Table 3 Potential disinvestment projects
Potential projects and reason for nomination | Source | Result of investigation |
|---|---|---|
1. Reduce ordering of ‘routine’ diagnostic tests in specific setting as thought to be unnecessary and result in increase risk of adverse events and increased costs to hospital and/or patient | Committee member | Not investigated: Further clarification of problem postponed in favour of subsequent proposals |
2. Reduce ordering of diagnostic tests in specified setting due to lack of evidence of benefit and concern about validity, reliability and performance of equipment | Committee member | Not investigated: Further clarification of problem postponed in favour of subsequent proposals |
3. Reduce ordering of diagnostic tests in specified setting as thought to be of little diagnostic value | Committee member | Not investigated: Further clarification of problem postponed in favour of subsequent proposals |
4. Replace equipment with alternative to reduce adverse events and improve patient outcomes in specified patient group resulting in cost savings | Project champion | Not investigated: Project identified too late to be completed within SHARE timelines |
5. Replace diagnostic test in specified patient group for one thought to be more appropriate | Committee member | Investigation not completed: Directed by Steering Committee to pursue Therapeutic Equivalence projects |
6. Reduce admission of specified patient group as thought to be unnecessary in many cases | Committee member | Investigation not completed: Directed by steering committee to pursue Therapeutic Equivalence projects |
7. Replace drug with lower cost but equally effective alternative in appropriate cases as project being undertaken anyway and it would be good way to learn about the change process | Therapeutic Equivalence project | Rejected: Project was already underway |
8. Replace drug with lower cost but equally effective alternative in appropriate cases as project being undertaken anyway and it would be good way to learn about the change process | Therapeutic Equivalence project | Rejected: Project was already underway |
9. Reduce use of therapeutic intervention due to concerns about safety and effectiveness | Committee member | Rejected: Lack of clarity regarding explicit problem, patient groups, etc. |
10. Reduce use of therapeutic intervention as thought to have no evidence of benefit | Committee member | Rejected: Evidence for change unclear |
11. Reduce use of therapeutic intervention as thought to have no benefit over less expensive alternative | Committee member | Rejected: Preference to wait until large RCT underway at the time provided conclusive evidence |
12. Reduce ordering of ‘routine’ diagnostic tests in specified setting as thought to be unnecessary, result in increase risk of adverse events and increased costs to hospital and/or patient | Committee member | Rejected: Specific setting already planned to be investigated by others in organisational review but timing was unspecified |
13. Cease use of therapeutic intervention in specified patient group due to published debate questioning effectiveness | Committee member | Rejected: Evidence not relevant to local patient population |
14. Reduce ordering of ‘routine’ diagnostic tests in specified patient group as thought to have no evidence of benefit | Committee member | Rejected: Department could not provide backfill to replace project champion who would undertake project |
15. Reduce use of therapeutic intervention in specified patient group due to concerns about patient safety, not recommended in clinical guidelines used elsewhere | Committee member | Decision postponed: While proposer confirmed evidence Rejected: When discovered that project had commenced |
16. Replace therapeutic intervention in specified patient group with one considered to be safer, more effective and more cost-effective and funded by state health department | VPACT project | Accepted then Withdrawn: Clinicians became aware of additional evidence and elected to undertake RCT |
17. Restrict use of therapeutic intervention in specified patient group as local practice thought to be inconsistent with recently published national guidelines | Expression of interest | Accepted then Withdrawn: Clinicians not convinced by evidence, local practice found not to be inconsistent |
18. Reduce ordering of diagnostic tests considered to be inappropriate in certain unspecified situations | Expression of interest | Accepted then Rejected: Inopportune timing due to external accreditation process and introduction of new computer database and electronic ordering system |
19. Replace therapeutic intervention in specified patient group with one considered to be safer, more effective and more cost-effective and funded by state health department | VPACT project | Accepted: Project undertaken with SHARE support but evaluation incomplete due to loss of funding prior to completion of implementation |