What is de-implementation?

De-implementation is the reduction of low-value care. It is derived from the word implementation, which is usually used for putting a plan into action or starting to use something new.

What is the difference between implementation and de-implementation?

De-implementation is a process of behaviour change, just as implementation. It requires the same steps, but has a few specific challenges. It often has a different context. Introducing new diagnostics and new treatments is like bringing good news; the message that the care practice that the patient expects or even is used to could be of low-value and maybe harmful, is bad news fot the patient and can be hard for the care provider to tell. It takes time and skills that not every care provider has. The fear of being criticized or sued and of loss of work and income are also more often an issue for de-implementation than for implementation. It takes more effort to get a positive attitude towards de-implementation in patients and care providers.

Why is it important to reduce low-value care?

De-implementing low-value care results in less risks for the patient, saves costs and gives room for valuable care. Many care practices have a risk of side effects and care providers and patients are willing to accept these risks when the treatment or diagnostic test is useful. However, when the treatment or test has little benefit to the patient, it may no longer be acceptable. Low-value care can also provide unnecessary concerns and subsequently more unnecessary care, and it can replace care that is of high-value. In addition, reducing low-value care can improve the accessibility of care that is valuable. It may help in the current shortage of health care personnel and the increasing waitings lists. A more efficient devision of resources is necessary.