Commentary On “A systematic review of experimentally tested implementation strategies across health and human service settings: evidence from 2010-2022”

When I teach my implementation science course or do consults with other faculty, a frequent question is which strategies have worked in a given setting. In other words, how do we winnow down the list of 73 ERIC strategies? Ashcraft and colleagues (2024) conducted a systematic review of implementation strategies used in health settings. The inclusion criteria were a control group and quantitative outcomes (i.e., interviews on acceptability were not included). The authors reviewed more than 9,000 abstracts and retained 129 studies. Approximately 40% of studies were conducted in the US. Studies tested a range of 1-21 strategies, with six strategies as the mean. Not surprisingly, implementation strategies were commonly used in combination in healthcare settings. But which ones were used successfully? During pre-implementation, strategies with evidence were educational (meetings, materials, visits, train the trainer) and site readiness assessments and support (local needs assessment, identify and prepare champions, and assess and redesign workflows). During go-live, strategies with evidence were providing coaching and support (facilitation), engaging patients, and quality improvement activities (audit and feedback, small tests of change, and developing tools for quality monitoring). However, many strategies were not tested sufficiently to draw conclusions. The RE-AIM outcomes assessed were effectiveness (64%), implementation (56%), maintenance (31%), adoption (26%), and reach (24%). The article did not report on equitable reach. The takeaways from the Ashcraft review are that we lack strong evidence for most ERIC strategies in healthcare settings and RE-AIM outcomes have not been universally operationalized. Limitations of the review are that healthcare organizations rarely have control groups in pragmatic implementation and use qualitative evaluative methods (e.g., interviews), which limit the utility and generalizability of the findings. For future healthcare studies, the field would benefit from better specification and linking of core components of the innovation with detailed implementation strategies, mechanism of change, and improved adoption, reach, and equity.

References:

Ashcraft, L. E., Goodrich, D. E., Hero, J., Phares, A., Bachrach, R. L., Quinn, D. A., ….Chinman, M. J. (2024). Implement Sci, 19(1), 43. doi:10.1186/s13012-024-01369-5