title: Interventions Aimed at Reducing Use of Low-Value Health Services: A Systematic Review.
abstract: The effectiveness of different types of interventions to reduce low-value care has been insufficiently summarized to allow for translation to practice. This article systematically reviews the literature on the effectiveness of interventions to reduce low-value care and the quality of those studies. We found that multicomponent interventions addressing both patient and clinician roles in overuse have the greatest potential to reduce low-value care. Clinical decision support and performance feedback are promising strategies with a solid evidence base, and provider education yields changes by itself and when paired with other strategies. Further research is needed on the effectiveness of pay-for-performance, insurer restrictions, and risk-sharing contracts to reduce use of low-value care. While the literature reveals important evidence on strategies used to reduce low-value care, meaningful gaps persist. More experimentation, paired with rigorous evaluation and publication, is needed.
authors.affiliation: 1 Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Carrie H
authors.initials: CH
authors.lastname: Colla
authors.affiliation: 1 Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Mainor
authors.affiliation: 1 Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Hargreaves
authors.affiliation: 2 Harvard Medical School, Boston, MA, USA.|3 Brigham and Women's Hospital, Boston, MA, USA.|4 Partners HealthCare, Boston, MA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Sequist
authors.affiliation: 1 Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.|5 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Morden
mesh_terms: D002755:Choice Behavior; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D010820:Physicians; D011320:Primary Health Care
keywords: interventions; low-value care; overuse; systematic review; waste