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Evidence is not enough: health technology reassessment to de-implement low-value care
Sara Ingvarsson1,2, Henna Hasson3,4, Ulrica von Thiele Schwarz3,5
1Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. sara.ingvarsson@ki.se.
Health Research Policy and Systems
|December 3, 2024
Summary
Health technology reassessment (HTR) can help reduce low-value care (LVC). However, evidence alone is insufficient for de-implementation, requiring stakeholder involvement and strategic actions despite potential resistance.
Area of Science:
- Health Services Research
- Health Technology Assessment
- Implementation Science
Background:
- Low-value care (LVC) presents a significant challenge in healthcare delivery.
- Health technology reassessment (HTR) aims to optimize the use of existing health technologies.
- HTR offers a potential pathway to identify and reduce LVC.
Purpose of the Study:
- To investigate how HTR is conducted to facilitate LVC de-implementation.
- To examine how HTR outcomes are received and acted upon in healthcare settings.
Main Methods:
- Qualitative interview study with 16 HTR agency representatives and 7 healthcare organization representatives in Sweden.
- Interviews were analyzed using qualitative content analysis.
Main Results:
- HTR facilitates LVC de-implementation through stakeholder engagement, clear criteria, quality reports, and dissemination.
- Healthcare organizations implement de-implementation via priority setting, networking, and monitoring LVC use.
- Sustained LVC use is evident through unchallenged continuation, ongoing funding, and opposition to de-implementation.
Conclusions:
- Evidence alone is insufficient for LVC de-implementation.
- HTR scope has expanded to include de-implementation strategies, emphasizing stakeholder involvement and organizational actions.
- Resistance to de-implementation persists through passive (continued use) and active (funding, opinion) means.
- Implementation and de-implementation research can guide HTR execution.
Keywords:
De-implementationDisinvestmentHealth care governanceHealth policyHealth technology assessmentLow-value careOveruseMore Related Videos
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