Below is a selection of recent journal articles and reports which are disinvestment in healthcare. If you are looking to answer a specific question please submit a literature search request at the link above. If you would like to be alerted when new content is available here then please sign in and select Follow. You are welcome to leave comments and suggestions below in the comments section.
Calabro, GE., Torre, G La., Waure, C de., et al (2018) Disinvestment in healthcare: an overview of HTA agencies and organisations activities at European level. BMC Health Services Research 18: 148. Today, in a healthcare context characterized by resource scarcity and increasing service demand, “disinvestment” from low-value services and reinvestment in high-value ones is a key strategy that may be supported by HTA. The lack of evaluation of technologies in use, in particular at the end of their lifecycle, may be due to the scant availability of frameworks and guidelines for identification and assessment of obsolete technologies that was shown by our work. Although several projects were carried out in different countries, most remain constrained to the field of research. Disinvestment is a relatively new concept in HTA that could pose challenges also from a methodological point of view. To tackle these challenges, it is necessary to construct experiences at international level with the aim to develop new methodological approaches to produce and grow evidence on disinvestment policies and practices.
Chambers, JD., Salem, MN., D'Cruz, BN., et al (2018) A review of empirical analysis of disinvestment initiatives. Value Health 20(7): 909-918. The success of disinvestment initiatives has been mixed, with fewer than half the indentified empirical studies reporting that use of the low-value service was reduced. Our findings suggest that promotion of the disinvestment initiative among clinicians is a key component to the success of the disinvestment initiative.
Daniels, T., Williams, I., Bryan, S., Mitton, C. (2018) Involving citizens in disinvestment decisions: what do health professionals think? Findings froma multi-method study in the English NHS. Health Economics, Policy and Law 13(2):162-188. Public involvement in disinvestment decision making in health care is widely advocated, and in some cases legally mandated. However, attempts to involve the public in other areas of health policy have been accused of tokenism and manipulation. This paper presents research into the views of local health care leaders in the English National Health Service (NHS) with regards to the involvement of citizens and local communities in disinvestment decision making. The research includes a Q study and follow-up interviews with a sample of health care clinicians and managers in senior roles in the English NHS. It finds that whilst initial responses suggest high levels of support for public involvement, further probing of attitudes and experiences shows higher levels of ambivalence and risk aversion and a far more cautious overall stance. This study has implications for the future of disinvestment activities and public involvement in health care systems faced with increased resource constraint. Recommendations are made for future research and practice.
Harris, C., Green, S. Elshaug, AG. (2017) Sustainability in Health care by Allocating Resources Effectively (SHARE) 10: operationalising disinvestment in a conceptual framework for resource allocation. BMC Health Services Research 17: 632. The framework can be employed at network, institutional, departmental, ward or committee level. It is proposed as an organisation-wide application, embedded within existing systems and processes, which can be responsive to needs and priorities at the level of implementation. It can be used in policy, management or clinical contexts.
Hasson, H., Nilson, P., Augustsson, H., Thiele Schwarz, U Von. (2018) Empiral and conceptual investigation of de-implimentation of low-value care from professional and health care system perspectives: a study protocol. Implementation Science 1391): 67 This project contributes new knowledge to implementation science consisting of empirical data, a conceptual framework, and strategy suggestions on de-implementation of low-value care. The professionals' perspectives will be highlighted, including insights into how they make decisions, handle de-implementation in daily practice, and what consequences it has on their work. Furthermore, the health care system perspective will be considered and new knowledge on how de-implementation can be understood across health care system levels will be obtained. The theories of habits and developmental learning can also offer insights into how context triggers and reinforces certain behaviors and how factors at the individual and the organizational levels interact. The project employs a solution-oriented perspective by developing a framework for de-implementation of low-value practices and suggesting practical strategies to improve de-implementation processes at all levels of the health care system. The framework and the strategies can thereafter be evaluated for their validity and impact in future studies.
Leigh, JP., Niven, DJ., Boyd, JM., Stelfox, HT. Developing a framework to guide the de-adoption of low-value clinical practices in acute care medicine: a study protocol. BMC Health Services Research 17: 54. There is a growing body of literature suggesting that the de-adoption of ineffective or harmful practices from patient care is integral to the delivery of high quality care and healthcare sustainability. The framework developed in this study will map barriers and facilitators to de-adoption to the most appropriate interventions, allowing stakeholders to effectively initiate, execute and sustain this process in an evidence-based manner.
Moore, L., Boukar, KM., Tardif, P., et al. (2017) Low-value clinical practices in injury care: a scoping review protocol, BMJ Open 7(7): e016024. We will perform a scoping review of peer-reviewed and non-peer-reviewed literature to identify research articles, reviews, recommendations and guidelines that identify at least one low-value clinical practice specific to injury populations. We will search Medline, EMBASE, COCHRANE central, and BIOSIS/Web of Knowledge databases, websites of government agencies, professional societies and patient advocacy organisations, thesis holdings and conference proceedings. Pairs of independent reviewers will evaluate studies for eligibility and extract data from included articles using a prepiloted and standardised electronic data abstraction form. Low-value clinical practices will be categorised using an extension of the Agency for Healthcare Research and Quality conceptual framework and data will be presented using narrative synthesis.
Niven, DJ., Mrklas, KJ., Holodinsky, JK., et al. (2015) Towards undestanding the de-adoption of low-value clinical practices: a scoping review. BMC Medicine 13:255. This review identified a large body of literature that describes current approaches and challenges to de-adoption of low-value clinical practices. Additional research is needed to determine an ideal strategy for identifying low-value practices, and facilitating and sustaining de-adoption. In the meantime, this study proposes a model that providers and decision-makers can use to guide efforts to de-adopt ineffective and harmful practices.