Advani Sonali D, McKay Virginia
Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.
Brown School, Washington University in St. Louis, St. Louis, Missouri.
Antimicrob Steward Healthc Epidemiol. 2023 Apr 17;3(1):e73. doi: 10.1017/ash.2023.150. eCollection 2023.
De-implementation is defined as the process of discontinuing, removing, reducing, or replacing a harmful, ineffective, or low-value clinical practice or intervention. The goal of de-implementation strategies is to minimize patient harm, maximize use of resources, and reduce healthcare costs and inequities. Both antibiotic and diagnostic stewardship programs focus on reducing low-value interventions (tests or antimicrobials). Stewardship interventions commonly involve de-implementation and deprescribing strategies. This commentary explores unique aspects of deimplementing low-value testing and unnecessary antimicrobial use, similarities between de-implementation and stewardship approaches, multilevel factors that impact de-implementation, and opportunities for future research.
去实施被定义为停止、消除、减少或取代有害、无效或低价值临床实践或干预措施的过程。去实施策略的目标是将患者伤害降至最低，最大限度地利用资源，并降低医疗成本和不公平现象。抗生素管理计划和诊断管理计划都侧重于减少低价值干预措施（检查或抗菌药物）。管理干预措施通常涉及去实施和停用药物策略。本评论探讨了取消低价值检查和不必要使用抗菌药物的独特方面、去实施与管理方法之间的相似之处、影响去实施的多层次因素以及未来研究的机会。
