This thesis described the stepwise development and execution of a de-implementation strategy to reduce the use of the low-value blood salvage techniques and preoperative treatment with... Show moreThis thesis described the stepwise development and execution of a de-implementation strategy to reduce the use of the low-value blood salvage techniques and preoperative treatment with erythropoietin in primary elective hip and knee arthroplasty. The implementation model of Grol was used to develop de-implementation goals, to identify barriers that hinder de-implementation, to develop a de-implementation strategy and to execute and evaluate the developed de-implementation strategy. The intention of de-implementing low-value patient blood-management techniques was to reduce costs and improve the quality of healthcare. However, this thesis showed that a tailored de-implementation strategy is not necessarily successful. When evaluating the effects we found that in the group of hospitals that were exposed to the de-implementation strategy the reduction in blood salvage techniques and erythropoietin was comparable to the control group hospitals. We did found that the reduction in blood salvage techniques was associated with the increased use of local analgesic infiltration and the use of tranexamic acid, an antifibrinolytic drug to prevent excessive blood loss. We found that the substitution of low-value care might contribute to de-implementation of this low-value care. In future de-implementation efforts this can be used to improve the results. Show less
