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De-implementation of low-value home-based nursing care: an effect and process evaluation
Milou Cremers1, Lisette Schoonhoven2,3, Leti van Bodegom-Vos4
1Department of Internal Medicine, Section Nursing Science, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands.
Implementation Science Communications
|October 2, 2025
Summary
A tailored strategy using de-implementation ambassadors significantly reduced low-value home nursing care. Involving clients and providing reassurance were key to success, enhancing independence and sustainability in healthcare.
Area of Science:
- Healthcare Management
- Nursing Practice
- Quality Improvement
Background:
- Increasing demand for homecare necessitates reducing low-value care for sustainable healthcare.
- Low-value care includes ineffective, inefficient, unwanted, or harmful practices.
- This study evaluated a strategy to decrease low-value home-based nursing care.
Purpose of the Study:
- To assess the impact of a tailored, multifaceted de-implementation strategy on reducing low-value home-based nursing care.
- To identify effective de-implementation strategies and influencing factors.
- To evaluate the role of de-implementation ambassadors.
Main Methods:
- Prospective, multicenter, convergent parallel mixed-methods design with a before-and-after study.
- Utilized the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework.
- Assessed care reduction via client records and qualitatively through interviews with healthcare professionals.
Main Results:
- Significant reductions in low-value care: 130 hours/week in showering/bathing/dressing, 54 hours/week in compression stocking assistance, and 8 hours/week in bandage changes.
- Key strategies included client/relative involvement, informational meetings, and interprofessional collaboration.
- Reassurance and stepwise approaches facilitated adoption; ambassadors were committed but found the role intense.
Conclusions:
- Deployment of de-implementation ambassadors and tailored strategies effectively reduced low-value home nursing care.
- Client and relative involvement, alongside reassurance, proved beneficial for de-implementation.
- The study highlights successful methods for improving efficiency and client independence in homecare settings.
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