Commentary: De-implementation Science: A Virtuous Cycle of Ceasing and Desisting Low-Value Care Before Implementing New High Value Care.

Implementation science has traditionally focused on increasing the delivery of evidence-based care. The science of systematically stopping low-value and wasteful care is substantially under-recognized, and if successful, may decrease the workload of clinicians. De-implementation science identifies problem areas of low-value and wasteful practice, carries out rigorous scientific examination of the factors that initiate and maintain such behaviors, and then employs evidence-based interventions to cease these practices. In this commentary, we describe how this approach for de-implementation might require a different set of health systems supports, economic and non-economic levers, and behavior change techniques that can lead to a virtuous cycle, ie, a complex chain of events that positively reinforce themselves through a feedback loop of removing low-value care to make room for high quality care.