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BMC Med. 2015 Oct 6;13:255. doi: 10.1186/s12916-015-0488-z.

Towards understanding the de-adoption of low-value clinical practices: a scoping review.

Author information

1
Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, T1Y 6J4, Canada. Daniel.niven@albertahealthservices.ca.
2
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. Daniel.niven@albertahealthservices.ca.
3
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. Kelly.mrklas@albertahealthservices.ca.
4
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. jkholodi@ucalgary.ca.
5
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, M5B 1T8, Canada. Sharon.straus@utoronto.ca.
6
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. Brenda.hemmelgarn@albertahealthservices.ca.
7
Department of Medicine, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. Brenda.hemmelgarn@albertahealthservices.ca.
8
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, M5B 1T8, Canada. jeffsl@smh.ca.
9
Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, T1Y 6J4, Canada. tstelfox@ucalgary.ca.
10
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. tstelfox@ucalgary.ca.
11
Department of Medicine, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada. tstelfox@ucalgary.ca.

Abstract

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.

PMID:
26444862
PMCID:
PMC4596285
DOI:
10.1186/s12916-015-0488-z
[Indexed for MEDLINE]
Free PMC Article
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