背景:临床实践指南(CPG)的实施是一个循环过程,其中评估阶段可以促进持续改进。实施科学利用了理论方法,例如模型和框架,理解和解决这个过程。本文旨在全面概述用于评估CPG实施的模型和框架。
方法:按照Cochrane方法进行了系统评价,由于本次审查的独特性质,对“选择过程”进行了调整。根据PRISMA(系统审查和荟萃分析的首选报告项目)报告指南报告了研究结果。电子数据库从成立到2023年5月15日一直被搜索。进行了预定的策略和手动搜索,以识别世界各地卫生机构的相关文件。合格的研究提出了评估CPG实施情况的模型和框架。有关文件特征的信息,使用模型的背景(具体目标,使用水平,卫生服务的类型,目标群体),以及每个模型或框架的特征(名称,域评估,和模型限制)被提取。根据关键结构对模型的领域进行了分析:策略,context,结果,保真度,适应,可持续性process,和干预。根据模型和框架的使用水平(临床,组织,和政策)和卫生服务的类型(社区,门诊,医院,机构)。JBI的关键评估工具被两名独立研究人员用来评估可信度,相关性,以及纳入研究的结果。
结果:数据库搜索产生了14,395项研究,其中80篇全文进行了审查。数据分析中包括了8项研究,手动搜索中还包括了4项方法学指南。本系统评价的结果认为研究中的偏倚风险并不重要。总共找到了十个评估CPG执行情况的模型/框架。使用水平主要是政策,最常见的卫生服务类型是机构,主要目标群体是直接参与临床实践的专业人员。模型之间的评估域不同,并且它们的概念化也存在差异。所有模型都寻址到域“上下文”,特别是在微观层面(8/12),其次是多层次(7/12)。域“结果”(9/12),“干预”(8/12),“战略”(7/12),和“过程”(5/12)经常被处理,而“可持续性”仅在一项研究中发现,并且未观察到“保真度/适应性”。
结论:评估CPG实施的模型和框架的使用仍处于初期阶段。这种系统审查可以帮助利益相关者选择或调整最合适的模型或框架,以根据其特定的健康状况评估CPG的实施情况。
背景:PROSPERO(国际前瞻性系统审查登记册)注册号:CRD42022335884。2022年6月7日注册。
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: 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: 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: 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.
BACKGROUND: PROSPERO (International Prospective Register of Systematic Reviews) registration number: CRD42022335884. Registered on June 7, 2022.