What does the program look like?

To do of not to do? has set the first steps in identifying and reducing low-value care in the Netherlands from 2015 to 2018. In the follow-up program from 2019 to 2022, we aim to further increase and apply our knowledge in the Netherlands.

To do or not to do 2015-2018

Identify what care is of low-value:

Researchers from three University Medical Centers searched scientific literature and Dutch clinical practice guidelines for do-not-do recommendations. This list of more than 1000 recommendations is integrated into the guidelines database of the Federation for Medical Specialists in the autumn of 2016. This shows that it is important for doctors to sometimes do nothing rather than act. The development of the list is described in a scientific paper. Inspired on this project, a list for nurses and a list for general practitioners have been developed. The do-not-do recommendations for nurses were spread by the Dutch Nurses Association in a campaign.

Together with a health care insurer from the Netherlands, we have analysed their claims database for measurable low-value care practices.

Reduce low-value care in practice:

Eight de-implementation projects have been e performed under coordination of the University Medical Centers (umc's). These projects are selected from over 40 submitted ideas. In these projects, the umc's have worked intensively with 30 hospitals in their region. In addition, more than 200 general practitioners and diagnostic labs, patient associations and provider associations have been involved. The central program team has supported the eight de-implementation projects using a de-implementation guide and five educational conferences.

Study how low-value care can be reduced:

We have analysed the results of the eight de-implementation projects to gain knowledge about thow to reduce low-value care, and we monitored the projects closely and interviewed the project leaders. In addition, we performed two systematic literature reviews and searched for barriers and facilitators in reducing unnecessary care and the strategies that are used. Based on these findings, we wrote the so-called de-implementation guide and two toolkits for reducing laboratory diagnostics and urinary and intravenous catheters specifically. These can help healthcare professionals in developing, implementing and evaluating a de-implementation project.

We also evaluated the implementation of the five Choosing Wisely recommendations for acute wound care. We found that most physicians and nurses are aware of the recommendations, but that they do not always adhere to them in practice and there is room for further improvement.