Randomized Experiments to Reduce Overuse of Health Care

A Scoping Review

Datos Bibliográficos

ID9103689
AutoresRavi Gupta (0000-0003-2583-563X, Johns Hopkins University, autor de correspondencia), Bingrui Emily Xie (Johns Hopkins University, Baltimore, Md), Meng Zhu (0009-0003-3824-4844, Johns Hopkins Carey Business School, Baltimore, MD), Jodi B Segal (0000-0003-3978-9662, Johns Hopkins University, autor de correspondencia)
Año2024
Volumen62
Número4
Páginas263-269
Fecha de publicación2024-04-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001978
PMID38315879
OpenAlexW4391543915
IdiomaEN
Referencias citadas48

OBJECTIVE: Health care overuse is pervasive in countries with advanced health care delivery systems. We hypothesize that effective interventions to reduce low-value care that targets patients or clinicians are mediated by psychological and cognitive processes that change behaviors and that interventions targeting these processes are varied. Thus, we performed a scoping review of experimental studies of interventions, including the interventions' objectives and characteristics, to reduce low-value care that targeted psychological and cognitive processes. METHODS: We systematically searched databases for experimental studies of interventions to change cognitive orientations and affective states in the setting of health care overuse. Outcomes included observed overuse or a stated intention to use services. We used existing frameworks for behavior change and mechanisms of change to categorize the interventions and the mediating processes. RESULTS: Twenty-seven articles met the inclusion criteria. Sixteen studied the provision of information to patients or clinicians, with most providing cost information. Six studies used educational interventions, including the provision of feedback about individual practice. Studies rarely used counseling, behavioral nudges, persuasion, and rewards. Mechanisms for behavior change included gain in knowledge or confidence and motivation by social norms. CONCLUSIONS: In this scoping review, we found few experiments testing interventions that directly target the psychological and cognitive processes of patients or clinicians to reduce low-value care. Most studies provided information to patients or clinicians without measuring or considering mediating factors toward behavior change. These findings highlight the need for process-driven experimental designs, including trials of behavioral nudges and persuasive language involving a trusting patient-clinician relationship, to identify effective interventions to reduce low-value care

Behavior change · Behavior change methods · Cognition · Health care · MEDLINE · Nudge theory · Persuasion · Psychiatry · Psychological intervention · Randomized controlled trial · Clinical Psychology · Health Systems, Economic Evaluations, Quality of Life · Healthcare cost, quality, practices · Medicine · Nursing · Obesity and Health Practices · Psychology · Social Psychology