Stopping the flood: reducing harmful cascades of care.

Abstract

Cascades of care are common and can lead to significant harms for patients, clinicians, and the health care system at large. In this commentary, we argue that there are 2 ways to reduce cascades: decrease the use of unnecessary services that often initiate cascades (ie, close the floodgates) and mitigate cascades once they begin (ie, slow the flow through the floodgates). So far, most efforts to address cascades have focused on identifying, measuring, and educating clinicians on low-value services, with only modest success. We explore potential solutions for both closing the floodgates and slowing a cascade once the floodgates have been opened, including information to assist patients and clinicians in making better decisions, relationships that enable shared decision-making, and policy changes. Ultimately, reducing cascades while maintaining our commitment to high-quality care requires equipping patients and clinicians with the information, tools, and support needed to embrace uncertainty.