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We conducted a pragmatic cluster-randomized clinical trial of a champion-led deprescribing intervention in accountable care organization (ACO) primary care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To (1) understand clinical champions\u2019 perspectives of their deprescribing projects and (2) identify key contextual factors that influenced champions\u2019 deprescribing PIMs for persons with dementia within ACO primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A qualitative study guided by the de-implementation outcomes framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Clinician champions who engaged in deprescribing projects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Approach<\/jats:title>\n                    <jats:p>Data sources included transcripts from monthly learning calls and semi-structured interviews. All champions were invited to participate in learning calls and semi-structured interviews. The 30- to 60-min interviews were conducted using a semi-structured guide. We coded transcripts and performed thematic analysis to identify overarching themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>Eleven champions participated. Feasibility and fidelity of deprescribing were commonly undermined by external and organizational disruptions. Five contextual factors influenced champions\u2019 experiences: limited organizational readiness, lack of information technology infrastructure to support data access and patient identification, the importance of relationship-building and care coordination, the dyadic nature of deprescribing involving care partners, and the pharmacist\u2019s role as a multidisciplinary liaison. Champions employed adaptive, communication- and relationship-centered strategies to support deprescribing efforts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Champion-led deprescribing for persons with dementia is shaped by key contextual factors within ACO primary care settings. Dementia-specific training helped clinicians tailor deprescribing to local needs, but sustained efforts require supportive organizational structures, including ongoing education, accessible clinical data, and multidisciplinary collaboration. Primary care clinicians are uniquely positioned to lead personalized deprescribing conversations while pharmacists serve as liaisons with providers, patients, and care partners to coordinate deprescribing. Interventions that align with value-based care principles may strengthen system-level coordination and promote safer medication management in dementia care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov ID: NCT05359679<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-026-10234-8","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T16:09:30Z","timestamp":1770048570000},"page":"2844-2855","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Champion-Led Deprescribing for Persons with Dementia in Primary Care: A Qualitative Study in Accountable Care Organizations"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2317-2628","authenticated-orcid":false,"given":"Masami","family":"Tabata-Kelly","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorella G.","family":"Palazzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Perloff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Kiel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Parchman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert B.","family":"Penfold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"10234_CR1","doi-asserted-by":"publisher","unstructured":"Alzheimer\u2019s Association. 2019 Alzheimer\u2019s disease facts and figures. 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We obtained verbal informed consent from each participant before data collection, and we maintained the confidentiality and security of all identifiable information.","order":2,"name":"Ethics","label":"Human Ethics and Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The sponsor had no role in the design, methods, data collection, analysis, or preparation of the article.","order":3,"name":"Ethics","label":"Sponsor\u2019s Role","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no relevant financial relationships with any commercial interests related to this work.","order":4,"name":"Ethics","label":"Financial Disclosures","group":{"name":"EthicsHeading","label":"Declarations"}}]}}