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Determinants of the de-implementation of low-value care: a multi-method study
Jeanna Parsons Leigh1, Emma E Sypes2, Sharon E Straus3
1School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada.
BMC Health Services Research
|April 7, 2022
Summary
Understanding barriers and facilitators to de-implementation is crucial. This study identified key determinants like evidence availability and stakeholder collaboration, informing future initiatives to reduce low-value care.
Area of Science:
- Health Services Research
- Evidence-Based Practice
- Healthcare Management
Background:
- De-implementation of low-value care requires understanding its determinants.
- Existing literature and stakeholder experiences offer insights into barriers and facilitators.
- Systematic review registered in PROSPERO (CRD42016050234).
Purpose of the Study:
- To compile a comprehensive list of de-implementation determinants from published literature.
- To compare literature-identified determinants with those experienced by stakeholders in critical care.
Main Methods:
- Two-phase multi-method study: systematic review and semi-structured interviews.
- Systematic review of English-language articles on de-implementation barriers/facilitators in adults.
- Conventional and thematic content analysis of extracted determinants and interview themes.
Main Results:
- Systematic review identified 29 distinct barriers and 24 distinct facilitators from 172 articles.
- Common barriers: lack of credible evidence (21%), clinician resistance (21%), patient preferences (6%).
- Common facilitators: stakeholder collaboration (15%), availability of credible evidence (12%).
- Stakeholder interviews confirmed relevance of 23/29 barriers and 20/24 facilitators in critical care.
Conclusions:
- Availability and quality of evidence identifying low-value care are critical determinants.
- Healthcare professional willingness to change and stakeholder collaboration are key factors.
- These determinants can guide future de-implementation initiatives.
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