Implementation Outcomes and Their Determinants for Hospital-Led Care Coordination Interventions Targeting Patients With Complex Care Needs: A Qualitative Systematic Review.
Mary Malakellis, Anna Wong Shee, Sarah Wood, Laura Alston, Hannah Beks, Margaret Murray, Vincent L Versace, Kevin Mc Namara
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Abstract
Aim: To describe the implementation determinants for care coordination interventions in a hospital context.
Design: Systematic review.
Methods: This review was guided by the Consolidated Framework of Implementation Research (CFIR), assessed for quality using the Mixed Methods Appraisal Tool and reported with the PRISMA guidelines.
Data sources: CINHAL Complete, EMBASE, MEDLINE Complete, PsychINFO (between January 1, 2013, and December 31, 2022, and updated May 09, 2024) and a manual reference list search of all included studies.
Results: The search returned 5614 articles after duplicates were removed. After title and abstract screening, 264 articles underwent full-text review. Sixteen studies (15 care coordination models) met the inclusion criteria. The CFIR inner setting domain and the implementation process domain were the most prominent domains and 'Partnerships & Connections', 'Work Infrastructure', 'Capability' and 'Reflecting and Evaluating' subdomains emerged as important determinants across the included studies.
Conclusion: Inconsistent findings relating to care coordination outcomes are likely to be substantially influenced by the complexity and heterogeneity of the interventions and variations in implementation and contextual factors. Intra- and inter-organisational relationships were important to connect previously disconnected parts of the health system and were facilitated by experienced care coordinators. Continual improvement was also important to increase fit with contextual factors. More high-quality studies are needed to identify commonalities and provide generalisable principles and characteristics associated with high-performance implementation.
Implications for the profession and/or patient care: Review findings will provide practitioners, policymakers, and researchers with a comprehensive synthesis of evidence underpinning implementation of effective community care coordination from hospital settings.
Impact: These review findings will inform the effective implementation of care coordination interventions in a hospital context for patients with complex multimorbidity.
Reporting methods: Preferred Reporting Items for Systematic reviews and Meta-Analysis.
Trial and registration: PROSPERO Registration: CRD42022376642.
Patient or public contribution: No patient or public Contribution.
期刊介绍：
The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice.
JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice.
We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.
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