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De-implementation of Low-Value Testing in Patients Undergoing Low-Risk Surgery

Award Number: R01HS029306
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/01/2023
PERIOD OF PERFORMANCE END DATE: 06/30/2028

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De-implementation of Low-Value Testing in Patients Undergoing Low-Risk Surgery - PROJECT SUMMARY/ABSTRACT Unnecessary tests and treatments represent two of the greatest sources of preventable patient harm and excess healthcare spending in the United States. Robust evidence demonstrates routine preoperative tests such as electrocardiograms, blood and urine tests, and chest radiographs before low-risk surgery do not prevent adverse events or improve outcomes. In addition, unnecessary preoperative testing can trigger care cascades leading to additional specialty consultations and invasive procedures, potentially resulting in significant patient harm, delays in surgery, and patient financial toxicity. Numerous professional societies recommend against routine preoperative testing prior to low-risk surgery but eliminating use has proven difficult. In the US, few investigators have moved beyond describing the prevalence of low value testing or testing limited strategies targeting a single procedure (i.e., cataract surgery) or hospital. As a result, there are no broadly scalable de-implementation strategies and unnecessary, wasteful, and harmful testing remains commonplace. This research will test a theory-informed and broadly scalable multi-level, multi-component de- implementation strategy to reduce unnecessary preoperative testing before low-risk surgery across diverse procedures and practice types. In the Michigan Value Collaborative (MVC), a consortium of 87 Michigan hospitals, routine preoperative testing occurs before low-risk surgery in more than 52% of patients with inter- facility variation ranging from 8% to 85%. Our preliminary data has identified important, yet modifiable determinants of unnecessary testing. Based on these findings, we will test a multi-level, multi-component de- implementation strategy across Michigan hospitals. Using facilities jointly participating in the Michigan Surgical Quality Collaborative (MSQC), the largest surgical collaborative quality improvement program in the United States, we will evaluate the effectiveness of our intervention through a stepped wedge cluster randomized trial.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $374,306 )
2026	2026	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE STE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	4/27/2026	NON-COMPETING CONTINUATION	$374,306
														Subtotal = $374,306

Issue Date FY: 2025 ( Subtotal = $374,902 )
2025	2025	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE STE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	002	3	6/19/2025	NON-COMPETING CONTINUATION	$374,902
2025	2024	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	1/23/2025	NON-COMPETING CONTINUATION	$0
2025	2024	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	11/6/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $374,902

Issue Date FY: 2024 ( Subtotal = $373,189 )
2024	2024	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	6/13/2024	NON-COMPETING CONTINUATION	$373,189
2024	2023	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	4/16/2024	NEW	$0
														Subtotal = $373,189

Issue Date FY: 2023 ( Subtotal = $378,337 )
2023	2023	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	8/30/2023	NEW	$378,337
														Subtotal = $378,337

Grand Total All Awards = $1,500,734

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De-implementation of Low-Value Testing in Patients Undergoing Low-Risk Surgery

Award Number: R01HS029306

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/01/2023

PERIOD OF PERFORMANCE END DATE: 06/30/2028

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