Protocol for a national intervention programme aimed to reduce unwarranted variation and overuse of shoulder arthroscopy in Norway.

Several advice-based approaches have aimed to reduce the overuse of procedures characterised as low-value healthcare services but have so far shown marginal impact on utilisation rates. Differences in utilisation rates tend to be associated with type of healthcare provider. Commercial providers have a tendency to have higher utilisations rates compared with non-profit providers. Norway has a publicly funded universal health coverage system where healthcare services are mainly provided by publicly owned hospitals in addition to a small number of non-profit hospitals and commercial hospitals reimbursed by the regional health authorities. According to previous experiences, unwarranted variation in utilisation rates can be associated with the type of healthcare provider. The aim of the present study is to evaluate the impact of tailoring the interventions on reducing overuse of low-value care based on an analysis of the clinical pathways and the various types of healthcare providers. The National Decision Forum in Norway has decided that acromion resection in patients with impingement symptoms and repair of non-traumatic cuff rupture should not be offered as standard treatment. The present protocol describes the planned intervention to reduce the overuse of these procedures.