Evidence That Drives Real Change

Authors: Andrea M Patey, Varunaavee Sivashanmugathas, Gillian Hurwitz, Adina Weinerman, Janet Simons, Wendy Levinson

Year: 2026

Abstract:
Background: Overuse of low-value laboratory tests can harm patients, waste healthcare resources and contribute to environmental damage. To address this, Choosing Wisely Canada launched Using Labs Wisely (ULW), a national learning collaborative designed to reduce unnecessary testing through shared data, training and quality improvement initiatives. ULW brought together hospitals of all sizes to implement stewardship projects, foster collaboration and monitor progress through a centralised data repository. This study evaluated ULW to identify successes, challenges and opportunities for improvement.

Methods: We conducted a qualitative study using a theory-informed interview guide based on the Theoretical Framework of Acceptability (TFA). Fifteen hospitals in the first ULW cohort were invited to participate. Interviews with clinicians and managers explored experiences with ULW, including what worked, what did not and recommendations for improvement. Transcripts were analysed inductively using thematic analysis, with themes reviewed collaboratively and mapped to TFA constructs.

Results: Thirteen hospitals participated, reflecting strong interest in reducing low-value testing and valuing ULW’s structured, collaborative approach. Participants highlighted the programme’s national credibility, resources and peer learning opportunities which facilitated institutional buy-in and elevated the laboratory’s role in quality improvement. While generally manageable, common challenges included difficulties with data extraction, lack of standardisation across systems and limited human resources, particularly during pandemic-related strain. Participants called for expanded quality improvement training, clinical outcome tracking and cross-site collaboration to address increasingly complex and costly tests.

Conclusions: ULW successfully supported hospitals to reduce low-value laboratory testing through structured improvement, benchmarking and peer learning. Challenges remain, particularly around data and resources, but the evaluation highlights key enablers and lessons that can inform the programme’s evolution and guide future collaboratives in other healthcare settings.

Authors: Cari Almazán, Johanna Milena Caro-Mendivelso, Montse Mias, Leslie Barrionuevo-Rosas, Montse Moharra, Marie-Pierre Gagnon

Year: 2022

Abstract:
Reducing ineffective practices is one way to ensure high-quality and efficient healthcare for the population. For this reason, several initiatives have been implemented worldwide to reduce low-value care. This article describes the experience of the Essencial project, a multifaceted deadoption strategy implemented in the Catalan primary care system. Lessons learnt from this project include the importance of considering the local context in deadoption strategies, providing adequate training and communication material to patients and clinicians and supporting the key role of clinical champions. Given the knowledge gaps regarding the conditions for successful deadoption strategies, the Catalan experience could provide enlightenment on how to implement, evaluate and sustain a large-scale collaborative deadoption strategy in primary healthcare.

Authors: Eva W Verkerk, Simone A van Dulmen, Gert P Westert, Lotty Hooft, Pauline Heus, Rudolf B Kool

Year: 2022

Abstract:
Background: Reducing the overuse of care that is proven to be of low value increases the quality and safety of care. We aimed to identify lessons for reducing low-value care by looking at: (1) The effects of eight de-implementation projects. (2) The barriers and facilitators that emerged. (3) The experiences with the different components of the projects.

Methods: We performed a process evaluation of eight multicentre projects aimed at reducing low-value care. We reported the quantitative outcomes of the eight projects on the volume of low-value care and performed a qualitative analysis of the project teams’ experiences and evaluations. A total of 40 hospitals and 198 general practitioners participated.

Results: Five out of eight projects resulted in a reduction of low-value care, ranging from 11.4% to 61.3%. The remaining three projects showed no effect. Six projects monitored balancing measures and observed no negative consequences of their strategy. The most important barriers were a lack of time, an inability to reassure the patient, a desire to meet the patient’s wishes, financial considerations and a discomfort with uncertainty. The most important facilitators were support among clinicians, knowledge of the harms of low-value care and a growing consciousness that more is not always better. Repeated education and feedback for clinicians, patient information material and organisational changes were valued components of the strategy.

Conclusions: Successfully reducing low-value care is possible in spite of the powerful barriers that oppose it. The projects managed to recruit many hospitals and general practices, with five of them achieving significant results without measuring negative consequences. Based on our findings, we offer practical recommendations for successfully reducing low-value care.