What strategies are used by clinician champions to reduce low-value care?

Autor:	Parchman ML; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA., Palazzo LG; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA., Mogk JM; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA., Webbon JC; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA., Demosthenes L; University of South Carolina School of Medicine Greenville, Greenville, SC, USA., Vossenkemper E; Tri-Cities Community Health, Pasco, WA, USA., Hoke G; University of Virginia School of Medicine, Charlottesville, VA, USA., Moskovitz J; Department of Emergency Medicine, Albert Einstein College of Medicine, New York, NY, USA.; Department of Public Health, Hofstra School of Health and Human Services, New York, NY, USA., Dunlap L; University of New Mexico Hospital, Albuquerque, NM, USA., Diaz Del Carpio R; CareMore Health, Cerritos, CA, USA.
Jazyk:	angličtina
Zdroj:	SAGE open medicine [SAGE Open Med] 2022 Jan 21; Vol. 10, pp. 20503121211069855. Date of Electronic Publication: 2022 Jan 21 (Print Publication: 2022).
DOI:	10.1177/20503121211069855
Abstrakt:	Background: Clinician champions are front-line clinicians who advocate for and influence practice change in their local context. The strategies they use when leading efforts to reduce the use of low-value care have not been well described. The purpose of this study is to identify and describe strategies used by six clinician champions who led a low-value care initiative in their clinical setting. Methods: Qualitative data collected during an overuse reduction initiative led by clinician champions were used to identify strategies, guided by the Expert Recommendations for Implementing Change compilation of strategies. Clinician champions were asked to rank the importance of these activities and indicate which one of the six most important activities they would be willing to discuss in an interview. A 30-min semi-structured interview was conducted with each clinician about the activity they selected and thematically analyzed. Results: Twelve Expert Recommendations for Implementing Change strategies were identified. The top six strategies discussed during interviews were: build a coalition, conduct a local needs assessment, develop a formal implementation blueprint, conduct educational meetings, use facilitation, and develop clinical reminders. Common themes that emerged across all interviews were the use of data to engage clinicians in conversations, including the patient's perspective in designing the interventions, and investing the time upfront to plan and launch the initiative because of the inherent challenges of relinquishing a service. Conclusions: Clinician champions identified multiple strategies as important when de-implementing a low-value service. Many were used to engage in conversations with stakeholders, including leadership, providers, and patients, to increase buy-in and support, challenge beliefs, promote behavior change, and gather insights about next steps in their effort. Future work is needed to better understand how prepare clinicians for this role and to understand the mechanisms through which these strategies might be effective. Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. (© The Author(s) 2022.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu