title: The ASTUTE Health study protocol: deliberative stakeholder engagements to inform implementation approaches to healthcare disinvestment.
abstract: BACKGROUND
  Governments and other payers are yet to determine optimal processes by which to review the safety, effectiveness, and cost-effectiveness of technologies and procedures that are in active use within health systems, and rescind funding (partially or fully) from those that display poor profiles against these parameters. To further progress a disinvestment agenda, a model is required to support payers in implementing disinvestment in a transparent manner that may withstand challenge from vested interests and concerned citizens. Combining approaches from health technology assessment and deliberative democratic theory, this project seeks to determine if and how wide stakeholder engagement can contribute to improved decision-making processes, wherein the views of both vested and non-vested stakeholders are seen to contribute to informing policy implementation within a disinvestment context.
  
  
  METHODS
  Systematic reviews pertaining to illustrative case studies were developed and formed the evidence base for discussion. Review findings were presented at a series of deliberative, evidence-informed stakeholder engagements, including partisan (clinicians and consumers) and non-partisan (representative community members) stakeholders. Participants were actively facilitated towards identifying shared and dissenting perspectives regarding public funding policy for each of the case studies and developing their own funding models in response to the evidence presented. Policy advisors will subsequently be invited to evaluate disinvestment options based on the scientific and colloquial evidence presented to them, and to explore the value of this information to their decision-making processes with reference to disinvestment.
  
  
  CONCLUSIONS
  Analysis of the varied outputs of the deliberative engagements will contribute to the methodological development around how to best integrate scientific and colloquial evidence for consideration by policy advisors. It may contribute to the legitimization of broad and transparent stakeholder engagement in this context. It is anticipated that decision making will benefit from the knowledge delivered through informed deliberation with engaged stakeholders, and this will be explored through interviews with key decision makers.
authors.affiliation: School of Population Health, The University of Adelaide, North Terrace, Adelaide, SA, Australia.
authors.forename: Amber M
authors.initials: AM
authors.lastname: Watt
authors.forename: Janet E
authors.initials: JE
authors.lastname: Hiller
authors.forename: Annette J
authors.initials: AJ
authors.lastname: Braunack-Mayer
authors.forename: John R
authors.initials: JR
authors.lastname: Moss
authors.forename: Heather
authors.initials: H
authors.lastname: Buchan
authors.forename: Janet
authors.initials: J
authors.lastname: Wale
authors.forename: Dagmara E
authors.initials: DE
authors.lastname: Riitano
authors.forename: Katherine
authors.initials: K
authors.lastname: Hodgetts
authors.forename: Jackie M
authors.initials: JM
authors.lastname: Street
authors.forename: Adam G
authors.initials: AG
authors.lastname: Elshaug
mesh_terms: D003256:Community Participation / Q000379:methods; D003362:Cost-Benefit Analysis; D003657:Decision Making; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D005492:Folic Acid / Q000008:administration & dosage; D006291:Health Policy; D006801:Humans; D011787:Quality of Health Care / Q000458:organization & administration; D027724:Reproductive Techniques, Assisted; D013673:Technology Assessment, Biomedical / Q000458:organization & administration*; D014805:Vitamin B 12 / Q000008:administration & dosage
chemical_list: D005492:Folic Acid; D014805:Vitamin B 12