東華大學圖書館 |

Tipping the Scale of Resources : De-Implementation of Low-Value Care from an Operant Perspective.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Tipping the Scale of Resources : De-Implementation of Low-Value Care from an Operant Perspective./
作者:	Ingvarsson, Sara.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2023,
面頁冊數:	83 p.
附註:	Source: Dissertations Abstracts International, Volume: 84-10, Section: B.
Contained By:	Dissertations Abstracts International84-10B.
標題:	Infections. -
電子資源:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=30394648
ISBN:	9798377694502

Tipping the Scale of Resources : De-Implementation of Low-Value Care from an Operant Perspective.
Ingvarsson, Sara.

Tipping the Scale of Resources : De-Implementation of Low-Value Care from an Operant Perspective. - Ann Arbor : ProQuest Dissertations & Theses, 2023 - 83 p.

Source: Dissertations Abstracts International, Volume: 84-10, Section: B.

Thesis (Ph.D.)--Karolinska Institutet (Sweden), 2023.

Background: The overarching goal within the field of implementation science is to generateknowledge that can contribute to bridging the gap between research and practice. Moststudies focus on how to implement research findings, with the aim of using evidence-basedinterventions. However, it has increasingly been recognized that working in accordance withevidence not only requires implementation of research findings but also the "opposite," i.e.,de-implementation of so called low-value care (LVC).LVC makes up between 11 and 30 percent of all care provided, depending on type of LVCand study population. To address the issue of LVC, several guidelines have been published -but this does not seem to be sufficient to influence its use. Like implementation, deimplementation of LVC requires behavior changes among professionals within health care.The difference is that whereas implementation most often involves increasing certainbehaviors, de-implementation involves both decreasing and increasing behaviors. Inimplementation, strategies are designed by identifying factors influencing behavior,identifying theoretically or empirically validated change methods to address those factors,and developing or choosing strategies that use those methods. However, it is not known whatfactors influence use and de-implementation of LVC. It is also not known if the sametheories, models, and frameworks are relevant for de-implementation as for implementationor what de-implementation strategies are effective. Applied behavior analysis (ABA) is theonly theory within psychology and sociology that discriminates between processes forincreasing and decreasing behavior suggesting that this could be a valuable theory to use tounderstand factors influencing the use of LVC and to design de-implementation strategies.The overarching aim of the thesis was to generate new knowledge and insights concerninguse and de-implementation of LVC. To achieve this aim, the four studies of the thesis havehad the following objectives:-To identify factors that influence use and de-implementation of LVC (Study I).-To understand why physicians in primary care use LVC (Study II).-To understand which management strategies are being used to de-implement LVCand possible mechanisms for those strategies using concepts from ABA (Study III).-To demonstrate how ABA can be used to understand contingencies related to use ofLVC and how de-implementation strategies can be developed by arranging alternativecontingencies (Study IV).Method:Four studies were conducted: one scoping review, one qualitative study withphysicians within primary care, using a grounded theory approach, one qualitative study withmanagers and key stakeholders within primary care on management strategies for deimplementation, and one intervention study where two strategies for de-implementation weredeveloped based on applied behavior analysis to reduce use of unnecessary X-ray examinations for knee arthrosis.Results: The scoping review showed factors influencing the use and de-implementation ofLVC related to both the outer and the inner context, the professionals, the LVC itself, theprocess of de-implementation, and the patients and their relatives. The qualitative studyshowed three factors that influenced use of LVC: uncertainty and disagreement about whatnot to do, perceived pressure from others, and a desire to do something for the patients. Thequalitative study on management strategies showed eight different management strategies:financial systems, scorecards, quality assurance systems, guidelines, lectures, local processstrategies, discussions about guidelines, and local lectures. The intervention study providedan analysis of factors influencing the unnecessary use of X-ray examinations for kneearthrosis: a rule stating that X-ray examinations are beneficial for diagnosing arthrosis andpatients expressing expectations of being referred to an X-ray examination and showingappreciation for being referred for one. Two strategies were developed: A lecture aiming atintroducing a new rule stating that X-ray examinations are not beneficial for diagnosingarthrosis and feedback meetings providing consequences encouraging diagnosis of arthrosiswithout the use of an X-ray examination. The strategies were perceived as helpful by thephysicians who participated in the study.Conclusion: This thesis has provided knowledge about factors that influenced use of LVC aswell as an understanding of how strategies for de-implementation could be developed.Factors external to the health care organizations seem to create a demand for LVC, mostlyinadvertently through financial conditions that provide payment or reduce costs in relation toLVC. Factors within health care organizations, such as lack of continuity and standardordering sets for laboratory tests, can also influence use of LVC, as can factors in theimmediate environment of the individual health care professionals, such as problems withguidelines, pressure from others, and a desire to do something for patients.Thus far, de-implementation strategies developed at a local level seem to have the greatestpotential to influence use of LVC. These strategies can be better adapted to local contextualfactors. One way of doing so is by using ABA to understand local contextual factors or inABA terms - contingencies. Strategies that influence processes, such as improved continuityor removing unnecessary laboratory tests from standard ordering sets, also have the potentialto reduce use of LVC. Lastly, there is a lack of strategies involving factors external to thehealth care organizations, even though these factors influence use of LVC.

ISBN: 9798377694502Subjects--Topical Terms:

1621997
Infections.

Tipping the Scale of Resources : De-Implementation of Low-Value Care from an Operant Perspective.
LDR:06982nmm a2200469 4500 001 2400239
005 20240924103815.5
006 m o d
007 cr#unu||||||||
008 251215s2023 ||||||||||||||||| ||eng d
020 $a 9798377694502
035 $a (MiAaPQ)AAI30394648
035 $a (MiAaPQ)Karolinska_1061648459
035 $a AAI30394648
040 $a MiAaPQ $c MiAaPQ
100 1 $a Ingvarsson, Sara. $3 3770208
245 1 0 $a Tipping the Scale of Resources : De-Implementation of Low-Value Care from an Operant Perspective.
260 1 $a Ann Arbor : $b ProQuest Dissertations & Theses, $c 2023
300 $a 83 p.
500 $a Source: Dissertations Abstracts International, Volume: 84-10, Section: B.
500 $a Advisor: Hasson, Henna;Augustsson, Hanna;Nilsen, Per.
502 $a Thesis (Ph.D.)--Karolinska Institutet (Sweden), 2023.
520 $a Background: The overarching goal within the field of implementation science is to generateknowledge that can contribute to bridging the gap between research and practice. Moststudies focus on how to implement research findings, with the aim of using evidence-basedinterventions. However, it has increasingly been recognized that working in accordance withevidence not only requires implementation of research findings but also the "opposite," i.e.,de-implementation of so called low-value care (LVC).LVC makes up between 11 and 30 percent of all care provided, depending on type of LVCand study population. To address the issue of LVC, several guidelines have been published -but this does not seem to be sufficient to influence its use. Like implementation, deimplementation of LVC requires behavior changes among professionals within health care.The difference is that whereas implementation most often involves increasing certainbehaviors, de-implementation involves both decreasing and increasing behaviors. Inimplementation, strategies are designed by identifying factors influencing behavior,identifying theoretically or empirically validated change methods to address those factors,and developing or choosing strategies that use those methods. However, it is not known whatfactors influence use and de-implementation of LVC. It is also not known if the sametheories, models, and frameworks are relevant for de-implementation as for implementationor what de-implementation strategies are effective. Applied behavior analysis (ABA) is theonly theory within psychology and sociology that discriminates between processes forincreasing and decreasing behavior suggesting that this could be a valuable theory to use tounderstand factors influencing the use of LVC and to design de-implementation strategies.The overarching aim of the thesis was to generate new knowledge and insights concerninguse and de-implementation of LVC. To achieve this aim, the four studies of the thesis havehad the following objectives:-To identify factors that influence use and de-implementation of LVC (Study I).-To understand why physicians in primary care use LVC (Study II).-To understand which management strategies are being used to de-implement LVCand possible mechanisms for those strategies using concepts from ABA (Study III).-To demonstrate how ABA can be used to understand contingencies related to use ofLVC and how de-implementation strategies can be developed by arranging alternativecontingencies (Study IV).Method:Four studies were conducted: one scoping review, one qualitative study withphysicians within primary care, using a grounded theory approach, one qualitative study withmanagers and key stakeholders within primary care on management strategies for deimplementation, and one intervention study where two strategies for de-implementation weredeveloped based on applied behavior analysis to reduce use of unnecessary X-ray examinations for knee arthrosis.Results: The scoping review showed factors influencing the use and de-implementation ofLVC related to both the outer and the inner context, the professionals, the LVC itself, theprocess of de-implementation, and the patients and their relatives. The qualitative studyshowed three factors that influenced use of LVC: uncertainty and disagreement about whatnot to do, perceived pressure from others, and a desire to do something for the patients. Thequalitative study on management strategies showed eight different management strategies:financial systems, scorecards, quality assurance systems, guidelines, lectures, local processstrategies, discussions about guidelines, and local lectures. The intervention study providedan analysis of factors influencing the unnecessary use of X-ray examinations for kneearthrosis: a rule stating that X-ray examinations are beneficial for diagnosing arthrosis andpatients expressing expectations of being referred to an X-ray examination and showingappreciation for being referred for one. Two strategies were developed: A lecture aiming atintroducing a new rule stating that X-ray examinations are not beneficial for diagnosingarthrosis and feedback meetings providing consequences encouraging diagnosis of arthrosiswithout the use of an X-ray examination. The strategies were perceived as helpful by thephysicians who participated in the study.Conclusion: This thesis has provided knowledge about factors that influenced use of LVC aswell as an understanding of how strategies for de-implementation could be developed.Factors external to the health care organizations seem to create a demand for LVC, mostlyinadvertently through financial conditions that provide payment or reduce costs in relation toLVC. Factors within health care organizations, such as lack of continuity and standardordering sets for laboratory tests, can also influence use of LVC, as can factors in theimmediate environment of the individual health care professionals, such as problems withguidelines, pressure from others, and a desire to do something for patients.Thus far, de-implementation strategies developed at a local level seem to have the greatestpotential to influence use of LVC. These strategies can be better adapted to local contextualfactors. One way of doing so is by using ABA to understand local contextual factors or inABA terms - contingencies. Strategies that influence processes, such as improved continuityor removing unnecessary laboratory tests from standard ordering sets, also have the potentialto reduce use of LVC. Lastly, there is a lack of strategies involving factors external to thehealth care organizations, even though these factors influence use of LVC.
590 $a School code: 0658.
650 4 $a Infections. $3 1621997
650 4 $a Health care policy. $3 3550686
650 4 $a Medical personnel. $2 itrt. $3 774747
650 4 $a Physicians. $3 667368
650 4 $a Systems analysis. $3 660001
650 4 $a Ethics. $3 517264
650 4 $a Grounded theory. $3 529332
650 4 $a Drug resistance. $3 1602664
650 4 $a Cognition & reasoning. $3 3556293
650 4 $a Back pain. $3 3563101
650 4 $a Antibiotics. $3 670318
650 4 $a Society. $3 700566
650 4 $a Primary care. $3 3681757
650 4 $a Design. $3 518875
650 4 $a Viral infections. $3 3540521
650 4 $a Education. $3 516579
650 4 $a Cognitive psychology. $3 523881
650 4 $a Health care management. $3 2122906
650 4 $a Health sciences. $3 3168359
650 4 $a Pharmaceutical sciences. $3 3173021
650 4 $a Pharmacology. $3 634543
650 4 $a Physical therapy. $3 588713
650 4 $a Psychology. $3 519075
650 4 $a Therapy. $3 3343697
690 $a 0394
690 $a 0389
690 $a 0207
690 $a 0703
690 $a 0515
690 $a 0633
690 $a 0769
690 $a 0566
690 $a 0454
690 $a 0572
690 $a 0419
690 $a 0382
690 $a 0621
690 $a 0212
710 2 $a Karolinska Institutet (Sweden). $3 3557748
773 0 $t Dissertations Abstracts International $g 84-10B.
790 $a 0658
791 $a Ph.D.
792 $a 2023
793 $a English
856 4 0 $u https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=30394648