Evidence map›Paper›PMID 39627808›Full record

ArticleHealth research policy and systems2024

Evidence is not enough: health technology reassessment to de-implement low-value care.

Sara Ingvarsson, Henna Hasson, Ulrica von Thiele Schwarz, Per Nilsen, Marta Roczniewska, Hanna Augustsson

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In one paragraph

Article in Health research policy and systems, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing 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

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
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

6 authors.

Sara IngvarssonCentre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. sara.ingvarsson@ki.se.
Henna HassonProcome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Ulrica von Thiele SchwarzProcome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Per NilsenDepartment of Health, Medical and Caring Sciences, Division of Public Health, Linköping University, Linköping, Sweden.
Marta RoczniewskaProcome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Hanna AugustssonProcome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.

Funding

Forskningsrådet om Hälsa, Arbetsliv och Välfärd 2018-01557
6 · The paper itself

Abstract

backgroundThe use of low-value care (LVC) is a persistent challenge in health care. Health technology reassessment (HTR) assesses the effects of technologies currently used in the health care system to guide optimal use of these technologies. Consequently, HTR holds promises for identifying and reducing, i.e., de-implementing, the use of LVC. There is limited research on how HTR is executed to support the de-implementation of LVC and whether and how HTR outcomes are translated into practical application. The aim of this study is to investigate how HTR is conducted to facilitate de-implementation of LVC and to investigate how the results of HTR are received and acted on in health care settings.

methodsThis study is a qualitative interview study with representatives from health technology assessment agencies (n = 16) that support the regional health care organizations in Sweden and with representatives from the health care organizations (n = 7). Interviews were analysed with qualitative content analysis.

resultsWe identified three overarching categories for how HTR facilitates de-implementation of LVC and how the results are received and acted on in health care settings: (1) involving key stakeholders to facilitate de-implementation of LVC in identifying potential LVC practices, having criteria for accepting HTR targets, ascertaining high-quality reports and disseminating the reports; (2) actions taken by health care organization to de-implement LVC by priority setting and decision-making, networking between health care organizations and monitoring changes in the use of LVC practices; and (3) sustaining use of LVC by not questioning continued use, continued funding of LVC and by creating opinion against de-implementation.

conclusionsEvidence is not enough to achieve de-implementation of LVC. This has made health technology assessment agencies and health care organizations widen the scope of HTR to encompass strategies to facilitate de-implementation, including involving key stakeholders in the HTR process and taking actions to support de-implementation. Despite these efforts, there can still be resistance to de-implementation of LVC in passive forms, involving continued use of the practice and more active resistance such as continued funding and opinion-making opposing de-implementation. Knowledge from implementation and de-implementation research can offer guidance in how to support the execution phase of HTR.

Indexed as

Delivery of Health CareQualitative ResearchTechnology Assessment, BiomedicalBiomedical TechnologyEvidence-Based MedicineHumansStakeholder ParticipationSwedenDe-implementationDisinvestmentHealth care governanceHealth policyHealth technology assessmentLow-value careOveruse

Identifiers

PMID39627808
PMCPMC11613514

What OpenQuestion holds

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Registered trials

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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.