Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
Int J Health Policy Manag. 2023;12:7089. doi: 10.34172/ijhpm.2023.7089. Epub 2023 Feb 14.
Avoidable hospital readmission is a major problem among health systems. Although there are effective peri-discharge interventions for reducing avoidable hospital readmission, successful implementation is challenging. This systematic review of qualitative studies aimed to identify barriers and facilitators to implementing peri-discharge interventions from providers' and service users' perspectives.
We searched four databases for potentially eligible qualitative studies from databases' inception to March 2020, and updated literature search for studies published between January 2020 to October 2021. Barriers and facilitators to implementing peri-discharge interventions were identified and mapped onto the Consolidated Framework for Implementation Research (CFIR) constructs. Inductive analysis of the CFIR constructs was performed to yield thematic areas that illustrated the relationship between various facilitators and barriers, generating practical insights to key implementation issues.
Thirteen qualitative studies were included in this systematic review. Key issues were clustered in the CFIR constructs of of the intervention, strength of , being responsive to with sufficient support, and . The three thematic areas were rationality of the interventions, readiness and effort of multidisciplinary implementation teams, and influence of external stakeholders. Common barriers included () limited resources, () poor communication among team members, () incompatibility between the new intervention and existing work routine, () complicated implementation process, () low practicality of supporting instruments, and () lack of understanding about the content and effectiveness of the new interventions. Common facilitators were () information sharing via regular meetings on implementation issues, () organizational culture that values quality and accountability, () financial penalties for hospitals with high avoidable readmissions rates, () external support offered via quality improvement programs and community resources, and () senior leadership support.
This study synthesized commonly-presenting barriers and facilitators to implementing peri-discharge interventions among different healthcare organizations. Findings may inform development of implementation strategies in different health systems after appropriate tailoring, based on a consensus-based formative research process.
可避免的医院再入院是医疗系统中的一个主要问题。尽管有一些有效的出院前干预措施可以减少可避免的医院再入院，但成功实施这些措施具有挑战性。本系统评价旨在从提供者和服务使用者的角度，确定实施出院前干预措施的障碍和促进因素。
我们从数据库建立之初到 2020 年 3 月，在四个数据库中搜索潜在的合格定性研究，并对 2020 年 1 月至 2021 年 10 月期间发表的研究进行了更新文献搜索。确定了实施出院前干预措施的障碍和促进因素，并将其映射到实施研究综合框架 (CFIR) 结构上。对 CFIR 结构进行归纳分析，得出主题领域，说明各种促进因素和障碍之间的关系，为关键实施问题提供实践见解。
本系统评价共纳入 13 项定性研究。关键问题集中在干预措施的 CFIR 结构的、、对、和。三个主题领域是干预措施的合理性、多学科实施团队的准备和努力，以及外部利益相关者的影响。常见障碍包括（）资源有限、（）团队成员之间沟通不畅、（）新干预措施与现有工作常规不兼容、（）实施过程复杂、（）支持工具实用性低、（）对新干预措施的内容和效果缺乏了解。常见的促进因素包括（）通过定期会议就实施问题进行信息共享、（）重视质量和问责制的组织文化、（）对避免不必要再入院率高的医院实施经济处罚、（）通过质量改进计划和社区资源提供外部支持、（）高层领导的支持。
本研究综合了不同医疗保健组织实施出院前干预措施的常见障碍和促进因素。这些发现可能为不同卫生系统在适当调整后，根据基于共识的形成性研究过程，制定实施策略提供信息。
