Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review
Abstract Background Health Service implementation projects are often guided by theoretical implementation frameworks. Little is known about the effectiveness of these frameworks to facilitate change in processes of care and patient outcomes within the inpatient setting. The aim of this review was to...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-09609-y |
| _version_ | 1797806760639070208 |
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| author | Rebecca Barnden David A. Snowdon Natasha A. Lannin Elizabeth Lynch Velandai Srikanth Nadine E. Andrew |
| author_facet | Rebecca Barnden David A. Snowdon Natasha A. Lannin Elizabeth Lynch Velandai Srikanth Nadine E. Andrew |
| author_sort | Rebecca Barnden |
| collection | DOAJ |
| description | Abstract Background Health Service implementation projects are often guided by theoretical implementation frameworks. Little is known about the effectiveness of these frameworks to facilitate change in processes of care and patient outcomes within the inpatient setting. The aim of this review was to assess the effectiveness of the application of theoretical implementation frameworks in inpatient healthcare settings to change processes of care and associated patient outcomes. Method We conducted a search in CINAHL, MEDLINE, EMBASE, PsycINFO, EMCARE and Cochrane Library databases from 1st January 1995 to 15th June 2021. Two reviewers independently applied inclusion and exclusion criteria to potentially eligible studies. Eligible studies: implemented evidence-based care into an in-patient setting using a theoretical implementation framework applied prospectively; used a prospective study design; presented process of care or patient outcomes; and were published in English. We extracted theoretical implementation frameworks and study design against the Workgroup for Intervention Development and Evaluation Research (WIDER) Checklist and implementation strategies mapped to the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy. We summarised all interventions using the Template for Intervention Description and Replication (TIDieR) checklist. We appraised study quality using the Item bank on risk of bias and precision of observational studies and the revised Cochrane risk of bias tool for cluster randomised trials. We extracted process of care and patient outcomes and described descriptively. We conducted meta-analysis for process of care and patient outcomes with reference to framework category. Results Twenty-five studies met the inclusion criteria. Twenty-one used a pre-post (no comparison), two a pre-post with a comparison, and two a cluster randomised trial design. Eleven theoretical implementation frameworks were prospectively applied: six process models; five determinant frameworks; and one classic theory. Four studies used two theoretical implementation frameworks. No authors reported their justification for selecting a particular framework and implementation strategies were generally poorly described. No consensus was reached for a preferred framework or subset of frameworks based on meta-analysis results. Conclusions Rather than the ongoing development of new implementation frameworks, a more consistent approach to framework selection and strengthening of existing approaches is recommended to further develop the implementation evidence base. Trial registration CRD42019119429. |
| first_indexed | 2024-03-13T06:12:15Z |
| format | Article |
| id | doaj.art-2520a1d021354bb6846d6895f4054a41 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-13T06:12:15Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-2520a1d021354bb6846d6895f4054a412023-06-11T11:09:34ZengBMCBMC Health Services Research1472-69632023-06-0123111410.1186/s12913-023-09609-yProspective application of theoretical implementation frameworks to improve health care in hospitals — a systematic reviewRebecca Barnden0David A. Snowdon1Natasha A. Lannin2Elizabeth Lynch3Velandai Srikanth4Nadine E. Andrew5Academic Unit, Peninsula HealthAcademic Unit, Peninsula HealthDepartment of Neuroscience, Faculty of Medicine, Nursing and Health Science, Monash UniversityCaring Futures Institute, College of Nursing and Health Sciences, Flinders UniversityAcademic Unit, Peninsula HealthAcademic Unit, Peninsula HealthAbstract Background Health Service implementation projects are often guided by theoretical implementation frameworks. Little is known about the effectiveness of these frameworks to facilitate change in processes of care and patient outcomes within the inpatient setting. The aim of this review was to assess the effectiveness of the application of theoretical implementation frameworks in inpatient healthcare settings to change processes of care and associated patient outcomes. Method We conducted a search in CINAHL, MEDLINE, EMBASE, PsycINFO, EMCARE and Cochrane Library databases from 1st January 1995 to 15th June 2021. Two reviewers independently applied inclusion and exclusion criteria to potentially eligible studies. Eligible studies: implemented evidence-based care into an in-patient setting using a theoretical implementation framework applied prospectively; used a prospective study design; presented process of care or patient outcomes; and were published in English. We extracted theoretical implementation frameworks and study design against the Workgroup for Intervention Development and Evaluation Research (WIDER) Checklist and implementation strategies mapped to the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy. We summarised all interventions using the Template for Intervention Description and Replication (TIDieR) checklist. We appraised study quality using the Item bank on risk of bias and precision of observational studies and the revised Cochrane risk of bias tool for cluster randomised trials. We extracted process of care and patient outcomes and described descriptively. We conducted meta-analysis for process of care and patient outcomes with reference to framework category. Results Twenty-five studies met the inclusion criteria. Twenty-one used a pre-post (no comparison), two a pre-post with a comparison, and two a cluster randomised trial design. Eleven theoretical implementation frameworks were prospectively applied: six process models; five determinant frameworks; and one classic theory. Four studies used two theoretical implementation frameworks. No authors reported their justification for selecting a particular framework and implementation strategies were generally poorly described. No consensus was reached for a preferred framework or subset of frameworks based on meta-analysis results. Conclusions Rather than the ongoing development of new implementation frameworks, a more consistent approach to framework selection and strengthening of existing approaches is recommended to further develop the implementation evidence base. Trial registration CRD42019119429.https://doi.org/10.1186/s12913-023-09609-yKnowledge translationImplementation frameworksImplementation modelsImplementation theoriesTranslation medical research |
| spellingShingle | Rebecca Barnden David A. Snowdon Natasha A. Lannin Elizabeth Lynch Velandai Srikanth Nadine E. Andrew Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review BMC Health Services Research Knowledge translation Implementation frameworks Implementation models Implementation theories Translation medical research |
| title | Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review |
| title_full | Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review |
| title_fullStr | Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review |
| title_full_unstemmed | Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review |
| title_short | Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review |
| title_sort | prospective application of theoretical implementation frameworks to improve health care in hospitals a systematic review |
| topic | Knowledge translation Implementation frameworks Implementation models Implementation theories Translation medical research |
| url | https://doi.org/10.1186/s12913-023-09609-y |
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