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Table 1 Study eligibility criteria

From: De-implementing low-value care in cancer care delivery: a systematic review

Study characteristic

Inclusion criteria

Exclusion criteria

Population

• Hospitals/clinics

• Inpatient units

• Outpatient general medical settings (e.g., primary care, urgent care, private offices)

• Cancer centers

• Emergency departments

• Managed care organizations

• Health insurance

• Free standing EDs

• Nursing home

Intervention

• Interventions that purposefully developed to removea, replaceb, reducec, restrictd, reverse, de-implement, de-adopt, disinvest, decrease in use, discontinue, abandon, reassess, obsolete, withdraw, contradict, refute, delist, substitute, exnovate, cease, or end an established low-value practice

• Changes in clinicians’ practice pattern over time in response to educational campaigns, guidelines, or dissemination of scientific publications without active effort to de-implement an established low value practice

• Quality improvement interventions without a de-implementation component

Reasonse

• Low value practicese (e.g., ineffectivef, contradictedg, mixedh, and untestedi interventions)

 

Outcome

• De-implementation determinants (i.e., factors influence de-implementation outcomes such as incentives and resources)

• De-implementation process (i.e., process of reducing, replacing, or stopping low-value services)

• De-implementation outcome (e.g., effectiveness, volume of procedures, cost saving, quality)

• Any outcomes not listed

Study design

• Randomized trials

• Quasi-experiment studies

• Cross-sectional

• Qualitative studies

• Case reports and case studies

• Interrupted time-series studies or repeated measures studies

• Prospective and retrospective observational studies (i.e., cohort studies, case control studies)

• Descriptive studies with no outcomes data

• Modeling studies that used simulated data

• Not a clinical study (e.g., editorial, nonsystematic review, letter to the editor)

• Prospective and retrospective observational studies

• Clinical guidelines

• Measurement or validation studies

• Pilot studies without adequate power to assess impact of intervention on outcomes.

Publication types

• Full publication in a peer-reviewed journal

• English-language publications

• 1990 to current date

• Non-English language

• Not a full publication in a peer-reviewed journal

• Letters, editorials, reviews, dissertations, meeting abstracts, protocols without results

  1. aRemoving an intervention is the process of stopping the delivery of an inappropriate intervention entirely
  2. bReplacing an intervention involves stopping an inappropriate intervention and starting a new, evidence-based intervention that targets the same or similar proximal or distal patient-level health behaviors or health outcomes
  3. cReducing an intervention involves changing the frequency and/or intensity with which that intervention is delivered
  4. dRestricting an intervention occurs when the scope of an intervention is narrowed by target population, health professional, and/or delivery setting
  5. eLow-value practices defined as those identified by by The American Society of Clinical Oncology and Choosing Wisely Canada
  6. fIneffective interventions are those for which a few (if not many) high-quality studies have shown to not improve patients’ health outcomes or behaviors and may actually incur more harm than benefit
  7. gContradicted interventions (i.e., medical reversals) are those for which a newer, higher-quality study (or studies) indicates that the health intervention does not improve outcomes, which is contrast to a previous, lower-quality study (or studies) indicating that it does work
  8. hMixed interventions are those for which the quantity and quality of evidence in support of and against the effectiveness of the intervention is approximately equal
  9. iUntested interventions are those for which little to no empirical evidence exists about their effectiveness because they have yet to be studied
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Implementation Science

ISSN: 1748-5908