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Strategies for de-implementation of low-value care—a scoping review
Karolinska Institutet, Sweden.
Unit for implementation and evaluation, Center for Epidemiology and Community Medicine (CES), Sweden.
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Karolinska, Sweden. (HAL)ORCID iD: 0000-0002-4771-8349
Department of Health, Medicine and Caring Sciences, Division of Public Health, Linköping University, Sweden.
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2022 (English)In: Implementation Science, E-ISSN 1748-5908, Vol. 17, no 1, article id 73Article in journal (Refereed) Published
Abstract [en]

Background: The use of low-value care (LVC) is a persistent problem that calls for knowledge about strategies for de-implementation. However, studies are dispersed across many clinical fields, and there is no overview of strategies that can be used to support the de-implementation of LVC. The extent to which strategies used for implementation are also used in de-implementing LVC is unknown. The aim of this scoping review is to (1) identify strategies for the de-implementation of LVC described in the scientific literature and (2) compare de-implementation strategies to implementation strategies as specified in the Expert Recommendation for Implementing Change (ERIC) and strategies added by Perry et al. Method: A scoping review was conducted according to recommendations outlined by Arksey and O’Malley. Four scientific databases were searched, relevant articles were snowball searched, and the journal Implementation Science was searched manually for peer-reviewed journal articles in English. Articles were included if they were empirical studies of strategies designed to reduce the use of LVC. Two reviewers conducted all abstract and full-text reviews, and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data-charting form. The strategies were first coded inductively and then mapped onto the ERIC compilation of implementation strategies. Results: The scoping review identified a total of 71 unique de-implementation strategies described in the literature. Of these, 62 strategies could be mapped onto ERIC strategies, and four strategies onto one added category. Half (50%) of the 73 ERIC implementation strategies were used for de-implementation purposes. Five identified de-implementation strategies could not be mapped onto any of the existing strategies in ERIC. Conclusions: Similar strategies are used for de-implementation and implementation. However, only a half of the implementation strategies included in the ERIC compilation were represented in the de-implementation studies, which may imply that some strategies are being underused or that they are not applicable for de-implementation purposes. The strategies assess and redesign workflow (a strategy previously suggested to be added to ERIC), accountability tool, and communication tool (unique new strategies for de-implementation) could complement the existing ERIC compilation when used for de-implementation purposes.

Place, publisher, year, edition, pages
BioMed Central Ltd , 2022. Vol. 17, no 1, article id 73
Keywords [en]
De-implementation, Low-value care, Scoping review, Strategies
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:mdh:diva-60547DOI: 10.1186/s13012-022-01247-yISI: 000874939000002PubMedID: 36303219Scopus ID: 2-s2.0-85140655359OAI: oai:DiVA.org:mdh-60547DiVA, id: diva2:1708220
Available from: 2022-11-03 Created: 2022-11-03 Last updated: 2024-01-17Bibliographically approved

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von Thiele Schwarz, Ulrica

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