephone interviews with 15 providers across 3 health systems.
• Assessment of 7 rationales for deimplementation using nonrecommended cancer imaging as a case study.
• Analysis of arguments based on cost/quality and stakeholder impact (clinicians, institutions, society, patients).

Main Results:

• Provider views on rationales varied significantly.
• Cost arguments were generally less persuasive, except for patient out-of-pocket expenses.
• Patient-quality rationales were highly resonant, but often followed by counterarguments or rationalizations ('yes, but' phenomenon).

Conclusions:

• Deimplementation strategies should integrate multiple arguments tailored to diverse clinician priorities.
• Addressing cognitive dynamics and potential biases is essential for successful deimplementation.
• Combining rationales and acknowledging psychological factors can enhance the effectiveness of deimplementation efforts.