Towards understanding the de-adoption of low-value clinical practices: a scoping review
Low-value clinical practices are common in healthcare, yet the optimal approach to de-adopting these practices is unknown. The objective of this study was to systematically review the literature on de-adoption, document current terminology and frameworks, map the literature to a proposed framework,...
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| Published in: | BMC medicine Vol. 13; no. 1; p. 255 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
BioMed Central Ltd
06-10-2015
BioMed Central |
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| Online Access: | Get full text |
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| Abstract | Low-value clinical practices are common in healthcare, yet the optimal approach to de-adopting these practices is unknown. The objective of this study was to systematically review the literature on de-adoption, document current terminology and frameworks, map the literature to a proposed framework, identify gaps in our understanding of de-adoption, and identify opportunities for additional research.
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts and Reviews of Effects, and CINAHL Plus were searched from 1 January 1990 to 5 March 2014. Additional citations were identified from bibliographies of included citations, relevant websites, the PubMed 'related articles' function, and contacting experts in implementation science. English-language citations that referred to de-adoption of clinical practices in adults with medical, surgical, or psychiatric illnesses were included. Citation selection and data extraction were performed independently and in duplicate.
From 26,608 citations, 109 were included in the final review. Most citations (65%) were original research with the majority (59%) published since 2010. There were 43 unique terms referring to the process of de-adoption-the most frequently cited was "disinvest" (39% of citations). The focus of most citations was evaluating the outcomes of de-adoption (50%), followed by identifying low-value practices (47%), and/or facilitating de-adoption (40%). The prevalence of low-value practices ranged from 16% to 46%, with two studies each identifying more than 100 low-value practices. Most articles cited randomized clinical trials (41%) that demonstrate harm (73%) and/or lack of efficacy (63%) as the reason to de-adopt an existing clinical practice. Eleven citations described 13 frameworks to guide the de-adoption process, from which we developed a model for facilitating de-adoption. Active change interventions were associated with the greatest likelihood of de-adoption.
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. |
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| AbstractList | Background Low-value clinical practices are common in healthcare, yet the optimal approach to de-adopting these practices is unknown. The objective of this study was to systematically review the literature on de-adoption, document current terminology and frameworks, map the literature to a proposed framework, identify gaps in our understanding of de-adoption, and identify opportunities for additional research. Methods MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts and Reviews of Effects, and CINAHL Plus were searched from 1 January 1990 to 5 March 2014. Additional citations were identified from bibliographies of included citations, relevant websites, the PubMed 'related articles' function, and contacting experts in implementation science. English-language citations that referred to de-adoption of clinical practices in adults with medical, surgical, or psychiatric illnesses were included. Citation selection and data extraction were performed independently and in duplicate. Results From 26,608 citations, 109 were included in the final review. Most citations (65 %) were original research with the majority (59 %) published since 2010. There were 43 unique terms referring to the process of de-adoption-the most frequently cited was "disinvest" (39 % of citations). The focus of most citations was evaluating the outcomes of de-adoption (50 %), followed by identifying low-value practices (47 %), and/or facilitating de-adoption (40 %). The prevalence of low-value practices ranged from 16 % to 46 %, with two studies each identifying more than 100 low-value practices. Most articles cited randomized clinical trials (41 %) that demonstrate harm (73 %) and/or lack of efficacy (63 %) as the reason to de-adopt an existing clinical practice. Eleven citations described 13 frameworks to guide the de-adoption process, from which we developed a model for facilitating de-adoption. Active change interventions were associated with the greatest likelihood of de-adoption. Conclusions 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. Low-value clinical practices are common in healthcare, yet the optimal approach to de-adopting these practices is unknown. The objective of this study was to systematically review the literature on de-adoption, document current terminology and frameworks, map the literature to a proposed framework, identify gaps in our understanding of de-adoption, and identify opportunities for additional research. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts and Reviews of Effects, and CINAHL Plus were searched from 1 January 1990 to 5 March 2014. Additional citations were identified from bibliographies of included citations, relevant websites, the PubMed 'related articles' function, and contacting experts in implementation science. English-language citations that referred to de-adoption of clinical practices in adults with medical, surgical, or psychiatric illnesses were included. Citation selection and data extraction were performed independently and in duplicate. From 26,608 citations, 109 were included in the final review. Most citations (65%) were original research with the majority (59%) published since 2010. There were 43 unique terms referring to the process of de-adoption-the most frequently cited was "disinvest" (39% of citations). The focus of most citations was evaluating the outcomes of de-adoption (50%), followed by identifying low-value practices (47%), and/or facilitating de-adoption (40%). The prevalence of low-value practices ranged from 16% to 46%, with two studies each identifying more than 100 low-value practices. Most articles cited randomized clinical trials (41%) that demonstrate harm (73%) and/or lack of efficacy (63%) as the reason to de-adopt an existing clinical practice. Eleven citations described 13 frameworks to guide the de-adoption process, from which we developed a model for facilitating de-adoption. Active change interventions were associated with the greatest likelihood of de-adoption. 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. Low-value clinical practices are common in healthcare, yet the optimal approach to de-adopting these practices is unknown. The objective of this study was to systematically review the literature on de-adoption, document current terminology and frameworks, map the literature to a proposed framework, identify gaps in our understanding of de-adoption, and identify opportunities for additional research. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts and Reviews of Effects, and CINAHL Plus were searched from 1 January 1990 to 5 March 2014. Additional citations were identified from bibliographies of included citations, relevant websites, the PubMed 'related articles' function, and contacting experts in implementation science. English-language citations that referred to de-adoption of clinical practices in adults with medical, surgical, or psychiatric illnesses were included. Citation selection and data extraction were performed independently and in duplicate. From 26,608 citations, 109 were included in the final review. Most citations (65 %) were original research with the majority (59 %) published since 2010. There were 43 unique terms referring to the process of de-adoption--the most frequently cited was "disinvest" (39 % of citations). The focus of most citations was evaluating the outcomes of de-adoption (50 %), followed by identifying low-value practices (47 %), and/or facilitating de-adoption (40 %). The prevalence of low-value practices ranged from 16 % to 46 %, with two studies each identifying more than 100 low-value practices. Most articles cited randomized clinical trials (41 %) that demonstrate harm (73 %) and/or lack of efficacy (63 %) as the reason to de-adopt an existing clinical practice. Eleven citations described 13 frameworks to guide the de-adoption process, from which we developed a model for facilitating de-adoption. Active change interventions were associated with the greatest likelihood of de-adoption. 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. BACKGROUNDLow-value clinical practices are common in healthcare, yet the optimal approach to de-adopting these practices is unknown. The objective of this study was to systematically review the literature on de-adoption, document current terminology and frameworks, map the literature to a proposed framework, identify gaps in our understanding of de-adoption, and identify opportunities for additional research.METHODSMEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts and Reviews of Effects, and CINAHL Plus were searched from 1 January 1990 to 5 March 2014. Additional citations were identified from bibliographies of included citations, relevant websites, the PubMed 'related articles' function, and contacting experts in implementation science. English-language citations that referred to de-adoption of clinical practices in adults with medical, surgical, or psychiatric illnesses were included. Citation selection and data extraction were performed independently and in duplicate.RESULTSFrom 26,608 citations, 109 were included in the final review. Most citations (65%) were original research with the majority (59%) published since 2010. There were 43 unique terms referring to the process of de-adoption-the most frequently cited was "disinvest" (39% of citations). The focus of most citations was evaluating the outcomes of de-adoption (50%), followed by identifying low-value practices (47%), and/or facilitating de-adoption (40%). The prevalence of low-value practices ranged from 16% to 46%, with two studies each identifying more than 100 low-value practices. Most articles cited randomized clinical trials (41%) that demonstrate harm (73%) and/or lack of efficacy (63%) as the reason to de-adopt an existing clinical practice. Eleven citations described 13 frameworks to guide the de-adoption process, from which we developed a model for facilitating de-adoption. Active change interventions were associated with the greatest likelihood of de-adoption.CONCLUSIONSThis 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. Background Low-value clinical practices are common in healthcare, yet the optimal approach to de-adopting these practices is unknown. The objective of this study was to systematically review the literature on de-adoption, document current terminology and frameworks, map the literature to a proposed framework, identify gaps in our understanding of de-adoption, and identify opportunities for additional research. Methods MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Cochrane Database of s and Reviews of Effects, and CINAHL Plus were searched from 1 January 1990 to 5 March 2014. Additional citations were identified from bibliographies of included citations, relevant websites, the PubMed 'related articles' function, and contacting experts in implementation science. English-language citations that referred to de-adoption of clinical practices in adults with medical, surgical, or psychiatric illnesses were included. Citation selection and data extraction were performed independently and in duplicate. Results From 26,608 citations, 109 were included in the final review. Most citations (65 %) were original research with the majority (59 %) published since 2010. There were 43 unique terms referring to the process of de-adoption--the most frequently cited was "disinvest" (39 % of citations). The focus of most citations was evaluating the outcomes of de-adoption (50 %), followed by identifying low-value practices (47 %), and/or facilitating de-adoption (40 %). The prevalence of low-value practices ranged from 16 % to 46 %, with two studies each identifying more than 100 low-value practices. Most articles cited randomized clinical trials (41 %) that demonstrate harm (73 %) and/or lack of efficacy (63 %) as the reason to de-adopt an existing clinical practice. Eleven citations described 13 frameworks to guide the de-adoption process, from which we developed a model for facilitating de-adoption. Active change interventions were associated with the greatest likelihood of de-adoption. Conclusions 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. Keywords: Abandon, Contradict, De-adoption, De-implementation, Disinvestment, Low-value, Medical reversal, Obsolete, Reassess, Withdrawal |
| ArticleNumber | 255 |
| Audience | Academic |
| Author | Hemmelgarn, Brenda R Mrklas, Kelly J Holodinsky, Jessalyn K Straus, Sharon E Niven, Daniel J Stelfox, Henry Thomas Jeffs, Lianne P |
| Author_xml | – sequence: 1 givenname: Daniel J surname: Niven fullname: Niven, Daniel J email: Daniel.niven@albertahealthservices.ca, Daniel.niven@albertahealthservices.ca organization: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. Daniel.niven@albertahealthservices.ca – sequence: 2 givenname: Kelly J surname: Mrklas fullname: Mrklas, Kelly J email: Kelly.mrklas@albertahealthservices.ca organization: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. Kelly.mrklas@albertahealthservices.ca – sequence: 3 givenname: Jessalyn K surname: Holodinsky fullname: Holodinsky, Jessalyn K email: jkholodi@ucalgary.ca organization: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. jkholodi@ucalgary.ca – sequence: 4 givenname: Sharon E surname: Straus fullname: Straus, Sharon E email: Sharon.straus@utoronto.ca organization: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, M5B 1T8, Canada. Sharon.straus@utoronto.ca – sequence: 5 givenname: Brenda R surname: Hemmelgarn fullname: Hemmelgarn, Brenda R email: Brenda.hemmelgarn@albertahealthservices.ca, Brenda.hemmelgarn@albertahealthservices.ca organization: Department of Medicine, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. Brenda.hemmelgarn@albertahealthservices.ca – sequence: 6 givenname: Lianne P surname: Jeffs fullname: Jeffs, Lianne P email: jeffsl@smh.ca organization: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, M5B 1T8, Canada. jeffsl@smh.ca – sequence: 7 givenname: Henry Thomas surname: Stelfox fullname: Stelfox, Henry Thomas email: tstelfox@ucalgary.ca, tstelfox@ucalgary.ca, tstelfox@ucalgary.ca organization: Department of Medicine, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. tstelfox@ucalgary.ca |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26444862$$D View this record in MEDLINE/PubMed |
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Arch Intern Med. 2012 Apr 23;172(8):656-9; discussion 659 21349971 - AJNR Am J Neuroradiol. 2011 Apr;32(4):647-8 20185495 - BMJ. 2010;340:c572 25889285 - Implement Sci. 2015;10:24 488_CR111 AG Elshaug (488_CR48) 2009; 190 DS Echt (488_CR3) 1991; 324 ID Graham (488_CR41) 2006; 26 C Cooper (488_CR60) 2010; 340 AG Elshaug (488_CR66) 2007; 4 488_CR115 S Garner (488_CR70) 2013; 18 D Mortimer (488_CR68) 2010; 10 DJ Niven (488_CR45) 2015; 175 L Leggett (488_CR58) 2012; 28 488_CR109 D Atkins (488_CR126) 2009; 25 AG Elshaug (488_CR8) 2012; 197 AM Watt (488_CR47) 2012; 28 488_CR22 488_CR21 BD Atwater (488_CR90) 2009; 32 488_CR20 E Setakis (488_CR34) 2008; 59 SR Majumdar (488_CR98) 2004; 292 N Ibargoyen-Roteta (488_CR55) 2010; 98 M Moscucci (488_CR116) 2011; 171 B Ahmed (488_CR93) 2011; 4 AG Elshaug (488_CR49) 2008; 24 C Cameron (488_CR6) 2010; 182 Second International Study of Infarct Survival (ISIS-2) Collaborative Group (488_CR1) 1988; 332 CA Chamberlain (488_CR56) 2013; 13 WF Huang (488_CR122) 2007; 7 W Smalley (488_CR121) 2000; 284 J Karnon (488_CR61) 2009; 7 PJ Hauptman (488_CR18) 2006; 296 JL Warner (488_CR114) 2013; 88 JR Landis (488_CR17) 1977; 33 P Thiebaud (488_CR31) 2006; 9 VM Voorn (488_CR125) 2012; 7 JE Sindby (488_CR26) 2011; 1 RS Stafford (488_CR37) 2003; 163 HD Banta (488_CR108) 1990; 264 C Donaldson (488_CR72) 2010; 103 DM Fatovich (488_CR117) 2013; 25 HB Gershengorn (488_CR128) 2013; 41 N Ibargoyen-Roteta (488_CR54) 2009; 25 V Prasad (488_CR107) 2012; 307 CL Roumie (488_CR25) 2004; 141 FY Hsiao (488_CR36) 2009; 31 A Tatsioni (488_CR86) 2010; 25 RN Moynihan (488_CR53) 2012; 196 C Henshall (488_CR52) 2012; 28 JM Hislop (488_CR76) 2011; 14 D Levac (488_CR11) 2010; 5 D Kulawik (488_CR28) 2009; 22 V Prasad (488_CR7) 2013; 88 JS Haas (488_CR118) 2004; 140 KJ Kowalczyk (488_CR82) 2012; 61 F Xie (488_CR95) 2005; 18 SX Sun (488_CR33) 2007; 23 V Prasad (488_CR4) 2011; 84 DA Hughes (488_CR63) 2010; 340 V Prasad (488_CR113) 2012; 172 CK Cassel (488_CR40) 2012; 307 DH Howard (488_CR101) 2011; 46 CD Naylor (488_CR123) 2004; 291 G MacKean (488_CR110) 2013; 29 488_CR57 D Moher (488_CR12) 2009; 151 M Sampson (488_CR13) 2009; 62 W Hollingworth (488_CR23) 2013; 16 C Duhigg (488_CR44) 2012 V Prasad (488_CR65) 2014; 9 M Paulden (488_CR74) 2012; 15 N Barozzi (488_CR32) 2007; 16 M Haas (488_CR42) 2012; 36 AM Watt (488_CR46) 2012; 7 MP Sukel (488_CR35) 2008; 17 KK Koo (488_CR87) 2011; 39 A Bonakdar tehrani (488_CR84) 2011; 14 T Noseworthy (488_CR71) 2012; 28 JP Ioannidis (488_CR83) 2013; 88 RS Wiener (488_CR91) 2007; 298 FL Kiechle (488_CR112) 2014; 427 LE Leggett (488_CR59) 2012; 10 T Haines (488_CR73) 2014; 67 SE Straus (488_CR15) 2013 V Prasad (488_CR5) 2011; 171 MT Luetmer (488_CR88) 2011; 32 RS Stafford (488_CR96) 2004; 291 SR Majumdar (488_CR97) 2001; 16 J Polisena (488_CR19) 2013; 29 JP Ioannidis (488_CR24) 2005; 294 488_CR78 V Ehrenstein (488_CR94) 2013; 3 488_CR77 F Werf Van De (488_CR2) 1999; 354 488_CR79 M Azermai (488_CR102) 2014; 18 MR Macleod (488_CR39) 2014; 383 488_CR130 MW Deyell (488_CR89) 2011; 171 PC Austin (488_CR99) 2003; 289 EM Rogers (488_CR9) 2003 K Hodgetts (488_CR62) 2012; 75 D Ross-Degnan (488_CR29) 1993; 270 R Nieuwlaat (488_CR50) 2013; 34 RR Massatti (488_CR100) 2008; 35 IP Williams (488_CR67) 2007; 65 488_CR81 488_CR80 D Grady (488_CR38) 2010; 170 DJ Murphy (488_CR92) 2013; 41 D Williams (488_CR30) 2006; 62 S Pearson (488_CR75) 2007; 12 N Krol (488_CR27) 2004; 19 T Greenhalgh (488_CR16) 2005 V Prasad (488_CR85) 2013; 88 GCM Siontis (488_CR119) 2009; 157 SQ Duffy (488_CR105) 1992; 30 B Lawton (488_CR124) 2003; 327 H Arksey (488_CR10) 2005; 8 ME Brunt (488_CR120) 2003; 18 AL Hersh (488_CR103) 2004; 291 JM Street (488_CR64) 2011; 27 S Nuti (488_CR69) 2010; 95 DH Howard (488_CR106) 2012; 23 S Garner (488_CR51) 2011; 343 A Tatsioni (488_CR104) 2007; 298 T Montini (488_CR43) 2015; 10 AG Elshaug (488_CR127) 2013; 309 P Colmenares (488_CR129) 2012; 111 488_CR14 |
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| Snippet | Low-value clinical practices are common in healthcare, yet the optimal approach to de-adopting these practices is unknown. The objective of this study was to... Background Low-value clinical practices are common in healthcare, yet the optimal approach to de-adopting these practices is unknown. The objective of this... BACKGROUNDLow-value clinical practices are common in healthcare, yet the optimal approach to de-adopting these practices is unknown. The objective of this... |
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| SubjectTerms | Clinical medicine Decision Making Drug therapy Drugs Funding Humans Librarians Patient outcomes Patient Safety Peer review Peer Review, Health Care Practice Patterns, Physicians' - standards Pulmonary arteries Qualitative research Quality Improvement Studies Technology adoption Type 2 diabetes Utilization Review Womens health |
| Title | Towards understanding the de-adoption of low-value clinical practices: a scoping review |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/26444862 https://www.proquest.com/docview/1779863870 https://search.proquest.com/docview/1721351522 https://pubmed.ncbi.nlm.nih.gov/PMC4596285 |
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