Table 4 Frameworks proposed to guide the de-adoption of low-value practices
From: Towards understanding the de-adoption of low-value clinical practices: a scoping review
Citation | Type of citation | Relationship to conceptual framework (Table 1) | Description | Documented clinical application |
|---|---|---|---|---|
Elshaug et al. 2009 [109] | Discussion paper prepared by Canadian Agency for Drugs and Technologies in Health Health Technology Strategy Policy Forum | Identify low-value practices | Criteria for identifying existing, potentially non-cost-effective practices as candidates for assessment | No |
Criteria to inform the prioritization of candidates for detailed review after identification | ||||
Facilitate the de-adoption process | Funding approaches to facilitating reduction in non-cost-effective practices | No | ||
Joshi et al. 2009 [80] | Narrative review | Identify low-value practices | HTR approach to identifying candidate technologies | No |
Ibargoyen-Roteta et al. 2010 [55] | Guideline | Identify of low-value practices | GuNFT: Hospital and patient-level criteria for not funding technologies | No |
Facilitate the de-adoption process | Barriers and mechanisms to remove funding from existing technologies | No | ||
Mortimer 2010 [68] | Narrative review | Facilitate the de-adoption process | Proposed re-orientation of traditional PBMA model to target strategies of disinvestment | Not with the re-oriented PBMA model as outlined by the authors |
Donaldson et al. 2010 [72] | Narrative review | Facilitate the de-adoption process | Describes the use of PBMA to promote rational disinvestment | Not according to the model outlined by the authors |
Gerdvilaite and Nachtnebel 2011 [57] | Systematic review | Identify of low-value practices | Authors cite criteria proposed by Elshaug et al. [109], Joshi et al. [80], Ibargoyen-Roteta et al. [55], and criteria proposed by National Institute for Health and Care Excellence | No |
Overlapping criteria include new evidence, cost effectiveness, safety, and available alternatives | ||||
Facilitate the de-adoption process | As described above for Ibargoyen-Roteta et al. [55] | No | ||
Levin 2011 [20] | Conference presentation | Identify of low-value practices | Ontario’s Evidence-based Analyses to Manage Technology Adoption and Obsolescence: Mega-analysis Evidence Based Analyses of technologies around disease conditions; prioritized by effectiveness and cost-effectiveness; criteria for identifying practices unclear | Yes |
Facilitate the de-adoption process | Mechanism for facilitating de-adoption appears to be based on funding effective technologies, and not funding ineffective technologies | Yes | ||
Leggett et al. 2012 [58] | Systematic review | Identify of low-value practices; Facilitate the de-adoption process | 1.GuNFT as outlined above | No |
2.5-steps for HTR should include: identification, prioritization, evaluation, implementation, and monitoring | ||||
Watt et al. 2012 [46] | Mixed methods | Facilitate the de-adoption process | Two technologies (assisted reproductive technology and vitamin B12/folate pathology tests) used as case studies to test a three-level model to facilitate de-adoption including: | No (study ongoing) |
1. Evidence reports | ||||
2. Stakeholder engagement | ||||
3. Policy deliberation and analysis; Process evaluation | ||||
Henshall and Schuller 2012 [52] | Qualitative | Identify of low-value practices | Identification and prioritization approaches include clinical stakeholder involvement, monitoring new evidence, use of data to identify practices with high variability and/or cost, inclusion of HTR within life-cycle of any technology | No |
Polisena et al. 2013 [19] | Systematic review | Facilitate the de-adoption process | Three different models to facilitate disinvestment decisions: | Yes; varied by included study |
1. Health technology assessment framework | ||||
2. Program budgeting and marginal analysis | ||||
3. Accountability for reasonableness and quality improvement theory |