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Empirical and conceptual investigation of de-implementation of low-value care from professional and health care system perspectives: a study protocol
Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Procome Res Grp, SE-17177 Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med CES, Unit Implementat & Evaluat, SE-17129 Stockholm, Sweden..
Linkoping Univ, Div Community Med, Dept Med & Hlth Sci, Linkoping, Sweden..
Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Procome Res Grp, SE-17177 Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med CES, Unit Implementat & Evaluat, SE-17129 Stockholm, Sweden..
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Stockholm.
2018 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13, article id 67Article in journal (Refereed) Published
Abstract [en]

Background: A considerable proportion of interventions provided to patients lacks evidence of their effectiveness This implies that patients may receive ineffective, unnecessary, or even harmful care Thus, in addition to implementing evidence based practices, there is also a need to abandon interventions that are not based on best evidence, i e, low value care However, research on de implementation is limited, and there is a lack of knowledge about how effective de implementation processes should be earned out The aim of this project is to explore the phenomenon of the de implementation of low value health care practices from the perspective of professionals and the health care system. Methods: Theories of habits and developmental learning in combination with theories of organizational alignment will be used The project's work will be conducted in five steps Step 1 is a scoping review of the literature, and Step 2 has an explorative design involving interviews with health care stakeholders Step 3 has a prospective design in which workplaces and professionals are shadowed during an ongoing de implementation In Step 4, a conceptual framework for de implementation will be developed based on the previous steps In Step 5, strategies for de implementation are identified using a co design approach. Discussion: This project contributes new knowledge to implementation science consisting of empirical data, a conceptual framework, and strategy suggestions on de implementation of low value care The professionals' perspectives will be highlighted, including insights into how they make decisions, handle de implementation in daily practice, and what consequences it has on their work Furthermore, the health care system perspective will be considered and new knowledge on how de implementation can be understood across health care system levels will be obtained The theories of habits and developmental learning can also offer insights into how context triggers and reinforces certain behaviors and how factors at the individual and the organizational levels interact The project employs a solution oriented perspective by developing a framework for de implementation of low value practices and suggesting practical strategies to improve de implementation processes at all levels of the health care system The framework and the strategies can thereafter be evaluated for their validity and impact in future studies.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2018. Vol. 13, article id 67
Keywords [en]
Disinvestment, Unlearning, Habits, ineffective, Abandon, De-adoption, Decrease use
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-39359DOI: 10.1186/s13012-018-0760-7ISI: 000432302900001PubMedID: 29764462Scopus ID: 2-s2.0-85047068635OAI: oai:DiVA.org:mdh-39359DiVA, id: diva2:1211481
Available from: 2018-05-31 Created: 2018-05-31 Last updated: 2018-05-31Bibliographically approved

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Publisher's full textPubMedScopushttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952615/pdf/13012_2018_Article_760.pdf

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von Thiele Schwarz, Ulrica

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