ASTUTE Health Study Background

Rationale

Australia has limited systems in place to identify and subsequently reduce or withdraw (disinvest) ineffective or inappropriate health care practices. Such practices result in sub-optimal care and inefficient use of scarce resources. Disinvestment models are few and have not been tested in Australia.

Aims

To trial and evaluate a model to refine the indications for resource allocation to ineffective or inappropriately applied health care practices.

We will use two case studies to:

• Examine current best evidence to document if, and to what extent, selected health care practices deviate from currently accepted notions of safety, effectiveness and cost-effectiveness.

• Engage with a broad range of stakeholders to identify the factors that may be operating, principally at the mid- and micro- levels, to sustain ineffective health care practices or to facilitate their reduction or removal. In particular, we will identify the facilitators and barriers of a clinical, political, ethical, social and/or economic nature that are of influence, including those that might support disinvestment.

Using process, impact and outcome evaluation of our case studies, we will:

• Assess if, and how, this model can be used by policy makers to reduce or remove (disinvest) ineffective health care practices in the future.

• Analyse the way in which evidence of various types is used by policy makers to underpin decisions about disinvestment.