Advancing Evidence Synthesis from Effectiveness to Implementation: Integration of Implementation Measures into Evidence Reviews

• Published in: Journal of general internal medicine : JGIM 2020-04, Vol.35 (4), p.1219-1226
• Main Authors: A Tierney, Aaron, C Haverfield, Marie, P McGovern, Mark, M Zulman, Donna
• Format: Article
• Language: English
• Subjects: Delivery of Health Care; Evidence-Based Practice; Feasibility studies; Health care; Humans; Internal Medicine; Intervention; Literature reviews; Medicine; Medicine & Public Health; Original Research; Patient satisfaction; Retention; Science; Sustainability; Synthesis; Systematic review; Systematic Reviews as Topic
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-019-05586-3

Background In order to close the gap between discoveries that could improve health, and widespread impact on routine health care practice, there is a need for greater attention to the factors that influence dissemination and implementation of evidence-based practices. Evidence synthesis projects (e.g., systematic reviews) could contribute to this effort by collecting and synthesizing data relevant to dissemination and implementation. Such an advance would facilitate the spread of high-value, effective, and sustainable interventions. Objective The objective of this paper is to evaluate the feasibility of extracting factors related to implementation during evidence synthesis in order to enhance the replicability of successes of studies of interventions in health care settings. Design Drawing on the implementation science literature, we suggest 10 established implementation measures that should be considered when conducting evidence synthesis projects. We describe opportunities to assess these constructs in current literature and illustrate these methods through an example of a systematic review. Subjects Twenty-nine studies of interventions aimed at improving clinician-patient communication in clinical settings. Key Results We identified acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, intervention complexity, penetration, reach, and sustainability as factors that are feasible and appropriate to extract during an evidence synthesis project. Conclusions To fully understand the potential value of a health care innovation, it is important to consider not only its effectiveness, but also the process, demands, and resource requirements involved in downstream implementation. While there is variation in the degree to which intervention studies currently report implementation factors, there is a growing demand for this information. Abstracting information about these factors may enhance the value of systematic reviews and other evidence synthesis efforts, improving the dissemination and adoption of interventions that are effective, feasible, and sustainable across different contexts.