|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||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||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.
|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.|
|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||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.|
|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.|