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VA RESEARCH QUARTERLY UPDATE
 

New Initiatives

De-implementation study launched


Based on past studies, VA experts have identified the unnecessary use of inhaled steroids in patients with COPD as a
Based on past studies, VA experts have identified the unnecessary use of inhaled steroids in patients with COPD as a "low value" practice that should be phased out. (Photo: ©iStock/Juanmonino)

Based on past studies, VA experts have identified the unnecessary use of inhaled steroids in patients with COPD as a "low value" practice that should be phased out. (Photo: ©iStock/Juanmonino)

In 2012, the ABIM Foundation launched an initiative called Choosing Wisely, with the goal of advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures.

While the ultimate goal of the initiative is to reduce wasteful care, its immediate goal is to encourage physicians and patients to have conversations about what care is truly needed, and to debunk the notion that more is better.

One of the program's main objectives is to stop using, or de-implement, health care practices that have only low value for patients, thereby improving the quality and value of health care. According to experts with VA's Quality Enhancement Research Initiative (QUERI), although Choosing Wisely has identified a number of targets for de-implementation, little is known about how to effectively stop using health care practices that have been shown to be of little value.

QUERI, VA's Pharmacy Benefits Management Service, and VA's Office of Specialty Care Services have identified and prioritized an initial set of common clinical practices that should be de-implemented, and a new clinical investigation will test strategies for de-implementation for several of these practices. One example of a low-value practice is the unnecessary use of inhaled corticosteroids in Veterans with chronic obstructive pulmonary disease.

During the investigation, the effectiveness of de-implementation strategies on reducing ineffective, contraindicated, or low-value diagnostics and therapeutics will be tested—as will the budget impact of these strategies. VA investigators will assess changes in clinicians' perceptions of the empirical evidence against the ineffective practice, both before and after de-implementation strategies are employed. They will also look at the intent of clinicians to reduce the ineffective practice.

The ultimate goal of the research is to improve health care delivery, safety, and value for Veterans and the entire VA health care system, consistent with strategies outlined in VHA's Blueprint for Excellence.


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