Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science
Laura J. Damschroder,David C. Aron,Rosalind E. Keith,Susan Kirsh,Jeffery A. Alexander,Julie C. Lowery +5 more
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TLDR
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.Abstract:
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.read more
Citations
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Journal ArticleDOI
Making sense of implementation theories, models and frameworks
TL;DR: A taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science is proposed to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers.
Journal ArticleDOI
Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact
TL;DR: Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.
Journal ArticleDOI
A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project.
Byron J. Powell,Thomas J. Waltz,Matthew Chinman,Laura J. Damschroder,Jeffrey L. Smith,Monica M. Matthieu,Monica M. Matthieu,Enola K. Proctor,JoAnn E. Kirchner,JoAnn E. Kirchner +9 more
TL;DR: The ERIC study aimed to refine a published compilation of implementation strategy terms and definitions by systematically gathering input from a wide range of stakeholders with expertise in implementation science and clinical practice to generate consensus on implementation strategies and definitions.
Journal ArticleDOI
Advancing a conceptual model of evidence-based practice implementation in public service sectors.
Gregory A. Aarons,Gregory A. Aarons,Michael S. Hurlburt,Michael S. Hurlburt,Sarah McCue Horwitz,Sarah McCue Horwitz +5 more
TL;DR: A multi-level, four phase model of the implementation process, derived from extant literature, is proposed and applied to public sector services and highlights features of the model likely to be particularly important in each phase, while considering the outer and inner contexts of public sector service systems.
Book
Clinical Practice Guidelines We Can Trust
TL;DR: Clinical Practice Guidelines The authors Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care.
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Posted Content
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Alan D. Meyer,Jim Goes +1 more
TL;DR: In this article, the assimilation of technological innovations into organizations, a process unfolding in a series of decisions to evaluate, adopt, and implement new technologies, was conceptualized as a nine-step process and measured by tracking 300 potential adoptions through organizations during a six-year period.