Models and frameworks for assessing the implementation of clinical practice guidelines: a systematic review.
Assessment
Evidence-Based Practice
Frameworks
Healthcare
Implementation
Implementation science
Models
Practice guideline
Systematic review
Journal
Implementation science : IS
ISSN: 1748-5908
Titre abrégé: Implement Sci
Pays: England
ID NLM: 101258411
Informations de publication
Date de publication:
07 Aug 2024
07 Aug 2024
Historique:
received:
06
02
2024
accepted:
01
08
2024
medline:
8
8
2024
pubmed:
8
8
2024
entrez:
7
8
2024
Statut:
epublish
Résumé
The implementation of clinical practice guidelines (CPGs) is a cyclical process in which the evaluation stage can facilitate continuous improvement. Implementation science has utilized theoretical approaches, such as models and frameworks, to understand and address this process. This article aims to provide a comprehensive overview of the models and frameworks used to assess the implementation of CPGs. A systematic review was conducted following the Cochrane methodology, with adaptations to the "selection process" due to the unique nature of this review. The findings were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Electronic databases were searched from their inception until May 15, 2023. A predetermined strategy and manual searches were conducted to identify relevant documents from health institutions worldwide. Eligible studies presented models and frameworks for assessing the implementation of CPGs. Information on the characteristics of the documents, the context in which the models were used (specific objectives, level of use, type of health service, target group), and the characteristics of each model or framework (name, domain evaluated, and model limitations) were extracted. The domains of the models were analyzed according to the key constructs: strategies, context, outcomes, fidelity, adaptation, sustainability, process, and intervention. A subgroup analysis was performed grouping models and frameworks according to their levels of use (clinical, organizational, and policy) and type of health service (community, ambulatorial, hospital, institutional). The JBI's critical appraisal tools were utilized by two independent researchers to assess the trustworthiness, relevance, and results of the included studies. Database searches yielded 14,395 studies, of which 80 full texts were reviewed. Eight studies were included in the data analysis and four methodological guidelines were additionally included from the manual search. The risk of bias in the studies was considered non-critical for the results of this systematic review. A total of ten models/frameworks for assessing the implementation of CPGs were found. The level of use was mainly policy, the most common type of health service was institutional, and the major target group was professionals directly involved in clinical practice. The evaluated domains differed between the models and there were also differences in their conceptualization. All the models addressed the domain "Context", especially at the micro level (8/12), followed by the multilevel (7/12). The domains "Outcome" (9/12), "Intervention" (8/12), "Strategies" (7/12), and "Process" (5/12) were frequently addressed, while "Sustainability" was found only in one study, and "Fidelity/Adaptation" was not observed. The use of models and frameworks for assessing the implementation of CPGs is still incipient. This systematic review may help stakeholders choose or adapt the most appropriate model or framework to assess CPGs implementation based on their specific health context. PROSPERO (International Prospective Register of Systematic Reviews) registration number: CRD42022335884. Registered on June 7, 2022.
Sections du résumé
BACKGROUND
BACKGROUND
The implementation of clinical practice guidelines (CPGs) is a cyclical process in which the evaluation stage can facilitate continuous improvement. Implementation science has utilized theoretical approaches, such as models and frameworks, to understand and address this process. This article aims to provide a comprehensive overview of the models and frameworks used to assess the implementation of CPGs.
METHODS
METHODS
A systematic review was conducted following the Cochrane methodology, with adaptations to the "selection process" due to the unique nature of this review. The findings were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Electronic databases were searched from their inception until May 15, 2023. A predetermined strategy and manual searches were conducted to identify relevant documents from health institutions worldwide. Eligible studies presented models and frameworks for assessing the implementation of CPGs. Information on the characteristics of the documents, the context in which the models were used (specific objectives, level of use, type of health service, target group), and the characteristics of each model or framework (name, domain evaluated, and model limitations) were extracted. The domains of the models were analyzed according to the key constructs: strategies, context, outcomes, fidelity, adaptation, sustainability, process, and intervention. A subgroup analysis was performed grouping models and frameworks according to their levels of use (clinical, organizational, and policy) and type of health service (community, ambulatorial, hospital, institutional). The JBI's critical appraisal tools were utilized by two independent researchers to assess the trustworthiness, relevance, and results of the included studies.
RESULTS
RESULTS
Database searches yielded 14,395 studies, of which 80 full texts were reviewed. Eight studies were included in the data analysis and four methodological guidelines were additionally included from the manual search. The risk of bias in the studies was considered non-critical for the results of this systematic review. A total of ten models/frameworks for assessing the implementation of CPGs were found. The level of use was mainly policy, the most common type of health service was institutional, and the major target group was professionals directly involved in clinical practice. The evaluated domains differed between the models and there were also differences in their conceptualization. All the models addressed the domain "Context", especially at the micro level (8/12), followed by the multilevel (7/12). The domains "Outcome" (9/12), "Intervention" (8/12), "Strategies" (7/12), and "Process" (5/12) were frequently addressed, while "Sustainability" was found only in one study, and "Fidelity/Adaptation" was not observed.
CONCLUSIONS
CONCLUSIONS
The use of models and frameworks for assessing the implementation of CPGs is still incipient. This systematic review may help stakeholders choose or adapt the most appropriate model or framework to assess CPGs implementation based on their specific health context.
TRIAL REGISTRATION
BACKGROUND
PROSPERO (International Prospective Register of Systematic Reviews) registration number: CRD42022335884. Registered on June 7, 2022.
Identifiants
pubmed: 39113109
doi: 10.1186/s13012-024-01389-1
pii: 10.1186/s13012-024-01389-1
doi:
Types de publication
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
59Subventions
Organisme : Fundação de Apoio à Pesquisa do Distrito Federal
ID : 44/2024
Informations de copyright
© 2024. The Author(s).
Références
Medicine I of. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001. Available from: http://www.nap.edu/catalog/10027 . Cited 2022 Sep 29.
Field MJ, Lohr KN. Clinical Practice Guidelines: Directions for a New Program. Washington DC: National Academy Press. 1990. Available from: https://www.nap.edu/read/1626/chapter/8 Cited 2020 Sep 2.
Dawson A, Henriksen B, Cortvriend P. Guideline Implementation in Standardized Office Workflows and Exam Types. J Prim Care Community Heal. 2019;10. Available from: https://pubmed.ncbi.nlm.nih.gov/30900500/ . Cited 2020 Jul 15.
Unverzagt S, Oemler M, Braun K, Klement A. Strategies for guideline implementation in primary care focusing on patients with cardiovascular disease: a systematic review. Fam Pract. 2014;31(3):247–66. Available from: https://academic.oup.com/fampra/article/31/3/247/608680 . Cited 2020 Nov 5.
doi: 10.1093/fampra/cmt080
pubmed: 24367069
Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10(1):1–13. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-015-0242-0 . Cited 2022 May 1.
doi: 10.1186/s13012-015-0242-0
Mangana F, Massaquoi LD, Moudachirou R, Harrison R, Kaluangila T, Mucinya G, et al. Impact of the implementation of new guidelines on the management of patients with HIV infection at an advanced HIV clinic in Kinshasa, Democratic Republic of Congo (DRC). BMC Infect Dis. 2020;20(1):N.PAG-N.PAG. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=146325052& .
Browman GP, Levine MN, Mohide EA, Hayward RSA, Pritchard KI, Gafni A, et al. The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation. 2016;13(2):502–12. https://doi.org/10.1200/JCO.1995.13.2.502 .
Killeen SL, Donnellan N, O’Reilly SL, Hanson MA, Rosser ML, Medina VP, et al. Using FIGO Nutrition Checklist counselling in pregnancy: A review to support healthcare professionals. Int J Gynecol Obstet. 2023;160(S1):10–21. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85146194829&doi=10.1002%2Fijgo.14539&partnerID=40&md5=d0f14e1f6d77d53e719986e6f434498f .
doi: 10.1002/ijgo.14539
Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3(1):1–12. Available from: https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-015-0089-9 . Cited 2020 Nov 5.
doi: 10.1186/s40359-015-0089-9
Cassetti V, M VLR, Pola-Garcia M, AM G, J JPC, L APDT, et al. An integrative review of the implementation of public health guidelines. Prev Med reports. 2022;29:101867. Available from: http://www.epistemonikos.org/documents/7ad499d8f0eecb964fc1e2c86b11450cbe792a39 .
Eccles MP, Mittman BS. Welcome to implementation science. Implementation Science BioMed Central. 2006. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-1-1 .
Damschroder LJ. Clarity out of chaos: Use of theory in implementation research. Psychiatry Res. 2020;1(283):112461.
doi: 10.1016/j.psychres.2019.06.036
Handley MA, Gorukanti A, Cattamanchi A. Strategies for implementing implementation science: a methodological overview. Emerg Med J. 2016;33(9):660–4. Available from: https://pubmed.ncbi.nlm.nih.gov/26893401/ . Cited 2022 Mar 7.
doi: 10.1136/emermed-2015-205461
pubmed: 26893401
Wang Y, Wong ELY, Nilsen P, Chung VC ho, Tian Y, Yeoh EK. A scoping review of implementation science theories, models, and frameworks — an appraisal of purpose, characteristics, usability, applicability, and testability. Implement Sci. 2023;18(1):1–15. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-023-01296-x . Cited 2024 Jan 22.
doi: 10.1186/s13012-023-01296-x
Moullin JC, Dickson KS, Stadnick NA, Albers B, Nilsen P, Broder-Fingert S, et al. Ten recommendations for using implementation frameworks in research and practice. Implement Sci Commun. 2020;1(1):1–12. Available from: https://implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-020-00023-7 . Cited 2022 May 20.
doi: 10.1186/s43058-020-00023-7
Glasgow RE, Vogt TM, Boles SM. *Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322. Available from: /pmc/articles/PMC1508772/?report=abstract. Cited 2022 May 22.
doi: 10.2105/AJPH.89.9.1322
pubmed: 10474547
pmcid: 1508772
Asada Y, Lin S, Siegel L, Kong A. Facilitators and Barriers to Implementation and Sustainability of Nutrition and Physical Activity Interventions in Early Childcare Settings: a Systematic Review. Prev Sci. 2023;24(1):64–83. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85139519721&doi=10.1007%2Fs11121-022-01436-7&partnerID=40&md5=b3c395fdd2b8235182eee518542ebf2b .
doi: 10.1007/s11121-022-01436-7
pubmed: 36198924
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions. version 6. Cochrane; 2022. Available from: https://training.cochrane.org/handbook. Cited 2022 May 23.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. Available from: https://www.bmj.com/content/372/bmj.n71 . Cited 2021 Nov 18.
M C, AD O, E P, JP H, S G. Appendix A: Guide to the contents of a Cochrane Methodology protocol and review. Higgins JP, Green S, eds Cochrane Handb Syst Rev Interv. 2011;Version 5.
Kislov R, Pope C, Martin GP, Wilson PM. Harnessing the power of theorising in implementation science. Implement Sci. 2019;14(1):1–8. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-019-0957-4 . Cited 2024 Jan 22.
doi: 10.1186/s13012-019-0957-4
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):1–10. Available from: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0384-4 . Cited 2022 May 20.
doi: 10.1186/s13643-016-0384-4
JBI. JBI’s Tools Assess Trust, Relevance & Results of Published Papers: Enhancing Evidence Synthesis. Available from: https://jbi.global/critical-appraisal-tools . Cited 2023 Jun 13.
Drisko JW. Qualitative research synthesis: An appreciative and critical introduction. Qual Soc Work. 2020;19(4):736–53.
doi: 10.1177/1473325019848808
Pope C, Mays N, Popay J. Synthesising qualitative and quantitative health evidence: A guide to methods. 2007. Available from: https://books.google.com.br/books?hl=pt-PT&lr=&id=L3fbE6oio8kC&oi=fnd&pg=PR6&dq=synthesizing+qualitative+and+quantitative+health+evidence&ots=sfELNUoZGq&sig=bQt5wt7sPKkf7hwKUvxq2Ek-p2Q#v=onepage&q=synthesizing=qualitative=and=quantitative=health=evidence& . Cited 2022 May 22.
Nilsen P, Birken SA, Edward Elgar Publishing. Handbook on implementation science. 542. Available from: https://www.e-elgar.com/shop/gbp/handbook-on-implementation-science-9781788975988.html . Cited 2023 Apr 15.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):1–15. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-4-50 . Cited 2023 Jun 13.
doi: 10.1186/1748-5908-4-50
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76. Available from: https://pubmed.ncbi.nlm.nih.gov/20957426/ . Cited 2023 Jun 11.
doi: 10.1007/s10488-010-0319-7
pubmed: 20957426
Bahtsevani C, Willman A, Khalaf A, Östman M, Ostman M. Developing an instrument for evaluating implementation of clinical practice guidelines: a test-retest study. J Eval Clin Pract. 2008;14(5):839–46. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=105569473& . Cited 2023 Jan 18.
doi: 10.1111/j.1365-2753.2007.00916.x
pubmed: 18331325
Balbale SN, Hill JN, Guihan M, Hogan TP, Cameron KA, Goldstein B, et al. Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: a mixed methods study. Implement Sci. 2015;10(1):130. Available from: https://pubmed.ncbi.nlm.nih.gov/26353798/ . Cited 2023 Apr 3.
doi: 10.1186/s13012-015-0318-x
pubmed: 26353798
pmcid: 4564999
Breimaier HE, Heckemann B, Halfens RJGG, Lohrmann C. The Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice. BMC Nurs. 2015;14(1):43. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=109221169& . Cited 2023 Apr 3.
doi: 10.1186/s12912-015-0088-4
pubmed: 26269693
pmcid: 4533946
Chou AF, Vaughn TE, McCoy KD, Doebbeling BN. Implementation of evidence-based practices: Applying a goal commitment framework. Health Care Manage Rev. 2011;36(1):4–17. Available from: https://pubmed.ncbi.nlm.nih.gov/21157225/ . Cited 2023 Apr 30.
doi: 10.1097/HMR.0b013e3181dc8233
pubmed: 21157225
Porritt K, McArthur A, Lockwood C, Munn Z. JBI Manual for Evidence Implementation. JBI Handbook for Evidence Implementation. JBI; 2020. Available from: https://jbi-global-wiki.refined.site/space/JHEI . Cited 2023 Apr 3.
Jeong HJJ, Jo HSS, Oh MKK, Oh HWW. Applying the RE-AIM Framework to Evaluate the Dissemination and Implementation of Clinical Practice Guidelines for Sexually Transmitted Infections. J Korean Med Sci. 2015;30(7):847–52. Available from: https://pubmed.ncbi.nlm.nih.gov/26130944/ . Cited 2023 Apr 3.
doi: 10.3346/jkms.2015.30.7.847
pubmed: 26130944
pmcid: 4479935
GPC G de trabajo sobre implementación de. Implementación de Guías de Práctica Clínica en el Sistema Nacional de Salud. Manual Metodológico. 2009. Available from: https://portal.guiasalud.es/wp-content/uploads/2019/01/manual_implementacion.pdf . Cited 2023 Apr 3.
Australia C of. A guide to the development, implementation and evaluation of clinical practice guidelines. National Health and Medical Research Council; 1998. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0029/143696/nhmrc_clinprgde.pdf .
Health Q. Guideline implementation checklist Translating evidence into best clinical practice. 2022.
Quittner AL, Abbott J, Hussain S, Ong T, Uluer A, Hempstead S, et al. Integration of mental health screening and treatment into cystic fibrosis clinics: Evaluation of initial implementation in 84 programs across the United States. Pediatr Pulmonol. 2020;55(11):2995–3004. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L2005630887&from=export . Cited 2023 Apr 3.
doi: 10.1002/ppul.24949
pubmed: 32649006
Urquhart R, Woodside H, Kendell C, Porter GA. Examining the implementation of clinical practice guidelines for the management of adult cancers: A mixed methods study. J Eval Clin Pract. 2019;25(4):656–63. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=137375535& . Cited 2023 Apr 3.
doi: 10.1111/jep.13073
pubmed: 30461140
Yinghui J, Zhihui Z, Canran H, Flute Y, Yunyun W, Siyu Y, et al. Development and validation for evaluation of an evaluation tool for guideline implementation. Chinese J Evidence-Based Med. 2022;22(1):111–9. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L2016924877&from=export .
Breimaier HE, Halfens RJG, Lohrmann C. Effectiveness of multifaceted and tailored strategies to implement a fall-prevention guideline into acute care nursing practice: a before-and-after, mixed-method study using a participatory action research approach. BMC Nurs. 2015;14(1):18. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=103220991& .
doi: 10.1186/s12912-015-0064-z
pubmed: 25870522
pmcid: 4394413
Lai J, Maher L, Li C, Zhou C, Alelayan H, Fu J, et al. Translation and cross-cultural adaptation of the National Health Service Sustainability Model to the Chinese healthcare context. BMC Nurs. 2023;22(1). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85153237164&doi=10.1186%2Fs12912-023-01293-x&partnerID=40&md5=0857c3163d25ce85e01363fc3a668654 .
Zhao J, Li X, Yan L, Yu Y, Hu J, Li SA, et al. The use of theories, frameworks, or models in knowledge translation studies in healthcare settings in China: a scoping review protocol. Syst Rev. 2021;10(1):13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792291 .
doi: 10.1186/s13643-020-01567-4
pubmed: 33413662
pmcid: 7792291
Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012;43(3):337–50. Available from: https://pubmed.ncbi.nlm.nih.gov/22898128/ . Cited 2023 Apr 4.
doi: 10.1016/j.amepre.2012.05.024
pubmed: 22898128
pmcid: 3592983
Phulkerd S, Lawrence M, Vandevijvere S, Sacks G, Worsley A, Tangcharoensathien V. A review of methods and tools to assess the implementation of government policies to create healthy food environments for preventing obesity and diet-related non-communicable diseases. Implement Sci. 2016;11(1):1–13. Available from: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-016-0379-5 . Cited 2022 May 1.
Buss PM, Pellegrini FA. A Saúde e seus Determinantes Sociais. PHYSIS Rev Saúde Coletiva. 2007;17(1):77–93.
doi: 10.1590/S0103-73312007000100006
Pereira VC, Silva SN, Carvalho VKSS, Zanghelini F, Barreto JOMM. Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. Heal Res Policy Syst. 2022;20(1):13. Available from: https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00815-4 . Cited 2022 Feb 21.
doi: 10.1186/s12961-022-00815-4
Grimshaw J, Eccles M, Tetroe J. Implementing clinical guidelines: current evidence and future implications. J Contin Educ Health Prof. 2004;24 Suppl 1:S31-7. Available from: https://pubmed.ncbi.nlm.nih.gov/15712775/ . Cited 2021 Nov 9.
doi: 10.1002/chp.1340240506
pubmed: 15712775
Lotfi T, Stevens A, Akl EA, Falavigna M, Kredo T, Mathew JL, et al. Getting trustworthy guidelines into the hands of decision-makers and supporting their consideration of contextual factors for implementation globally: recommendation mapping of COVID-19 guidelines. J Clin Epidemiol. 2021;135:182–6. Available from: https://pubmed.ncbi.nlm.nih.gov/33836255/ . Cited 2024 Jan 25.
doi: 10.1016/j.jclinepi.2021.03.034
pubmed: 33836255
pmcid: 8022513
Lenzer J. Why we can’t trust clinical guidelines. BMJ. 2013;346(7913). Available from: https://pubmed.ncbi.nlm.nih.gov/23771225/ . Cited 2024 Jan 25.
Molino C de GRC, Ribeiro E, Romano-Lieber NS, Stein AT, de Melo DO. Methodological quality and transparency of clinical practice guidelines for the pharmacological treatment of non-communicable diseases using the AGREE II instrument: A systematic review protocol. Syst Rev. 2017;6(1):1–6. Available from: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-017-0621-5 . Cited 2024 Jan 25.
doi: 10.1186/s13643-017-0621-5
Albers B, Mildon R, Lyon AR, Shlonsky A. Implementation frameworks in child, youth and family services – Results from a scoping review. Child Youth Serv Rev. 2017;1(81):101–16.
doi: 10.1016/j.childyouth.2017.07.003