Evidence map›Paper›PMID 29907158›Full record

SynthesisHealth research policy and systems2018

Addressing overuse of health services in health systems: a critical interpretive synthesis.

Moriah E Ellen, Michael G Wilson, Marcela Vélez, Ruth Shach, John N Lavis, Jeremy M Grimshaw, Kaelan A Moat, Synthesis working group

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Health research policy and systems, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed.

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  18. HLSInternational journal of environmental research and public health · 2022
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Moriah E EllenDepartment of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel.
Michael G WilsonMcMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada. wilsom2@mcmaster.ca.
Marcela VélezMcMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.
Ruth ShachBrown School of Social Work, Washington University in St Louis, 1 Brookings Dr, St Louis, MO, 63130, United States of America.
John N LavisMcMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.
Jeremy M GrimshawClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
Kaelan A MoatMcMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.
Synthesis working group

Funding

Canadian Institutes of Health Research (CA) 315602
6 · The paper itself

Abstract

backgroundHealth systems are increasingly focusing on the issue of 'overuse' of health services and how to address it. We developed a framework focused on (1) the rationale and context for health systems prioritising addressing overuse, (2) elements of a comprehensive process and approach to reduce overuse and (3) implementation considerations for addressing overuse.

methodsWe conducted a critical interpretive synthesis informed by a stakeholder-engagement process. The synthesis identified relevant empirical and non-empirical articles about system-level overuse. Two reviewers independently screened records, assessed for inclusion and conceptually mapped included articles. From these, we selected a purposive sample, created structured summaries of key findings and thematically synthesised the results.

resultsOur search identified 3545 references, from which we included 251. Most articles (76%; n = 192) were published within 5 years of conducting the review and addressed processes for addressing overuse (63%; n = 158) or political and health system context (60%; n = 151). Besides negative outcomes at the patient, system and global level, there were various contextual factors to addressing service overuse that seem to be key issue drivers. Processes for addressing overuse can be grouped into three elements comprising a comprehensive approach, including (1) approaches to identify overused health services, (2) stakeholder- or patient-led approaches and (3) government-led initiatives. Key implementation considerations include the need to develop 'buy in' from stakeholders and citizens.

conclusionsHealth systems want to ensure the use of high-value services to keep citizens healthy and avoid harm. Our synthesis can be used by policy-makers, stakeholders and researchers to understand how the issue has been prioritised, what approaches have been used to address it and implementation considerations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014013204 .

Indexed as

Patient Acceptance of Health CareCommunity ParticipationGovernment ProgramsHealth ServicesHumansMedical OveruseStakeholder ParticipationHealth policyLow-value careOveruse of health servicesWaste

Identifiers

PMID29907158
PMCPMC6003114

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.