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Table 1 Conceptualization of de-implementation outcomes

From: Defining and conceptualizing outcomes for de-implementation: key distinctions from implementation outcomes

De-implementation outcomeTarget of measurement (if applicable)DefinitionExamplesAdditional considerations
AcceptabilityPracticeThe degree to which a practice is perceived as not agreeable, palatable, or satisfactoryProviders 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.
 ProcessThe degree to which the idea of stopping a practice is perceived as not agreeable, palatable, or satisfactoryProviders 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 practiceA 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.
AppropriatenessPracticeThe 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.
 ProcessThe 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 settingThe 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.
FidelityPracticeThe degree to which the entire or whole practice is stopped for the right people and in the right contextsThe number of components of a bundled intervention for ventilated patients that are stopped. 
 StakeholdersThe degree to which the practice is stopped equally, across patients/clients and providersThe 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 subsystemsThe 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 maintainedThe 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.