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Table 3 Potential disinvestment projects

From: Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting

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