VA Clinicians' Perspectives on Low-Value Health Service Use in the Veterans Health Administration: A Qualitative Study.

Cupler ZA, Hruska KL, Beyer NM, Schleiden LJ, Rodriguez KL, Rose L, Pickering AN, Thorpe CT, Radomski TR. VA Clinicians' Perspectives on Low-Value Health Service Use in the Veterans Health Administration: A Qualitative Study. Journal of general internal medicine. 2025 Dec 1; 40(16):3942-3953, DOI: 10.1007/s11606-025-09838-3.

Related HSR&D Project(s)

• IIR 19-089 – Use and costs of low-value health services by Veterans in VA and non-VA settings

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

BACKGROUND: Low-value health services adversely affect outcomes and unnecessarily increase the cost of care. Approximately 10% of Veterans receive at least one of 29 low-value services delivered or paid for by the Veterans Health Administration (VA) annually. However, determinants of and potential solutions to reduce low-value service delivery are poorly understood. OBJECTIVE: To characterize the drivers of and approaches to reduce low-value service delivery across VA Medical Centers (VAMCs) from the perspective of VA clinicians. DESIGN: Qualitative study using semi-structured interviews conducted from October 2022 to November 2023. PARTICIPANTS: 65 VA clinicians, including 32 generalists and 33 medical and surgical specialists, at 46 VAMCs. APPROACH: We used deductive analysis based on a priori categories and definitions structured by the Theoretical Domains Framework to identify predominant themes related to drivers of low-value service delivery. We used inductive analysis to identify clinician-suggested approaches to reduce low-value services. KEY RESULTS: We identified three overarching domains as drivers of low-value service delivery at VA: 1) environmental context and resources; 2) social influence; and 3) belief about consequences. Regarding key subthemes, social pressure from Veterans emerged among generalists and specialists. Generalists were more likely to identify referral parameters or requirements compared to specialists, while specialists were more like to identify negative consequences compared to generalists. We identified four overarching domains as approaches to reduce low-value service delivery at VA, which were consistently identified by both generalists and specialists: 1) improving quality and access to VA health care; 2) dissemination of best practices; 3) optimizing use of the electronic health record; and 4) instilling an organizational culture on value. CONCLUSIONS: We identified the most salient drivers of and approaches to reduce low-value services from the perspective of VA clinicians. These findings may inform the design of future de-implementation interventions and policy to reduce VA-delivered low-value services.