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Overcoming challenges in de-implementing low-value care: Routines, asymmetry of outcomes, and psychological reactance

December 19, 2023 at 2PM ET | 11AM PT

Presenter: Dr. Christian Helfrich

Christian D. Helfrich, MPH, PhD (he/him) is an implementation scientist and core investigator at the Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care. He studies organizational change and implementation science in healthcare, and how to design and evaluate strategies to reduce low-value practices.


Some low-value clinical practices persist and are commonly delivered to patients long after evidence has established that the practice fails to benefit patients or poses risks to patients that outweigh any expected benefits. Efforts to systematically reduce low-value clinical practices is sometimes referred to as de-implementation, and many insights from research implementation of evidence-based practices can also be applied to de-implementation. However, de-implementation poses some unique challenges that make it different from efforts to promote the appropriate uptake of new evidence-based practices. This talk explains three unique challenges posed by de-implementation: Routines, asymmetry of outcomes, and psychological reactance. We discuss why these challenges arise, using the example of a provider-randomized trial to reduce inappropriate use of inhaled corticosteroids prescribed to patients with chronic obstructive pulmonary disease. And, we talk about ways to mitigate these challenges, as well as important areas for future research. 


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