advancing the field of deimplementation

Abstract

INTRODUCTION: Clinical preventive services, such as screening tests, vaccinations, and health behavior counseling provided in primary care settings, aim to prevent future disease, detect early disease, or mitigate the impact of unhealthy behaviors on future health. However, research advances have shown that some clinical preventive services do not confer benefit and may even cause harm for some populations. Experts have increasingly emphasized discontinuing low-value health services, a process known as deimplementation. This project gathered expert input on the state of deimplementation of low-value clinical preventive services.

METHODS: The author conducted (1) an environmental scan of current work on deimplementation, (2) key informant interviews (n=4 individuals), and (3) a facilitated discussion with a technical expert panel (n=12 members) and synthesized the findings. The author used an iterative, inductive approach to identify themes from the discussions with experts.

RESULTS: The environmental scan and technical experts identified no frameworks and few empiric studies specific to the deimplementation of low-value clinical preventive services. The experts advised that terminology surrounding deimplementation efforts and low-value health services be revised to better resonate with patients and families. Experts suggested refining existing health services deimplementation frameworks and recommended future research to test deimplementation strategies specific to low-value clinical preventive services. Experts also described unintended consequences of deimplementation that could increase health inequities. Finally, experts emphasized the importance of engaging patients and families in deimplementation efforts.

CONCLUSIONS: These findings offer guidance for future work, including advancing methods; testing strategies specific to low-value clinical preventive services; and engaging patients, families, and communities in deimplementation efforts.