8.5 Implications for practice

Evaluating low-value care programs and interventions has taught us the importance of robust evidence-based practice, effective communication and adaptive healthcare policy. Successes demonstrate the potential for improving patient care and reducing unnecessary costs when interventions are critically assessed and updated. Failures often highlight systemic barriers such as resistance to change, the complexity of disentangling financial incentives, and the challenge of aligning healthcare provider and patient expectations with best practices. These lessons underscore the need for ongoing education, transparent policymaking and a culture that embraces evidence over habit or convenience (Roski et al., 2014). Examples of success strategies, and some of their complexities, include:

• Provider and patient education: effective in increasing awareness but must be coupled with actionable tools and system-level support for sustained change
• System-level incentives and supports: critical for enabling and sustaining practice change; misaligned incentives can undermine interventions
• Tailored interventions: strategies need to be adapted to specific contexts, healthcare settings and target populations for maximum effectiveness
• Measurement and feedback: ongoing measurement of intervention impact and regular feedback to providers are key components of successful programs
• Cultural and behavioural change: addressing underlying cultural norms and behaviours within healthcare settings is essential for reducing low-value care
• Maintaining a patient-centred approach: reducing low-value care emphasises the role of the patient as an active participant in their care, promoting informed choice and shared decision-making

These examples underscore the complexity of reducing low-value care and the need for comprehensive, contextually adapted strategies that address the multifaceted drivers of healthcare provider behaviour and healthcare system dynamics.

Policy implications

The evaluation of interventions aimed at reducing low-value care yields significant insights with broad policy implications. These findings can inform strategies for healthcare policymakers, providers and institutions, guiding the development of effective, scalable interventions that enhance care quality and efficiency (Colla et al., 2015; Schwartz et al., 2014). Below is an analysis of these policy implications and recommendations for various stakeholders.

• Cost savings and resource allocation: evaluations often reveal that reducing low-value care can lead to substantial cost savings and more efficient use of healthcare resources (Pandaya, 2018). Policymakers must consider reallocating these savings to areas of greater need, improving overall healthcare system sustainability.
• Quality of care: findings typically indicate that eliminating low-value interventions does not harm patient outcomes and may even improve them by reducing exposure to unnecessary risks. This underscores the need for policies that prioritise patient safety and quality of care over the volume of services provided.
• Health equity: evaluations may highlight disparities in the impact of low-value care reduction interventions across different populations. Policies should address these disparities to ensure that efforts to reduce low-value care improve health equity rather than exacerbate existing inequities.
• Provider behaviour and incentives: insights into how healthcare providers respond to interventions suggest that traditional fee-for-service models may incentivise low-value care. Policymakers should consider alternative payment models that align provider incentives with the delivery of high-value, patient-centred care.

Policy recommendations

• Support evidence-based policymaking: encourage the use of data from evaluations in policy development. Invest in ongoing research to identify and understand low-value practices and effective interventions for reducing them (Chalmers et al., 2018).
• Implement alternative payment models: transition from fee-for-service to value-based payment models that reward providers for quality, not quantity, of care. Models could include bundled payments, accountable care organisations or pay-for-performance schemes.
• Promote transparency and patient engagement: develop policies that enhance transparency about the benefits, risks and costs of treatments. Support initiatives that empower patients to make informed decisions about their care.
• Address health disparities: ensure that policies aimed at reducing low-value care do not inadvertently limit access to necessary services for underprivileged populations. Monitor and evaluate the impact of these policies on different demographic groups (Kim et al., 2021).

For healthcare providers (Chalmers et al., 2018):

• Foster a culture of high-value care: emphasise the importance of reducing low-value care in training and continuing education. Encourage clinical decision-making that considers the latest evidence, patient preferences and the potential value of interventions.
• Use decision support tools: implement clinical decision support systems in electronic health records that alert providers to potential low-value care and suggest alternatives based on best practices and evidence.
• Engage in shared decision-making: adopt shared decision-making approaches that involve patients in care decisions, using decision aids where appropriate to facilitate understanding of options.

For healthcare institutions (Chalmers et al., 2018):

• Incorporate low-value care reduction into quality improvement: make the reduction of low-value care a key component of quality improvement initiatives. Use data analytics to identify areas for improvement and track the impact of interventions.
• Support provider education and training: provide resources and opportunities for healthcare providers to learn about identifying and reducing low-value care, including workshops, seminars and access to current research.
• Create incentive structures: develop incentive structures that reward providers for reducing low-value care and improving patient outcomes, aligning institutional goals with the delivery of high-value care.

By implementing these recommendations, policymakers, healthcare providers and institutions can effectively address the challenges identified in evaluations of low-value care reduction interventions, enhancing healthcare quality, efficiency and equity.