Deimplementation of Established Medical Practice Without Intervention: Does It Actually Happen?

Gill, Peter; Mahant, Sanjay

doi:10.12788/jhm.3467

Cited by 2 publications

(3 citation statements)

References 18 publications

(25 reference statements)

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“…Five hospitals consistently reduced testing rates over 10 years with no clear worsening of clinical outcomes. We know from previous studies that changing clinical practice patterns and hospital-wide culture change can be difficult to achieve, 36,37 so this degree of consistency would be unusual without specific and consistent interventions. In addition, a second pattern emerged around sustainability.…”

Section: Discussionmentioning

confidence: 99%

Changing patterns of routine laboratory testing over time at children's hospitals

Tchou,

Hall,

Markham

et al. 2024

Journal of Hospital Medicine

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BackgroundResearch into low‐value routine testing at children's hospitals has not consistently evaluated changing patterns of testing over time.ObjectivesTo identify changes in routine laboratory testing rates at children's hospitals over ten years and the association with patient outcomes.Design, Settings, and ParticipantsWe performed a multi‐center, retrospective cohort study of children aged 0–18 hospitalized with common, lower‐severity diagnoses at 28 children's hospitals in the Pediatric Health Information Systems database.Main Outcomes and MeasuresWe calculated average annual testing rates for complete blood counts, electrolytes, and inflammatory markers between 2010 and 2019 for each hospital. A > 2% average testing rate change per year was defined as clinically meaningful and used to separate hospitals into groups: increasing, decreasing, and unchanged testing rates. Groups were compared for differences in length of stay, cost, and 30‐day readmission or ED revisit, adjusted for demographics and case mix index.ResultsOur study included 576,572 encounters for common, low‐severity diagnoses. Individual hospital testing rates in each year of the study varied from 0.3 to 1.4 tests per patient day. The average yearly change in hospital‐specific testing rates ranged from ‐6% to +7%. Four hospitals remained in the lowest quartile of testing and two in the highest quartile throughout all ten years of the study. We grouped hospitals with increasing (8), decreasing (n = 5), and unchanged (n = 15) testing rates. No difference was found across subgroups in costs, length of stay, 30‐day ED revisit, or readmission rates. Comparing resource utilization trends over time provides important insights into achievable rates of testing reduction.

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Section: Discussionmentioning

confidence: 99%

Changing patterns of routine laboratory testing over time at children's hospitals

Tchou,

Hall,

Markham

et al. 2024

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…However, there is ample evidence that deimplementation can be difficult. 21 Building in deimplementation mechanisms, such as standing educational sessions or hospital committees dedicated to value that review practices, from the beginning may ease these changes.…”

Section: Strategies For Hvc Practice During Future Major Eventsmentioning

confidence: 99%

“…It is inevitable that some practices implemented early in pandemic response may need to be deimplemented later as the evidence and situation evolve. However, there is ample evidence that deimplementation can be difficult 21 . Building in deimplementation mechanisms, such as standing educational sessions or hospital committees dedicated to value that review practices, from the beginning may ease these changes.…”

Section: Strategies For Hvc Practice During Future Major Eventsmentioning

confidence: 99%

Practicing High‐Value Pediatric Care During a Pandemic: The Challenges and Opportunities

Jain

Cotter

Tchou

2021

Journal of Hospital Medicine

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High-value care (HVC) is a philosophy and approach to medicine that focuses on achieving the best patient outcomes through evidence-based practice while minimizing harm to patients, wasted healthcare resources, and costs. Incorporating HVC principles in pediatric clinical decision-making is particularly important owing to the harms of hospitalization, overutilization, and overdiagnosis, as well as rising costs of pediatric care. [1][2][3][4] How can we maintain these principles in the face of a global pandemic and new emerging syndrome, multisystem inflammatory syndrome in children (MIS-C), which has dramatically impacted healthcare systems for children?In this article, we discuss the barriers and opportunities around practicing HVC in our evolving approach to novel COVID-19 management in hospitalized children. We also draw lessons from our experiences on how we can respond to future events that rapidly shift our approach to care.

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Deimplementation of Established Medical Practice Without Intervention: Does It Actually Happen?

Cited by 2 publications

References 18 publications

Changing patterns of routine laboratory testing over time at children's hospitals

Changing patterns of routine laboratory testing over time at children's hospitals

Practicing High‐Value Pediatric Care During a Pandemic: The Challenges and Opportunities

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