BMJ Quality & Safety最新文献

{"title":"Eliminating hospital nurse understaffing is a cost-effective patient safety intervention.","authors":"Karen B Lasater","doi":"10.1136/bmjqs-2025-018677","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018677","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and clinician perspectives on misgendering in healthcare.","authors":"Kyle Okamuro, Alan Card, Hanna J Barton, Falisha Kanji, Victor Trasvina, Jill Blumenthal, Tara Cohen, Jennifer T Anger","doi":"10.1136/bmjqs-2024-018364","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018364","url":null,"abstract":"<p><strong>Purpose: </strong>Misgendering of transgender and non-binary (TGNB) individuals in healthcare settings can lead to worsened mental and physical health outcomes and decreased utilisation of care. Few studies have investigated the factors that contribute to this phenomenon. The purpose of this study was to apply qualitative methods to explore sources of misgendering, its perceived impact, prevention strategies and clinician responses to accidentally misgendering a patient, as identified by TGNB patients and gender-affirming care clinicians.</p><p><strong>Methods: </strong>Between April and June 2022, 20 semi-structured interviews were performed at an academic medical centre in Southern California. Participants were recruited via purposive sampling and included: (1) TGNB patients (n=8) recruited from an interdisciplinary gender-affirming urological practice and (2) gender-affirming care clinicians (n=12) recruited from a regional interdisciplinary Gender Health conference, three of whom identified as TGNB. Interviews were conducted in person or virtually using an open-ended topic guide, audio recorded and transcribed verbatim. Inductive thematic analysis was performed by two independent study personnel who hand-coded the transcripts.</p><p><strong>Results: </strong>Four overarching themes were identified: (1) misgendering originates from multiple sources, (2) misgendering discourages individual access to healthcare, creates community hesitation and its perceived impact is modified by setting and intentionality, (3) building a gender-affirming healthcare system requires integration of behaviour, policy and technology and (4) clinicians respond to accidental misgendering by acknowledging, apologising, advancing and acting.</p><p><strong>Conclusion: </strong>Our data suggest that misgendering arises from both interpersonal communication and structural factors within healthcare systems, leading to perceived harm and diminished TGNB access to health services. Any potential solution to reduce this phenomenon will require a multifaceted approach integrating behavioural, technological and institutional policy strategies with system-level implementation efforts.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a patient-centred complex intervention to improve Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care (the IMA-cRCT study): a mixed-methods process evaluation.","authors":"Carmen Corral-Partearroyo, Alba Sánchez-Viñas, María Teresa Peñarrubia-María, Montserrat Gil-Girbau, Ignacio Aznar-Lou, Claudia Palma-Vasquez, Carmen Gallardo-González, María Del Carmen Olmos-Palenzuela, Maria Rubio-Valera","doi":"10.1136/bmjqs-2024-018403","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018403","url":null,"abstract":"<p><strong>Introduction: </strong>The initial medication adherence (IMA) intervention aims to improve adherence to cardiovascular disease (CVD) and diabetes treatments in primary care (PC) through standardised shared decision-making (SDM) and healthcare professional (HCP) collaboration (general practitioners (GPs), nurses and pharmacists). This study assessed the intervention's implementation (strategies, fidelity and integration into routine practice-based on the Normalisation Process Theory), mechanisms of action and the role of context.</p><p><strong>Methods: </strong>The IMA-cRCT was an effectiveness-implementation cluster-Randomised Controlled Trial involving 24 Spanish PC centres (>300 HCP; >3000 patients) based on real-world evidence. This nested process evaluation used quantitative (monitoring data; HCP questionnaires) and qualitative methods (field diaries; 36 semistructured individual interviews and two focus groups (19 patients, 28 HCPs)). Quantitative data explored implementation and context and were analysed descriptively, while qualitative data examined implementation, mechanisms of action and context and were analysed using framework analysis. Both analyses were integrated for interpretation.</p><p><strong>Results: </strong>Intervention implementation fidelity (6.5/10) and normalisation into clinical practice (7.6/10) were adequate, particularly regarding SDM and use of decision aids. HCPs recognised the importance of SDM, although some assumed it was already part of routine practice. The anticipated mechanisms of action were moderately supported. HCPs' knowledge and attitudes towards SDM improved as they acknowledged its relevance to practice. Some patients reported participation in decision-making, while others preferred the GP to decide on their behalf. Patients found leaflets helpful for understanding information. Contextual factors influencing the intervention were mainly organisational, such as lack of time and familiarity with SDM.</p><p><strong>Conclusions: </strong>The interprofessional SDM-based IMA intervention was considered beneficial for patients and HCPs, with adequate implementation fidelity and normalisation into practice. The intervention was important for HCPs, and patients accepted it. However, greater effort is needed to extend SDM throughout healthcare, moving towards patient-centred care. These results have enhanced understanding of SDM interventions and support their refinement for future implementation.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov, NCT05026775.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regulating voluntary assisted dying at the clinical coalface: a qualitative interview study in Victoria, Australia.","authors":"Casey M Haining, Lindy Willmott, Ben P White","doi":"10.1136/bmjqs-2024-018314","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018314","url":null,"abstract":"<p><strong>Background: </strong>Voluntary assisted dying (VAD) in Victoria, Australia, is governed by a stringent legislative framework, designed and enforced by the state, as well as other forms of regulation. However, there remains limited understanding about how these various forms of regulation operate at the frontline or how clinicians themselves can influence regulation.</p><p><strong>Objectives: </strong>This article explores how clinicians working at the frontline (clinical coalface) may influence the regulation of VAD in Victoria, and how this contributes to the safe and effective delivery of VAD.</p><p><strong>Methods: </strong>Reflexive thematic analysis of 30 semistructured interviews with 37 'regulators' (defined as those capable of steering and guiding behaviour with respect to VAD).</p><p><strong>Results: </strong>Data analysis resulted in the generation of three main themes: (1) coalface regulation extends regulations at the clinical level, ensuring adherence to laws while developing new standards and systems for safe and effective practice; (2) coalface regulation guides day-to-day VAD practice; and (3) coalface regulation plays a critical role in quality monitoring and improvement.</p><p><strong>Conclusions: </strong>Clinicians play a significant role in VAD regulation in Victoria and fulfil what we define as a 'coalface regulator' role. These coalface regulators are influential in ensuring the safe and effective delivery of VAD. Understanding how coalface regulation intersects with other forms of VAD regulation and how this regulatory influence can be harnessed is critical for optimising VAD regulation, safety and improving service delivery at a local and system level.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Child Opportunity Index and paediatric sepsis recognition and treatment in a large quality improvement collaborative: a retrospective cohort study.","authors":"Lori Rutman, Troy Richardson, Jeffery Auletta, Fran Balamuth, Amber Chambers, Julie Fitzgerald, Javier Gelvez, Karen A Genzel, Amy Grant, Vishal Gunnala, Hana Hakim, Leslie Hueschen, Sarah Kandil, Gitte Larsen, Justin Lockwood, Kate Lucey, Elizabeth Mack, Kate Madden, Matthew Niedner, Raina Paul, Anireddy Reddy, Ruth Riggs, Johanna Rosen, Melissa Schafer, Halden Scott, Jennifer Wilkes, Matthew A Eisenberg","doi":"10.1136/bmjqs-2024-017844","DOIUrl":"10.1136/bmjqs-2024-017844","url":null,"abstract":"<p><strong>Background: </strong>The Child Opportunity Index (COI) is a multidimensional measure of US neighbourhood-level conditions needed for healthy development. COI is associated with healthcare delivery and outcomes. Formal quality improvement (QI) may influence the relationship between COI, quality of care and outcomes in children.</p><p><strong>Objective: </strong>To assess the association between COI and paediatric sepsis care delivery and outcomes and determine if baseline disparities in care change over time among hospitals in the Improving Pediatric Sepsis Outcomes (IPSO) collaborative.</p><p><strong>Methods: </strong>Retrospective cohort study of IPSO patients probabilistically linked to the Pediatric Health Information System database from 2017 to 2021. Primary exposure was COI. We estimated differences in the proportions of patients in each COI quintile identified via standardised sepsis recognition protocols (screening tool, huddle documentation and/or order set use) and who received a bundle of recommended care (standardised sepsis recognition, plus bolus <1 hour and antibiotic <3 hours). We further assessed the timeliness of each bundle component and mortality. We evaluated changes in standardised sepsis recognition over time using generalised linear models.</p><p><strong>Results: </strong>31 260 sepsis cases from 24 hospitals were included. Cross-sectional analysis over the entire study period found patients in the Very High COI quintile were most likely to be identified via standardised recognition protocols and receive IPSO's recommended care bundle (67.7% and 46%, respectively). Over time, standardised sepsis recognition improved for all; the greatest improvements were among inpatients in the Very Low COI quintile.</p><p><strong>Conclusion: </strong>Disparities exist in paediatric sepsis care delivery by COI. Over the course of the IPSO collaborative, care improved most for children in the lowest COI quintile. QI collaboratives focused on standardisation and shared learning may reduce disparities.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of computerised alerts to reduce drug-drug interactions (DDIs) and DDI-related harm in hospitalised patients: a quasi-experimental controlled pre-post study.","authors":"Melissa Therese Baysari, Sarah Nicole Hilmer, Richard O Day, Bethany Annemarie Van Dort, Wu Yi Zheng, Renee Quirk, Danielle Deidun, Maria Moran, Kristian Stanceski, Nanda Aryal, Ahmed Abo Salem, Lauren Farrow, Jannah Baker, Andrew Hargreaves, James Grant, Paula Doherty, Karma Zarif Sourial Mekhail, Johanna I Westbrook, Ling Li","doi":"10.1136/bmjqs-2024-018243","DOIUrl":"10.1136/bmjqs-2024-018243","url":null,"abstract":"<p><strong>Background: </strong>Drug-drug interaction (DDI) alerts target the co-prescription of two potentially interacting medications and are a frequent feature of electronic medical records (EMRs). There have been few controlled studies evaluating the effectiveness of DDI alerts. This study aimed to determine the impact of DDI alerts on rates of DDIs and on associated patient harms.</p><p><strong>Methods: </strong>Quasi-experimental controlled pre-post study in five Australian hospitals. Three hospitals acted as control hospitals (EMR with no DDI alerts) and two as intervention (EMR with DDI alerts). Only DDI alerts at the highest severity level (defined as 'major contraindicated') were switched on at intervention hospitals. These alerts were not tailored to clinical context (ie, patient, drug). A total of 2078 patients were randomly selected from all patients (adult and paediatric) admitted to hospitals 6 months before and 6 months after EMR implementation. A retrospective chart review was performed by study pharmacists. The primary outcome was the proportion of admissions with a clinically relevant DDI. Secondary outcomes included the proportions of admissions with a potential DDI and with DDI-related harm.</p><p><strong>Results: </strong>Potential DDIs were identified in the majority of admissions (n=1574, 74.7%) and clinically relevant DDIs identified in half (n=1026, 48.7%). DDI alerts were associated with a reduction in the proportion of admissions with potential DDIs (adjusted OR (AOR)=0.38 (0.19, 0.78)) but no change in clinically relevant DDIs (AOR=1.12 (0.68, 1.84)) or in DDI-related harm (AOR=2.42 (0.47,12.31)). 199 DDIs (76 at control and 123 at intervention hospitals) for 35 patient admissions were associated with patient harm, and 2 patients experienced severe DDI-related harm pre-EMR implementation.</p><p><strong>Discussion: </strong>Implementation of DDI alerts, without tailoring alerts to clinical context, is unlikely to reduce patient harms from DDIs. Organisations should reconsider implementation of DDI alerts in EMRs where significant tailoring of alerts is not possible. Future research should focus on identifying safe, efficient and cost-effective ways of refining DDI alerts, so expected clinical benefits are achieved, and negative consequences of excessive alerting are minimised.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What do people do in the aftermath of healthcare-related harm? A qualitative study on experiences and factors influencing decision-making.","authors":"Lavanya Thana, Helen Crocker, Shivali Modha, Linda Mulcahy, Catherine Pope, Charles Vincent, Helen Hogan, Michele Peters","doi":"10.1136/bmjqs-2024-018214","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018214","url":null,"abstract":"<p><strong>Objectives: </strong>To capture experiences of people self-reporting harm and contrast responses and actions between those who do or do not take formal action.</p><p><strong>Design: </strong>Semi-structured qualitative interview study.</p><p><strong>Setting: </strong>People self-reporting harm experienced in the National Health Service (NHS) or their family/friends identified from a general Great British population survey.</p><p><strong>Participants: </strong>49 participants.</p><p><strong>Results: </strong>There were commonalities in experiences after harm whether formal action (including making a formal complaint or litigation) was taken or not. Many participants reported raising concerns informally with NHS staff, trying to access explanations or support, but were usually unsuccessful. Decision-making on action was complex. There were multiple reasons for not pursuing formal action, including fears of damaging relationships with clinicians, being occupied coping with the consequences of the harm or not wanting to take action against the NHS. NHS advocacy services were not regarded as helpful. Knowledge of how to proceed and feeling entitled to do so, along with proactive social networks, could facilitate action, but often only after people were spurred on by anger and frustration about not receiving an explanation, apology or support for recovery from the NHS. Those from marginalised groups were more likely to feel disempowered to act or be discouraged by family or social contacts, which could lead to self-distancing and reduced trust in services.</p><p><strong>Conclusions: </strong>People actively seek resolution and recovery after harm but often face multiple barriers in having their needs for explanations, apologies and support addressed. Open and compassionate engagement, especially with those from more marginalised communities, plus tailored support to address needs, could promote recovery, decrease compounded harm and reduce use of grievance services where other provision may be more helpful.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing quality and safety regulations in residential disability services: a qualitative interview study.","authors":"Paul Dunbar, Laura Keyes, John Browne","doi":"10.1136/bmjqs-2024-018012","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018012","url":null,"abstract":"<p><strong>Background: </strong>Regulation plays a central role in health and social care systems, particularly in ensuring quality, safety and accountability. However, there is limited understanding of how organisations effectively implement and adhere to these regulatory requirements. In particular, little is known about how providers of residential care facilities for people with disabilities (RCF-D) navigate and apply statutory care regulations.</p><p><strong>Methods: </strong>We conducted semistructured interviews with managers of RCF-D. Participant recruitment followed a purposive maximum variation sampling approach. 19 participants were interviewed, representing 22 RCF-D and 16 provider organisations. Interview data were analysed using a mixed deductive-inductive approach.</p><p><strong>Results: </strong>Most managers were supportive of regulatory goals, creating a more favourable environment for successful implementation. By making sense of regulatory requirements and sharing insights across their organisations, managers facilitated smoother implementation. Crucially, building strong internal and external networks played a pivotal role in driving success. Collaborative relationships with inspectors, centred on a shared commitment to improving residents' lives, further strengthened the implementation process.</p><p><strong>Conclusion: </strong>Managers of RCF-D devised a range of strategies to manage compliance, balancing regulatory demands with problem-solving and relationship-building. These efforts were supported by a collaborative approach to working with inspectors, which fostered a shared commitment to improving residents' lives. Our findings offer practical guidance for organisations seeking to improve regulatory compliance through effective relationship management and resource alignment. Future research could investigate how framing regulation as an adaptive intervention could further enhance implementation and sustain compliance.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metrics used in quality improvement publications addressing environmental sustainability in healthcare: a scoping review.","authors":"Colin Sue-Chue-Lam, Sezgi Yanikomeroglu, Darius Baginskis, Doulia M Hamad, Brian M Wong, Nicole Simms, Karen B Born","doi":"10.1136/bmjqs-2025-018519","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018519","url":null,"abstract":"<p><strong>Objective: </strong>Quality improvement (QI) practices and scholarship are increasingly concerned with environmental sustainability given the negative health outcomes caused by the ecological crisis, as well as the environmental impacts of healthcare delivery itself. A core component of QI activities is measuring change. How sustainability metrics have been used in QI is unclear. We conducted a scoping review of metrics used in published sustainability-focused QI initiatives.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, CINAHL and Scopus from 2000 to 2023.</p><p><strong>Eligibility criteria: </strong>Published healthcare QI initiatives intended to address environmental sustainability with at least one quantitative sustainability metric.</p><p><strong>Data analysis: </strong>Publication, study, measurement and QI intervention characteristics were charted from included studies. Data items were synthesised and presented narratively as well as quantitatively.</p><p><strong>Results: </strong>We screened 6294 studies and included 90 full-text publications. The studies were published from 2000 to 2023, with the majority (61%, 55/90) published since 2020. Publications originated from a wide range of clinical disciplines with most QI projects situated in the inpatient setting (78%, 70/90). Environmental sustainability metrics were subcategorised into activity data and environmental impact indicators. Some papers included more than one category of activity data, with the most common being cost (88%, 79/90), hospital waste (52%, 47/90), anaesthetic gases (49%, 44/90), disposable use (24%, 22/90) and distance travelled (14%, 13/90). Fewer publications included environmental impact indicators, with global warming potential dominating this category (53%, 48/90).</p><p><strong>Discussion: </strong>There is a need to align QI efforts with environmental sustainability. However, there is limited guidance specific to healthcare QI on how to measure environmental impacts of these efforts. This review illuminates that sustainability-focused QI efforts to date have used a relatively narrow set of sustainability metrics. QI scholars and practitioners can benefit from further education, measurement frameworks and guidelines to effectively incorporate environmental sustainability metrics into QI efforts.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to de-implementation of low-value cancer screening practices: a narrative review.","authors":"Jennifer H LeLaurin, Kathryn Pluta, Wynne E Norton, Ramzi G Salloum, Naykky Singh Ospina","doi":"10.1136/bmjqs-2025-018558","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018558","url":null,"abstract":"<p><p>The continued use of low-value cancer screening practices not only represents healthcare waste but also a potential cascade of invasive diagnostic procedures and patient anxiety and distress. While prior research has shown it takes an average of 15 years to implement evidence-based practices in cancer control, little is known about how long it takes to de-implement low-value cancer screening practices. We reviewed evidence on six United States Preventive Services Task Force 'Grade D' cancer screening practices: (1) cervical cancer screening in women<21 years and >65 years, (2) prostate cancer screening in men≥70 years and (3) ovarian, (4) thyroid, (5) testicular and (6) pancreatic cancer screening in asymptomatic adults. We measured the time from a landmark publication supporting the guideline publication and subsequent de-implementation, defined as a 50% reduction in the use of the practice in routine care. The pace of de-implementation was assessed using nationally representative surveillance systems and peer-reviewed literature from the USA. We found the time to de-implementation of cervical cancer screening was 4 years for women<21 and 16 years for women>65. Prostate screening in men ≥70 has not reached a 50% reduction in use since the 2012 guideline release. We did not identify sufficient evidence to measure the time to de-implementation for ovarian, thyroid, testicular and pancreatic cancer screening in asymptomatic adults. Surveillance of low-value cancer screening is sparse, posing a clear barrier to tracking the de-implementation of these screening practices. Improving the systematic measurement of low-value cancer control practices is imperative for assessing the impact of de-implementation on patient outcomes, healthcare delivery and healthcare costs.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}