De-implementing wisely: developing the evidence base to reduce low-value care

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 the...

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Bibliographic Details
Published in:BMJ quality & safety Vol. 29; no. 5; pp. 409 - 417
Main Authors: Grimshaw, Jeremy M, Patey, Andrea M, Kirkham, Kyle R, Hall, Amanda, Dowling, Shawn K, Rodondi, Nicolas, Ellen, Moriah, Kool, Tijn, van Dulmen, Simone A, Kerr, Eve A, Linklater, Stefanie, Levinson, Wendy, Bhatia, R Sacha
Format: Journal Article
Language:English
Published: England BMJ Publishing Group Ltd 01.05.2020
BMJ Publishing Group LTD
BMJ Publishing Group
Subjects:
Accountability
Delivery of Health Care - standards
evaluation methodology
Guidelines as Topic
Health care
Health Plan Implementation - methods
health services research
healthcare quality improvement
Hospitals
Humans
Identification
Implementation Science
Initiatives
Intervention
Medical Overuse - prevention & control
Patient-centered care
patient-centred care
Patients
Program Development - methods
Program Evaluation - methods
Quality control
Quality improvement
Research and Reporting Methodology
Surgery
Theory
Canada
health services research
healthcare quality improvement
evaluation methodology
patient-centred care
implementation science
ISSN:2044-5415, 2044-5423, 2044-5423
Online Access:Get full text
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Summary: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.
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ISSN:2044-5415
2044-5423
2044-5423
DOI:10.1136/bmjqs-2019-010060