Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study

Abstract

ObjectiveWe aimed to increase the understanding of the scaling of de-implementation strategies by identifying the determinants of the process and developing a determinant framework.Design and methodsThis study has a mixed-methods design. First, we performed an integrative review to build a literature-based framework describing the determinants of the scaling of healthcare innovations and interventions. PubMed and EMBASE were searched for relevant studies from 1995 to December 2020. We systematically extracted the determinants of the scaling of interventions and developed a literature-based framework. Subsequently, this framework was discussed in four focus groups with national and international de-implementation experts. The literature-based framework was complemented by the findings of the focus group meetings and adapted for the scaling of de-implementation strategies.ResultsThe literature search resulted in 42 articles that discussed the determinants of the scaling of innovations and interventions. No articles described determinants specifically for de-implementation strategies. During the focus groups, all participants agreed on the relevance of the extracted determinants for the scaling of de-implementation strategies. The experts emphasised that while the determinants are relevant for various countries, the implications differ due to different contexts, cultures and histories. The analyses of the focus groups resulted in additional topics and determinants, namely, medical training, professional networks, interests of stakeholders, clinical guidelines and patients’ perspectives. The results of the focus group meetings were combined with the literature framework, which together formed the supporting the scaling of de-implementation strategies (SPREAD) framework. The SPREAD framework includes determinants from four domains: (1) scaling plan, (2) external context, (3) de-implementation strategy and (4) adopters.ConclusionsThe SPREAD framework describes the determinants of the scaling of de-implementation strategies. These determinants are potential targets for various parties to facilitate the scaling of de-implementation strategies. Future research should validate these determinants of the scaling of de-implementation strategies.

Advancing healthcare equity through dissemination and implementation science

“…Require representation of community members from historically marginalized populations in studies of de‐implementation and mis‐implementation to inform the development of multi‐level strategies and outcome measurement. 92 , 93 …”

“…90 Collect evaluation data across healthcare systems and practices to examine whether interventions are implemented effectively, for whom and why.Implement guidelines calling for de-implementation of low-value care 24,91. Require representation of community members from historically marginalized populations in studies of de-implementation and mis-implementation to inform the development of multi-level strategies and outcome measurement 92,93. …”

Reporting of costs and economic impacts in randomized trials of de-implementation interventions for low-value care: a systematic scoping review

“…The lack of cost information has been identified as a barrier to implementation [ 12 , 14 ]. De-implementation requires sufficient financial, technical, and human resources [ 34 ]. The lack of cost information makes it impossible to evaluate the costs in a systematic way or to basing decision-making on this information.…”

Low Value Surgical Care: Are We Choosing Wisely?

“…An expert task force of multidisciplinary stakeholders including input from patient support groups, led by a clinical champion, systematically working with a frameworkdriven Delphi consensus process and based on EBM, examines a list of existing practices or guidelines, refines and reduces the long list to a short list, and selects and endorses a final list [14,15]. Next stage is all about implementation science, i.e., identification of local context and priorities, identification of barriers to implementing and potential interventions to overcome these, rigorous evaluations of implementation programmes, spread of effective implementation programmes, and sustain the process [16][17][18]. Review of these at regular time intervals will ensure newer emerging evidence is given due weightage.…”