title: Creating value in health by understanding and overcoming resistance to de-innovation.
abstract: As hard as it may be for clinicians to adopt new practices, it is often harder for them to "de-innovate," or give up old practices, even when new evidence reveals that those practices offer little value. In this article we explore recent controversies over screening for breast and prostate cancer and testing for sleep disorders. We show that these controversies are not caused solely by a lack of clinical data on the harms and benefits of these tests but are also influenced by several psychological biases that make it difficult for clinicians to de-innovate. De-innovation could be fostered by making sure that advisory panels and guideline committees include experts who have competing biases; emphasizing evidence over clinical judgment; resisting "indication creep," or the premature extension of innovations into unproven areas; and encouraging clinicians to explicitly consider how their experiences bias their interpretations of clinical evidence.
authors: Peter A. Ubel is a professor in the Department of Medicine, Fuqua School of Business, and Sanford School of Public Policy, all at Duke University, in Durham, North Carolina.
authors: Peter A
authors: PA
authors: Ubel
authors: David A. Asch (asch@wharton.upenn.edu) is executive director of the Center for Health Care Innovation and a professor in the Wharton School and the Perelman School of Medicine, all at the University of Pennsylvania, and a physician in the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center.
authors: David A
authors: DA
authors: Asch
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D055317:Evidence-Based Practice / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000639:trends; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control; D012051:Reimbursement Mechanisms / Q000191:economics* / Q000639:trends; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000191:economics
keywords: Business Of Health; Evidence-Based Medicine; Organization and Delivery of Care; Public Opinion; Quality Of Care