The De-adoption of Low-value Clinical Practices in Adult Critical Care Medicine

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atmire.migration.oldid3977
dc.contributor.advisorStelfox, H. Thomas
dc.contributor.advisorStraus, Sharon
dc.contributor.authorNiven, Daniel
dc.contributor.committeememberHemmelgarn, Brenda
dc.contributor.committeememberJeffs, Lianne
dc.date.accessioned2015-12-24T17:17:13Z
dc.date.available2015-12-24T17:17:13Z
dc.date.issued2015-12-24
dc.date.submitted2015en
dc.description.abstractLow-value clinical practices are common, and potentially harmful to patients and healthcare systems, yet the optimal approach to reducing (i.e. de-adopting) these practices is unknown. This thesis reports the results of three studies conducted with the overall objective of improving knowledge related to the de-adoption of low-value clinical practices in patients admitted to adult intensive care units (ICUs), an area known to have high resource consumption. First, a scoping review of the literature was conducted to systematically identify current knowledge regarding the science of de-adoption. From 109 citations, this review identified that current terminology is heterogeneous and poorly defined, that most of the literature evaluates the outcomes of some type of de-adoption effort, and that the most common (and least successful) approach to de-adoption is to wait for it to occur following passive diffusion of published research. A framework to guide the de-adoption process is proposed. Second, another scoping review using a replication research framework was conducted to identify low-value clinical practices among patients admitted to adult ICUs. Low-value practices were those wherein new evidence (i.e. replication research) suggests that an intervention previously thought to be beneficial is ineffective or harmful (i.e. evidence reversal). This review demonstrated that the results of nearly half of original replicated citations were reversed (n = 35, 49%), with the highest proportion of reversals in practices originally found to be beneficial (n = 21, 60%). Third, an interrupted time series analysis using the APACHE clinical database and patients admitted to adult ICUs in the United States examined the effects of replication research on clinical practice for a practice with evidence reversal, namely tight glycemic control. This study found notable changes in the practice of glycemic control following a clinical trial that demonstrated the benefits of tight glycemic control, with comparatively less change following a methodologically more rigorous trial that demonstrated its harmful effects. Taken together, the results of these three studies demonstrate the urgent need for additional research to understand and promote the de-adoption of low-value clinical practices.en_US
dc.identifier.citationNiven, D. (2015). The De-adoption of Low-value Clinical Practices in Adult Critical Care Medicine (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/28042en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/28042
dc.identifier.urihttp://hdl.handle.net/11023/2716
dc.language.isoeng
dc.publisher.facultyGraduate Studies
dc.publisher.institutionUniversity of Calgaryen
dc.publisher.placeCalgaryen
dc.rightsUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subjectEpidemiology
dc.subjectMedicine and Surgery
dc.subject.classificationde-adoptionen_US
dc.subject.classificationlow-valueen_US
dc.subject.classificationmedical reversalen_US
dc.subject.classificationdisinvesten_US
dc.subject.classificationCritical careen_US
dc.subject.classificationICUen_US
dc.titleThe De-adoption of Low-value Clinical Practices in Adult Critical Care Medicine
dc.typedoctoral thesis
thesis.degree.disciplineCommunity Health Sciences
thesis.degree.grantorUniversity of Calgary
thesis.degree.nameDoctor of Philosophy (PhD)
ucalgary.item.requestcopytrue
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