基于证据的创新实施中的背景、复杂性和过程：一项基于现实主义的综述。
Context, complexity and process in the implementation of evidence-based innovation: a realist informed review.
机构信息
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Critical Care Program, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada.
出版信息
BMC Health Serv Res. 2020 Feb 3;20(1):81. doi: 10.1186/s12913-020-4935-y.
BACKGROUND
This review of scholarly work in health care knowledge translation advances understanding of implementation components that support the complete and timely integration of new knowledge. We adopt a realist approach to investigate what is known from the current literature about the impact of, and the potential relationships between, context, complexity and implementation process.
METHODS
Informed by two distinct pathways, knowledge utilization and knowledge translation, we utilize Rogers' Diffusion of Innovations theory (DOI) and Harvey and Kitson's integrated- Promoting Action on Research Implementation in Health Service framework (PARIHS) to ground this review. Articles from 5 databases; Medline, Scopus, PsycInfo, Web of Science, and Google Scholar and a search of authors were retrieved. Themes and patterns related to these implementation components were extracted. Literature was selected for inclusion by consensus. Data extraction was iterative and was moderated by the authors.
RESULTS
A total of 67 articles were included in the review. Context was a central component to implementation. It was not clear how and to what extent context impacted implementation. Complexity was found to be a characteristic of context, implementation process, innovations and a product of the relationship between these three elements. Social processes in particular were reported as influential however; descriptions of how these social process impact were limited. Multiple theoretical and operational models were found to ground implementation processes. We offer an emerging conceptual model to illustrate the key discoveries.
CONCLUSIONS
The review findings indicate there are dynamic relationship between context, complexity and implementation process for enhancing uptake of evidence-based knowledge in hospital settings. These are represented in a conceptual model. Limited empiric evidence was found to explain the nature of the relationships.
背景
本综述研究了医疗保健知识转化领域的学术成果，旨在深入了解支持新知识全面及时整合的实施环节。我们采用现实主义方法，调查当前文献中关于背景、复杂性和实施过程的影响及其潜在关系的已有知识。
方法
本研究受两条不同路径（知识应用和知识转化）的启发，利用罗格斯创新扩散理论（DOI）和哈维和基森的综合促进卫生服务研究实施行动框架（PARIHS）作为本综述的理论基础。我们从 Medline、Scopus、PsycInfo、Web of Science 和 Google Scholar 这 5 个数据库中检索文章，并对作者进行了搜索。提取与这些实施环节相关的主题和模式。通过共识选择纳入文献。数据提取是迭代进行的，由作者进行协调。
结果
本综述共纳入 67 篇文章。背景是实施的核心组成部分。目前尚不清楚背景如何以及在何种程度上影响实施。复杂性被认为是背景、实施过程、创新的特征，也是这三个要素之间关系的产物。特别是社会过程被报道为具有影响力，但对这些社会过程如何影响的描述有限。我们发现了多种理论和操作模型来为实施过程提供基础。我们提供了一个新兴的概念模型来说明主要发现。
结论
综述结果表明，在医院环境中，背景、复杂性和实施过程之间存在动态关系，以增强对循证知识的采用。这些在一个概念模型中得到了体现。但我们发现，解释这些关系性质的经验证据有限。
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