Association for Public Policy Analysis & Management

Medical practice is an evolving field where a significant amount of resources are allocated to develop medical innovations and to enhance clinical evidence on new and existing treatments. In most cases, new evidence supporting approval by federal regulators demonstrates efficacy of new treatments; after approval, new evidence for existing treatments may show them to be ineffective or unsafe. Clinical evidence based on robust studies should quickly diffuse into clinical practice, but that is not always the case and it can take time for evidence to be integrated into practice. Much of the focus on diffusion of evidence is focused on adoption of new treatments; less is known about de-adoption of treatments that are shown to be ineffective or unsafe. The de-adoption process is not necessarily the reverse image of adoption, and clinical, social and psychological characteristics may result in physicians’ unwillingness to de-adopt. Using administrative claims data for Medicare Fee-for-Service, Medicare Advantage and commercially insured populations in the United States, and focusing on several case studies in which clinical evidence or guidelines show treatments to be ineffective or unsafe, we examine several questions: Whether and how fast do physicians de-adopt? What is the extent of geographic and physician variation in de-adoption? Which physician characteristics are associated with the de-adoption? Are there racial/ethnic, socioeconomic, and geographic disparities that emerge in the de-adoption process?