Improving value by reducing care that does more harm than good, with emphasis on the safety net
For many years, efforts like Choosing Wisely have been raising awareness that to improve quality, safety, and affordability, U.S. health care must quit overusing certain tests and treatments that do patients more harm than good. Reducing overuse in safety-net settings is especially important. Although rates of low-value services delivered are no different in safety-net versus other settings, the stakes are higher for underserved populations because the adverse impact of financial, emotional, and physical harm can be higher.
Yet providers, health care teams, and patients across the country find it challenging to implement interventions to thoroughly and systematically reduce overuse. That's why the MacColl Center for Health Care Innovation (now the ACT Center) partnered with the Robert Wood Johnson Foundation in 2015 to address an important question: We know what we need to do less of, but how?
- Phase I: Developing the Taking Action on Overuse Framework and Change Package
- Conduct a comprehensive literature review and a national scan of innovative approaches tried by leading health care organizations
- Conduct interviews with 23 leaders of overuse-reduction initiatives
- Gather input from an advisory group of experts in health care, behavioral economics, learning, policy and management, patient advocacy, and overuse-reduction initiatives.
- Phase II: Testing the Framework and Change Package
We partnered with 3 diverse health care organizations to test the Taking Action on Overuse Framework in an overuse reduction project: UCLA Medical Group, Swedish Medical System, and Missouri Primary Care Association.
Phase III: The Safety-Net Clinical Value Champion Fellowship
Learning in Phase II how important clinical value champions are to successful overuse reduction initiatives, we launched a Fellowship program for 6 clinical value champions working in safety-net settings. Based on what we learned from this first group of champions, we created the Value Champions Training Curriculum, a series of online learning modules paired with a project workbook. These are available to train and support new value champions in their overuse reduction initiatives.
What we learned
- Reducing overuse is challenging and takes time, perhaps more so than traditional quality improvement projects.
- Sustained leadership engagement is necessary to the success of overuse reduction efforts. In addition to leader support, front-line engagement is critical to succeed — one cannot be prioritized over the other.
- Ongoing conversations about overused services are key to engaging providers and having frontline teams take ownership of the work. Trusted data and evocative stories are both necessary.
- Clinical value champions are essential in leading the way in organizations working to reduce low-value care.
Health care providers and health system leaders everywhere can use tools and resources from Taking Action on Overuse to train clinicians on how to start de-implementation projects and advance efforts to reduce medical overuse within their institutions.
View the complete collection of resources we collected, including implementation and general resources developed by other organizations working to reduce low-value care.
Parchman ML, Palazzo L, Mogk JM, Webbon JC, Demosthenes L, Vossenkemper E, Hoke G, Moskovitz J, Dunlap L, Diaz del Carpio R. What strategies are used by clinician champions to reduce low-value care? SAGE Open Medicine. 2022 Jan 21. doi.org/10.1177/20503121211069855. Full text
Parchman ML, Palazzo L, Austin BT, Blasi P, Henrikson NB, Gundersen G, Ganos E. Taking action to address medical overuse: common challenges and facilitators. Am J Med. 2020 Feb 4. pii: S0002-9343(20)30052-8. doi: 10.1016/j.amjmed.2020.01.001. Full text
Parchman ML, Henrikson NB, Blasi PR, Buist DS, Penfold R, Austin B, Ganos EH. Taking action on overuse: creating the culture for change. Healthc (Amst). 2016 Nov 10. pii: S2213-0764(16)30167-1. doi: 10.1016/j.hjdsi.2016.10.005. Full text