De-implementing wisely: developing the evidence base to reduce low-value care
De-implementing wisely: developing the evidence base to reduce low-value care
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DOI：
10.1136/bmjqs-2019-010060
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发表时间：
2020-05-01
影响因子：
5.4
通讯作者：
Bhatia, R. Sacha
中科院分区：
文献类型：
--
作者：
Grimshaw, Jeremy M.;Patey, Andrea M.;Bhatia, R. Sacha
全球范围内的明智选择（CW）活动将注意力集中在减少低价值护理的必要性上，这可能占医疗保健成本的30%。尽管早期对CW倡议的热情，但自这些运动发起以来，很少有大规模的低价值护理率变化的报道。最近的评论建议，运动的重点应该是实施以证据为基础的战略，以有效地减少低价值的护理。本文介绍了明智地选择去执行框架（CWDIF），这是一个新的框架，它建立在执行科学领域的先前工作的基础上，提出了一个全面的方法，以系统地减少医院和社区环境中的低价值医疗，并推进去执行的科学。CWDIF包括五个阶段：第0阶段，识别潜在的低价值医疗领域;第一阶段，确定执行《化学武器公约》建议的地方优先事项;第二阶段，确定执行《化学武器公约》建议的障碍和克服这些障碍的可能干预措施;第三阶段，严格评估《化学武器公约》执行方案;第四阶段，推广有效的《化学武器公约》执行方案。我们提供了一个应用CWDIF开发和评估实施方案的工作实例，以减少接受低风险手术的健康患者不必要的术前检查，并进一步开发证据基础以减少低价值护理。
Choosing Wisely (CW) campaigns globally have focused attention on the need to reduce low-value care, which can represent up to 30% of the costs of healthcare. Despite early enthusiasm for the CW initiative, few large-scale changes in rates of low-value care have been reported since the launch of these campaigns. Recent commentaries suggest that the focus of the campaign should be on implementation of evidence-based strategies to effectively reduce low-value care. This paper describes the Choosing Wisely De-Implementation Framework (CWDIF), a novel framework that builds on previous work in the field of implementation science and proposes a comprehensive approach to systematically reduce low-value care in both hospital and community settings and advance the science of de-implementation.The CWDIF consists of five phases: Phase 0, identification of potential areas of low-value healthcare; Phase 1, identification of local priorities for implementation of CW recommendations; Phase 2, identification of barriers to implementing CW recommendations and potential interventions to overcome these; Phase 3, rigorous evaluations of CW implementation programmes; Phase 4, spread of effective CW implementation programmes. We provide a worked example of applying the CWDIF to develop and evaluate an implementation programme to reduce unnecessary preoperative testing in healthy patients undergoing low-risk surgeries and to further develop the evidence base to reduce low-value care.