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

Area of Science:

• Health Services Research
• Implementation Science

Background:

• Choosing Wisely (CW) campaigns aim to reduce low-value care, which constitutes a significant portion of healthcare costs.
• Despite initial enthusiasm, large-scale reductions in low-value care have been limited, highlighting the need for effective implementation strategies.

Purpose of the Study:

• To introduce the Choosing Wisely De-Implementation Framework (CWDIF), a novel approach to systematically reduce low-value care.
• To advance the science of de-implementation in both hospital and community settings.

Main Methods:

• The CWDIF comprises five phases: identifying low-value care areas, prioritizing CW recommendations, identifying barriers and interventions, evaluating implementation programs, and spreading effective programs.
• A worked example is provided, applying the CWDIF to reduce unnecessary preoperative testing for low-risk surgeries.

Main Results:

• The framework provides a systematic methodology for de-implementation.
• The worked example demonstrates the practical application of the CWDIF in a clinical setting.

Conclusions:

• The CWDIF offers a comprehensive approach to systematically reduce low-value care.
• Further development of the evidence base for de-implementation is crucial for improving healthcare value.