理解在卫生和保健领域中，为何以及如何实施（de-implementation）：对证据进行实际主义综合分析的研究方案。
Understanding how and why de-implementation works in health and care: research protocol for a realist synthesis of evidence.
机构信息
Noreen Edwards Chair of Rehabilitation and Nursing Research, Head of School, School of Health Sciences, Bangor University, Bangor, Gwynedd, UK.
Bangor University, Bangor, UK.
出版信息
Syst Rev. 2019 Aug 5;8(1):194. doi: 10.1186/s13643-019-1111-8.
BACKGROUND
Strategies to improve the effectiveness and quality of health and care have predominantly emphasised the implementation of new research and evidence into service organisation and delivery. A parallel, but less understood issue is how clinicians and service leaders stop existing practices and interventions that are no longer evidence based, where new evidence supersedes old evidence, or interventions are replaced with those that are more cost effective. The aim of this evidence synthesis is to produce meaningful programme theory and practical guidance for policy makers, managers and clinicians to understand how and why de-implementation processes and procedures can work.
METHODS AND ANALYSIS
The synthesis will examine the attributes or characteristics that constitute the concept of de-implementation. The research team will then draw on the principles of realist inquiry to provide an explanatory account of how, in what context and for whom to explain the successful processes and impacts of de-implementation. The review will be conducted in four phases over 18 months. Phase 1: develop a framework to map the preliminary programme theories through an initial scoping of the literature and consultation with key stakeholders. Phase 2: systematic searches of the evidence to develop the theories identified in phase 1. Phase 3: validation and refinement of programme theories through stakeholder interviews. Phase 4: formulating actionable recommendations for managers, commissioners and service leaders about what works through different approaches to de-implementation.
DISCUSSION
This evidence synthesis will address gaps in knowledge about de-implementation across health and care services and ensure that guidance about strategies and approaches accounts for contextual factors, which may be operating at different organisational and decision-making levels. Through the development of the programme theory, which explains what works, how and under which circumstances, findings from the evidence synthesis will support managers and service leaders to make measured decisions about de-implementation.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42017081030.
背景
提高卫生和保健服务的效果和质量的策略主要强调将新的研究和证据应用于服务组织和提供。一个平行但理解较少的问题是，临床医生和服务领导者如何停止不再基于证据的现有做法和干预措施，当新证据取代旧证据时，或者用更具成本效益的干预措施取代这些干预措施。本证据综合的目的是为政策制定者、管理者和临床医生提供有意义的方案理论和实际指导，以了解如何以及为何可以实施取消实施的过程和程序。
方法和分析
综合将检查构成取消实施概念的属性或特征。然后，研究团队将利用现实主义探究的原则，提供一个解释性的说明，说明如何、在什么情况下以及为谁可以解释取消实施的成功过程和影响。审查将在 18 个月内分四个阶段进行。第 1 阶段：通过初步文献范围界定和与主要利益相关者协商，制定一个框架来映射初步方案理论。第 2 阶段：系统搜索证据，以发展第 1 阶段确定的理论。第 3 阶段：通过利益相关者访谈验证和完善方案理论。第 4 阶段：制定针对管理者、委托人和服务领导者的可操作建议，说明通过不同的取消实施方法什么是有效的。
讨论
本次证据综合将解决医疗保健服务中取消实施方面的知识差距，并确保关于策略和方法的指导考虑到可能在不同组织和决策层面运作的背景因素。通过制定解释什么是有效的、如何有效的以及在什么情况下有效的方案理论，证据综合的结果将支持管理者和服务领导者做出关于取消实施的审慎决策。
系统评价注册
PROSPERO CRD42017081030。
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