Abstract
BackgroundHealthcare systems have difficulty incorporating scientific evidence into clinical practice, especially when science suggests that existing clinical practices are of low-value (e.g. ineffective or harmful to patients). While a number of lists outlining low-value practices in acute care medicine currently exist, less is known about how best to initiate and sustain the removal of low-value clinical practices (i.e. de-adoption). This study will develop a comprehensive list of barriers and facilitators to the de-adoption of low-value clinical practices in acute care facilities to inform the development of a framework to guide the de-adoption process.MethodsThe proposed project is a multi-stage mixed methods study to develop a framework to guide the de-adoption of low-value clinical practices in acute care medicine that will be tested in a representative sample of acute care settings in Alberta, Canada. Specifically, we will: 1) conduct a systematic review of the de-adoption literature to identify published barriers and facilitators to the de-adoption of low-value clinical practices in acute care medicine and any associated interventions proposed (Phase one); 2) conduct focus groups with acute care stakeholders to identify important themes not published in the literature and obtain a comprehensive appreciation of stakeholder perspectives (Phase two); 3) extend the generalizability of focus group findings by conducting individual stakeholder surveys with a representative sample of acute care providers throughout the province to determine which barriers and facilitators identified in Phases one and two are most relevant in their clinical setting (Phase three). Identified barriers and facilitators will be catalogued and integrated with targeted interventions in a framework to guide the process of de-adoption in each of four targeted areas of acute care medicine (Emergency Medicine, Cardiovascular Health and Stroke, Surgery and Critical Care Medicine). Analyses will be descriptive using a combination of qualitative and quantitative analyses.DiscussionThere is a growing body of literature suggesting that the de-adoption of ineffective or harmful practices from patient care is integral to the delivery of high quality care and healthcare sustainability. The framework developed in this study will map barriers and facilitators to de-adoption to the most appropriate interventions, allowing stakeholders to effectively initiate, execute and sustain this process in an evidence-based manner.
Highlights
Healthcare systems have difficulty incorporating scientific evidence into clinical practice, especially when science suggests that existing clinical practices are of low-value
There is a growing body of literature [4] which suggests that the removal of ineffective and potentially harmful clinical practices is integral to the delivery of high quality care and the sustainability of our healthcare system [5,6,7,8]
Study design We propose to identify and catalogue the top barriers and facilitators to the de-adoption of low-value clinical practices in a representative sample of adult acute care settings in Alberta in an effort to build an evidencebased applied framework that will guide the process of de-adoption
Summary
Healthcare systems have difficulty incorporating scientific evidence into clinical practice, especially when science suggests that existing clinical practices are of low-value (e.g. ineffective or harmful to patients). The challenge of implementing best evidence into clinical practice is a significant problem in modern healthcare [1] that can result in inappropriate, ineffective, inefficient and unsafe care This is problematic in acute care facilities, where large numbers of expensive therapies, technologies and treatments are used daily in an effort to save lives [2, 3]. There is a growing body of literature [4] which suggests that the removal (i.e. de-adoption) of ineffective and potentially harmful (i.e. low-value) clinical practices is integral to the delivery of high quality care and the sustainability of our healthcare system [5,6,7,8] This is highlighted by the growing number of initiatives—such as the Choosing Wisely Campaign®—designed to reduce the use of low-value practices. While there is an urgent need to de-adopt practices that are of low-value, the process of de-adoption remains poorly understood
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