Academic Unit, Peninsula Health, Frankston, VIC, Australia.
Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, VIC, Australia.
BMC Health Serv Res. 2023 Jun 9;23(1):607. doi: 10.1186/s12913-023-09609-y.
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.
We conducted a search in CINAHL, MEDLINE, EMBASE, PsycINFO, EMCARE and Cochrane Library databases from 1 January 1995 to 15 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.
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.
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.
CRD42019119429.
卫生服务实施项目通常由理论实施框架指导。然而，对于这些框架在促进住院环境中护理流程的改变和患者结局方面的有效性，我们知之甚少。本研究旨在评估在住院医疗环境中应用理论实施框架来改变护理流程和相关患者结局的效果。
我们于 1995 年 1 月 1 日至 2021 年 6 月 15 日，在 CINAHL、MEDLINE、EMBASE、PsycINFO、EMCARE 和 Cochrane Library 数据库中进行了检索。两位评审员独立应用纳入和排除标准筛选可能符合条件的研究。纳入研究标准：使用理论实施框架将循证护理应用于住院环境中，并前瞻性实施；采用前瞻性研究设计；呈现护理流程或患者结局；以英文发表。我们根据工作组干预开发和评估研究（WIDER）清单提取理论实施框架和研究设计，并根据科克伦护理实践和组织（EPOC）分类法映射实施策略。我们使用干预描述和复制模板（TIDieR）清单总结所有干预措施。我们使用观察性研究的风险偏倚项目库和修订后的科克伦群组随机试验风险偏倚工具评估研究质量。我们提取护理流程和患者结局，并进行描述性描述。我们根据框架类别对护理流程和患者结局进行了荟萃分析。
共有 25 项研究符合纳入标准。21 项研究采用了前后（无对照）设计，2 项采用了前后对照加对照设计，2 项采用了群组随机试验设计。11 个理论实施框架被前瞻性应用：6 个流程模型；5 个决定因素框架；1 个经典理论。有 4 项研究使用了两个理论实施框架。没有作者报告选择特定框架的理由，实施策略通常描述得很差。基于荟萃分析结果，没有达成对首选框架或框架子集的共识。
与其不断开发新的实施框架，建议更一致地选择框架并加强现有方法，以进一步发展实施证据基础。
CRD42019119429。
