Conefrey Carmel, Farrar Nicola, Coyle Maeve, Bell Mike, Blazeby Jane, Burton Christopher, Donovan Jenny, Gibson Andy, Glynn Joel, Jones Tim, McNair Angus, Morley Josie, Owen-Smith Amanda, Rule Ellen, Thornton Gail, Tucker Victoria, Williams Iestyn, Hollingworth William, Rooshenas Leila
Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
BMC Health Serv Res. 2025 Jul 29;25(1):995. doi: 10.1186/s12913-025-13012-0.
In 2019 the English National Health Service (NHS) launched a national de-adoption programme to stop or limit access to surgical procedures considered to have little, or uncertain, evidence of benefit to justify their risks and/or costs: the Evidence-Based Interventions (EBI) programme. Central to the programme was the publication of guidance detailing clinical recommendations targeting 17 surgical procedures: four to be stopped and 13 to be restricted to patients satisfying specific criteria. Local commissioning organisations, NHS bodies responsible for purchasing surgical services, were instructed to reflect national EBI recommendations in their local commissioning policies. This study (which is part of the NIHR OLIVIA study, an evaluation of the EBI programme) assessed local commissioning policy compliance with EBI recommendations and identified funding mechanisms employed locally to promote enforcement.
A documentary analysis was conducted on a purposive sample of local commissioning policies for each of the 17 EBI surgical procedures. Local policies were compared to EBI recommendations and any differences were categorised against an established five category framework for capturing differences in local policies. Funding mechanisms were also recorded. Data were analysed using descriptive statistics supported by written summaries to describe the nature of discrepancies between local and national recommendations.
Three hundred six local commissioning policies were analysed. 72% (44/61) of procedures to be stopped and 43% (106/245) of restricted access policies matched EBI recommendations. Concordance rates varied by surgical procedures. Where local policies for the 13 restricted access procedures differed, variations were most commonly categorised as differences in diagnostic approach followed by differences in specification of symptom severity and disease progression. The funding mechanism most frequently stated for the stopped procedures was ‘Individual Funding Request’ (74%, 45/61), whilst for restricted access procedures, policies relied on ‘Criteria Based Access’ (48%, 117/245) followed by ‘Prior Approval’ (33%, 80/245).
This study, to our knowledge, is the first to explore variation between local and national de-adoption policies. With under half of local commissioning policies matching national EBI recommendations, reliance on the take up of national de-adoption policy is inadequate. More support is needed for local commissioners to reflect national guidance.
The online version contains supplementary material available at 10.1186/s12913-025-13012-0.
2019年，英国国家医疗服务体系（NHS）启动了一项全国性的弃用计划，以停止或限制使用那些被认为益处证据很少或不确定，不足以证明其风险和/或成本合理的外科手术：循证干预（EBI）计划。该计划的核心是发布指南，详细列出针对17种外科手术的临床建议：4种手术应停止，13种手术应仅限于符合特定标准的患者。当地委托组织，即负责购买外科手术服务的NHS机构，被指示在其当地委托政策中体现国家EBI建议。本研究（这是NIHR OLIVIA研究的一部分，该研究是对EBI计划的评估）评估了当地委托政策与EBI建议的合规情况，并确定了当地采用的促进执行的资金机制。
对17种EBI外科手术的每种手术的当地委托政策进行了有目的抽样的文献分析。将当地政策与EBI建议进行比较，并根据一个既定的五类框架对任何差异进行分类，以捕捉当地政策的差异。还记录了资金机制。使用描述性统计分析数据，并辅以书面总结，以描述当地和国家建议之间差异的性质。
分析了306项当地委托政策。应停止的手术中有72%（44/61），限制准入政策中有43%（106/245）与EBI建议相符。符合率因外科手术而异。在13项限制准入手术的当地政策存在差异的情况下，差异最常见的分类是诊断方法的差异，其次是症状严重程度和疾病进展的规范差异。停止手术最常提及的资金机制是“个人资金申请”（74%，45/61），而对于限制准入手术，政策依赖于“基于标准的准入”（48%，117/245），其次是“事先批准”（33%，80/245）。
据我们所知，本研究是首次探索当地和国家弃用政策之间的差异。由于不到一半的当地委托政策符合国家EBI建议，仅依靠国家弃用政策的实施是不够的。需要更多支持，以使当地委托机构能够体现国家指南。
在线版本包含可在10.1186/s12913 - 025 - 13012 - 0获取的补充材料。
