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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
  1. aMajor clinical journals included New England Journal of Medicine, Journal of the American Medical Association, and The Lancet
  2. bMedical reversal occurs when a new study—superior to predecessors because of better design, increased power, or more appropriate controls—contradicts current clinical practice [5]
  3. cConference abstract limited availability of data from this study
  4. dReplacement = new practice surpasses older standard of care; back to the drawing board = new practice fails to surpass standard of care; reversal = current practice inferior to a lesser or prior standard; reaffirmation = existing practice superior to a lesser or prior standard
  5. NICE National Institute for Health and Care Excellence, PCT, Primary Care Trusts