Defining and conceptualizing outcomes for de-implementation: key distinctions from implementation outcomes

Abstract

Background: Increasingly, scholars argue that de-implementation is a distinct concept from implementation; factors contributing to stopping a current practice might be distinct from those that encourage adoption of a new one. One such distinction is related to de-implementation outcomes. We offer preliminary analysis and guidance on de-implementation outcomes, including how they may differ from or overlap with implementation outcomes, how they may be conceptualized and measured, and how they could be measured in different settings such as clinical care vs. community programs. Conceptualization of outcomes: We conceptualize each of the outcomes from Proctor and colleagues' taxonomy of implementation outcomes for de-implementation research. First, we suggest key considerations for researchers assessing de-implementation outcomes, such as considering how the cultural or historical significance to the practice may impact de-implementation success and, as others have stated, the importance of the patient in driving healthcare overuse. Second, we conceptualize de-implementation outcomes, paying attention to a number of factors such as the importance of measuring outcomes not only of the targeted practice but of the deimplementation process as well. Also, the degree to which a practice should be de-implemented must be distinguished, as well as if there are thresholds that certain outcomes must reach before action is taken. We include a number of examples across all outcomes, both from clinical and community settings, to demonstrate the importance of these considerations. We also discuss how the concepts of health disparities, cultural or community relevance, and altruism impact the assessment of de-implementation outcomes. Conclusion: We conceptualized existing implementation outcomes within the context of de-implementation, noted where there are similarities and differences to implementation research, and recommended a clear distinction between the target for de-implementation and the strategies used to promote de-implementation. This critical analysis can serve as a building block for others working to understand de-implementation processes and de-implement practices in real-world settings.

Commentary: Adapting and Operationalizing the RE-AIM Framework for Implementation Science in Environmental Health: Clean Fuel Cooking Programs in Low Resource Countries

“…This discussion is timely as the field starts to understand the unique aspects of de-implementation and how to define them. Accordingly, Prusaczyk et al (8) suggest expanding the adoption concept to include de-adoption, defined as the intention or initial decision to stop a practice.…”

De-implementation and Substitution of Clinical Care Processes: Stakeholder Perspectives on the Transition to Primary Human Papillomavirus (HPV) Testing for Cervical Cancer Screening

“…Typically, implementation efforts and strategies focus on adoption of novel technologies or treatments, rather than deimplementation of low-value services (39)(40)(41)(42); the addition of domains speci c to patient and clinician perceptions of cost-cutting, health care competition, and more tests and services equaling better care could strengthen existing practice change frameworks. (43)(44)(45) Participants suggested clinicians should be su ciently prepared to have di cult conversations with anxious patients about the substitution. Additionally, participants recommended development of clinician scripts and talking points and/or physician training on how to effectively discuss evidence and high-value care with patients (e.g., introducing the concept of de-implementation in relation to the reality of shifting medical evidence).…”

Implementing Evidence-Based Practices in School Psychology: Excavation by De-Implementing the Disproved

“…Debunking can be effective, but requires a sustained and strategic effort. Effective debunking requires multiple sources, over a long period of time, and repeated often (Prusaczyk et al, 2020). There must be enough negative or alternative information in the educational mindspace that serves to change the entire culture of a profession (Prasad & Ioannidis, 2014).…”