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Implementation of effective practices in health facilities: A systematic review of cluster randomised trials

Publication ,  Journal Article
Allanson, ER; Tunçalp, Ö; Vogel, JP; Khan, DN; Oladapo, OT; Long, Q; Gülmezoglu, AM
Published in: BMJ Global Health
January 1, 2017

Background The capacity for health systems to support the translation of research in to clinical practice may be limited. The cluster randomised controlled trial (cluster RCT) design is often employed in evaluating the effectiveness of implementation of evidence-based practices. We aimed to systematically review available evidence to identify and evaluate the components in the implementation process at the facility level using cluster RCT designs. Methods All cluster RCTs where the healthcare facility was the unit of randomisation, published or written from 1990 to 2014, were assessed. Included studies were analysed for the components of implementation interventions employed in each. Through iterative mapping and analysis, we synthesised a master list of components used and summarised the effects of different combinations of interventions on practices. results Forty-six studies met the inclusion criteria and covered the specialty groups of obstetrics and gynaecology (n=9), paediatrics and neonatology (n=4), intensive care (n=4), internal medicine (n=20), and anaesthetics and surgery (n=3). Six studies included interventions that were delivered across specialties. Nine components of multifaceted implementation interventions were identified: leadership, barrier identification, tailoring to the context, patient involvement, communication, education, supportive supervision, provision of resources, and audit and feedback. The four main components that were most commonly used were education (n=42, 91%), audit and feedback (n=26, 57%), provision of resources (n=23, 50%) and leadership (n=21, 46%). conclusions Future implementation research should focus on better reporting of multifaceted approaches, incorporating sets of components that facilitate the translation of research into practice, and should employ rigorous monitoring and evaluation.

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Published In

BMJ Global Health

DOI

EISSN

2059-7908

Publication Date

January 1, 2017

Volume

2

Issue

2

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems
 

Citation

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Allanson, E. R., Tunçalp, Ö., Vogel, J. P., Khan, D. N., Oladapo, O. T., Long, Q., & Gülmezoglu, A. M. (2017). Implementation of effective practices in health facilities: A systematic review of cluster randomised trials. BMJ Global Health, 2(2). https://doi.org/10.1136/bmjgh-2016-000266
Allanson, E. R., Ö. Tunçalp, J. P. Vogel, D. N. Khan, O. T. Oladapo, Q. Long, and A. M. Gülmezoglu. “Implementation of effective practices in health facilities: A systematic review of cluster randomised trials.” BMJ Global Health 2, no. 2 (January 1, 2017). https://doi.org/10.1136/bmjgh-2016-000266.
Allanson ER, Tunçalp Ö, Vogel JP, Khan DN, Oladapo OT, Long Q, et al. Implementation of effective practices in health facilities: A systematic review of cluster randomised trials. BMJ Global Health. 2017 Jan 1;2(2).
Allanson, E. R., et al. “Implementation of effective practices in health facilities: A systematic review of cluster randomised trials.” BMJ Global Health, vol. 2, no. 2, Jan. 2017. Scopus, doi:10.1136/bmjgh-2016-000266.
Allanson ER, Tunçalp Ö, Vogel JP, Khan DN, Oladapo OT, Long Q, Gülmezoglu AM. Implementation of effective practices in health facilities: A systematic review of cluster randomised trials. BMJ Global Health. 2017 Jan 1;2(2).

Published In

BMJ Global Health

DOI

EISSN

2059-7908

Publication Date

January 1, 2017

Volume

2

Issue

2

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems