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 (2020). De-implementing wisely: developing the evidence base to reduce low-value care. BMJ Quality and Safety, 29(5), pp. 409-417. BMJ Publ. Group 10.1136/bmjqs-2019-010060
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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.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine 04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM) |
UniBE Contributor: |
Rodondi, Nicolas |
Subjects: |
600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services |
ISSN: |
2044-5415 |
Publisher: |
BMJ Publ. Group |
Language: |
English |
Submitter: |
Andrea Flükiger-Flückiger |
Date Deposited: |
13 Feb 2020 15:27 |
Last Modified: |
05 Dec 2022 15:36 |
Publisher DOI: |
10.1136/bmjqs-2019-010060 |
PubMed ID: |
32029572 |
Uncontrolled Keywords: |
evaluation methodology health services research healthcare quality improvement implementation science patient-centred care |
BORIS DOI: |
10.7892/boris.140238 |
URI: |
https://boris.unibe.ch/id/eprint/140238 |
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