. 2018 Jun 15;16(1):48.

doi: 10.1186/s12961-018-0325-x.

Addressing overuse of health services in health systems: a critical interpretive synthesis

Moriah E Ellen^{1

2

3}, Michael G Wilson^{4

5

6}, Marcela Vélez^{3

7

8}, Ruth Shach⁹, John N Lavis^{3

10

11

12

13}, Jeremy M Grimshaw^{14

15}, Kaelan A Moat^{3

10

11}; Synthesis working group

Collaborators, Affiliations

Collaborators

Synthesis working group:
Sarah Garner, Roberto Grilli, Justin Peffer, Kevin Samra, Joshua Shemer, Terry Sullivan

Affiliations

¹ Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel.
² Institute for Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
³ McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.
⁴ McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada. wilsom2@mcmaster.ca.
⁵ Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada. wilsom2@mcmaster.ca.
⁶ Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada. wilsom2@mcmaster.ca.
⁷ Health Policy PhD Program, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
⁸ Faculty of Medicine, University of Antioquia, Cra. 51d #62-29, Medellín, Antioquia, Colombia.
⁹ Brown School of Social Work, Washington University in St Louis, 1 Brookings Dr, St Louis, MO, 63130, United States of America.
¹⁰ Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
¹¹ Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
¹² Department of Political Science, McMaster University, Hamilton, Canada.
¹³ Department of Global Health and Population, Harvard School of Public Health, Cambridge, MA, United States of America.
¹⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
¹⁵ Department of Medicine, University of Ottawa, Ottawa, Canada.

PMID: 29907158
PMCID: PMC6003114
DOI: 10.1186/s12961-018-0325-x

Addressing overuse of health services in health systems: a critical interpretive synthesis

Moriah E Ellen et al. Health Res Policy Syst. 2018.

. 2018 Jun 15;16(1):48.

doi: 10.1186/s12961-018-0325-x.

Authors

Collaborators

Synthesis working group:
Sarah Garner, Roberto Grilli, Justin Peffer, Kevin Samra, Joshua Shemer, Terry Sullivan

Affiliations

¹ Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, 84105, Beer-Sheva, Israel.
² Institute for Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
³ McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada.
⁴ McMaster Health Forum, McMaster University, 1280 Main St. West, MML-417, Hamilton, ON, L8S 4L6, Canada. wilsom2@mcmaster.ca.
⁵ Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada. wilsom2@mcmaster.ca.
⁶ Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada. wilsom2@mcmaster.ca.
⁷ Health Policy PhD Program, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
⁸ Faculty of Medicine, University of Antioquia, Cra. 51d #62-29, Medellín, Antioquia, Colombia.
⁹ Brown School of Social Work, Washington University in St Louis, 1 Brookings Dr, St Louis, MO, 63130, United States of America.
¹⁰ Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
¹¹ Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
¹² Department of Political Science, McMaster University, Hamilton, Canada.
¹³ Department of Global Health and Population, Harvard School of Public Health, Cambridge, MA, United States of America.
¹⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
¹⁵ Department of Medicine, University of Ottawa, Ottawa, Canada.

PMID: 29907158
PMCID: PMC6003114
DOI: 10.1186/s12961-018-0325-x

Abstract

Background: Health systems are increasingly focusing on the issue of 'overuse' of health services and how to address it. We developed a framework focused on (1) the rationale and context for health systems prioritising addressing overuse, (2) elements of a comprehensive process and approach to reduce overuse and (3) implementation considerations for addressing overuse.

Methods: We conducted a critical interpretive synthesis informed by a stakeholder-engagement process. The synthesis identified relevant empirical and non-empirical articles about system-level overuse. Two reviewers independently screened records, assessed for inclusion and conceptually mapped included articles. From these, we selected a purposive sample, created structured summaries of key findings and thematically synthesised the results.

Results: Our search identified 3545 references, from which we included 251. Most articles (76%; n = 192) were published within 5 years of conducting the review and addressed processes for addressing overuse (63%; n = 158) or political and health system context (60%; n = 151). Besides negative outcomes at the patient, system and global level, there were various contextual factors to addressing service overuse that seem to be key issue drivers. Processes for addressing overuse can be grouped into three elements comprising a comprehensive approach, including (1) approaches to identify overused health services, (2) stakeholder- or patient-led approaches and (3) government-led initiatives. Key implementation considerations include the need to develop 'buy in' from stakeholders and citizens.

Conclusions: Health systems want to ensure the use of high-value services to keep citizens healthy and avoid harm. Our synthesis can be used by policy-makers, stakeholders and researchers to understand how the issue has been prioritised, what approaches have been used to address it and implementation considerations.

Systematic review registration: PROSPERO CRD42014013204 .

Keywords: Health policy; Low-value care; Overuse of health services; Waste.

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Conflict of interest statement

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 2**
Framework for understanding and addressing the issue of health services overuse

See this image and copyright information in PMC

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Addressing overuse of health services in health systems: a critical interpretive synthesis

Collaborators

Affiliations

Addressing overuse of health services in health systems: a critical interpretive synthesis

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Competing interests

Publisher’s Note

Figures

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Cited by

References

Publication types

MeSH terms

Grants and funding

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Full Text Sources

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