Skip to main content

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
  1. GuNFT Guideline for Not Funding Health Technology, HTR health technology reassessment, PBMA program budgeting and marginal analysis