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Topic Title

  • Contextual Frameworks for Research on the Implementation of Complex System Interventions

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Abstract - Final – Nov. 15, 2012

Developing and Assessing Contextual Frameworks for Research on Implementation of Complex System Interventions

Topic Abstract

Background: Organizational contexts and implementation practices play a vital role in shaping the outcomes of complex system interventions. As directed by the Agency for Healthcare Research and Quality (AHRQ), the RTI-UNC Evidence-based Practice Center recently developed two frameworks based on the Consolidated Framework for Implementation Research (CFIR) with input from a focused literature search and Technical Expert Panels. These modified CFIR frameworks apply to two complex system interventions: Process Redesign (PR) and Patient Centered Medical Homes (PCMH). To improve, refine, and continue to build the evidence base for complex system interventions, AHRQ seeks the assessment of the modified frameworks as applied to PR and PCMH, and also seeks to adapt and apply the refined framework to a third complex system intervention.

Objective: The goals of this project are

  1. to assess the processes by which the CFIR framework was modified for application to PR and PCMH, assess the usability of these frameworks, and to use the findings of this evaluation to refine the framework.
  2. In addition, the refined framework will be applied to a third complex system intervention, hospital-ambulatory transitions of care.

Methods: This project includes the following steps:

  1. Self-evaluation and assessment of processes used to develop the modified frameworks for PR and PCMH
  2. Assessment of the usability of the two frameworks for PR and PCMH
  3. Refinement of frameworks for PR and PCMH as necessary
  4. Apply revised methods to adapt the CFIR framework to hospital-ambulatory transitions of care

This project will include interaction with three sets of experts, each forming a Technical Expert Panel (TEP) that will provide guidance and insight into: (1) refinement of the initial modified CFIR framework including its usability and usefulness with relation to PR and PCMH, and (2) application of the refined methods to develop a framework for hospital-ambulatory transitions of care.