Top

BMC Health Services Research

Published in:

Open Access 01-12-2017 | Research article

Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting

Authors: Claire Harris, Kelly Allen, Vanessa Brooke, Tim Dyer, Cara Waller, Richard King, Wayne Ramsey, Duncan Mortimer

Published in: BMC Health Services Research | Issue 1/2017

Abstract

Background

This is the sixth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE program was established to investigate a systematic, integrated, evidence-based approach to disinvestment within a large Australian health service. This paper describes the methods employed in undertaking pilot disinvestment projects. It draws a number of lessons regarding the strengths and weaknesses of these methods; particularly regarding the crucial first step of identifying targets for disinvestment.

Methods

Literature reviews, survey, interviews, consultation and workshops were used to capture and process the relevant information. A theoretical framework was adapted for evaluation and explication of disinvestment projects, including a taxonomy for the determinants of effectiveness, process of change and outcome measures. Implementation, evaluation and costing plans were developed.

Results

Four literature reviews were completed, surveys were received from 15 external experts, 65 interviews were conducted, 18 senior decision-makers attended a data gathering workshop, 22 experts and local informants were consulted, and four decision-making workshops were undertaken. Mechanisms to identify disinvestment targets and criteria for prioritisation and decision-making were investigated. A catalogue containing 184 evidence-based opportunities for disinvestment and an algorithm to identify disinvestment projects were developed. An Expression of Interest process identified two potential disinvestment projects. Seventeen additional projects were proposed through a non-systematic nomination process. Four of the 19 proposals were selected as pilot projects but only one reached the implementation stage. Factors with potential influence on the outcomes of disinvestment projects are discussed and barriers and enablers in the pilot projects are summarised.

Conclusion

This study provides an in-depth insight into the experience of disinvestment in one local healthcare service. To our knowledge, this is the first paper to report the process of disinvestment from identification, through prioritisation and decision-making, to implementation and evaluation, and finally explication of the processes and outcomes.

Available only for authorised users

Harris C, Green S, Ramsey W, Allen K, King R. Sustainability in Health care by Allocating Resources Effectively (SHARE) 9: Conceptualising disinvestment in the local healthcare setting. BMC Health Serv Res. 2017 in press.

Harris C, Garrubba M, Allen K, King R, Kelly C, Thiagarajan M, et al. Development, implementation and evaluation of an evidence-based program for introduction of new health technologies and clinical practices in a local healthcare setting. BMC Health Serv Res. 2015;15(1):575. doi:10.1186/s12913-015-1178-4.PubMedPubMedCentralCrossRef

Evans BA, Snooks H, Howson H, Davies M. How hard can it be to include research evidence and evaluation in local health policy implementation? Results from a mixed methods study. Implement Sci. 2013;8:17. doi:10.1186/1748-5908-8-17.PubMedPubMedCentralCrossRef

Garcia-Armesto S, Campillo-Artero C, Bernal-Delgado E. Disinvestment in the age of cost-cutting sound and fury. Tools for the Spanish National Health System. Health Policy. 2013;110(2–3):180–5. doi:10.1016/j.healthpol.2013.01.007.PubMedCrossRef

Polisena J, Clifford T, Elshaug AG, Mitton C, Russell E, Skidmore B. Case studies that illustrate disinvestment and resource allocation decision-making processes in health care: A systematic review. Int J Technol Assess Health Care. 2013;29(2):174–84. doi:10.1017/s0266462313000068.PubMedCrossRef

Robinson S, Glasby J, Allen K. ‘It ain’t what you do it’s the way that you do it’: lessons for health care from decommissioning of older people’s services. Health Soc Care Community. 2013;21(6):614–22. doi:10.1111/hsc.12046.PubMed

Henshall C, Schuller T, Mardhani-Bayne L. Using health technology assessment to support optimal use of technologies in current practice: the challenge of “disinvestment”. Int J Technol Assess Health Care. 2012;28(3):203–10. doi:10.1017/s0266462312000372.PubMedCrossRef

Leggett L, Noseworthy TW, Zarrabi M, Lorenzetti D, Sutherland LR, Clement FM. Health technology reassessment of non-drug technologies: current practices. Int J Technol Assess Health Care. 2012;28(3):220–7. doi:10.1017/S0266462312000438.PubMedCrossRef

Robinson S, Williams I, Dickinson H, Freeman T, Rumbold B. Priority-setting and rationing in healthcare: evidence from the English experience. Soc Sci Med. 2012;75(12):2386–93. doi:10.1016/j.socscimed.2012.09.014.PubMedCrossRef

10.

Watt AM, Hiller JE, Braunack-Mayer AJ, Moss JR, Buchan H, Wale J, et al. The ASTUTE Health study protocol: deliberative stakeholder engagements to inform implementation approaches to healthcare disinvestment. Implement Sci. 2012;7:101. doi:10.1186/1748-5908-7-101.PubMedPubMedCentralCrossRef

11.

Gerdvilaite J, Nachtnebel A. Disinvestment: overview of disinvestment experiences and challenges in selected countries. HTA-Projektbericht., vol Nr. 57. Ludwig Boltzmann Institut für Health Technology Assessment; 2011.

12.

Riley BL, Robinson KL, Gamble J, Finegood DT, Sheppard D, Penney TL, et al. Knowledge to action for solving complex problems: insights from a review of nine international cases. Health Promot Chronic Dis Prev Can. 2015;35(3):47–53.PubMedPubMedCentralCrossRef

13.

Harris C, Green S, Ramsey W, Allen K, King R. Sustainability in Health care by Allocating Resources Effectively (SHARE) 1: Introducing a series of papers reporting an investigation of disinvestment in a local healthcare setting. BMC Health Serv Res. 2017. doi:10.1186/s12913-017-2210-7.

14.

Harris C, Allen K, Waller C, Green S, King R, Ramsey W, et al. Sustainability in Health care by Allocating Resources Effectively (SHARE) 5: Developing a model for evidence-driven resource allocation in the local healthcare setting. BMC Health Serv Res. 2017. doi:10.1186/s12913-017-2208-1.

15.

Harris C, Allen K, Waller C, Dyer T, Brooke V, Garrubba M, et al. Sustainability in Health care by Allocating Resources Effectively (SHARE) 7: Supporting staff in evidence-based decision-making, implementation and evaluation in a local healthcare setting. BMC Health Serv Res. 2017 in press.

16.

Harris C, Garrubba M, Melder A, Voutier C, Waller C, King R, et al. Sustainability in Health care by Allocating Resources Effectively (SHARE) 8: Developing, implementing and evaluating an Evidence Dissemination Service in a local healthcare setting. BMC Health Serv Res. 2017 in press.

17.

Niven DJ, Mrklas KJ, Holodinsky JK, Straus SE, Hemmelgarn BR, Jeffs LP, et al. Towards understanding the de-adoption of low-value clinical practices: a scoping review. BMC Med. 2015;13:255. doi:10.1186/s12916-015-0488-z.PubMedPubMedCentralCrossRef

18.

Daniels T, Williams I, Robinson S, Spence K. Tackling disinvestment in health care services. The views of resource allocators in the English NHS. J Health Organ Manag. 2013;27(6):762–80.PubMedCrossRef

19.

Leggett L, MacKean G, Noseworthy T, Sutherland L, Clement F. Current status of health technology reassessment of non-drug technologies: survey and key informant interviews. Health Res Policy Syst. 2012. doi:10.1186/1478-4505-10-38.

20.

Eddama O, Coast J. A systematic review of the use of economic evaluation in local decision-making. Health Policy. 2008;86(2–3):129–41. doi:10.1016/j.healthpol.2007.11.010.PubMedCrossRef

21.

Hollingworth W, Rooshenas L, Busby J, Hine CE, Badrinath P, Whiting PF, et al. Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study. Southampton: Queen’s Printer and Controller of HMSO 2015; 2015.

22.

Paprica PA, Culyer AJ, Elshaug AG, Peffer J, Sandoval GA. From talk to action: Policy stakeholders, appropriateness, and selective disinvestment. Int J Technol Assess Health Care. 2015;31(4):236–40. doi:10.1017/s0266462315000392.PubMedPubMedCentralCrossRef

23.

Rooshenas L, Owen-Smith A, Hollingworth W, Badrinath P, Beynon C, Donovan JL. “I won’t call it rationing…”: an ethnographic study of healthcare disinvestment in theory and practice. Soc Sci Med. 2015;128:273–81. doi:10.1016/j.socscimed.2015.01.020.PubMedCrossRef

24.

Mayer J, Nachtnebel A. Disinvesting from ineffective technologies: Lessons learned from current programs. Int J Technol Assess Health Care. 2015;1–8. doi:10.1017/s0266462315000641.

25.

Michie S, Fixsen D, Grimshaw JM, Eccles MP. Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci. 2009;4:40. doi:10.1186/1748-5908-4-40.PubMedPubMedCentralCrossRef

26.

Douet L, Milne R, Anstee S, Habens F, Young A, Wright D. The completeness of intervention descriptions in published National Institute of Health Research HTA-funded trials: a cross-sectional study. BMJ Open. 2014;4(1):e003713. doi:10.1136/bmjopen-2013-003713.PubMedPubMedCentralCrossRef

27.

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach. BMC Med Res Methodol. 2011;11:100. doi:10.1186/1471-2288-11-100.PubMedPubMedCentralCrossRef

28.

Baxter P, Jack S. Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers. Qual Rep. 2008;13(4):544–59.

29.

Gilson L. Health Policy and Systems Research: A Methodology Reader. Alliance for Health Policy and Systems Research, World Health Organization; 2012. Available from: http://www.who.int/alliance-hpsr/alliancehpsr_reader.pdf. Accessed 5 May 2017.

30.

Yin R. Case study research, design and method. 4th ed. London: Sage Publications Ltd; 2009.

31.

Harris C, Turner T, Wilkinson F. SEAchange: Guide to a pragmatic evidence-based approach to Sustainable, Effective and Appropriate change in health services. 2015. Available from: http://arrow.monash.edu.au/hdl/1959.1/1225377. Accessed 5 May 2017.

32.

Meyer J. Qualitative research in health care. Using qualitative methods in health related action research. BMJ. 2000;320(7228):178–81.PubMedPubMedCentralCrossRef

33.

Meyer J. Evaluating action research. Age Ageing. 2000;29 Suppl 2:8–10.PubMedCrossRef

34.

NVivo qualitative data analysis software Version 8. QSR International Pty Ltd; 2008. http://www.qsrinternational.com/. Accessed 5 May 2017.

35.

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88. doi:10.1177/1049732305276687.PubMedCrossRef

36.

Srivastava A, Thomson SB. Framework analysis: a qualitative methodology for applied policy research. JOAAG. 2009;4(4):72–9.

37.

Centre for Clinical Effectiveness. Sustainability in Healthcare by Allocating Resources Effectively (SHARE): Evaluation and Research Plan. Southern Health; 2009. Available from: https://figshare.com/articles/Sustainability_in_Healthcare_by_Allocating_Resources_Effectively_SHARE_Evaluation_and_Research_Plan/3979575. Accessed 5 May 2017.

38.

Harris C, Allen K, King R, Ramsey W, Kelly C, Thiagarajan M. Sustainability in Health care by Allocating Resources Effectively (SHARE) 2: Identifying opportunities for disinvestment in a local healthcare setting. BMC Health Serv Res. 2017. doi:10.1186/s12913-017-2211-6.

39.

Harris C, Allen K, Waller C, Brooke V. Sustainability in Health care by Allocating Resources Effectively (SHARE) 3: Examining how resource allocation decisions are made, implemented and evaluated in a local healthcare setting. BMC Health Serv Res. 2017. doi:10.1186/s12913-017-2207-2.

40.

Harris C, Ko H, Waller C, Sloss P, Williams P. Sustainability in Health care by Allocating Resources Effectively (SHARE) 4: Exploring opportunities and methods for consumer engagement in resource allocation in a local healthcare setting. BMC Health Serv Res. 2017. doi:10.1186/s12913-017-2212-5.

41.

Bennett CC. Are we there yet? A journey of health reform in Australia. Med J Aust. 2013;199(4):251–5.PubMedCrossRef

42.

Mitchell MD, Williams K, Brennan PJ, Umscheid CA. Integrating local data into hospital-based healthcare technology assessment: two case studies. Int J Technol Assess Health Care. 2010;26(3):294–300. doi:10.1017/s0266462310000334.PubMedCrossRef

43.

Rubinstein A, Belizan M, Discacciati V. Are economic evaluations and health technology assessments increasingly demanded in times of rationing health services? The case of the Argentine financial crisis. Int J Technol Assess Health Care. 2007;23(2):169–76. doi:10.1017/s0266462307070274.PubMedCrossRef

44.

Centre for Clinical Effectiveness. Guide to implementation of health service protocols, procedures and guidelines. Southern Health; 2010. Available from: http://arrow.monash.edu.au/hdl/1959.1/1225381. Accessed 5 May 2017.

45.

Chamberlain CA, Martin RM, Busby J, Gilbert R, Cahill DJ, Hollingworth W. Trends in procedures for infertility and caesarean sections: was NICE disinvestment guidance implemented? NICE recommendation reminders. BMC Public Health. 2013;13:112. doi:10.1186/1471-2458-13-112.PubMedPubMedCentralCrossRef

46.

Haas M, Hall J, Viney R, Gallego G. Breaking up is hard to do: why disinvestment in medical technology is harder than investment. Aust Health Rev. 2012;36(2):148–52. doi:10.1071/AH11032.PubMedCrossRef

47.

Owens DK, Qaseem A, Chou R, Shekelle P. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med. 2011;154(3):174–80. doi:10.7326/0003-4819-154-3-201102010-00007.PubMedCrossRef

48.

Garner S, Littlejohns P. Disinvestment from low value clinical interventions: NICEly done? BMJ. 2011;343(jul27 2):d4519-d. doi:10.1136/bmj.d4519.CrossRef

49.

Pearson S, Littlejohns P. Reallocating resources: how should the National Institute for Health and Clinical Excellence guide disinvestment efforts in the National Health Service? J Health Serv Res Policy. 2007;12(3):160–5.PubMedCrossRef

50.

Cochrane Library. http://www.cochranelibrary.com/. Accessed 5 May 2017.

51.

International Network of Agencies for Health Technology Assessment (INAHTA). http://www.inahta.org/. Accessed 5 May 2017.

52.

National Institute for Health and Care Excellence (UK). https://www.nice.org.uk/. Accessed 5 May 2017.

53.

National Prescribing Service (Australia). http://www.nps.org.au/. Accessed 5 May 2017.

54.

Australia and New Zealand Horizon Scanning Network http://www.horizonscanning.gov.au/. Accessed 5 May 2017.

55.

National Institute of Health and Clinical Excellence. ‘Do Not Do’ Recommendations. UK: National Institute of Health and Clinical Excellence. http://www.nice.org.uk/savingsAndProductivity/collection?page=1&pageSize=2000&type=Do%20not%20do&published=&impact=Unclassified&filter=. Accessed 5 May 2017.

56.

Jones C. Procedures not routinely funded. Report to the Board. Birmingham: South Birmingham Primary Care Trust. 2006.

57.

National Library of Medicine Medical Subject Headings (MeSH). https://www.nlm.nih.gov/mesh/. Accessed 5 May 2017.

58.

International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification. https://www.accd.net.au/Icd10.aspx. Accessed 5 May 2017.

59.

McMaster Evidence Updates. https://plus.mcmaster.ca/evidenceupdates/. Accessed 5 May 2017.

60.

Academy Health. Glossary of Terms Commonly Used in Health Care. Washington, USA. 2004. https://govinfo.library.unt.edu/chc/resources/AcademyHealth_glossary_rd.pdf. Accessed 5 May 2017.

61.

U.S. Preventive Services Task Force. The Guide to Clinical Preventive Services Recommendations of the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality; 2014. Available from: http://www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care. Accessed 5 May 2017.

62.

HealthPACT. Disinvestment in Australia and New Zealand. Health Policy Advisory Committee on Technology; 2013. Available from: http://www.health.qld.gov.au/healthpact/docs/papers/workshop/disinvestment-report.pdf. Accessed 5 May 2017.

63.

Audit Commission. Reducing spending on low clinical value treatments. London: Health Briefing; 2011.

64.

Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307(17):1801–2. doi:10.1001/jama.2012.476.PubMedCrossRef

65.

Qaseem A, Alguire P, Dallas P, Feinberg LE, Fitzgerald FT, Horwitch C, et al. Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Ann Intern Med. 2012;156(2):147–9. doi:10.7326/0003-4819-156-2-201201170-00011.PubMedCrossRef

66.

Prasad V, Vandross A, Toomey C, Cheung M, Rho J, Quinn S, et al. A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices. In: Mayo Clinic proceedings Mayo Clinic. 2013. doi:10.1016/j.mayocp.2013.05.012.

67.

Elshaug AG, Watt AM, Mundy L, Willis CD. Over 150 potentially low-value health care practices: an Australian study. Med J Aust. 2012;197(10):556–60.PubMedCrossRef

68.

Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294(2):218–28. doi:10.1001/jama.294.2.218.PubMedCrossRef

69.

Admon AJ, Cooke CR. Will Choosing Wisely(R) Improve Quality and Lower Costs of Care for Patients with Critical Illness? Ann Am Thorac Soc. 2014. doi:10.1513/AnnalsATS.201403-093OI.

70.

Morden NE, Colla CH, Sequist TD, Rosenthal MB. Choosing wisely—the politics and economics of labeling low-value services. N Engl J Med. 2014;370(7):589–92. doi:10.1056/NEJMp1314965.PubMedPubMedCentralCrossRef

71.

Blumenthal-Barby JS. “Choosing Wisely” to Reduce Low-Value Care: A Conceptual and Ethical Analysis. J Med Philos. 2013;38(5):559–80. doi:10.1093/jmp/jht042.PubMedCrossRef

72.

Elshaug AG, McWilliams J, Landon BE. The value of low-value lists. JAMA. 2013;309(8):775–6. doi:10.1001/jama.2013.828.PubMedCrossRef

73.

Elshaug AG. Over 150 potentially low-value health care practices: an Australian study. Reply. Med J Aust. 2013;198(11):597–8.PubMedCrossRef

74.

Duckett S, Breadon P, Romanes D, Fennessy P, Nolan J. Questionable care: Stopping ineffective treatments. Grattan Institute; 2015. Available from: http://grattan.edu.au/wp-content/uploads/2015/08/828-Questionable-Care3.pdf. Accessed 5 May 2017.

75.

Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, Kerr EA. ‘Choosing Wisely’: a growing international campaign. BMJ Qual Saf. 2015;24(2):167–74. doi:10.1136/bmjqs-2014-003821.PubMedCrossRef

76.

Gallego G, Haas M, Hall J, Viney R. Reducing the use of ineffective health care interventions: an Evidence Check rapid review brokered by the Sax Institute for the NSW Treasury; 2010. Available from: https://www.saxinstitute.org.au/wp-content/uploads/21_Reducing-the-use-of-ineffective-health-care-interventions.pdf. Accessed 5 May 2017.

77.

Marks L, Weatherly H, Mason A. Prioritizing investment in public health and health equity: what can commissioners do? Public Health. 2013;127(5):410–8. doi:10.1016/j.puhe.2013.01.027.PubMedCrossRef

78.

Rubenfeld GD. Cost-effective critical care: cost containment and rationing. Semin Respir Crit Care Med. 2012;33(4):413–20. doi:10.1055/s-0032-1322411.PubMedCrossRef

79.

Hauck K, Smith P, Goddard M. The Economics of Priority Setting for Health Care: A Literature Review. Health, Nutrition and Population Discussion Paper World Bank; 2004. Available from: http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/Chapter3Final.pdf. Accessed 5 May 2017.

80.

Mitton C, Donaldson C. Tools of the trade: a comparative analysis of approaches to priority setting in healthcare. Health Serv Manag Res. 2003;16(2):96–105.CrossRef

81.

Segal L, Mortimer D. A population-based model for priority setting across the care continuum and across modalities. Cost Eff Resour Alloc. 2006;4:6.PubMedPubMedCentralCrossRef

82.

Murray CJ, Evans DB, Acharya A, Baltussen RM. Development of WHO guidelines on generalized cost-effectiveness analysis. Health Econ. 2000;9(3):235–51.PubMedCrossRef

83.

Mitton C, Dionne F, Donaldson C. Managing healthcare budgets in times of austerity: the role of program budgeting and marginal analysis. Appl Health Econ Health Policy. 2014;12(2):95–102. doi:10.1007/s40258-013-0074-5.PubMedPubMedCentralCrossRef

84.

Cornelissen E, Mitton C, Davidson A, Reid RC, Hole R, Visockas AM, et al. Changing priority setting practice: The role of implementation in practice change. Health Policy. 2014. doi:10.1016/j.healthpol.2014.04.010.

85.

Donaldson C, Bate A, Mitton C, Dionne F, Ruta D. Rational disinvestment. QJM. 2010;103(10):801–7. doi:10.1093/qjmed/hcq086.PubMedCrossRef

86.

Institute for Healthcare Improvement. Going Lean in Health Care. IHI Innovation Series white paper Cambridge, MA; 2005. Available from: http://www.ihi.org/knowledge/Pages/IHIWhitePapers/GoingLeaninHealthCare.aspx. Accessed 5 May 2017.

87.

O’Connell T, Ben-Tovim D, McCaughan B, Szwarcbord M, McGrath K. Health services under seige: the case for clinical process redesign. Med J Aust. 2008;188(6):S9–S13.PubMed

88.

The Health Communication Unit. Logic Models Workbook. Centre for Health Promotion, University of Toronto; 2001. Available from: http://www.blazesports.org/wp-content/uploads/2011/02/THCU-Logic-Model-Workbook.pdf. Accessed 5 May 2017.

89.

Speroff T, O’Connor G. Study designs for PDSA quality improvement research. Qual Manag Health Care. 2004;13(1):17–32.PubMedCrossRef

90.

Spath PL. Using failure mode and effects analysis to improve patient safety. AORN J. 2003;78(1):16–37.PubMedCrossRef

91.

Martin L, Neumann C, Mountford J, Bisognano M, Nolan T. Increasing Efficiency and Enhancing Value in Health Care: Ways to Achieve Savings in Operating Costs per Year. IHI Innovation. Innovation Series 2009. Institute for Healthcare Improvement; 2009. Available from: http://www.imagefirst.com/Portals/276565/docs/856157170.pdf. Accessed 5 May 2017.

92.

Nolan T. Execution of Strategic Improvement Initiatives to Produce System-Level Results. Innovation Series 2007. Institute for Healthcare Improvement; 2007. Available from: http://www.ihi.org/resources/Pages/IHIWhitePapers/ExecutionofStrategicImprovementInitiativesWhitePaper.aspx. Accessed 5 May 2017.

93.

Gabow P, Eisert S, Karkhanis A, Knight A, Dickson P. A Toolkit for Redesign in Health Care. AHRQ Publication No 05-0108-EF. Agency for Healthcare Research and Quality; 2005. Available from: http://archive.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/toolkit/toolkit.pdf. Accessed 5 May 2017.

94.

Robinson S, Dickinson H, Williams I, Freeman T, Rumbold B, Spence K. Setting priorities in health: A study of English primary care trusts. Health Services Management Centre, University of Birmingham and the Nuffield Trust; 2011.

95.

Schmidt DE. The development of a disinvestment framework to guide resource allocation decisions in health service delivery organizations. The University of British Columbia; 2010. Available from: https://open.library.ubc.ca/cIRcle/collections/ubctheses/24/items/1.0073252. Accessed 5 May 2017.

96.

Ibargoyen-Roteta N, Gutierrez-Ibarluzea I, Asua J. Guiding the process of health technology disinvestment. Health Policy. 2010;98(2–3):218–26. doi:10.1016/j.healthpol.2010.06.018.PubMedCrossRef

97.

National Health Committee NZ. Business Plan 2013/14-2015/16. Wellington: New Zealand Ministry of Health; 2013.

98.

Harris C, Green S, Elshaug AG. Sustainability in Health care by Allocating Resources Effectively (SHARE) 10: Operationalising disinvestment in an evidence-based framework for resource allocation BMC health services research. 2017 in press.

99.

Robert G, Harlock J, Williams I. Disentangling rhetoric and reality: an international Delphi study of factors and processes that facilitate the successful implementation of decisions to decommission healthcare services. Implement Sci. 2014;9(1):123. 10.1186/s13012-014-0123-y.PubMedPubMedCentralCrossRef

100.

Ruano-Ravina A, Velasco-Gonzalez M, Varela-Lema L, Cerda-Mota T, Ibargoyen-Roteta N, Gutierrez-Ibarluzea I, et al. Identification, prioritisation and assessment of obsolete health technologies. A methodolgical guideline. HTA Reports: avalia-t No. 2007/01: Galician Health Technology Assessment Agency; 2009.

101.

Leggat SG, Scheil W, Williams H, Kerin K. Tools for priority setting: lessons from South Australia. Aust Health Rev. 2006;30(1):65–72.PubMed

102.

Leggat S. Developing a clinical priority setting framework. Melbourne: South Australian Department of Health, Adelaide & La Trobe University, School of Public Health; 2004. Available from: http://www.health.vic.gov.au/archive/archive2010/ambulatorycare/ciyctrial/downloads/developing_clinical_priority_setting_framework.pdf. Accessed 5 May 2017.

103.

National Institute of Health and Clinical Excellence. Guide to the multiple technology appraisal process; 2009. Available from: https://www.nice.org.uk/Media/Default/About/what-we-do/NICE-guidance/NICE-technology-appraisals/Guide-to-the-multiple-technology-appraisal-process.pdf. Accessed 5 May 2017.

104.

Golan O, Hansen P, Kaplan G, Tal O. Health technology prioritization: which criteria for prioritizing new technologies and what are their relative weights? Health Policy. 2011;102(2–3):126–35. doi:10.1016/j.healthpol.2010.10.012.PubMedCrossRef

105.

Noorani HZ, Husereau DR, Boudreau R, Skidmore B. Priority setting for health technology assessments: a systematic review of current practical approaches. Int J Technol Assess Health Care. 2007;23(3):310–5. doi:10.1017/S026646230707050X.PubMedCrossRef

106.

Sabik LM, Lie RK. Priority setting in health care: Lessons from the experiences of eight countries. Int J Equity Health. 2008;7:4. doi:10.1186/1475-9276-7-4.PubMedPubMedCentralCrossRef

107.

Ibargoyen-Roteta N, Gutiérrez-Ibarluzea I, Asua J. Report on the development of the GuNFT Guideline. Guideline for Not Funding existing health Technologies in health care systems. Quality Plan for the NHS of the MHSP: Basque Office for Health Technology Assessment (Osteba); 2009.

108.

Elshaug A, Moss J, Littlejohns P, Karnon J, Merlin T, Hiller J. Identifying existing health care services that do not provide value for money. Med J Aust. 2009;190(5):269–73.PubMed

109.

Parkinson B, Sermet C, Clement F, Crausaz S, Godman B, Garner S, et al. Disinvestment and Value-Based Purchasing Strategies for Pharmaceuticals: An International Review. Pharmacoeconomics. 2015;33(9):905–24. doi:10.1007/s40273-015-0293-8.PubMedCrossRef

110.

Prasad V, Ioannidis JP. Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices. Implement Sci. 2014;9:1. doi:10.1186/1748-5908-9-1.PubMedPubMedCentralCrossRef

111.

Guindo LA, Wagner M, Baltussen R, Rindress D, van Til J, Kind P, et al. From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking. Cost Eff Resour Alloc. 2012;10(1):9. doi:10.1186/1478-7547-10-9.PubMedPubMedCentralCrossRef

112.

Tromp N, Baltussen R. Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers. BMC Health Serv Res. 2012;12:454. doi:10.1186/1472-6963-12-454.PubMedPubMedCentralCrossRef

113.

Tanios N, Wagner M, Tony M, Baltussen R, van Til J, Rindress D, et al. Which criteria are considered in healthcare decisions? Insights from an international survey of policy and clinical decision makers. Int J Technol Assess Health Care. 2013;29(04):456–65. doi:10.1017/S0266462313000573.PubMedCrossRef

114.

Golan O, Hansen P. Which health technologies should be funded? A prioritization framework based explicitly on value for money. Isr J Health Policy Res. 2012;1(1):44. doi:10.1186/2045-4015-1-44.PubMedPubMedCentralCrossRef

115.

Baltussen R, Mikkelsen E, Tromp N, Hurtig A, Byskov J, Olsen O, et al. Balancing efficiency, equity and feasibility of HIV treatment in South Africa–development of programmatic guidance. Cost Eff Resour Alloc. 2013;11(1):26. doi:10.1186/1478-7547-11-26.PubMedPubMedCentralCrossRef

116.

Williams I, Robinson S, Dickinson H. Rationing in Health Care. The theory and practice of priority setting. Bristol: The Policy Press; 2012.

117.

Daniels N, Sabin J. Limits to health care: fair procedures, democratic deliberation, and the legitimacy problem for insurers. Philos Public Aff. 1997;26(4):303–50.PubMedCrossRef

118.

The Health Foundation. Star: Socio-Technical Allocation of Resources. Guidance document; 2013. Available from: http://www.health.org.uk/collection/star-socio-technical-allocation-resources. Accessed 5 May 2017.

119.

The Health Foundation. Looking for value in hard times. How a new approach to priority setting can help improve patient care while making savings; 2012. Available from: http://www.health.org.uk/sites/health/files/LookingForValueInHardTimes.pdf. Accessed 5 May 2017.

120.

Airoldi M, Morton A, Smith J, Bevan G. Healthcare prioritisation at the local level: a socio-technical approach. Priority Setting for Population Health; 2011. Available from: http://eprints.lse.ac.uk/59892/1/__lse.ac.uk_storage_LIBRARY_Secondary_libfile_shared_repository_Content_Bevan,%20G_Bevan_Healthcare_prioritisation_local_2011_Bevan_Healthcare_prioritisation. Accessed 5 May 2017.

121.

Goetghebeur MM, Wagner M, Khoury H, Levitt RJ, Erickson LJ, Rindress D. Evidence and Value: Impact on DEcisionMaking--the EVIDEM framework and potential applications. BMC Health Serv Res. 2008;8:270. doi:10.1186/1472-6963-8-270.PubMedPubMedCentralCrossRef

122.

Browman GP, Manns B, Hagen N, Chambers CR, Simon A, Sinclair S. 6-STEPPPs: A Modular Tool to Facilitate Clinician Participation in Fair Decisions for Funding New Cancer Drugs. J Oncol Pract. 2008;4(1):2–7. doi:10.1200/jop.0812001.PubMedPubMedCentralCrossRef

123.

Youngkong S, Tromp N, Chitama D. The EVIDEM framework and its usefulness for priority setting across a broad range of health interventions. Cost Eff Resour Alloc. 2011;9:8. doi:10.1186/1478-7547-9-8.PubMedPubMedCentralCrossRef

124.

Elshaug AG, Hiller JE, Tunis SR, Moss JR. Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Aust New Zealand Health Policy. 2007;4:23. doi:10.1186/1743-8462-4-23.PubMedPubMedCentralCrossRef

125.

Williams I, McIver S, Moore D, Bryan S. The use of economic evaluations in NHS decision making: A review and empirical investigation. Health Technology Assessment. 2008;12(7).

126.

Baker DW, Qaseem A, Reynolds PP, Gardner LA, Schneider EC. Design and use of performance measures to decrease low-value services and achieve cost-conscious care. Ann Intern Med. 2013;158(1):55–9. doi:10.7326/0003-4819-158-1-201301010-00560.PubMedCrossRef

127.

Rumbold B, Alakeson V, Smith P. Rationing health care. Quest for NHS Efficiency Series; 2012. Available from: https://www.nuffieldtrust.org.uk/files/2017-01/rationing-health-care-web-final.pdf. Accessed 5 May 2017.

128.

Noseworthy T, Clement F. Health technology reassessment: Scope, methodology, & language. Int J Technol Assess Health Care. 2012;28(03):201–2. doi:10.1017/S0266462312000359.PubMedCrossRef

129.

Larmour I, Pignataro S, Barned KL, Mantas S, Korman MG. A therapeutic equivalence program: evidence-based promotion of more efficient use of medicines. Med J Aust. 2011;194(12):631–4.PubMed

130.

Barasa EW, Molyneux S, English M, Cleary S. Setting Healthcare Priorities at the Macro and Meso Levels: A Framework for Evaluation. Int J Health Policy Manag. 2015;4(11):719–32. doi:10.15171/ijhpm.2015.167.PubMedPubMedCentralCrossRef

131.

Bhatia RS, Levinson W, Shortt S, Pendrith C, Fric-Shamji E, Kallewaard M, et al. Measuring the effect of Choosing Wisely: an integrated framework to assess campaign impact on low-value care. BMJ Qual Saf. 2015;24(8):523–31. doi:10.1136/bmjqs-2015-004070.PubMedCrossRef

132.

de Vries EF, Struijs JN, Heijink R, Hendrikx RJ, Baan CA. Are low-value care measures up to the task? A systematic review of the literature. BMC Health Serv Res. 2016;16(1):405. doi:10.1186/s12913-016-1656-3.PubMedPubMedCentralCrossRef

133.

Ovretveit J. Does improving quality save money? A review of evidence of which improvements to quality reduce costs to health service providers. London: The Health Foundation; 2009.

134.

Garner S, Docherty M, Somner J, Sharma T, Choudhury M, Clarke M, et al. Reducing ineffective practice: challenges in identifying low-value health care using Cochrane systematic reviews. J Health Serv Res Policy. 2013;18(1):6–12. doi:10.1258/jhsrp.2012.012044.PubMedCrossRef

135.

Stafinski T, Menon D, McCabe C, Philippon DJ. To fund or not to fund: development of a decision-making framework for the coverage of new health technologies. Pharmacoeconomics. 2011;29(9):771–80. doi:10.2165/11539840-000000000-00000.PubMedCrossRef

136.

Tricco AC, Cardoso R, Thomas SM, Motiwala S, Sullivan S, Kealey MR, et al. Barriers and facilitators to uptake of systematic reviews by policy makers and health care managers: a scoping review. Implement Sci. 2016;11(1):4. doi:10.1186/s13012-016-0370-1.PubMedPubMedCentralCrossRef

137.

Oliver K, Innvar S, Lorenc T, Woodman J, Thomas J. A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res. 2014;14(1):2. doi:10.1186/1472-6963-14-2.PubMedPubMedCentralCrossRef

138.

Wallace J, Nwosu B, Clarke M. Barriers to the uptake of evidence from systematic reviews and meta-analyses: a systematic review of decision makers’ perceptions. BMJ Open. 2012;2(5). doi:10.1136/bmjopen-2012-001220.

139.

Solomons NM, Spross JA. Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review. J Nurs Manag. 2011;19(1):109–20. doi:10.1111/j.1365-2834.2010.01144.x.PubMedCrossRef

140.

Brown CE, Wickline MA, Ecoff L, Glaser D. Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. J Adv Nurs. 2009;65(2):371–81. doi:10.1111/j.1365-2648.2008.04878.x.PubMedCrossRef

141.

Karkos B, Peters K. A Magnet community hospital: Fewer barriers to nursing research utilization. J Nurs Adm. 2006;36(7–8):377–82.PubMedCrossRef

142.

Bowen S, Erickson T, Martens PJ, Crockett S. More than “using research”: the real challenges in promoting evidence-informed decision-making. Healthc Policy. 2009;4(3):87–102.PubMedPubMedCentral

143.

Peacock SJ, Mitton C, Ruta D, Donaldson C, Bate A, Hedden L. Priority setting in healthcare: towards guidelines for the program budgeting and marginal analysis framework. Expert Rev Pharmacoecon Outcomes Res. 2010;10(5):539–52. doi:10.1586/erp.10.66.PubMedCrossRef

144.

Scott T, Mannion R, Davies HTO, Marshall MN. Implementing culture change in health care: theory and practice. Int J Qual Health Care. 2003;15(2):111–8.PubMedCrossRef

145.

Flodgren G, Rojas-Reyes MX, Cole N, Foxcroft DR. Effectiveness of organisational infrastructures to promote evidence-based nursing practice. Cochrane Database Syst Rev (Online). 2012;2:CD002212. doi:10.1002/14651858.CD002212.pub2.

146.

Rumbold G, Allen K, Harris C. Disinvestment of technologies and clinical practices in health services: Conceptual and policy perspectives. Centre for Clinical Effectiveness, Southern Health; 2008. Available from: http://arrow.monash.edu.au/hdl/1959.1/1218935. Accessed 5 May 2017.

147.

NHS Confederation. Two sides of the same coin. Balancing quality and finance to deliver greater value; 2014. Available from: http://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/two_sides_same_coin150413.pdf. Accessed 5 May 2017.

148.

Scott IA. Looking for value in health care. Med J Aust. 2012;197(10):538–9.PubMedCrossRef

149.

Department of Human Services. Future directions for health technology uptake, diffusion and disinvestment in Victorian public health services. Victoria, Australia: Department of Human Services; 2007.

150.

Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet. 2003;362(9391):1225–30.PubMedCrossRef

151.

Grol R, Wensing M, Eccles ME. Improving practice: A systematic approach to implementation of change in patient care. Oxford: Elsevier Science; 2004.

152.

Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629. doi:10.1111/j.0887-378X.2004.00325.x.PubMedPubMedCentralCrossRef

153.

NSW Health Department. A Framework for Building Capacity to Improve Health. 2001.

154.

Iglesias CP, Drummond MF, Rovira J. Health-care decision-making processes in Latin America: problems and prospects for the use of economic evaluation. Int J Technol Assess Health Care. 2005;21(1):1–14.PubMedCrossRef

155.

Ellen ME, Leon G, Bouchard G, Ouimet M, Grimshaw JM, Lavis JN. Barriers, facilitators and views about next steps to implementing supports for evidence-informed decision-making in health systems: a qualitative study. Implement Sci. 2014;9(1):179. doi:10.1186/s13012-014-0179-8.PubMedPubMedCentralCrossRef

156.

Cilenti D, Brownson RC, Umble K, Erwin PC, Summers R. Information-seeking behaviors and other factors contributing to successful implementation of evidence-based practices in local health departments. J Public Health Manag Pract. 2012;18(6):571–6. doi:10.1097/PHH.0b013e31825ce8e2.PubMedPubMedCentralCrossRef

157.

Healthcare Improvement Scotland. What approaches have been taken and efforts made to ensure public involvement in decision making relating to potential disinvestment in healthcare interventions and technologies? In: Public involvement in decision making relating to potential: Technologies scoping report 16; 2013. Available from: http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_scoping_reports/technologies_scoping_report_16.aspx?. Accessed 5 May 2017.

158.

Centre for Health Economics Research and Evaluation. Reducing the use of ineffective health care interventions, Working Paper 2010/5. Sydney: University of Technology Sydney; 2010.

159.

Hughes D, Ferner R. New drugs for old: disinvestment and NICE. BMJ. 2010;340. doi:10.1136/bmj.c572.

160.

Watt AM, Willis CD, Hodgetts K, Elshaug AG, Hiller JE. Engaging clinicians in evidence-based disinvestment: role and perceptions of evidence. Int J Technol Assess Health Care. 2012;28(03):211–9. doi:10.1017/S0266462312000402.PubMedCrossRef

161.

Mortimer D. Reorienting programme budgeting and marginal analysis (PBMA) towards disinvestment. BMC Health Serv Res. 2010;10:288. doi:10.1186/1472-6963-10-288.PubMedPubMedCentralCrossRef

162.

National Health and Medical Research Council. Ethical Considerations in Quality Assurance and Evaluation Activities. Canberra: Commonwealth of Australia; 2014.

163.

Harris C, Brooke V, Turner T, Wilkinson F. Implementation of evidence-based paediatric guidelines: evaluation of complex interventions based on a theoretical framework. Centre for Clinical Effectiveness; 2007. Available from: http://arrow.monash.edu.au/hdl/1959.1/1218931. Accessed 5 May 2017.

Title: Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting
Authors: Claire Harris
Kelly Allen
Vanessa Brooke
Tim Dyer
Cara Waller
Richard King
Wayne Ramsey
Duncan Mortimer
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-017-2269-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2017

The treatment of non-malarial febrile illness in Papua New Guinea: findings from cross sectional and longitudinal studies of health worker practice

Developing a standardized healthcare cost data warehouse

Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh

A questionnaire measuring staff perceptions of Lean adoption in healthcare: development and psychometric testing

Addressing the gaps in diabetes care in first nations communities with the reorganizing the approach to diabetes through the application of registries (RADAR): the project protocol

Does the impact of case management vary in different subgroups of multimorbidity? Secondary analysis of a quasi-experiment