Table 5 Original research citations that identified lists of low-value clinical practices
From: Towards understanding the de-adoption of low-value clinical practices: a scoping review
Citation | Stakeholder engagement | Single clinical area of focus | Methodology | Results |
|---|---|---|---|---|
Ioannidis 2005 [24] | No | No | Broad literature search (1990–2003) for highly cited clinical research studies published in three major clinical journalsa or medical specialty journals with an impact factor >7.0 | 7 of 45 (16 %) highly cited studies claiming effectiveness eventually contradicted by replication research |
Supplemental, tailored searches to determine if each highly cited study had been replicated | 7 other replication studies (16 %) found effect size not as large as in original study | |||
Comparison of direction of results between replicated and original highly cited study | ||||
Prasad et al. 2011 [5] | No | No | Review of all “original articles” published in New England Journal of Medicine in 2009 | 35 of 124 (28 %) articles examined an existing medical practice |
Articles classified according to whether the practice examined was new or already in place, and whether the results were positive or negative for the primary endpoint | 16 of 35 (46 %) articles examining an existing practice demonstrated medical reversalb | |||
Elshaug et al. 2012 [8] | Comprehensive Management Framework for Australia’s Medicare Benefits Schedule | No | Environmental scanning approach triangulating data from broad PubMed search (2000–2010), targeted searches within select databases (e.g., Cochrane library), and opportunistic sampling among clinical and non-clinical stakeholders | 156 potentially ineffective or unsafe practices identified from 5,209 screened articles |
Excluded pharmaceuticals | ||||
Choosing Wisely 2012 [21] | Yes | Yes, specialty specific recommendations | Varied by specialty society but generally included one or more of literature search, expert opinion, and/or a modified Delphi process | 67 specialty specific Top 5 ‘do not do’ lists |
Garner et al. 2013 [70] | NICE | No | Present results from the first 6 months of the Cochrane Quality and Productivity project to identify low-value practices | 28 of 65 (43 %) reviews published over a 6-month period identified potentially low-value practices |
Routine scanning of “implications for practice” section in new or updated Cochrane reviews to identify those wherein the author concluded an intervention is ineffective/harmful or should be confined to use within a research context | Most reviews cited a lack of randomized evidence of effectiveness, rather than robust evidence of lack of effectiveness | |||
Each review is examined to ensure it meets Cochrane Quality and Productivity criteria (potential impact on quality, safety, patient/provider experience, and potential for cash-releasing savings) for recommendation as a potential “disinvestment” candidate | To date the NICE Health Technology Appraisal Program has generated 1,347 ‘do not do’ recommendations [130] | |||
Hollingworth et al. 2013 [23] | No | Yes, interventional procedures | Used UK Hospital Episode Statistics to identify inpatient interventional procedures with high variation in rates of use between PCTs in England | Substantial inter-procedure, inter-PCT variation in procedure rates |
Procedures with high variation not listedc | ||||
Prasad et al. 2013 [7] | No | No | Review of all original research articles published in New England Journal of Medicine from 2001 to 2010 | 363 of 1,344 (27 %) articles re-examined an established practice |
Articles classified according to whether the practice examined was new or already in place, and whether the results were positive or negative for the primary endpoint | 146 of 363 (40 %) articles re-examining an existing practice demonstrated evidence of reversal | |||
Articles further classified as replacement, back to the drawing board, reversal, or reaffirmation d | ||||
Choosing Wisely Canada 2014 [22] | Yes | Yes, specialty specific recommendations | Varied by specialty society but generally included one or more of literature search, expert opinion, and/or a modified Delphi process | 61 recommendations across 18 medical and surgical specialties |