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Management strategies to de-implement low-value care-an applied behavior analysis.

Sara Ingvarsson1, Henna Hasson2,3, Hanna Augustsson2,3

  • 1Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, SE, Sweden. sara.ingvarsson@ki.se.

Implementation Science Communications
|June 25, 2022
PubMed
Summary

Understanding management strategies to de-implement low-value care (LVC) is crucial. Both regional and local healthcare center strategies, analyzed using applied behavior analysis, effectively influence physician behavior to reduce LVC.

Keywords:
Applied behavior analysisDe-implementationLow-value carePhysiciansPrimary health careRule-governed behaviorSwedenThree-term contingency

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Area of Science:

  • Healthcare Management
  • Behavioral Science
  • Health Services Research

Background:

  • Limited understanding exists regarding management strategies for de-implementing low-value care (LVC).
  • The mechanisms through which these strategies influence physician behavior remain unclear in current literature.
  • Applied behavior analysis (ABA) offers a framework to understand behavioral change processes relevant to de-implementation.

Purpose of the Study:

  • To identify management strategies used for de-implementing LVC.
  • To explore the mechanisms involved in these strategies using ABA concepts.
  • To understand how strategies can modify physicians' LVC-related behaviors.

Main Methods:

  • Qualitative study design with an inductive approach to identify strategies.
  • Deductive analysis of strategy mechanisms using applied behavior analysis (ABA) concepts.

Main Results:

  • Eight distinct management strategies for influencing LVC were identified.
  • Five strategies originated at the regional level, influencing LVC through rules or initiating local actions.
  • Local strategies within healthcare centers demonstrated a stronger potential for influencing de-implementation of LVC.

Conclusions:

  • Effective de-implementation of LVC requires consideration of both systemic (regional) and local (healthcare center) strategies.
  • Local strategies offer unique advantages for impacting LVC due to their adaptability to specific circumstances.
  • Applied behavior analysis (ABA) can aid in tailoring strategies to effectively reduce LVC utilization.