Top

BMC Health Services Research

Published in:

Open Access 01-12-2018 | Debate

Sustainability in Health care by Allocating Resources Effectively (SHARE) 11: reporting outcomes of an evidence-driven approach to disinvestment in a local healthcare setting

Authors: Claire Harris, Kelly Allen, Wayne Ramsey, Richard King, Sally Green

Published in: BMC Health Services Research | Issue 1/2018

Abstract

Background

This is the final paper in a thematic series reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was established to explore a systematic, integrated, evidence-based organisation-wide approach to disinvestment in a large Australian health service network. This paper summarises the findings, discusses the contribution of the SHARE Program to the body of knowledge and understanding of disinvestment in the local healthcare setting, and considers implications for policy, practice and research.

Discussion

The SHARE program was conducted in three phases. Phase One was undertaken to understand concepts and practices related to disinvestment and the implications for a local health service and, based on this information, to identify potential settings and methods for decision-making about disinvestment. The aim of Phase Two was to implement and evaluate the proposed methods to determine which were sustainable, effective and appropriate in a local health service. A review of the current literature incorporating the SHARE findings was conducted in Phase Three to contribute to the understanding of systematic approaches to disinvestment in the local healthcare context.

SHARE differed from many other published examples of disinvestment in several ways: by seeking to identify and implement disinvestment opportunities within organisational infrastructure rather than as standalone projects; considering disinvestment in the context of all resource allocation decisions rather than in isolation; including allocation of non-monetary resources as well as financial decisions; and focusing on effective use of limited resources to optimise healthcare outcomes.

Conclusion

The SHARE findings provide a rich source of new information about local health service decision-making, in a level of detail not previously reported, to inform others in similar situations. Multiple innovations related to disinvestment were found to be acceptable and feasible in the local setting. Factors influencing decision-making, implementation processes and final outcomes were identified; and methods for further exploration, or avoidance, in attempting disinvestment in this context are proposed based on these findings. The settings, frameworks, models, methods and tools arising from the SHARE findings have potential to enhance health care and patient outcomes.

Available only for authorised users

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. https://doi.org/10.1016/j.socscimed.2015.01.020.CrossRefPubMed

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. https://doi.org/10.1007/s40273-015-0293-8.CrossRefPubMed

Bryan S, Mitton C, Donaldson C. Breaking the addiction to technology adoption. Health Econ. 2014;23(4):379–83. https://doi.org/10.1002/hec.3034.CrossRefPubMed

Morgan DJ, Brownlee S, Leppin AL, Kressin N, Dhruva SS, Levin L, et al. Setting a research agenda for medical overuse. BMJ. 2015;351:h4534. https://doi.org/10.1136/bmj.h4534.CrossRefPubMedPubMedCentral

Scott I. Ten clinician-driven strategies for maximising value of Australian health care. Aust Health Rev. 2014;38(2):125–33. https://doi.org/10.1071/ah13248. CrossRefPubMed

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

Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):1513–6. https://doi.org/10.1001/jama.2012.362.CrossRefPubMed

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; https://doi.org/10.1186/s12913-017-2388-8.

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. https://doi.org/10.1186/s12913-015-1178-4.CrossRefPubMedPubMedCentral

10.

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.CrossRefPubMedPubMedCentral

11.

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. https://doi.org/10.1186/1748-5908-8-17. CrossRefPubMedPubMedCentral

12.

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. https://doi.org/10.1016/j.healthpol.2013.01.007.CrossRefPubMed

13.

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. https://doi.org/10.1017/s0266462313000068.CrossRefPubMed

14.

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. https://doi.org/10.1111/hsc.12046.PubMedCrossRef

15.

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. https://doi.org/10.1017/s0266462312000372.CrossRefPubMed

16.

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. https://doi.org/10.1017/S0266462312000438.CrossRefPubMed

17.

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. https://doi.org/10.1016/j.socscimed.2012.09.014.CrossRefPubMed

18.

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. https://doi.org/10.1186/1748-5908-7-101. CrossRefPubMedPubMedCentral

19.

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

20.

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.CrossRefPubMed

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. p. 2015.

22.

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

23.

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; https://doi.org/10.1186/s12913-017-2211-6.

24.

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; https://doi.org/10.1186/s12913-017-2207-2.

25.

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; https://doi.org/10.1186/s12913-017-2212-5.

26.

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; https://doi.org/10.1186/s12913-017-2208-1.

27.

Harris C, Allen K, Brooke V, Dyer T, Waller C, King R, et al. 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. BMC Health Serv Res. 2017; https://doi.org/10.1186/s12913-017-2269-1.

28.

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; https://doi.org/10.1186/s12913-017-2388-8.

29.

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. https://doi.org/10.1186/S12913-018-2932-1.

30.

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 Serv Res. 2017; https://doi.org/10.1186/s12913-017-2506-7.

31.

Monash Health. http://www.monashhealth.org/. Accessed 24 Oct 2017.

32.

Campbell NC, Murry E, Darbyshire J, Emery J, Farmer A, Griffiths F, et al. Designing and evaluating complex interventions to improve health care. BMJ. 2007;334:455–9.CrossRefPubMedPubMedCentral

33.

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 24 Oct 2017.

34.

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. https://doi.org/10.1186/1748-5908-4-40. CrossRefPubMedPubMedCentral

35.

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. https://doi.org/10.1136/bmjopen-2013-003713.CrossRefPubMedPubMedCentral

36.

Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet. 2009;374(9683):86–9.CrossRefPubMed

37.

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

38.

Baxter P, Jack S. Qualitative case study methodology: study design and implementation for novice researchers. Qual Rep. 2008;13(4):544–59.

39.

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 13 Jun 2017.

40.

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

41.

Rodgers M, Thomas S, Harden M, Parker G, Street A, Eastwood A. Developing a methodological framework for organisational case studies: a rapid review and consensus development process. Health Serv Deliv Res. 2016;4(1) https://doi.org/10.3310/hsdr04010.

42.

Pinnock H, Barwick M, Carpenter CR, Eldridge S, Grandes G, Griffiths CJ, et al. Standards for reporting implementation studies (StaRI) statement. BMJ. 2017;356:i6795. https://doi.org/10.1136/bmj.i6795.CrossRefPubMedPubMedCentral

43.

Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (standards for QUality improvement reporting excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2016;25(12):986–92. https://doi.org/10.1136/bmjqs-2015-004411.CrossRefPubMed

44.

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; https://doi.org/10.1186/s12913-017-2210-7.

45.

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 17 Apr 2017.

46.

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 8 May 2018.

47.

Cochrane Library. http://www.cochranelibrary.com/. Accessed 24 Oct 2017.

48.

International Network of Agencies for Health Technology Assessment (INAHTA). http://www.inahta.org/. Accessed 8 May 2018.

49.

National Institute for Health and Care Excellence (UK). https://www.nice.org.uk/. Accessed 8 May 2018.

50.

National Prescribing Service (Australia). http://www.nps.org.au/. Accessed 8 May 2018.

51.

Australia and New Zealand Horizon Scanning Network http://www.horizonscanning.gov.au/. Accessed 8 May 2018.

52.

National Institute of Health and Clinical Excellence. ‘Do Not Do’ Recommendations. National Institute of Health and Clinical Excellence, UK. http://www.nice.org.uk/savingsAndProductivity/collection?page=1&pageSize=2000&type=Do%20not%20do&published=&impact=Unclassified&filter=. Accessed 17 Apr 2017.

53.

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

54.

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. https://doi.org/10.1136/bmjqs-2014-003821.CrossRefPubMed

55.

Centre for Clinical Effectiveness. Sustainability in Health care 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 24 10 2017.

56.

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 24 Oct 2017.

57.

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

58.

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

59.

Harris C, Allen K, Waller C, Voutier C, Brooke V. Health technology disinvestment: tests, drugs and clinical practice. Report on a national disinvestment workshop. Part 1: Report. Centre for Clinical Effectiveness 2009. Available from: http://arrow.monash.edu.au/hdl/1959.1/1218926. Accessed 17 Apr 2017.

60.

Harris C, Allen K, Waller C, Voutier C, Brooke V. Health technology disinvestment: tests, drugs and clinical practice. Report on a national disinvestment workshop. Part 2: Appendices. Centre for Clinical Effectiveness 2009. Available from: http://arrow.monash.edu.au/hdl/1959.1/1218922. Accessed 17 Apr 2017.

61.

Schroeder AR, Harris SJ, Newman TB. Safely doing less: a missing component of the patient safety dialogue. Pediatrics. 2011;128(6):e1596–7. https://doi.org/10.1542/peds.2011-2726.CrossRefPubMed

62.

Department of Health Victoria. Activity Based Funding https://www2.health.vic.gov.au/hospitals-and-health-services/funding-performance-accountability/activity-based-funding. Accessed 29 Sept 2017.

63.

Martelli N, Lelong AS, Prognon P, Pineau J. Hospital-based health technology assessment for innovative medical devices in university hospitals and the role of hospital pharmacists: learning from international experience. Int J Technol Assess Health Care. 2013;29(2):185–91. https://doi.org/10.1017/s0266462313000019.CrossRefPubMed

64.

Battista RN, Cote B, Hodge MJ, Husereau D. Health technology assessment in Canada. Int J Technol Assess Health Care. 2009;25(Suppl 1):53–60. https://doi.org/10.1017/s0266462309090424.CrossRefPubMed

65.

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 29 Sept 2017.

66.

Garner S, Littlejohns P. Disinvestment from low value clinical interventions: NICEly done? BMJ. 2011;343:d4519. https://doi.org/10.1136/bmj.d4519.CrossRefPubMed

67.

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. Vitoria-Gasteiz: Basque Office for Health Technology Assessment (Osteba); 2009.

68.

NHS Commissioning Board. Commissioning Policy: Ethical framework for priority setting and resource allocation 2013. Available from: http://www.england.nhs.uk/wp-content/uploads/2013/04/cp-01.pdf. Accessed 29 Sept 2017.

69.

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

70.

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. http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_scoping_reports/technologies_scoping_report_16.aspx?theme=mobile. Accessed 29 Sept 2017.

71.

HealthPACT. Disinvestment in Australia and New Zealand. Herston: Health Policy Advisory Committee on Technology; 2013.

72.

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. https://doi.org/10.1017/S0266462312000402.CrossRefPubMed

73.

MacKean G, Noseworthy T, Elshaug AG, Leggett L, Littlejohns P, Berezanski J, et al. Health technology reassessment: the art of the possible. Int J Technol Assess Health Care. 2013;29(04):418–23. https://doi.org/10.1017/S0266462313000494.CrossRefPubMedPubMedCentral

74.

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; https://doi.org/10.1186/1478-4505-10-38.

75.

Cooper C, Starkey K. Disinvestment in health care. BMJ. 2010;340 https://doi.org/10.1136/bmj.c1413.

76.

Fronsdal KB, Facey K, Klemp M, Norderhaug IN, Morland B, Rottingen JA. Health technology assessment to optimize health technology utilization: using implementation initiatives and monitoring processes. Int J Technol Assess Health Care. 2010;26(3):309–16. https://doi.org/10.1017/s0266462310000309.CrossRefPubMed

77.

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. https://doi.org/10.1258/jhsrp.2012.012044.CrossRefPubMed

78.

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. https://doi.org/10.1016/j.puhe.2013.01.027.CrossRefPubMed

79.

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. https://doi.org/10.1016/j.healthpol.2007.11.010.CrossRefPubMed

80.

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

81.

The Conference Board of Canada. Understanding health care cost drivers and escalators 2004. Available from: http://www.health.alberta.ca/documents/Health-Costs-Drivers-CBC-2004.pdf Accessed 29 Sept 2017.

82.

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 24 Oct 2017.

83.

Hamilton S, Huby G, Tierney A, Powell A, Kielmann T, Sheikh A, et al. Mind the gap between policy imperatives and service provision: a qualitative study of the process of respiratory service development in England and Wales. BMC Health Serv Res. 2008;8:248. https://doi.org/10.1186/1472-6963-8-248.CrossRefPubMedPubMedCentral

84.

Smith N, Mitton C, Peacock S, Cornelissen E, MacLeod S. Identifying research priorities for health care priority setting: a collaborative effort between managers and researchers. BMC Health Serv Res. 2009;9:165. https://doi.org/10.1186/1472-6963-9-165.CrossRefPubMedPubMedCentral

85.

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

86.

Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci. 2012;7:50. https://doi.org/10.1186/1748-5908-7-50. CrossRefPubMedPubMedCentral

87.

Redman S, Turner T, Davies H, Williamson A, Haynes A, Brennan S, et al. The SPIRIT action framework: a structured approach to selecting and testing strategies to increase the use of research in policy. Soc Sci Med. 2015;136-137:147–55. https://doi.org/10.1016/j.socscimed.2015.05.009.CrossRefPubMed

88.

Wye L, Brangan E, Cameron A, Gabbay J, Klein JH, Pope C. Evidence based policy making and the ‘art’ of commissioning - how English healthcare commissioners access and use information and academic research in ‘real life’ decision-making: an empirical qualitative study. BMC Health Serv Res. 2015;15:430. https://doi.org/10.1186/s12913-015-1091-x.CrossRefPubMedPubMedCentral

89.

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. https://doi.org/10.1097/PHH.0b013e31825ce8e2. CrossRefPubMedPubMedCentral

90.

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. https://doi.org/10.1186/s13012-014-0123-y.CrossRefPubMedPubMedCentral

91.

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. https://doi.org/10.1186/s13012-014-0179-8.CrossRefPubMedPubMedCentral

92.

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. https://doi.org/10.1111/j.1365-2834.2010.01144.x.CrossRefPubMed

93.

Wallace J, Byrne C, Clarke M. Improving the uptake of systematic reviews: a systematic review of intervention effectiveness and relevance. BMJ Open. 2014;4(10):e005834. https://doi.org/10.1136/bmjopen-2014-005834.CrossRefPubMedPubMedCentral

94.

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. https://doi.org/10.1186/s13012-016-0370-1.CrossRefPubMedPubMedCentral

95.

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. https://doi.org/10.1186/1743-8462-4-23.CrossRefPubMedPubMedCentral

96.

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

97.

Mitton C, Donaldson C. Setting priorities in Canadian regional health authorities: a survey of key decision makers. Health Policy. 2002;60(1):39–58. https://doi.org/10.1016/S0168-8510(01)00190-7. CrossRefPubMed

98.

Eddama O, Coast J. Use of economic evaluation in local health care decision-making in England: a qualitative investigation. Health Policy. 2009;89(3):261–70. https://doi.org/10.1016/j.healthpol.2008.06.004.CrossRefPubMed

99.

Chitama D, Baltussen R, Ketting E, Kamazima S, Nswilla A, Mujinja PG. From papers to practices: district level priority setting processes and criteria for family planning, maternal, newborn and child health interventions in Tanzania. BMC Womens Health. 2011;11:46. https://doi.org/10.1186/1472-6874-11-46.CrossRefPubMedPubMedCentral

100.

Innvaer S, Vist G, Trommald M, Oxman A. Health policy-makers’ perceptions of their use of evidence: a systematic review. J Health Serv Res Policy. 2002;7(4):239–44. https://doi.org/10.1258/135581902320432778.CrossRefPubMed

101.

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.

102.

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

103.

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

104.

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. https://doi.org/10.1007/s40258-013-0074-5.CrossRefPubMedPubMedCentral

105.

National Health and Medical Research Council. Ethical considerations in quality assurance and evaluation activities. Canberra: Commonwealth of Australia; 2014.

Title: Sustainability in Health care by Allocating Resources Effectively (SHARE) 11: reporting outcomes of an evidence-driven approach to disinvestment in a local healthcare setting
Authors: Claire Harris
Kelly Allen
Wayne Ramsey
Richard King
Sally Green
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-018-3172-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sustainability in Health care by Allocating Resources Effectively (SHARE) 11: reporting outcomes of an evidence-driven approach to disinvestment in a local healthcare setting

Abstract

Background

Discussion

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Discussion

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

A comparative study of catastrophic health expenditure in Zhejiang and Qinghai province, China

Transferring skills in quality collaboratives focused on improving patient logistics

Physicians’ and nurses’ thoughts and concerns about introducing neonatal male circumcision in Thailand: a qualitative study

A categorisation of problems and solutions to improve patient referrals from primary to specialty care

Patient satisfaction, patients leaving hospital against medical advice and mortality in Italian university hospitals: a cross-sectional analysis

Evaluation of the impact of the ARC program on national nursing and midwifery regulations, leadership, and organizational capacity in East, Central, and Southern Africa