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Disinvestment in the presence of uncertainty: Description of a novel, multi-group, disinvestment trial design and protocol for an application to reduce or cease use of mobilisation alarms for preventing falls in hospitals

Author

Listed:
  • Terry P Haines
  • Mari Botti
  • Natasha Brusco
  • Lisa O’Brien
  • Bernice Redley
  • Kelly-Ann Bowles
  • Alison Hutchinson
  • Debra Mitchell
  • Joanna Jellett
  • Kate Steen
  • Leanne Boyd
  • Melinda Webb-St Mart
  • Melissa Raymond
  • Peter Hunter
  • Phillip Russo
  • Rachel Bonnici
  • Dai Pu
  • Samantha Sevenhuysen
  • Vicki Davies
  • Ronald Shorr

Abstract

Disinvestment is the removal or reduction of previously provided practices or services, and has typically been undertaken where a practice or service has been clearly shown to be ineffective, inefficient and/or harmful. However, practices and services that have uncertain evidence of effectiveness, efficiency and safety can also be considered as candidates for disinvestment. Disinvestment from these practices and services is risky as they may yet prove to be beneficial if further evidence becomes available. A novel research approach has previously been described for this situation, allowing disinvestment to take place while simultaneously generating evidence previously missing from consideration. In this paper, we describe how this approach can be expanded to situations where three or more conditions are of relevance, and describe the protocol for a trial examining the reduction and elimination of use of mobilisation alarms on hospital wards to prevent patient falls. Our approach utilises a 3-group, concurrent, non-inferiority, stepped wedge, randomised design with an embedded parallel, cluster randomised design. Eighteen hospital wards with high rates of alarm use (≥3%) will be paired within their health service and randomly allocated to a calendar month when they will transition to a “Reduced” (

Suggested Citation

  • Terry P Haines & Mari Botti & Natasha Brusco & Lisa O’Brien & Bernice Redley & Kelly-Ann Bowles & Alison Hutchinson & Debra Mitchell & Joanna Jellett & Kate Steen & Leanne Boyd & Melinda Webb-St Mart , 2021. "Disinvestment in the presence of uncertainty: Description of a novel, multi-group, disinvestment trial design and protocol for an application to reduce or cease use of mobilisation alarms for preventi," PLOS ONE, Public Library of Science, vol. 16(12), pages 1-17, December.
  • Handle: RePEc:plo:pone00:0261793
    DOI: 10.1371/journal.pone.0261793
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    References listed on IDEAS

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    1. Joanna Jellett & Cylie Williams & Diana Clayton & Virginia Plummer & Terry Haines, 2020. "Falls risk score removal does not impact inpatient falls: A stepped‐wedge, cluster‐randomised trial," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(23-24), pages 4505-4513, December.
    2. Borislava Mihaylova & Andrew Briggs & Anthony O'Hagan & Simon G. Thompson, 2011. "Review of statistical methods for analysing healthcare resources and costs," Health Economics, John Wiley & Sons, Ltd., vol. 20(8), pages 897-916, August.
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