Pauline Heus

Background: Digital health technologies (DHTs) are increasingly implemented to improve efficiency, quality, and patient experience. However, conditions that could influence the impact on well-being of healthcare professionals (HCPs) are rarely assessed. Objective: To develop a tool to support policymakers, hospital administrators, and implementation teams in considering workforce experience and well-being implications of DHTs on HCPs. Methods: A mixed-methods study was conducted in three Dutch university medical centres. First, we re-analysed a scoping review on DHT-implementation, applying criteria focusing on HCP-related determinants and thematically analysing these within a modified Work-System model and Quintuple Aim framework. Second, we conducted a prioritisation survey using the Reweighted Priority-Setting tool to rank themes related to Care-team well-being , one of the Quintuple Aim domains. Third, we explored the highest-ranked themes in focus-groups and interviews with HCPs and stakeholders. Finally, we synthesised findings into a tool. Results: From 73 eligible studies we extracted determinants, generating themes and subthemes, of which 44 mapped to Care-team well-being , and were used as survey items. Twelve respondents (eight HCPs and four policy-staff) prioritised these. Top-ranked themes included perceived benefits, acceptance, involvement in development and implementation, ‘champions’, training and skills, communication, and role clarity. Analysis of two focus-groups and three interviews yielded six domains: acceptance, champions, process and development, role of the professional, communication, and training. These informed a 14-item checklist for use during DHT-implementation. Conclusion: We developed a reflective checklist to support structured consideration of conditions shaping workforce experience in DHT-implementation. The tool offers a starting point for embedding workforce conditions in DHT-governance.

Introduction: The implementation of artificial intelligence‐based electrocardiogram interpretation (AI‐ECG) algorithms relies heavily on end‐user acceptance and a well‐designed implementation plan. This study aimed to identify the key barriers, facilitators and strategies for the successful adoption of AI‐ECG in clinical practice.Methods: A sequential explanatory mixed‐methods study was conducted among future AI‐ECG end‐users in the Netherlands, including doctors, nurses, and ambulance professionals, using a clinical scenario involving chest pain. Quantitative data were collected through a three‐round Delphi survey (n = 25) to identify key barriers and facilitators. Building on these findings, qualitative data were gathered through semi‐structured interviews (n = 7) and focus groups (n = 12) to further explain the barriers and facilitators, and discuss relevant implementation strategies.Results: Participants expressed a general openness to working with AI‐ECG. Four key barriers and twelve facilitators were identified in the quantitative phase. Participants mentioned the relative advantage of AI‐ECG in the context of recognizing subtle, or rare, ECG abnormalities and assisting in patient triage. However, successful implementation requires end‐users to have trust in the algorithm, clear protocols, actionable model output, integration with existing clinical systems and multidisciplinary implementation teams. Several strategies were proposed to address these challenges, including conducting local consensus discussions, identifying and preparing local champions and revising professional roles.Conclusions: This mixed‐methods study grounded in established theoretical frameworks identified several barriers and facilitators to AI‐ECG implementation and proposed strategies to address these challenges. These findings provide valuable insights for developing effective implementation plans for AI‐ECG in clinical practice.

Decision making regarding pharmacologic treatments for the prevention of episodic migraine may depend on the importance that patients place on outcomes and specific treatment preferences. To assess patients' values and preferences regarding pharmacologic treatments for the prevention of episodic migraine. MEDLINE and CINAHL from inception to April 2024. Quantitative studies reporting on values and preferences regarding pharmacologic treatments for the prevention of migraine in adults were eligible. We extracted data on study design, participants, and findings and assessed risk of bias using a tool developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group. We included 6 studies (5 discrete choice experiments and 1 survey) comprising a total of 2307 participants and assessing the importance of a total of 32 attributes. Risk of bias was moderate in 3 and low in 3 studies; all but 1 were industry spon sored. Migraine severity, frequency, and duration were found to be the most important among several outcomes including acute medication need and side effects (low certainty). Other outcomes of importance were migraine attack on day 1 postdosing (moderate certainty) and duration of daily activity limitations (high certainty). Patients preferred oral tablets to injections and infusions (moderate certainty). Importance of attributes relative to each other could not be assessed due to the scarcity of direct comparisons. Participant sampling was unclearly reported in most studies. Patients may have the strongest preference for oral treatments that reduce the severity, frequency, and duration of their migraine attacks, which reduce the duration of daily activity limitations and reduce risk of migraine on day 1. Side effects may be less important. American College of Physicians. (PROSPERO: CRD42023414305).

Various treatments for preventing episodic migraine are available. To evaluate the comparative effectiveness and harms of pharmacologic prevention of episodic migraine, focusing on treatments already determined to be superior to placebo. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from inception until April 2024. Randomized trials evaluating selected efficacious pharmacologic treatments in adults with episodic migraine. Selection was done independently by 2 reviewers. Data were extracted by 1 reviewer and checked by a second. Risk of bias and certainty of the evidence were assessed using the Cochrane Risk of Bias tool and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, respectively. Sixty-one studies (20 680 patients) evaluating 16 treatments were included. Nineteen studies had low risk of bias. All selected treatments were deemed efficacious against placebo on the basis of previous systematic reviews. In network meta-analyses, calcitonin gene-related peptide antagonist monoclonal antibodies (CGRP-mAbs) probably resulted in fewer discontinuations due to adverse events than topiramate (risk difference, -16.2% [95% CI, -18.4% to -12.8%]; moderate-certainty evidence), and CGRP-mAbs may result in less migraine-related disability and improved quality of life compared with gepants (mean differences, -4.12 [CI, -9.30 to 1.05] and 2.25 [CI, -0.85 to 5.34], respectively; low-certainty evidence). For other outcomes and comparisons, there was moderate- or low-certainty evidence of no clinically important differences, uncertain evidence, or no evidence. Limited literature was available to determine the minimal important differences. The number of head-to-head comparisons of treatments was limited. No high-certainty evidence favored one pharmacologic treatment for prevention of episodic migraine over another. Evidence was mostly insufficient or of low certainty. American College of Physicians. (PROSPERO: CRD42023414305).

Background: Low-value care is healthcare leading to no or little clinical benefit for the patient. The best (combinations of) interventions to reduce low-value care are unclear. Purpose: To provide an overview of randomized controlled trials (RCTs) evaluating deimplementation strategies, to quantify the effectiveness and describe different combinations of strategies. Methods: Analysis of 121 RCTs (1990–2019) evaluating a strategy to reduce low-value care, identified by a systematic review. Deimplementation strategies were described and associations between strategy characteristics and effectiveness explored. Results: Of 109 trials comparing deimplementation to usual care, 75 (69%) reported a significant reduction of low-value healthcare practices. Seventy-three trials included in a quantitative analysis showed a median relative reduction of 17% (IQR 7%–42%). The effectiveness of deimplementation strategies was not associated with the number and types of interventions applied. Conclusions and Implications: Most deimplementation strategies achieved a considerable reduction of low-value care. We found no signs that a particular type or number of interventions works best for deimplementation. Future deimplementation studies should map relevant contextual factors, such as the workplace culture or economic factors. Interventions should be tailored to these factors and provide details regarding sustainability of the effect.

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.