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Strategies to reduce low-value care - An applied behavior analysis using a single-case design.

Sara Ingvarsson1, Ingunn Sandaker2, Per Nilsen3

  • 1Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.

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Summary

Applied behavior analysis can identify factors that sustain low-value care (LVC) and inform de-implementation strategies. While results were inconclusive, participants perceived strategy effectiveness, suggesting potential for behavior change.

Keywords:
applied behavior analysis (ABA)de-implementationlow-value carephysiciansprimary care (MeSH)single-case design

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Area of Science:

  • Implementation Science
  • Behavioral Science
  • Health Services Research

Background:

  • Implementation science increasingly focuses on de-implementation of low-value care (LVC).
  • Existing de-implementation strategies often lack analysis of sustaining factors and underlying mechanisms.
  • Applied behavior analysis (ABA) offers a framework to study de-implementation mechanisms.

Purpose of the Study:

  • To analyze contingencies maintaining LVC in primary care using ABA.
  • To develop and evaluate ABA-informed de-implementation strategies for reducing LVC.
  • To explore participant perceptions of strategy effectiveness and ABA feasibility.

Main Methods:

  • ABA was used to analyze contingencies of unnecessary knee x-ray use in primary care.
  • Two de-implementation strategies (lecture, feedback meetings) were developed based on ABA.
  • A single-case design and qualitative interviews were employed for evaluation.

Main Results:

  • Quantitative data from single-case design were inconclusive regarding behavior change.
  • Qualitative interview data indicated participants perceived strategy effectiveness.
  • Findings suggest ABA can inform de-implementation strategy design.

Conclusions:

  • ABA provides insights into LVC contingencies and strategy development for de-implementation.
  • While quantitative results were inconclusive, qualitative data suggest potential for behavior change.
  • Refining feedback mechanisms and meeting structures can enhance ABA-informed de-implementation strategies.