Promoting Health Equity through De-Implementation Research.

Area of Science:

• Health Services Research
• Health Equity Studies
• Medical De-implementation Science

Background:

• Equitable healthcare access traditionally focuses on underuse (patients not receiving beneficial care).
• High-quality care also necessitates reducing low-value care (overuse) where harms outweigh benefits.
• De-implementation is the process of reducing or eliminating low-value care.

Purpose of the Study:

• To argue that de-implementation is critical for advancing health equity.
• To identify how medical overuse impacts different patient populations, particularly concerning race, ethnicity, and socioeconomic status.
• To propose research actions to address equity gaps in de-implementation efforts.

Main Methods:

• The article presents a conceptual argument based on existing literature regarding healthcare overuse and equity.
• It analyzes the association between medical overuse and patient demographics (race, ethnicity, socioeconomic status).
• It discusses the concept of 'double jeopardy' where minorities face both overuse and underuse.

Main Results:

• Medical overuse is linked to patient race, ethnicity, and socioeconomic status, sometimes creating a 'double jeopardy' scenario.
• Overuse of preventive care and screening is often higher among socioeconomically advantaged patients.
• Racial and ethnic minorities may experience overuse differently than White populations, complicating de-implementation.

Conclusions:

• Addressing only underuse is insufficient for achieving health equity; overuse must also be tackled.
• De-implementation strategies must consider and mitigate potential biases affecting different demographic groups.
• Further research is needed, including subgroup analyses and studies on equity-related mechanisms in overuse and de-implementation.