Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.
Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.
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DOI：
10.1186/1748-5908-4-50
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发表时间：
2009-08-07
期刊：
影响因子：
--
通讯作者：
Lowery JC
中科院分区：
文献类型：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
在卫生服务研究中发现的许多有效干预措施未能在多种情况下转化为有意义的患者护理结果。卫生服务研究人员认识到，不仅需要评估总结性成果，而且需要评估形成性成果，以评估实施在特定环境中的有效程度，可持续性，并促进向其他环境的传播。许多执行理论已经出版，以帮助促进有效的执行。然而，它们在个别理论中包含的结构中有相当大的重叠，并且理论的比较表明，每个理论都缺少其他理论中包含的重要结构。此外，各种理论的术语和定义并不一致。我们描述了实施研究的综合框架（CFIR），它提供了一个总体的类型学，以促进实施理论的发展和验证什么在哪里以及为什么在多个环境中起作用。我们使用了滚雪球抽样的方法来识别已发表的理论，这些理论被评估以识别基于概念或经验支持的强度对实施的影响、定义的一致性、与我们自己的发现的一致性以及测量的潜力的结构。我们将已发表的理论中具有不同标签但在定义上冗余或重叠的结构组合在一起，并将混淆了基础概念的结构分开。CFIR由五个主要领域组成：干预特征、外部环境、内部环境、所涉个人特征和实施过程。确定了与干预相关的八个结构（例如，证据强度和质量），确定了四个与外部环境相关的结构（例如，患者需求和资源），12个结构被识别为与内部设置相关（例如，文化，领导参与），五个结构被识别为与个体特征相关，八个结构被识别为与过程相关（例如，计划、评估和反思）。我们提出了明确的定义为每个结构。CFIR提供了一个实用的结构，接近复杂的，相互作用的，多层次的，在真实的世界中的瞬时状态的结构，通过拥抱，巩固和统一的关键结构，从出版的实施理论。它可用于指导形成性评价，并在多项研究和环境中建立执行知识库。
Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
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DOI：
10.1016/0749-5978(91)90020-t
发表时间：
1991-12-01
影响因子：
4.6
作者：
AJZEN, I
通讯作者：
AJZEN, I
DOI：
10.1108/01443570410552108
发表时间：
2004-01-01
影响因子：
9.9
作者：
Burnes, B
通讯作者：
Burnes, B
影响因子：
2.8
作者：
Fitzgerald, LA;van Eijnatten, FM
通讯作者：
van Eijnatten, FM
影响因子：
4.2
作者：
Brehm, J;Rahn, W
通讯作者：
Rahn, W
影响因子：
10.4
作者：
Edmondson, AC;Bohmer, RM;Pisano, GP
通讯作者：
Pisano, GP