FROM TALK TO ACTION: POLICY STAKEHOLDERS, APPROPRIATENESS, AND SELECTIVE DISINVESTMENT.
OBJECTIVE
There is widespread commitment--at least in principle--to "evidence-informed" clinical practice and policy development in health care. The intention is that only "appropriate" care ought to be delivered at public expense. Although the rationale for an appropriateness agenda is widely endorsed, and methods have been proposed for addressing it, few published studies exist of contemporary policy initiatives which have actually led to successful disinvestment. Our objective was to explore whether the direct involvement of policy stakeholders could advance appropriateness and disinvestment.


METHODS
Several collaborative engagements with policy stakeholders were undertaken to adapt and combine conceptual and empirical material related to appropriateness and disinvestment from the literature to create tools and processes for use in Canada and the province of Ontario in particular.


RESULTS
By combining inputs from the literature with colloquial evidence from policy stakeholders, a definition of appropriateness was developed and, importantly, endorsed by all the provincial and territorial ministers of health in Canada. Second, a reassessment framework was successfully implemented for identifying priorities for selective disinvestment.


CONCLUSIONS
When scientific evidence was combined with colloquial evidence from policy stakeholders, progress was made on the design and successful implementation of policies for appropriateness and disinvestment.
alison.paprica@utoronto.ca.
P Alison
PA
Paprica
Institute of Health Policy,Management and Evaluation,University of Toronto,Health Sciences Building.
Anthony J
AJ
Culyer
Menzies Centre for Health Policy,Sydney School of Public Health,The University of Sydney.
Adam G
AG
Elshaug
Ontario Ministry of Health and Long-Term Care.
Justin
J
Peffer
Ontario Ministry of Health and Long-Term Care.
Guillermo A
GA
Sandoval
D019317:Evidence-Based Medicine; D009864:Ontario; D011050:Policy Making; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
Appropriateness; De-implementation; Disinvestment; Evidence-based health care; Health economics; Health policy