What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies

Pauline Heus, Simone A. Van Dulmen*, Jan Willem Weenink, Christiana A. Naaktgeboren, Toshihiko Takada, Eva W. Verkerk, Isabelle Kamm, Maarten J. Van Der Laan, Lotty Hooft, Rudolf B. Kool

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)
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Low-value care is healthcare leading to no or little clinical benefit for the patient. The best (combinations of) interventions to reduce low-value care are unclear. 


To provide an overview of randomized controlled trials (RCTs) evaluating deimplementation strategies, to quantify the effectiveness and describe different combinations of strategies. 


Analysis of 121 RCTs (1990-2019) evaluating a strategy to reduce low-value care, identified by a systematic review. Deimplementation strategies were described and associations between strategy characteristics and effectiveness explored. 


Of 109 trials comparing deimplementation to usual care, 75 (69%) reported a significant reduction of low-value healthcare practices. Seventy-three trials included in a quantitative analysis showed a median relative reduction of 17% (IQR 7%-42%). The effectiveness of deimplementation strategies was not associated with the number and types of interventions applied. 

Conclusions and Implications: 

Most deimplementation strategies achieved a considerable reduction of low-value care. We found no signs that a particular type or number of interventions works best for deimplementation. Future deimplementation studies should map relevant contextual factors, such as the workplace culture or economic factors. Interventions should be tailored to these factors and provide details regarding sustainability of the effect.

Original languageEnglish
Pages (from-to)261-271
Number of pages11
JournalJournal for Healthcare Quality
Issue number5
Publication statusPublished - Sept 2023

Bibliographical note

Funding Information:
This project received funding of The Netherlands Organisation for Health Research and Development (ZonMW - Citrienfonds 80-83920-98-101). This funding source had no role in the design, conduct, analyses, or reporting of the study or in the decision to submit the manuscript for publication.

Publisher Copyright:
© 2023 National Association for Healthcare Quality.


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