Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review
Abstract Background Some outcomes for children with mental health problems remain suboptimal because of poor access to care and the failure of systems and providers to adopt established quality improvement strategies and interventions with proven effectiveness. This review had three goals: (1) asses...
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| Format: | Article |
| Language: | English |
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BMC
2017-07-01
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| Series: | Implementation Science |
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| Online Access: | http://link.springer.com/article/10.1186/s13012-017-0626-4 |
| _version_ | 1830432269102219264 |
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| author | Valerie L. Forman-Hoffman Jennifer Cook Middleton Joni L. McKeeman Leyla F. Stambaugh Robert B. Christian Bradley N. Gaynes Heather Lynne Kane Leila C. Kahwati Kathleen N. Lohr Meera Viswanathan |
| author_facet | Valerie L. Forman-Hoffman Jennifer Cook Middleton Joni L. McKeeman Leyla F. Stambaugh Robert B. Christian Bradley N. Gaynes Heather Lynne Kane Leila C. Kahwati Kathleen N. Lohr Meera Viswanathan |
| author_sort | Valerie L. Forman-Hoffman |
| collection | DOAJ |
| description | Abstract Background Some outcomes for children with mental health problems remain suboptimal because of poor access to care and the failure of systems and providers to adopt established quality improvement strategies and interventions with proven effectiveness. This review had three goals: (1) assess the effectiveness of quality improvement, implementation, and dissemination strategies intended to improve the mental health care of children and adolescents; (2) examine harms associated with these strategies; and (3) determine whether effectiveness or harms differ for subgroups based on system, organizational, practitioner, or patient characteristics. Methods Sources included MEDLINE®, the Cochrane Library, PsycINFO, and CINAHL, from database inception through February 17, 2017. Additional sources included gray literature, additional studies from reference lists, and technical experts. Two reviewers selected relevant randomized controlled trials (RCTs) and observational studies, extracted data, and assessed risk of bias. Dual analysis, synthesis, and grading of the strength of evidence for each outcome followed for studies meeting inclusion criteria. We also used qualitative comparative analysis to examine relationships between combinations of strategy components and improvements in outcomes. Results We identified 18 strategies described in 19 studies. Eleven strategies significantly improved at least one measure of intermediate outcomes, final health outcomes, or resource use. Moderate strength of evidence (from one RCT) supported using provider financial incentives such as pay for performance to improve the competence with which practitioners can implement evidence-based practices (EBPs). We found inconsistent evidence involving strategies with educational meetings, materials, and outreach; programs appeared to be successful in combination with reminders or providing practitioners with newly collected clinical information. We also found low strength of evidence for no benefit for initiatives that included only educational materials or meetings (or both), or only educational materials and outreach components. Evidence was insufficient to draw conclusions on harms and moderators of interventions. Conclusions Several strategies can improve both intermediate and final health outcomes and resource use. This complex and heterogeneous body of evidence does not permit us to have a high degree of confidence about the efficacy of any one strategy because we generally found only a single study testing each strategy. Trial registration PROSPERO, CRD42015024759 . |
| first_indexed | 2024-12-21T02:22:11Z |
| format | Article |
| id | doaj.art-d01344224b4b4eeab47c73a88d26b2d7 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-21T02:22:11Z |
| publishDate | 2017-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-d01344224b4b4eeab47c73a88d26b2d72022-12-21T19:19:07ZengBMCImplementation Science1748-59082017-07-0112112110.1186/s13012-017-0626-4Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic reviewValerie L. Forman-Hoffman0Jennifer Cook Middleton1Joni L. McKeeman2Leyla F. Stambaugh3Robert B. Christian4Bradley N. Gaynes5Heather Lynne Kane6Leila C. Kahwati7Kathleen N. Lohr8Meera Viswanathan9RTI InternationalCecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel HillDepartment of Psychiatry, UNC School of MedicineRTI InternationalThe Carolina Institute for Developmental Disabilities, University of North Carolina Chapel HillDepartment of Psychiatry, UNC School of MedicineRTI InternationalRTI InternationalRTI InternationalRTI InternationalAbstract Background Some outcomes for children with mental health problems remain suboptimal because of poor access to care and the failure of systems and providers to adopt established quality improvement strategies and interventions with proven effectiveness. This review had three goals: (1) assess the effectiveness of quality improvement, implementation, and dissemination strategies intended to improve the mental health care of children and adolescents; (2) examine harms associated with these strategies; and (3) determine whether effectiveness or harms differ for subgroups based on system, organizational, practitioner, or patient characteristics. Methods Sources included MEDLINE®, the Cochrane Library, PsycINFO, and CINAHL, from database inception through February 17, 2017. Additional sources included gray literature, additional studies from reference lists, and technical experts. Two reviewers selected relevant randomized controlled trials (RCTs) and observational studies, extracted data, and assessed risk of bias. Dual analysis, synthesis, and grading of the strength of evidence for each outcome followed for studies meeting inclusion criteria. We also used qualitative comparative analysis to examine relationships between combinations of strategy components and improvements in outcomes. Results We identified 18 strategies described in 19 studies. Eleven strategies significantly improved at least one measure of intermediate outcomes, final health outcomes, or resource use. Moderate strength of evidence (from one RCT) supported using provider financial incentives such as pay for performance to improve the competence with which practitioners can implement evidence-based practices (EBPs). We found inconsistent evidence involving strategies with educational meetings, materials, and outreach; programs appeared to be successful in combination with reminders or providing practitioners with newly collected clinical information. We also found low strength of evidence for no benefit for initiatives that included only educational materials or meetings (or both), or only educational materials and outreach components. Evidence was insufficient to draw conclusions on harms and moderators of interventions. Conclusions Several strategies can improve both intermediate and final health outcomes and resource use. This complex and heterogeneous body of evidence does not permit us to have a high degree of confidence about the efficacy of any one strategy because we generally found only a single study testing each strategy. Trial registration PROSPERO, CRD42015024759 .http://link.springer.com/article/10.1186/s13012-017-0626-4AdolescentsChildrenDisseminationEvidence-based medicineImplementationMental health |
| spellingShingle | Valerie L. Forman-Hoffman Jennifer Cook Middleton Joni L. McKeeman Leyla F. Stambaugh Robert B. Christian Bradley N. Gaynes Heather Lynne Kane Leila C. Kahwati Kathleen N. Lohr Meera Viswanathan Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review Implementation Science Adolescents Children Dissemination Evidence-based medicine Implementation Mental health |
| title | Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review |
| title_full | Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review |
| title_fullStr | Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review |
| title_full_unstemmed | Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review |
| title_short | Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review |
| title_sort | quality improvement implementation and dissemination strategies to improve mental health care for children and adolescents a systematic review |
| topic | Adolescents Children Dissemination Evidence-based medicine Implementation Mental health |
| url | http://link.springer.com/article/10.1186/s13012-017-0626-4 |
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