Promoting Health Equity through De-Implementation Research
Bibliographic Data
| ID | 15314950 |
|---|---|
| Authors | Christian D Helfrich (0000-0002-9827-4768, VA Puget Sound Health Care System, corresponding author), Christine W Hartmann (0000-0003-0983-0601, Edith Nourse Rogers Memorial Veterans Hospital), Toral J Parikh (0000-0002-8534-7307, VA Puget Sound Health Care System), David H Au (0000-0001-8207-4975, VA Puget Sound Health Care System) |
| Year | 2019 |
| Volume | 29 |
| Issue | Suppl 1 |
| Pages | 93-96 |
| Publication date | 2019-02-21 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Ethnicity & Disease (JOURNAL) |
| Journal identifiers | ISSN: 1049-510X • E-ISSN: 1945-0826 |
| Publisher | Ethnicity & Disease, Inc (PUBLISHER) |
| DOI | 10.18865/ed.29.s1.93 |
| PMID | 30906155 |
| OpenAlex | W2915579123 |
| Language | EN |
| Citations received | 6 |
| References cited | 1 |
Ensuring equitable access to quality health care historically has focused on gaps in care, where patients fail to receive the high-value care that will benefit them, something termed underuse. But providing high-quality health care sometimes requires reducing low-value care that delivers no benefit or where known harms outweigh expected benefits. These situations represent health care overuse. The process involved in reducing low-value care is known as de-implementation. In this article, we argue that de-implementation is critical for advancing equity for several reasons. First, medical overuse is associated with patient race, ethnicity, and socioeconomic status. In some cases, the result is even double jeopardy, where racial and ethnic minorities are at higher risk of both overuse and underuse. In these cases, more traditional efforts focused exclusively on underuse ignore half of the problem. Second, overuse of preventive care and screening is often greater for more socioeconomically advantaged patients. Within insured populations, this means more socioeconomically disadvantaged patients subsidize overuse. Finally, racial and ethnic minorities may have different experiences of overuse than Whites in the United States. This may make efforts to de-implement overuse particularly fraught. We therefore provide several actions for closing current research gaps, including: adding subgroup analyses in studies of medical overuse; specifying and measuring potential mechanisms related to equity (eg, double jeopardy vs thermostat models of overuse); and testing de-implementation strategies that may mitigate bias
Business · Disadvantaged · Environmental health · Equity (law · Ethnic group · Family medicine · Health care · Health equity · Political science · Population · Public health · Socioeconomic status · Health Policy Implementation Science · Health Systems, Economic Evaluations, Quality of Life · Healthcare cost, quality, practices · Medicine · Nursing · Psychology · Gerontology
How does culture fit into de‐implementation? A scoping review of empirical research
Provider Perspectives on De-Implementation of Routine Blood Typing and Rh Immune Globulin Administration in the First Trimester
A Critical Case for De-Implementation in U.S. Social Services
A critical commentary of the paradoxical ‘success’ of Making Every Contact Count (Mecc)
Blending de-implementation and implementation to promote adoption of universal PrEP guidelines
Iterative Decision‐making for Evaluation of Adaptations (Idea)
| Citations per year | 1 |
|---|---|
| Citation span | 2020 - 2025 (6) |
| Highly cited | No |