Table 1 Study description of empirical studies (N = 13)
From: A scoping review of de-implementation frameworks and models
Author, year | Setting | Sample characteristics | Topic/content area | De-implementation intervention | Primary action | Secondary action | Evidence for de-imp. | Cost | Stakeholder | Method | Study design | Measures used | Primary outcomes |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Cuttler et al., 2005 [39] | Clinical (academic, specialty) | Physicians (n = 222) | Pediatric specialty medicine | Physician decision to terminate growth hormone therapy in pediatric patients | Reduce, remove | NA | Mixed | Y | Y | Mixed methods | Cross-sectional | Interview; survey | Physician recommendation for case Scenarios |
Goodwin, 2013 [40] | Healthcare (broad) | Healthcare manager, staff, and clinicians (n = 13) | Reducing low-value care and costs in healthcare | Program budgeting and Marginal analysis | Reduce | NA | NR | Y | Y | Mixed methods | Case study | Interviews; archival data | Satisfaction and compliance with pbma process; cost |
Grimshaw et al., 2020 [41] | Healthcare (broad) | Hospitals (n = 137) | Preoperative tests; imaging for lower back pain | Identify low-value care; identify local priorities; identify barriers and potential interventions; evaluate choosing wisely implementation; spread effective choosing wisely programs | Reduce | NA | Ineffective | Y | Y | Mixed methods | Case study | Hospital administrative data | % reduction in low-value care |
Gupta et al., 2019 [42] | Hospital | Patient records (n = 4,781) | Neutropenic diet for immunocompromised patients | Multi-step implementation strategy bundle targeting clinician and system-level change (e.g., training, EHR updates) | Remove | NA | Ineffective | Y | Y | Mixed methods | Case study | Content analysis of neutropenic diet prescribing; EHR review | Absolute reduction in prescribing |
Harris et al., 2017a [29] | Health service network | Healthcare experts, steering committee members, workshop attendees (n = 28) | Disinvestment of clinically or cost ineffective health services (broadly) | Development of deimplementation framework | Remove | NA | NR | Y | Y | Mixed methods | Case study | Literature review; interview; survey; workshop | Development of deimplementation framework |
Harris et al., 2017b [43] | Health service network | Healthcare experts (n = 15), healthcare staff (n = 65), senior administrators (n = 18) | Disinvestment of clinically or cost ineffective health services (broadly) | Development of deimplementation framework | Remove | NA | NR | Y | Y | Mixed methods | Case study | Literature review; interview; survey; workshop | Describe methods for disinvestment |
Harris et al., 2017c [44] | Health service network | Healthcare experts (n = 15), healthcare staff (n = 65), senior administrators (n = 18) | Disinvestment of clinically or cost ineffective health services (broadly) | Development of deimplementation framework | Remove | NA | NR | Y | Y | Mixed methods | Case study | Literature review; interview; survey; workshop | Development of deimplementation framework |
Harris et al., 2018 [45] | Health service network | NA | Disinvestment of clinically or cost ineffective health services (broadly) | Development of deimplementation framework | Remove | NA | NR | Y | Y | Mixed methods | Case study | Literature review; interview; survey; workshop | Development of deimplementation framework |
McKay et al., 2017 [46] | Non-profit community based organization | Organization staff (n = 5); clients (n = 396) | HIV prevention | Counseling intervention to identify and reduce risk behaviors. De-adoption involved transition of resource to replacement intervention. | Remove | Replace | Ineffective | Y | N | Mixed methods | Archival secondary data analysis, interview | Data abstraction of agency archival and client records, interviews (with program staff) | Intervention deadoption process and consequences |
Padek et al., 2018 [47] | State health departments | Program staff and leaders (n not available in protocol) | Cancer prevention and control programs in public health departments | NR | Reduce | NA | Ineffective | Y | Y | Mixed methods | Study protocol (quantitative crosssectional, qualitative case study, abm simulation) | Survey, case studies (interview), abm | Mis-implementation of cancer prevention and control programs |
Skolarus et al., 2018 [48] | Clinical (VA) | Patients and physicians (n not available in protocol) | Prostate cancer (androgen deprivation therapy) | Organization policy and behavior change (assess preferences and barriers; discrete choice experiment; formulary restriction; strategy targeting patient/provider decision making) | Reduce | Restrict | Ineffective, contradicted | N | Y | Mixed methods | Study protocol (crosssectional) | Interviews, surveys | Acceptability, feasibility, scalability |
Tangpong et al., 2015 [49] | Organization/firm (multiple industries) | Organizations (n = 96) | Business/management | Organizational behavior, layoffs, divestments, geographic exits | Reduce | Remove, restrict | NR | Y | N | Quantitative | Longitudinal | Survey | Likelihood of turnaround success, changes in form operating conditions, internal firm performance, external capital market support |
Voorn et al., 2018 [50] | Hospital | Hospitals (n = 21) | Patient blood management in transfusion medicine (surgery) | Information provision, goal specification, clinician feedback, benchmark with comparison to best practice hospitals (behavior change) | Reduce | NA | Ineffective | Y | Y | Quantitative | Cluster randomized control trial | Survey | Use of low- value care (esa + blood salvage) |