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Deimplementing Untested Practices in Homecare Services: A Preobservational-Postobservational Design.

Manon Guay1,2, Mélanie Ruest2,3, Damien Contandriopoulos4

  • 1School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, J1H 5N4, Canada.

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This summary is machine-generated.

A knowledge transfer intervention successfully introduced an evidence-based bathing tool (Algo) in Quebec healthcare centers. However, the study found that deimplementation of non-evidence-based tools did not occur, highlighting implementation challenges.

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Area of Science:

  • Healthcare Management
  • Knowledge Translation
  • Clinical Practice Improvement

Background:

  • Community-dwelling elders require adapted bathrooms, prompting Quebec's Health and Social Services Centers to form interdisciplinary teams via cross-skilling.
  • Occupational therapists developed in-house tools for non-therapists to select bathing equipment, but their psychometric properties and deimplementation processes are unknown.

Purpose of the Study:

  • To evaluate a knowledge transfer and exchange (KTE) intervention designed to deimplement non-evidence-based in-house bathing tools.
  • To assess the replacement of these tools with a new evidence-based tool called Algo.

Main Methods:

  • A census of 94 Quebec Health and Social Services Centers providing homecare services was conducted before (2009) and after (2013) the KTE intervention.
  • Knott and Wildavsky's levels of utilization were used to measure the deimplementation of in-house tools and the adoption of Algo.

Main Results:

  • Interdisciplinary team cross-skilling increased from 87% to 98%, and the use of in-house tools rose from 67% to 81%.
  • Algo adoption began during the KTE process, with 25 centers reaching the first utilization level.
  • No centers fully deimplemented their in-house tools to exclusively use Algo.

Conclusions:

  • The KTE intervention facilitated the development and adoption of the evidence-based Algo tool, challenging the use of non-evidence-based practices.
  • Despite the introduction of Algo, the deimplementation of existing non-evidence-based tools was not observed.
  • Proactive strategies are needed to address both deimplementation and implementation processes in clinical practice.