ArticleMayo Clinic proceedings. Innovations, quality & outcomes2020
Why Not? Persuading Clinicians to Reduce Overuse.
Article in Mayo Clinic proceedings. Innovations, quality & outcomes, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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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.
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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.
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Who cites it
4 citing papers in PubMed.
- Assessing the Alignment Between the Humpty Dumpty Fall Scale and Fall Risk Nursing Diagnosis in Pediatric Patients: A Retrospective ROC Curve Analysis.Healthcare (Basel, Switzerland) · 2025Article
- What Promotes Medical Overuse: Perspective on Evolutionary Game between Administration and Medical Institutions.Computational and mathematical methods in medicine · 2022Article
- Low-value care and excess out-of-pocket expenditure among older adults with incident cancer - A machine learning approach.Journal of cancer policy · 2021Article
- Examining Medical Interventions in Older Adults with Limited Life Expectancy-Opportunities and Challenges for De-implementation.Sage open agingReview
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
objectiveTo explore how best to deimplement nonrecommended medical services, which can result in excess costs and patient harm.
methodsWe conducted telephone interviews with 15 providers at 3 health systems from June 19 to November 21, 2017. Using the case of nonrecommended imaging in patients with cancer, participants assessed the potential for 7 rationales or "arguments," each characterizing overuse in terms of a single problem type (cost or quality) and affected stakeholder group (clinicians, institutions, society, or patients), to convince colleagues to change their practices. We tested rationales for all problem-stakeholder combinations appearing in prior deimplementation studies.
resultsParticipants' views varied widely. Relatively few found cost arguments powerful, except for patients' out-of-pocket costs. Participants were divided on institution-quality and clinician-quality rationales. Patient-quality rationales resonated strongly with nearly all participants. However, a "yes, but" phenomenon emerged: after initially expressing strong support for a rationale, participants often undercut it with denials or rationalizations.
conclusionDeimplementation efforts should combine multiple rationales appealing to clinicians' diverse perspectives and priorities. In addition, efforts must consider the complex cognitive dynamics that can undercut data and reasoned argumentation.
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