The ASTUTE Health study protocol: Deliberative stakeholder engagements to inform implementation approaches to healthcare disinvestment

Abstract

BackgroundGovernments and other payers are yet to determine optimal processes by which to review the safety, effectiveness, and cost-effectiveness of technologies and procedures that are in active use within health systems, and rescind funding (partially or fully) from those that display poor profiles against these parameters. To further progress a disinvestment agenda, a model is required to support payers in implementing disinvestment in a transparent manner that may withstand challenge from vested interests and concerned citizens. Combining approaches from health technology assessment and deliberative democratic theory, this project seeks to determine if and how wide stakeholder engagement can contribute to improved decision-making processes, wherein the views of both vested and non-vested stakeholders are seen to contribute to informing policy implementation within a disinvestment context.Methods/designSystematic reviews pertaining to illustrative case studies were developed and formed the evidence base for discussion. Review findings were presented at a series of deliberative, evidence-informed stakeholder engagements, including partisan (clinicians and consumers) and non-partisan (representative community members) stakeholders. Participants were actively facilitated towards identifying shared and dissenting perspectives regarding public funding policy for each of the case studies and developing their own funding models in response to the evidence presented. Policy advisors will subsequently be invited to evaluate disinvestment options based on the scientific and colloquial evidence presented to them, and to explore the value of this information to their decision-making processes with reference to disinvestment.DiscussionAnalysis of the varied outputs of the deliberative engagements will contribute to the methodological development around how to best integrate scientific and colloquial evidence for consideration by policy advisors. It may contribute to the legitimization of broad and transparent stakeholder engagement in this context. It is anticipated that decision making will benefit from the knowledge delivered through informed deliberation with engaged stakeholders, and this will be explored through interviews with key decision makers.

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

“…This study also addresses the lack of models and frameworks noted in the disinvestment literature [4, 5, 8, 10, 11, 19, 149, 157–159]. Firstly, a framework and taxonomy for evaluation and explication of implementation of change have been adapted specifically for use in disinvestment projects.…”

A systematic review on current status of health technology reassessment: insights for South Korea

“…In Australia, deliberative democratic methods were adopted to develop evidence-informed stakeholder engagements that include clinicians, consumers and representative community members in the process. The community consultations were held over 2 days to allow for information sharing, deliberation and an understanding of the HTR reports [26]. …”

Überversorgung: Initiativen zur Identifikation ineffektiver oder nicht bedarfsgerechter Leistungen

“…Zwei Forschungsprojekte (ASTUTE/"Assessing Service and Technology Use To Enhance Health" Study [38] und das SHARE/"Sustainability in Healthcare by Allocating Resources Effectively"-Projekt [39]) aus Australien befassen sich mit der Methodenentwicklung zur systematischen Identifikation ineffektiver medizinischer Interventionen und der Pilotierung der Methoden. Zahlreiche weitere -stark fokussierte -Initiativen etwa aus der Qualitätsmessung beinhalten auch Elemente zu unangemessenen oder unwirksamen medizinischen Leistungen: so enthalten etwa Projekte zur Entwicklung von Qualitätsindikatoren in der Onkologie Parameter, die auch die Unterlassung von Leistungen (etwa eine systemische Therapie in den letzten Lebenswochen) benennen [40].…”