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A1O2 | Using evidence to stop ineffective practice: The UK Cochrane Centre (UKCC) and the National Institute of Health and Clinical Excellence (NICE) work together

Abstract text
Background

All healthcare systems face increasing pressures to control expenditure without compromising quality or patient safety. Disinvestment in clinically or cost ineffective interventions is thought key to transferring resources to higher-value care.

Objectives

NICE and the UKCC undertook a pilot project using Cochrane reviews as an evidence base to identify low-value interventions for local NHS disinvestment.


Methods

Over six months all Cochrane reviews concluding that an intervention could not be recommended or should be used only in research were identified by Cochrane and evaluated by NICE. (Figure1)

The potential impact of stopping the intervention was assessed against four domains: quality of care, patient/carer experience, patient safety and productivity savings. (Table1)

Interventions were excluded if they were not relevant to UK practice, required additional investigation or were unlikely to achieve gains in any domains.
Evaluated topics were published as reports suggesting disinvestment opportunities for local healthcare providers. (Table2)

Results

Of the 65 reviews appraised, 43% provided candidate interventions for local disinvestment. (Table3) Quantification of potential productivity savings was difficult due to the absence of NHS usage data. Most could not be quantified; one suggested potential savings of £2 million. Many reviews required additional analyses by NICE. Furthermore, many interventions were no longer used or had insufficient evidence to refute potential benefits, making disinvestment recommendations either irrelevant or inappropriate.

Conclusions

This is the first large-scale systematic application of a gold standard evidence base to the problem of disinvestment. It challenges assumptions that disinvestment can produce large savings, highlights the importance of robust processes to evaluate interventions when research evidence is inadequate and demonstrates the need for detailed data on healthcare usage/ expenditure. It identifies a translational gap between the requirements of decision makers and the content of Cochrane reviews highlighting a need to improve the consistency and precision of Cochrane review conclusions.
Authors
Docherty M1, Garner S2, Littlejohns P2, Clarke M3
1 Institute of Psychiatry, Kings College London United Kingdom
2 NICE United Kingdom
3 Centre for Public Health, Queen's University Belfast, Northern Ireland
Presenting author and contact person
Presenting author: 
Mary Docherty
Contact person: 
Mary Docherty (Contact this person)
Attachments
Date and Location
Session: 
Oral session A1O2
Date: 
Thursday 20 October 2011 - 11:35 - 12:05
Location: