National Institute for Health and Clinical Excellence, London.
J Health Serv Res Policy. 2013 Jan;18(1):6-12. doi: 10.1258/jhsrp.2012.012044.
Despite international agreement that stopping low value practices will increase efficiency, identifying them is difficult and controversial. Opponents of centralized lists of low value practices stress that the actual problem is inappropriate low value use, and better targeting and implementation of treatment thresholds is needed. Our objective was to use Cochrane Reviews to identify low value practices to support local disinvestment decisions.
New or updated reviews were included if the authors concluded that the uncertain effectiveness of an intervention meant it should only be used in research, or that it was ineffective or harmful and should not be used. The reviews go through a production and quality assurance process, and are published as 'Cochrane Quality and Productivity topics' through the NHS Evidence website (http://www.library.nhs.uk/qipp/).
Over a six-month period, 65 Cochrane reviews were processed by the National Institute for Health and Clinical Excellence (NICE). Of these, 28 identified potentially low value practices in the UK context. This was primarily due to a lack of randomized evidence of effectiveness, rather than robust evidence of a lack of effectiveness, or evidence of harm.
Identifying low-value health care practices for local disinvestment (total or partial) is both practically and politically challenging, yet it is necessary to manage health budgets. This project identified that Cochrane Reviews can potentially identify low value health care practices. However, each review has to be reinterpreted for the UK context and additional analysis has to be undertaken to facilitate local implementation. Recommendations to improve the usability of systematic reviews are made.
尽管国际上一致认为停止低价值实践将提高效率，但识别低价值实践具有难度且颇具争议。反对集中列出低价值实践的人强调，实际问题是低价值的不当使用，需要更好地针对和实施治疗阈值。我们的目标是使用 Cochrane 综述来确定低价值实践，以支持当地的撤资决策。
如果作者得出结论认为某项干预措施的效果不确定，意味着它只应在研究中使用，或者该干预措施无效或有害，不应使用，则将新的或更新的综述纳入研究范围。这些综述经过制作和质量保证流程，并通过 NHS Evidence 网站（http://www.library.nhs.uk/qipp/）以“Cochrane Quality and Productivity topics”的形式发布。
在六个月的时间内，国家卫生与临床优化研究所（NICE）共处理了 65 项 Cochrane 综述。其中，28 项在英国背景下确定了潜在的低价值实践。这主要是由于缺乏关于有效性的随机证据，而不是缺乏有效性的有力证据，或存在危害的证据。
确定用于局部撤资（全部或部分）的低价值医疗实践在实践和政治上都具有挑战性，但管理医疗预算是必要的。该项目确定，Cochrane 综述可能有助于确定低价值医疗实践。然而，每项综述都必须针对英国背景进行重新解释，并进行额外的分析，以促进当地的实施。提出了一些建议来提高系统综述的可用性。
