VA Clinicians' Perspectives on Low-Value Health Service Use in the Veterans Health Administration: A Qualitative...

Area of Science:

• Health Services Research
• Quality Improvement
• Healthcare Management

Background:

• Low-value health services contribute to poor patient outcomes and increased healthcare costs.
• An estimated 10% of Veterans receive at least one of 29 identified low-value services annually through the Veterans Health Administration (VA).
• Understanding the drivers and solutions for reducing low-value service delivery within the VA is crucial but currently limited.

Purpose of the Study:

• To identify the key factors driving the delivery of low-value services within VA Medical Centers (VAMCs).
• To explore clinician-proposed strategies for reducing the incidence of low-value services across the VA system.

Main Methods:

• A qualitative study involving semi-structured interviews with 65 VA clinicians (32 generalists, 33 specialists) across 46 VAMCs.
• Interviews were conducted between October 2022 and November 2023.
• Deductive analysis using the Theoretical Domains Framework identified drivers, while inductive analysis uncovered proposed solutions.

Main Results:

• Three primary drivers of low-value service delivery were identified: environmental context/resources, social influence, and beliefs about consequences.
• Social pressure from Veterans was a notable factor for both generalists and specialists.
• Four key approaches to reduce low-value services were consistently proposed: enhancing VA healthcare quality/access, disseminating best practices, optimizing electronic health record (EHR) use, and cultivating an organizational culture focused on value.

Conclusions:

• This study elucidates the primary drivers and practical approaches for reducing low-value services from the perspective of VA clinicians.
• The findings provide a foundation for developing targeted de-implementation interventions and policies within the VA.
• Addressing environmental, social, and belief-related factors, alongside implementing proposed solutions, can help reduce low-value care in the VA system.