A new approach to disinvestment: Application to falls prevention mobilisation alarms

Health service improvements require changes in practice. Some activities have to be stopped to release resources to allow other activities to commence. Disinvestment refers to stopping or reducing some activities and can apply when an activity has been found to be harmful, ineffective, overused, misused or obsolete. However, for a large number of activities, there may be some evidence indicating it may not be effective but insufficient evidence to clearly say whether there is a lack of benefit or not. Continuing provision of these activities is problematic, as they can consume substantial amounts of health service resource, resource that could instead be used to invest in activities that do have evidence of benefit. In this project, we focus on a strategy that simultaneously leads to disinvestment from activities like this with an uncertain evidence-base, while also generating the evidence base required to examine whether the activity was indeed ineffective. We make conceptual advances on an approach we have previously developed so that comparisons across three or more activity options can be made. We will examine the effect of using this strategy, the economic efficiency of using this disinvestment approach, the acceptability of health professionals and managers toward being involved in this strategy, and the important of evidence generated through use of this strategy on the decision making of other health services who have not been involved in its use. We will undertake a mixed methods evaluation of the world's first application of this strategy in the context of disinvestment from use of mobilisation alarms for the prevention of falls in hospital wards. These alarms are widely used, have a limited evidence base of benefit, have some potential to cause unintended harms, and consume considerable time and effort on hospital wards to purchase, set-up, and respond to.