SynthesisBMC health services research2022
Determinants of the de-implementation of low-value care: a multi-method study.
Synthesis in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 33 citations in OpenAlex.
- "Point education" and "rotation communication" on antimicrobial policy implementation: an interrupted time series analysis of declining cephalosporin skin test rates.BMC health services research · 2026Observational
- Provider comments reveal barriers to EHR nudge effectiveness: process evaluation of a null deprescribing trial.Implementation science communications · 2026Article
- Unloading the excess baggage: key informant interviews with Malaysian stakeholders on healthcare disinvestment initiatives.International journal of technology assessment in health care · 2026Article
- De-implementation of low-value home-based nursing care: an effect and process evaluation.Implementation science communications · 2025Article
- Advancing the Field of Deimplementation: Perspectives on Low-Value Clinical Preventive Services.AJPM focus · 2025Article
- Relative importance and interactions of factors influencing low-value care provision: a factorial survey experiment among Swedish primary care physicians.BMJ quality & safety · 2025Article
- Breaking with the status quo in end-of-life care through de-implementation.Journal of internal medicine · 2025Review
- Time to de-implementation of low-value cancer screening practices: a narrative review.BMJ quality & safety · 2025Review
- Evidence is not enough: health technology reassessment to de-implement low-value care.Health research policy and systems · 2024Article
- Australian and Canadian clinicians' views and application of 'carbon health literacy': a qualitative study.BMC health services research · 2024Article
- Stakeholders' perspectives on disinvestment of low-value healthcare interventions and practices in Malaysia: an online survey.International journal of technology assessment in health care · 2024Article
- Multicomponent processes to identify and prioritise low-value care in hospital settings: a scoping review.BMJ open · 2024Article
- What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review.BMJ open · 2023Article
- Article
- Optimizing Respiratory Therapy Resources by De-Implementing Low-Value Care.Respiratory care · 2023Article
Corrections and comments
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Authors and funding
11 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is an urgent need to understand the determinants (i.e., barriers and facilitators) of de-implementation. The purpose of this study was to develop a comprehensive list of determinants of the de-implementation of low-value care from the published literature and to compare this list to determinants identified by a group of stakeholders with lived experience with de-implementation.
methodsThis was a two-phase multi-method study. First, a systematic review examined published barriers and facilitators to de-implementation. Articles were identified through searches within electronic databases, reference lists and the grey literature. Citations were screened independently and in duplicate and included if they were: 1) written in English; and 2) described a barrier or facilitator to de-implementation of any clinical practice in adults (age ≥ 18 years). 'Raw text' determinants cited within included articles were extracted and synthesized into a list of representative determinants using conventional content analysis. Second, semi-structured interviews were conducted with decision-makers (unit managers and medical directors) and healthcare professionals working in adult critical care medicine to explore the overlap between the determinants found in the systematic review to those experienced in critical care medicine. Thematic content analysis was used to identify key themes emerging from the interviews.
resultsIn the systematic review, reviewers included 172 articles from 35,368 unique citations. From 437 raw text barriers and 280 raw text facilitators, content analysis produced 29 distinct barriers and 24 distinct facilitators to de-implementation. Distinct barriers commonly cited within raw text included 'lack of credible evidence to support de-implementation' (n = 90, 21%), 'entrenched norms and clinicians' resistance to change (n = 43, 21%), and 'patient demands and preferences' (n = 28, 6%). Distinct facilitators commonly cited within raw text included 'stakeholder collaboration and communication' (n = 43, 15%), and 'availability of credible evidence' (n = 33, 12%). From stakeholder interviews, 23 of 29 distinct barriers and 20 of 24 distinct facilitators from the systematic review were cited as key themes relevant to de-implementation in critical care.
conclusionsThe availability and quality of evidence that identifies a clinical practice as low-value, as well as healthcare professional willingness to change, and stakeholder collaboration are common and important determinants of de-implementation and may serve as targets for future de-implementation initiatives.
trial registrationThe systematic review was registered in PROSPERO CRD42016050234 .
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.