{
  "abstract": "Objectives Essencial is a public policy initiative by the public administration in Catalonia that seeks to reduce unnecessary care through evidence-based recommendations and support for de-implementing low-value clinical practices (LVCP), without adopting an authoritative approach. In 2023, a participatory process was conducted involving healthcare quality professionals (HQP) from both hospital and primary care settings. Prior to this, a practical guide on de-implementation was co-developed and published in collaboration with Catalan healthcare professionals (HCP) with successful experiences on reducing LVCP.This study aims to 1) assess the current level of adoption of the Essencial initiative, 2) evaluate the existing capacity for de-implementation within the Catalonian healthcare system, and 3) inform the development of a professional network focused in clinical practice appropriateness.Methods A mixed-methods approach was employed, comprising an online survey with a series of five in-person workshops attended by HQP. These workshops provided the platform for in-depth discussions on the challenges and opportunities of de-implementing LVCP, allowed for collective reflection on current practices, and helped identify specific needs, barriers, and enablers within different healthcare contexts. As part of the process, participants determined which LVCPs were most relevant to target for de-implementation. In addition, five semi-structured interviews were conducted with key stakeholders and gatekeepers to guide the development of a professional network integrating insights from behavioral and implementation science theories, including the Transtheoretical Model of Change, Social Cognitive Theory, and the Behavior Change Wheel.Results A total of 82 healthcare centers (hospitals and primary care centers) were invited to complete the survey, with 68 responses received (response rate: 79.3%). Among the respondents, 79% were familiar with the Essencial initiative, 76% were aware of the guide on de-implementation, 50% reported using Essencial resources, 74% indicated they had de-implementation strategies in place, and 44% reported having achieved results from such efforts. Of all the healthcare centers invited to participate, 74 (90.2%) attended the workshops. The top-prioritized LVCP by HQP were reducing unnecessary blood transfusions in hospitals and antibiotic prescribing in primary care. Key informants confirmed the need to formalize a collaborative network of HCP to support de-implementation efforts. Interviewees also identified clinical leadership, establishing benchmarks for appropriateness, and implementing effective engagement strategies as the most critical factors. The Essencial initiative plans to launch this network in May 2025, initially involving all 64 hospitals in Catalonia, with a second phase including representatives from the 360 primary care centers across the region.Conclusions The Essencial initiative is advancing as a key strategy to reduce low-value care in Catalonia. The combination of survey and in-person workshops revealed both a high level of awareness and strong willingness among HCP to engage in de-implementation efforts. In parallel, insights from stakeholder interviews guided the development of an appropriateness network, aimed at supporting practice change. This network represents a critical step toward system-wide, sustainable de-implementation through shared learning and coordinated action.",
  "authors": [
    {
      "affiliations": [
        "Healthcare Quality and Evaluation Agency of Catalonia (AQAS), Barcelona, Spain"
      ],
      "name": "Elisabet Henderson"
    },
    {
      "affiliations": [
        "Healthcare Quality and Evaluation Agency of Catalonia (AQAS), Barcelona, Spain"
      ],
      "name": "Laia Ramos-Masdeu"
    },
    {
      "affiliations": [
        "Healthcare Quality and Evaluation Agency of Catalonia (AQAS), Barcelona, Spain"
      ],
      "name": "Garazi Carrillo-Aguirre"
    },
    {
      "affiliations": [
        "Healthcare Quality and Evaluation Agency of Catalonia (AQAS), Barcelona, Spain"
      ],
      "name": "Helena Bentué-Jiménez"
    },
    {
      "affiliations": [
        "Healthcare Quality and Evaluation Agency of Catalonia (AQAS), Barcelona, Spain"
      ],
      "name": "Claudia Malca"
    },
    {
      "affiliations": [
        "Healthcare Quality and Evaluation Agency of Catalonia (AQAS), Barcelona, Spain"
      ],
      "name": "Johanna Caro-Mendivelso"
    },
    {
      "affiliations": [
        "Healthcare Quality and Evaluation Agency of Catalonia (AQAS), Barcelona, Spain"
      ],
      "name": "Edurne Gallastegu"
    }
  ],
  "title": "091 De-implementing low-value clinical practice: essencial network of healthcare professionals in Catalonia, Spain",
  "uid": "163af5b9-080f-5b00-8a67-b5ae15ebde50"
}