TY - JOUR
T1 - De-implementing wisely
T2 - Developing the evidence base to reduce low-value care
AU - Grimshaw, Jeremy M.
AU - Patey, Andrea M.
AU - Kirkham, Kyle R.
AU - Hall, Amanda
AU - Dowling, Shawn K.
AU - Rodondi, Nicolas
AU - Ellen, Moriah
AU - Kool, Tijn
AU - Van Dulmen, Simone A.
AU - Kerr, Eve A.
AU - Linklater, Stefanie
AU - Levinson, Wendy
AU - Bhatia, R. Sacha
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Choosing Wisely (CW) campaigns globally have focused attention on the need to reduce low-value care, which can represent up to 30% of the costs of healthcare. Despite early enthusiasm for the CW initiative, few large-scale changes in rates of low-value care have been reported since the launch of these campaigns. Recent commentaries suggest that the focus of the campaign should be on implementation of evidence-based strategies to effectively reduce low-value care. This paper describes the Choosing Wisely De-Implementation Framework (CWDIF), a novel framework that builds on previous work in the field of implementation science and proposes a comprehensive approach to systematically reduce low-value care in both hospital and community settings and advance the science of de-implementation. The CWDIF consists of five phases: Phase 0, identification of potential areas of low-value healthcare; Phase 1, identification of local priorities for implementation of CW recommendations; Phase 2, identification of barriers to implementing CW recommendations and potential interventions to overcome these; Phase 3, rigorous evaluations of CW implementation programmes; Phase 4, spread of effective CW implementation programmes. We provide a worked example of applying the CWDIF to develop and evaluate an implementation programme to reduce unnecessary preoperative testing in healthy patients undergoing low-risk surgeries and to further develop the evidence base to reduce low-value care.
AB - Choosing Wisely (CW) campaigns globally have focused attention on the need to reduce low-value care, which can represent up to 30% of the costs of healthcare. Despite early enthusiasm for the CW initiative, few large-scale changes in rates of low-value care have been reported since the launch of these campaigns. Recent commentaries suggest that the focus of the campaign should be on implementation of evidence-based strategies to effectively reduce low-value care. This paper describes the Choosing Wisely De-Implementation Framework (CWDIF), a novel framework that builds on previous work in the field of implementation science and proposes a comprehensive approach to systematically reduce low-value care in both hospital and community settings and advance the science of de-implementation. The CWDIF consists of five phases: Phase 0, identification of potential areas of low-value healthcare; Phase 1, identification of local priorities for implementation of CW recommendations; Phase 2, identification of barriers to implementing CW recommendations and potential interventions to overcome these; Phase 3, rigorous evaluations of CW implementation programmes; Phase 4, spread of effective CW implementation programmes. We provide a worked example of applying the CWDIF to develop and evaluate an implementation programme to reduce unnecessary preoperative testing in healthy patients undergoing low-risk surgeries and to further develop the evidence base to reduce low-value care.
KW - evaluation methodology
KW - health services research
KW - healthcare quality improvement
KW - implementation science
KW - patient-centred care
UR - http://www.scopus.com/inward/record.url?scp=85079277671&partnerID=8YFLogxK
U2 - 10.1136/bmjqs-2019-010060
DO - 10.1136/bmjqs-2019-010060
M3 - Article
C2 - 32029572
AN - SCOPUS:85079277671
SN - 2044-5415
VL - 29
SP - 409
EP - 417
JO - BMJ Quality and Safety
JF - BMJ Quality and Safety
IS - 5
ER -