Overview, Learning Objectives, Reading Assignments, and Resources
Module 3: So Many to Consider: Choosing an Overused Service
Overuse of low-value care is common and selecting a target area of overuse requires careful consideration of multiple factors that will impact subsequent success.
Overview
Overuse of health care services is widespread in most healthcare settings. Selecting a target area of overuse as a value champion requires careful consideration of multiple factors that will impact success. Identifying a high value care initiative is more successful when incorporating engagement, technical merit and cultural compatibility.
Learning Objectives
- Identify at least 3 key ingredients in your setting that should be considered when selecting a target area of overuse for a reduction initiative.
- Incorporate input from key stakeholders (leaders, clinicians and patients) to identify relevant overuse topics in your setting.
- Provide two examples of a target area of overuse in your setting that would be considered “low hanging fruit” as defined by the Newman-Toker article.
Reading Assignments
Setting a Research Agenda for Medical Overuse
Although ostensibly an article about a research agenda, this reading also provides some guidance on criteria we should use to prioritize areas of overuse to be addressed.
- Citation: Morgan DJ, Brownlee S, Leppin AL, et al. Setting a research agenda for medical overuse. BMJ. 2015;351:h4534. Published 2015 Aug 25. doi:10.1136/bmj.h4534.
Addressing Overuse of Health Services in Health Systems: A Critical Interpretive Synthesis
Identifying the factors that contribute to overuse of a health care service can be informative in choosing a topic to address. This synthesis/review identifies most of the major contributing factors.
- Citation: Ellen ME, Wilson MG, Vélez M, et al. Addressing overuse of health services in health systems: a critical interpretive synthesis. Health Res Policy Syst. 2018;16(1):48. Published 2018 Jun 15. doi:10.1186/s12961-018-0325-x.
When considering what overused service to address, it is important to consider it within the context of the clinician-patient interaction, and what drivers of overuse are feasible for you to address in your setting with the resources available to you.
- Citation: Morgan DJ, Leppin AL, Smith CD, Korenstein D. A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient-Clinician Interaction. J Hosp Med. 2017;12(5):346-351. doi:10.12788/jhm.2738.
Where Is the "Low-Hanging Fruit" in Diagnostic Quality and Safety?
This article is behind a paywall, for subscribers of LWW Journals, Quality Management in Healthcare. Check with your clinic or organization for access.
When considering what area of overuse to address, this article suggests that you consider three factors: simplicity of the topic, the order in which problems must be addressed, and problems with a large margin for improvement.
Resources
TAO Webinar: A Recipe for Choosing a High Value Project
Ways to Approach the Quality Improvement Process
Selecting an overused service to tackle is an early step in any improvement initiative. This document is an excellent summary of the Model for Improvement and the steps any change initiative should follow to be successful.
- Citation: Section 4: Ways to Approach the Quality Improvement Process (Page 1 of 2). Content last reviewed January 2020. Agency for Healthcare Research and Quality, Rockville, MD.
How to Begin a Quality Improvement Project
This article will familiarize the reader with how to begin a quality improvement project and demonstrates the real-world utility of planning a project thoughtfully and the steps involved.
- Citation: Silver SA, Harel Z, McQuillan R, et al. How to Begin a Quality Improvement Project. Clin J Am Soc Nephrol. 2016;11(5):893-900. doi:10.2215/CJN.11491015