Did the evidence-based intervention (EBI) programme reduce inappropriate procedures, lessen unwarranted variation or lead to spill-over effects in the National Health Service?

Journal article

Glynn, J., Jones, Timothy, Bell, Mike, Blazeby, Jane, Burton, Christopher, Conefrey, Carmel, Donovan, Jenny L, Farrar, Nicola, Morley, J., McNair, A., Owen-Smith, Amanda, Rule, Ellen, Thornton, Gail, Tucker, Victoria, Williams, I., Rooshenas, Leila and Hollingworth, William 2023. Did the evidence-based intervention (EBI) programme reduce inappropriate procedures, lessen unwarranted variation or lead to spill-over effects in the National Health Service? PLoS ONE. 18 (9), p. e0290996. https://doi.org/10.1371/journal.pone.0290996
AuthorsGlynn, J., Jones, Timothy, Bell, Mike, Blazeby, Jane, Burton, Christopher, Conefrey, Carmel, Donovan, Jenny L, Farrar, Nicola, Morley, J., McNair, A., Owen-Smith, Amanda, Rule, Ellen, Thornton, Gail, Tucker, Victoria, Williams, I., Rooshenas, Leila and Hollingworth, William
Abstract

Background
Health systems are under pressure to maintain services within limited resources. The Evidence-Based Interventions (EBI) programme published a first list of guidelines in 2019, which aimed to reduce inappropriate use of interventions within the NHS in England, reducing potential harm and optimising the use of limited resources. Seventeen procedures were selected in the first round, published in April 2019.

Methods
We evaluated changes in the trends for each procedure after its inclusion in the EBI’s first list of guidelines using interrupted time series analysis. We explored whether there was any evidence of spill-over effects onto related or substitute procedures, as well as exploring changes in geographical variation following the publication of national guidance.

Results
Most procedures were experiencing downward trends in the years prior to the launch of EBI. We found no evidence of a trend change in any of the 17 procedures following the introduction of the guidance. No evidence of spill-over increases in substitute or related procedures was found. Geographic variation in the number of procedures performed across English CCGs remained at similar levels before and after EBI.

Conclusions
The EBI programme had little success in its aim to further reduce the use of the 17 procedures it deemed inappropriate in all or certain circumstances. Most procedure rates were already decreasing before EBI and all continued with a similar trend afterwards. Geographical variation in the number of procedures remained at a similar level post EBI. De-adoption of inappropriate care is essential in maintaining health systems across the world. However, further research is needed to explore context specific enablers and barriers to effective identification and de-adoption of such inappropriate health care to support future de-adoption endeavours

KeywordsState Medicine; Evidence-Based Medicine; Geography; Behavior Therapy; England
Year2023
JournalPLoS ONE
Journal citation18 (9), p. e0290996
ISSN1932-6203
Digital Object Identifier (DOI)https://doi.org/10.1371/journal.pone.0290996
https://doi.org/PONE-D-22-30207
Official URLhttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0290996
Publication dates
Online01 Sep 2023
Publication process dates
Accepted20 Aug 2023
Deposited14 Sep 2023
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