Miech Edward J, Rattray Nicholas A, Flanagan Mindy E, Damschroder Laura, Schmid Arlene A, Damush Teresa M
VA Precision Monitoring (PRIS-M) QUERI, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.
William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA.
SAGE Open Med. 2018 May 17;6:2050312118773261. doi: 10.1177/2050312118773261. eCollection 2018.
BACKGROUND/AIMS: The idea that champions are crucial to effective healthcare-related implementation has gained broad acceptance; yet the champion construct has been hampered by inconsistent use across the published literature. This integrative review sought to establish the current state of the literature on champions in healthcare settings and bring greater clarity to this important construct.
This integrative review was limited to research articles in peer-reviewed, English-language journals published from 1980 to 2016. Searches were conducted on the online MEDLINE database via OVID and PubMed using the keyword "champion." Several additional terms often describe champions and were also included as keywords: implementation leader, opinion leader, facilitator, and change agent. Bibliographies of full-text articles that met inclusion criteria were reviewed for additional references not yet identified via the main strategy of conducting keyword searches in MEDLINE. A five-member team abstracted all full-text articles meeting inclusion criteria.
The final dataset for the integrative review consisted of 199 unique articles. Use of the term champion varied widely across the articles with respect to topic, specific job positions, or broader organizational roles. The most common method for operationalizing champion for purposes of analysis was the use of a dichotomous variable designating champion presence or absence. Four studies randomly allocated of the presence or absence of champions.
The number of published champion-related articles has markedly increased: more articles were published during the last two years of this review (i.e. 2015-2016) than during its first 30 years (i.e. 1980-2009).The number of champion-related articles has continued to increase sharply since the year 2000. Individual studies consistently found that champions were important positive influences on implementation effectiveness. Although few in number, the randomized trials of champions that have been conducted demonstrate the feasibility of using experimental design to study the effects of champions in healthcare.
背景/目的：倡导者对于有效的医疗相关实施至关重要这一观点已获得广泛认可；然而，倡导者这一概念在已发表文献中的使用并不一致，这给该概念的发展带来了阻碍。本整合性综述旨在确定医疗环境中关于倡导者的文献现状，并使这一重要概念更加清晰明了。
本整合性综述仅限于1980年至2016年在同行评审的英文期刊上发表的研究文章。通过OVID和PubMed在在线MEDLINE数据库中使用关键词“倡导者”进行检索。另外几个常用于描述倡导者的术语也被作为关键词纳入：实施领导者、意见领袖、促进者和变革推动者。对符合纳入标准的全文文章的参考文献进行了审查，以查找通过在MEDLINE中进行关键词搜索的主要策略尚未识别的其他参考文献。一个由五名成员组成的团队提取了所有符合纳入标准的全文文章。
整合性综述的最终数据集由199篇独特的文章组成。在文章中，“倡导者”一词在主题、具体工作职位或更广泛的组织角色方面的使用差异很大。为了分析目的，最常用的将倡导者进行操作化的方法是使用一个二分变量来表示倡导者的存在或不存在。四项研究随机分配了倡导者的存在或不存在情况。
已发表的与倡导者相关的文章数量显著增加：在本综述的最后两年（即2015 - 2016年）发表的文章比前30年（即1980 - 2009年）发表的还多。自2000年以来，与倡导者相关的文章数量持续急剧增加。个别研究一致发现，倡导者对实施效果有重要的积极影响。虽然数量很少，但已进行的关于倡导者的随机试验证明了使用实验设计来研究倡导者在医疗保健中的作用的可行性。
