Did the evidence-based intervention (EBI) programme reduce inappropriate procedures, lessen unwarranted variation or lead to spill-over effects in the National Health Service?

Joel Glynn*, Timothy Jones, Mike Bell, Jane Blazeby, Christopher Burton, Carmel Conefrey, Jenny l. Donovan, Nicola Farrar, Josie Morley, Angus Mcnair, Amanda Owen-Smith, Ellen Rule, Gail Thornton, Victoria Tucker, Iestyn Williams, Leila Rooshenas, William Hollingworth

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review


Health systems are under pressure to maintain services within limited resources. The Evidence-Based Interventions (EBI) programme published a first list of guidelines in 2019, which aimed to reduce inappropriate use of interventions within the NHS in England, reducing potential harm and optimising the use of limited resources. Seventeen procedures were selected in the first round, published in April 2019.

We evaluated changes in the trends for each procedure after its inclusion in the EBI’s first list of guidelines using interrupted time series analysis. We explored whether there was any evidence of spill-over effects onto related or substitute procedures, as well as exploring changes in geographical variation following the publication of national guidance.

Most procedures were experiencing downward trends in the years prior to the launch of EBI. We found no evidence of a trend change in any of the 17 procedures following the introduction of the guidance. No evidence of spill-over increases in substitute or related procedures was found. Geographic variation in the number of procedures performed across English CCGs remained at similar levels before and after EBI.

The EBI programme had little success in its aim to further reduce the use of the 17 procedures it deemed inappropriate in all or certain circumstances. Most procedure rates were already decreasing before EBI and all continued with a similar trend afterwards. Geographical variation in the number of procedures remained at a similar level post EBI. De-adoption of inappropriate care is essential in maintaining health systems across the world. However, further research is needed to explore context specific enablers and barriers to effective identification and de-adoption of such inappropriate health care to support future de-adoption endeavours.
Original languageEnglish
Article numbere0290996
JournalPLoS ONE
Issue number9
Publication statusPublished - 1 Sept 2023

Bibliographical note

Funding Information:
Funding: This project is funded by the NIHR Health and Social Care Delivery Research Programme (NIHR130547). TJ’s time is supported by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West). The views expressed in this article are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
Copyright: © 2023 Glynn et al.

Structured keywords

  • HEHP@Bristol


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