De-implementation outcome | Target of measurement (if applicable) | Definition | Examples | Additional considerations |
---|---|---|---|---|
Acceptability | Practice | The degree to which a practice is perceived as not agreeable, palatable, or satisfactory | Providers may find 12-step programs for opioid use disorders unacceptable. | It is important to ask the stakeholders of a practice if they find the practice and the idea of stopping that practice acceptable. |
 | Process | The degree to which the idea of stopping a practice is perceived as not agreeable, palatable, or satisfactory | Providers may find stopping the referral of patients to 12-step programs as unacceptable if the providers cannot provide a more acceptable treatment in its place, such as methadone. | |
Adoption | Â | The initial decision or action to stop using a practice | A physician makes the decision to stop ordering imaging for patients with low-back pain. | To avoid confusion between implementation and de-implementation studies, we recommend calling this de-adoption. |
Appropriateness | Practice | The degree to which a practice is perceived to not fit, have relevance, or be compatible for a given setting, provider, consumer, issue, or problem. | Emergency room providers may not find smoking cessation as an appropriate practice to provide in the emergency setting. | It is important to ask the end-users of a practice if they find the practice and the idea of stopping that practice appropriate. |
 | Process | The degree to which the idea of stopping a practice is appropriate given a setting, provider, consumer, issue, or problem. | Emergency room providers may not find the idea of stopping smoking cessation as appropriate because they need to provide this to patients to meet hospital quality metrics. | |
Cost | Â | The cost of the de-implementation strategies or the costs-saved from stopping the practice. | The costs associated with using local technical assistance as a de-implementation strategy. The costs saved by not ordering routine lipid panels as screening tests for cardiovascular disease. | Â |
Feasibility |  | The extent to which a practice can be successfully stopped within a given agency or setting | The feasibility of stopping some practices that are required to provide to meet quality improvement metrics. | It is important to understand how stakeholders’ beliefs on acceptability and appropriateness impact providers’ beliefs on the feasibility of de-implementation. It is also important to consider structural, organizational, or procedural barriers to the feasibility of de-implementation. |
Fidelity | Practice | The degree to which the entire or whole practice is stopped for the right people and in the right contexts | The number of components of a bundled intervention for ventilated patients that are stopped. | Â |
 | Stakeholders | The degree to which the practice is stopped equally, across patients/clients and providers | The number of physicians in the intensive care unit who stop delivering the bundled intervention. |  |
Penetration | Â | The extent to which the practice is discontinued within a service setting and its subsystems | The number of intensive care units across a large, healthcare system that stops delivering the bundled intervention. | Â |
Sustainability |  | The extent to which a practice’s discontinuation is maintained | The number of physicians in the intensive care unit who are still no longer delivering the bundled intervention six months after the de-implementation strategies have discontinued. |  |