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De-implementation of ineffective and harmful clinical practices: unlearning and substitution

Helfrich CD. De-implementation of ineffective and harmful clinical practices: unlearning and substitution. [Cyberseminar]. 2016 Jul 7.


In the US, medical overuse, care provided to patients who do not benefit from it, represents from 10-16% of all clinical care on the low end, to 30%-46% on the high end, depending on the clinical practice and setting. Efforts to address overuse, often referred to as de-implementation, may encounter different challenges than efforts to address underuse of medical care. A planned action model of de-implementation of harmful and ineffective practices may be useful to researchers and quality improvement specialists. Research in cognitive psychology and behavioral economics suggests that it may be helpful to consider how clinicians' behaviors result from both conscious, reflective cognition and largely unconscious automatic cognition. This presentation will discuss how de-implementation strategies might be developed to promote unlearning (reflective cognition) and substitution (automatic cognition), and some of the potential consequences of de-implementation strategies. Intended audience: Implementation researchers and clinicians interested in the development of theory underpinning dissemination and implementation research.

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