What does the program look like?

The program has a preparation and an execution phase.

In the preparation phase (April 1, 2015 to April 1, 2016), researchers from three University Medical Centers searched scientific literature and Dutch clinical practice guidelines for do-not-do recommendations. This list of more than 1000 recommendations is integrated into the guidelines database of the Federation for Medical Specialists in the autumn of 2016. This shows that it is important for doctors to sometimes do nothing rather than act. The creation of the list is described in an article.

In addition, we performed a systematic review and searched for barriers and facilitators in reducing unnecessary care and the strategies that are used. Two articles have been written about this. Based on this, the so-called de-implementation guide has been written. This guide can help healthcare professionals in developing, implementing and evaluating a de-implementation project.

Finally, several conferences were organized to share ideas and knowledge on reducing unnecessary care.

In the execution phase (April 1, 2016 to December 31, 2018) the actual de-implementation will be performed. Eight de-implementation projects have been selected to be performed under coordination of the UMCs. These projects are selected from over 40 submitted ideas. In these projects, the UMCs work intensively with other UMCs and nearby general hospitals and general practices, other healthcare providers, patients, health care insurers and other relevant parties. The central question is: How can we reduce unnecessary care? What are effective strategies, what are the necessary preconditions and what are the expected and observed barriers and facilitators? Projects may focus on: behavioral change of healthcare providers through education or feedback, behavioral change of patients by through information, or adjustment of financial incentives. Data of all projects will be collected and analyzed to draw general conclusions and lessons about the de-implementation of unnecessary care. Based on the experience and knowledge acquired in the program and the existing literature, the de-implementation guide is updated. This forms the basis for greater spread of similar projects in other regions and with other unnecessary care.