Failing to use available science is costly and harmful; it leads to overuse of unhelpful care, underuse of effective care, and errors in execution. De-implementation, the process of reducing or stopping the use of ineffective, harmful, or low-value healthcare practice, has emerged as a highly important and increasingly studied field within implementation science. As health systems focus more on value, patient safety, and sustainability, successfully removing entrenched, low-value practices has become just as crucial as introducing new ones. This page offers journal articles and video presentations on de-implementation, providing key papers that lay a solid foundation on the conceptual underpinnings and theoretical frameworks shaping this vital area of healthcare improvement.

Articles

  • Grimshaw, J. M., Patey, A. M., Kirkham, K. R., Hall, A., Dowling, S. K., Rodondi, N., ... & Bhatia, R. S. (2020). De-implementing wisely: developing the evidence base to reduce low-value care. BMJ quality & safety, 29(5), 409-417. https://doi.org/10.1136/bmjqs-2019-010060

  • Ingvarsson, S., Hasson, H., von Thiele Schwarz, U. et al. Strategies for de-implementation of low-value care—a scoping review. Implementation Sci 17, 73 (2022). https://doi.org/10.1186/s13012-022-01247-

  • Van Bodegom-Vos, L., Davidoff, F., & Marang-van de Mheen, P. J. (2017). Implementation and de-implementation: two sides of the same coin?. BMJ quality & safety, 26(6), 495-501. https://doi.org/10.1136/bmjqs-2016-005473

  • Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P., & Stelfox, H. T. (2015). Towards understanding the de-adoption of low-value clinical practices: a scoping review. BMC medicine, 13(1), 1-21. https://doi.org/10.1186/s12916-015-0488-z

  • Rietbergen, T., Spoon, D., Brunsveld-Reinders, A.H. et al. Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and
    meta-analysis. Implementation Sci 15, 38 (2020). https://doi.org/10.1186/s13012-020-00995-z

Models & frameworks specific to de-implementation

  • Nilsen, P., Ingvarsson, S., Hasson, H., von Thiele Schwarz, U., & Augustsson, H. (2020). Theories, models, and frameworks for de-implementation of low-value care: A scoping review of the literature.Implementation Research and Practice, 1. https://doi.org/10.1177/2633489520953762
  • Niven, D.J., Mrklas, K.J., Holodinsky, J.K. et al. Towards understanding the de-adoption of low-value clinical practices: a scoping review. BMC Med 13, 255 (2015). https://doi.org/10.1186/s12916-015-0488-z
  • Augustsson, H., Ingvarsson, S., Nilsen, P.et al.Determinants for the use and de-implementation of low-value care in health care: a scoping review. Implement Sci Commun 2, 13 (2021). https://doi.org/10.1186/s43058-021-00110-3
  • Grimshaw JM, Patey AM,Kirkham KR, et al. De-implementing wisely: developing the evidence base to reduce low-value care BMJ Quality & Safety2020;29:409-417. https://doi.org/10.1136/bmjqs-2019-010060
  • Morgan DJ, Leppin AL, Smith CD, Korenstein D. A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient-Clinician Interaction. J Hosp Med. 2017 May;12(5):346-351. https://doi.org/10.12788/jhm.2738
  • van Dulmen S, Naaktgeboren C, Heus P, et alBarriers and facilitators to reduce low-value care: a qualitative evidence synthesis BMJ Open 2020;10:e040025. https://doi.org/10.1136/bmjopen-2020-040025

      Books

      • ·Kool, T., Patey, A. M., van Dulmen, S., & Grimshaw, J. M. (Eds.). (2023).How to reduce overuse in healthcare: a practical guide. John Wiley & Sons.

      Videos

      Chapter overview