1
|
Proctor EK, Bunger AC, Lengnick-Hall R, Gerke DR, Martin JK, Phillips RJ, Swanson JC. Ten years of implementation outcomes research: a scoping review. Implement Sci 2023; 18:31. [PMID: 37491242 PMCID: PMC10367273 DOI: 10.1186/s13012-023-01286-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Proctor and colleagues' 2011 paper proposed a taxonomy of eight implementation outcomes and challenged the field to address a research agenda focused on conceptualization, measurement, and theory building. Ten years later, this paper maps the field's progress in implementation outcomes research. This scoping review describes how each implementation outcome has been studied, research designs and methods used, and the contexts and settings represented in the current literature. We also describe the role of implementation outcomes in relation to implementation strategies and other outcomes. METHODS Arksey and O'Malley's framework for conducting scoping reviews guided our methods. Using forward citation tracing, we identified all literature citing the 2011 paper. We conducted our search in the Web of Science (WOS) database and added citation alerts sent to the first author from the publisher for a 6-month period coinciding with the WOS citation search. This produced 1346 titles and abstracts. Initial abstract screening yielded 480 manuscripts, and full-text review yielded 400 manuscripts that met inclusion criteria (empirical assessment of at least one implementation outcome). RESULTS Slightly more than half (52.1%) of included manuscripts examined acceptability. Fidelity (39.3%), feasibility (38.6%), adoption (26.5%), and appropriateness (21.8%) were also commonly examined. Penetration (16.0%), sustainability (15.8%), and cost (7.8%) were less frequently examined. Thirty-two manuscripts examined implementation outcomes not included in the original taxonomy. Most studies took place in healthcare (45.8%) or behavioral health (22.5%) organizations. Two-thirds used observational designs. We found little evidence of progress in testing the relationships between implementation strategies and implementation outcomes, leaving us ill-prepared to know how to achieve implementation success. Moreover, few studies tested the impact of implementation outcomes on other important outcome types, such as service systems and improved individual or population health. CONCLUSIONS Our review presents a comprehensive snapshot of the research questions being addressed by existing implementation outcomes literature and reveals the need for rigorous, analytic research and tests of strategies for attaining implementation outcomes in the next 10 years of outcomes research.
Collapse
Affiliation(s)
- Enola K Proctor
- The Brown School, Shanti Khinduka Distinguished Professor Emerita, Washington University in St. Louis, St. Louis, USA.
| | - Alicia C Bunger
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | | | - Donald R Gerke
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, USA
| | - Jared K Martin
- College of Education & Human Ecology, The Ohio State University, Columbus, OH, USA
| | - Rebecca J Phillips
- College of Liberal Arts & Sciences, Western Oregon University, Monmouth, OR, USA
| | - Julia C Swanson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
2
|
Richardson E, Hogan TP, Shimada SL, Sliwinski SK, Kim B. Common procedures of remote measurement-based care in an integrated behavioural health context: protocol for a scoping review. BMJ Open 2022; 12:e064450. [PMID: 36171037 PMCID: PMC9528588 DOI: 10.1136/bmjopen-2022-064450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Integrated behavioural health, a model of care that embeds mental health services in primary care, can potentially increase access to mental healthcare. With the increase in health information technologies, remote measurement-based care (RMBC) presents an opportunity to improve support of integrated care. This scoping review will comprehensively examine what common procedures are followed when RMBC for mental health is tested in integrated care settings. METHODS AND ANALYSIS Based on an established six-step framework for conducting scoping reviews, we will search PubMed, Embase, PsycINFO, Cochrane, EBSCOhost and Web of Science with search terms related to 'integrated care' and 'RMBC'. Articles published from 2015 onwards, in English, including an intervention that meets our definition of RMBC, and are conducted in collaboration with primary care or in a primary care setting will be included. After data extraction, we will categorise key findings along the following dimensions: (1) common delivery practices of RMBC; (2) common technologies and instruments used and (3) most common barriers and facilitators when implementing RMBC in an integrated care model. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review. For maximum impact, we will disseminate the findings to the scientific community (via publication in a peer-reviewed journal and at national conferences) and to the broader healthcare community. We will share findings with the broader healthcare community through our research centre's existing stakeholder communication structures and through guidance from our multidisciplinary research team. These key stakeholder relationships will continue to guide our subsequent RMBC research following the review.
Collapse
Affiliation(s)
- Eric Richardson
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Samantha K Sliwinski
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Abstract
INTRODUCTION A 2011 paper proposed a working taxonomy of implementation outcomes, their conceptual distinctions and a two-pronged research agenda on their role in implementation success. Since then, over 1100 papers citing the manuscript have been published. Our goal is to compare the field's progress to the originally proposed research agenda, and outline recommendations for the next 10 years. To accomplish this, we are conducting the proposed scoping review. METHODS AND ANALYSIS Our approach is informed by Arksey and O'Malley's methodological framework for conducting scoping reviews. We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We first aim to assess the degree to which each implementation outcome has been investigated in the literature, including healthcare settings, clinical populations and innovations represented. We next aim to describe the relationship between implementation strategies and outcomes. Our last aim is to identify studies that empirically assess relationships among implementation and/or service and client outcomes. We will use a forward citation tracing approach to identify all literature that cited the 2011 paper in the Web of Science (WOS) and will supplement this with citation alerts sent to the second author for a 6-month period coinciding with the WOS citation search. Our review will focus on empirical studies that are designed to assess at least one of the identified implementation outcomes in the 2011 taxonomy and are published in peer-reviewed journals. We will generate descriptive statistics from extracted data and organise results by these research aims. ETHICS AND DISSEMINATION No human research participants will be involved in this review. We plan to share findings through a variety of means including peer-reviewed journal publications, national conference presentations, invited workshops and webinars, email listservs affiliated with our institutions and professional associations, and academic social media.
Collapse
Affiliation(s)
| | - Enola K Proctor
- The Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Alicia C Bunger
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
| | - Donald R Gerke
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| |
Collapse
|
4
|
Ruderman MA, Kim B, Stolzmann K, Connolly S, Miller CJ, Bauer MS. Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using routinely collected electronic medical records. PLoS One 2021; 16:e0249007. [PMID: 33765038 PMCID: PMC7993804 DOI: 10.1371/journal.pone.0249007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Health systems are undergoing widespread adoption of the collaborative chronic care model (CCM). Care structured around the CCM may reduce costly psychiatric hospitalizations. Little is known, however, about the time course or heterogeneity of treatment effects (HTE) for CCM on psychiatric hospitalization. RATIONALE Assessment of CCM implementation support on psychiatric hospitalization might be more efficient if the timing were informed by an expected time course. Further, understanding HTE could help determine who should be referred for intervention. OBJECTIVES (i) Estimate the trajectory of CCM effect on psychiatric hospitalization rates. (ii) Explore HTE for CCM across demographic and clinical characteristics. METHODS Data from a stepped wedge CCM implementation trial were reanalyzed using 5 570 patients in CCM treatment and 46 443 patients receiving usual care. Time-to-event data was constructed from routine medical records. Effect trajectory of CCM on psychiatric hospitalization was simulated from an extended Cox model over one year of implementation support. Covariate risk contributions were estimated from subset stratified Cox models without using simulation. Ratios of hazard ratios (RHR) allowed comparison by trial arm for HTE analysis, also without simulation. No standard Cox proportional hazards models were used for either estimating the time-course or heterogeneity of treatment effect. RESULTS The effect of CCM implementation support increased most rapidly immediately after implementation start and grew more gradually throughout the rest of the study. On the final study day, psychiatric hospitalization rates in the treatment arm were 17% to 49% times lower than controls, with adjustment for all model covariates (HR 0.66; 95% CI 0.51-0.83). Our analysis of HTE favored usual care for those with a history of prior psychiatric hospitalization (RHR 4.92; 95% CI 3.15-7.7) but favored CCM for those with depression (RHR 0.61; 95% CI: 0.41-0.91). Having a single medical diagnosis, compared to having none, favored CCM (RHR 0.52; 95% CI 0.31-0.86). CONCLUSION Reduction of psychiatric hospitalization is evident immediately after start of CCM implementation support, but assessments may be better timed once the effect size begins to stabilize, which may be as early as six months. HTE findings for CCM can guide future research on utility of CCM in specific populations.
Collapse
Affiliation(s)
- Michael A. Ruderman
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Jamaica Plain, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bo Kim
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Jamaica Plain, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kelly Stolzmann
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Jamaica Plain, Boston, Massachusetts, United States of America
| | - Samantha Connolly
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Jamaica Plain, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Christopher J. Miller
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Jamaica Plain, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark S. Bauer
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Jamaica Plain, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
5
|
Kim B, Weatherly C, Wolk CB, Proctor EK. Measurement of unnecessary psychiatric readmissions in the context of care transition interventions: a scoping review. BMJ Open 2021; 11:e045364. [PMID: 33558362 PMCID: PMC7871679 DOI: 10.1136/bmjopen-2020-045364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine how published studies of inpatient to outpatient mental healthcare transition processes have approached measuring unnecessary psychiatric readmissions. DESIGN Scoping review using Levac et al's enhancement to Arksey and O'Malley's framework for conducting scoping reviews. DATA SOURCES Medline (Ovid), Embase (Ovid), PsycINFO, CINAHL, Cochrane and ISI Web of Science article databases were searched from 1 January 2009 through 28 February 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included studies that (1) are about care transition processes associated with unnecessary psychiatric readmissions and (2) specify use of at least one readmission time interval (ie, the time period since previous discharge from inpatient care, within which a hospitalisation can be considered a readmission). DATA EXTRACTION AND SYNTHESIS We assessed review findings through tabular and content analyses of the data extracted from included articles. RESULTS Our database search yielded 3478 unique articles, 67 of which were included in our scoping review. The included articles varied widely in their reported readmission time intervals used. They provided limited details regarding which readmissions they considered unnecessary and which risks they accounted for in their measurement. There were no perceptible trends in associations between the variation in these findings and the included studies' characteristics (eg, target population, type of care transition intervention). CONCLUSIONS The limited specification with which studies report their approach to unnecessary psychiatric readmissions measurement is a noteworthy gap identified by this scoping review, and one that can hinder both the replicability of conducted studies and adaptations of study methods by future investigations. Recommendations stemming from this review include (1) establishing a framework for reporting the measurement approach, (2) devising enhanced guidelines regarding which approaches to use in which circumstances and (3) examining how sensitive research findings are to the choice of the approach.
Collapse
Affiliation(s)
- Bo Kim
- HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Weatherly
- George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri, USA
| | - Courtney Benjamin Wolk
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Enola K Proctor
- George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri, USA
| |
Collapse
|
6
|
Elhassan NM, Elhusein B, Al Abdulla M, Saad TA, Kumar R. Sociodemographic and clinical characteristics of patients with recurrent psychiatric readmissions in Qatar. J Int Med Res 2020; 48:300060520977382. [PMID: 33289594 PMCID: PMC7727067 DOI: 10.1177/0300060520977382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/03/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To examine the sociodemographic and clinical characteristics of psychiatric patients with recurrent psychiatric readmissions (RPR). METHODS A retrospective study was conducted at Hamad General Hospital in Qatar on psychiatric patients with recurrent readmissions from August 2018 to January 2019. RESULTS Of 380 psychiatric patients admitted during the study period, 40 (10.5%) were readmitted within 30 days of discharge. Most of the patients who were readmitted were single, male and unemployed. Psychotic spectrum disorder was the most frequent psychiatric condition and was diagnosed in 18 (45%) patients. A total of 30% of the patients were receiving treatment with anti-psychotics, and a similar number received more than one medication. Most patients showed poor or no compliance. Only 12.5% of patients stayed in the hospital for more than 5 weeks in their last admission during the study period. CONCLUSIONS Poor compliance, male sex and single status were the most common demographic and clinical features of patients with RPR. Post-discharge psychiatric care should be tailored to meet the requirements of patients prone to RPR.
Collapse
Affiliation(s)
- Nahid M. Elhassan
- Mental Health Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Bushra Elhusein
- Mental Health Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Majid Al Abdulla
- Mental Health Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | | | - Rajeev Kumar
- Mental Health Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| |
Collapse
|