Abstract
Research into the prevalence and impact of low-value medical practices has evolved substantially over the past two decades. However, despite international efforts, many challenges still remain with regards to progress in this field, including limits in the capacity to identify and prioritize low-value care practices and to systematically appraise clinical and policy attempts at redressing low-value care. A recent article by Niven et al. in BMC Medicine consolidates the current literature and terminology on the de-adoption of clinical practices, advocating the use of de-adoption as an appropriate term to label low-value care and proposes a new synthesis model to facilitate efforts to reverse ineffective and harmful medical practices. We hope that this work will facilitate advances in low-value care research and policy, and shift focus towards establishing evidence for de-adopting low-value interventions, which is crucial since attempts to reduce low-value care interventions have shown mixed results.Please see related article: http://www.biomedcentral.com/1741-7015/13/255
Highlights
In the 1990s, England’s National Institute for Health and Care Excellence co-opted the term ‘disinvestment’ from industry parlance, heralding its transition to the health sector [1]
As Niven et al [3] so aptly indicate, many related concepts are subsumed within misuse, overtreatment, overdiagnosis, overmedicalization, waste, opportunity cost, allocative and/or technical efficiency, resource re-allocation, and de-adoption
The authors identified 43 different terms used to refer to the process of deadoption, with ‘disinvest’ (39 %) and ‘decrease use’ (24 %) being the most frequently cited terms. They further recommend that ‘de-adoption’ should be the term used to standardize the literature on low-value clinical care
Summary
The article by Niven et al [3] represents an important contribution to the field, representing, along with the manuscripts referenced within it, a valuable repository cataloguing the current state-of-the-science from around the world with regards to efforts at reducing the use of low-value healthcare. While the desire to minimize waste and deliver safe, effective, and efficient healthcare is old wine, the new bottle is represented by ever-evolving research, analysis, health technology assessment methods, and dovetailed policy processes. Despite increasing international efforts, researchers are still faced with significant challenges with regards to research on low-value clinical practices [6].
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