Towards understanding the de-adoption of low-value clinical practices: a scoping review
Towards understanding the de-adoption of low-value clinical practices: a scoping review
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DOI：
10.1186/s12916-015-0488-z
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发表时间：
2015-10-06
期刊：
影响因子：
9.3
通讯作者：
Stelfox, Henry Thomas
中科院分区：
文献类型：
--
作者：
Niven, Daniel J.;Mrklas, Kelly J.;Stelfox, Henry Thomas
背景：低价值的临床实践在医疗保健中很常见，但取消这些实践的最佳方法尚不清楚。本研究的目的是系统地回顾关于取消采用的文献，记录当前的术语和框架，将文献映射到拟议的框架，确定我们对取消采用的理解中的差距，并确定进一步研究的机会。方法：MEDLINE、EMBASE、对照试验的科克伦中心注册库、系统评价的科克伦数据库、摘要和疗效评价的科克伦数据库，和CINAHL Plus的检索时间为1990年1月1日至2014年3月5日。从纳入引文的参考书目、相关网站、PubMed "相关文章"功能和联系实施科学专家中确定其他引文。纳入了提及在患有内科、外科或精神疾病的成人中取消临床实践的英文引文。结果：从26,608篇引文中，109篇被纳入最终综述。大多数引文（65%）是原创研究，大多数（59%）是自2010年以来发表的。有43个独特的术语指的是取消采用的过程-最常被引用的是“撤资”（39%的引用）。大多数引用的重点是评估取消采用的结果（50%），其次是确定低价值的做法（47%）和/或促进取消采用（40%）。低价值实践的流行率从16%到46%不等，两项研究分别确定了100多个低价值实践。大多数文章引用了随机临床试验（41%），证明损害（73%）和/或缺乏疗效（63%）是取消采用现有临床实践的原因。11篇引文描述了13个框架来指导取消采用过程，我们从中开发了一个促进取消采用的模型。积极的变革干预措施与取消采用的可能性最大相关。结论：本综述确定了大量文献，描述了取消采用低价值临床实践的当前方法和挑战。需要进行更多的研究，以确定一个理想的战略，以确定低价值的做法，并促进和维持去采用。与此同时，本研究提出了一个模式，供应商和决策者可以使用，以指导努力去采用无效和有害的做法。
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.