Jbi Evidence Implementation最新文献

{"title":"Implementation science in hybrid randomized controlled trials: a state-of-the-art systematic review.","authors":"Mark G Liu, Elouise Comber, Andrew Martin, Natasha Roberts, Mike Trott, Nathalia Costa, Nadine E Foster, Ingrid J Hickman","doi":"10.1097/XEB.0000000000000568","DOIUrl":"10.1097/XEB.0000000000000568","url":null,"abstract":"<p><strong>Introduction: </strong>Hybrid randomized controlled trials (RCTs) combine effectiveness and implementation aims to accelerate evidence translation. As this is a new yet evolving methodology, it is timely to review the characteristics and reporting quality of hybrid RCTs, and how implementation science theories, models and frameworks (TMFs) have been used in this context.</p><p><strong>Methods: </strong>Citation-indexed databases (Web of Science, Scopus) were searched from 2012 (inception of \"hybrid\" terminology) to 2025 for RCTs that were identified as \"hybrid\" in the title/abstract/keywords and that cited and applied a TMF. RCT design and implementation characteristics were extracted and analyzed descriptively. Reporting quality assessment followed the Standards for Reporting Implementation Studies (StaRI).</p><p><strong>Results: </strong>Of the 1,846 initial hits, 111 papers were included, comprising 52 main results papers, 37 protocols, and 22 secondary papers. Most RCTs were published in the past 5 years (79%), conducted in North America (62%), in primary care/community settings (50%), and calculated sample sizes using the clinical effectiveness outcome (64%). TMFs were mostly used to inform implementation outcomes (88%) versus implementation strategies (52%). The most common TMFs were the Reach, Effectiveness, Adoption, Implementation, Maintenance Framework (RE-AIM) (44%) and Proctor's taxonomy of implementation outcomes (29%). Reporting quality was stronger for clinical intervention components, with fewer RCTs reporting the rationale and fidelity of implementation strategies (27%) compared to the clinical intervention (60%).</p><p><strong>Conclusions: </strong>Hybrid RCTs that apply TMFs are increasing, yet there is evidence that maturation is warranted. Clinical effectiveness rather than implementation remains the focus of most hybrid RCTs. More deliberate application and reporting of implementation science TMFs may improve the quality of future hybrid RCTs.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A518.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":"24 3","pages":"634-651"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing aggression in psychiatric settings: a best practice implementation project.","authors":"Louis Prod'hom, Stéphanie Mahé, Pierre Lequin, Dorota Drozdek, Béatrice Perrenoud","doi":"10.1097/XEB.0000000000000535","DOIUrl":"10.1097/XEB.0000000000000535","url":null,"abstract":"<p><strong>Introduction: </strong>Aggression is a frequent occurrence in psychiatric settings and results from complex multifactorial phenomena. Verbal or physical aggression has a significant impact on the quality of care, with negative repercussions on patients, professionals, and health care institutions.</p><p><strong>Objectives: </strong>This project aimed to prevent and manage hetero-aggression in a university hospital psychiatric department in Switzerland through the promotion of evidence-based practices.</p><p><strong>Methods: </strong>The project used JBI's Evidence Implementation Framework, which is grounded in an audit and feedback process. A baseline audit was conducted to measure current practices for preventing and managing aggression and compare these to eight best practice recommendations. Interventions to improve compliance with best practices were implemented, and a follow-up audit was conducted to measure the changes achieved.</p><p><strong>Results: </strong>Despite a high prevalence of staff exposure to aggression, the baseline audit showed that violence risk assessments were not systematically documented. The follow-up audit revealed improvements, with the use of a validated screening tool to identify violence risk and increased prevention interventions. However, these measures had a relatively low impact on the exposure to violence of health care professionals. Patient involvement in the violence risk assessment also remained low.</p><p><strong>Conclusions: </strong>The JBI approach used in this project led to significant improvements in professional practices related to violence risk assessment and reduced the gaps between recommendations and clinical practices. Clinical practice analysis sessions are a successful means of promoting understanding of prevention interventions.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A410.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"506-516"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collective agency in the implementation of computerized clinical decision support: an interpretive description study.","authors":"Manasha Fernando, Sundresan Naicker, Bridget Abell, Steven M McPhail, Zephanie Tyack","doi":"10.1097/XEB.0000000000000561","DOIUrl":"10.1097/XEB.0000000000000561","url":null,"abstract":"<p><strong>Introduction: </strong>Digital health interventions, such as computerized clinical decision support systems (CDSSs), often falter due to resource constraints, misaligned workflows, and limited engagement from key users and stakeholders. Little is known about how research-to-practice professionals navigate these challenges.</p><p><strong>Aim: </strong>This study sought to understand how CDSSs can be integrated into routine clinical practice and the contextual factors that influence translation.</p><p><strong>Methods: </strong>Using interpretive description methodology, we conducted semi-structured interviews with 32 participants and three focus groups involving 11 participants to explore perspectives and experiences of translating implementation knowledge into practice. Participants included experts in health services research, implementation science, and health informatics. Convenience, purposive, and snowball sampling were used to recruit participants.</p><p><strong>Results: </strong>The findings describe how CDSS implementation is a socially driven process. Success was framed in terms of harnessing collective agency-building trust, fostering collaboration, and empowering people to work toward shared understanding. This process involved (1) laying the groundwork by engaging those affected; (2) making implementation accessible by adapting theories into usable tools; and (3) breaking slow progress by learning from past efforts and strengthening clinical-academic partnerships.</p><p><strong>Conclusions: </strong>The findings highlight opportunities for developing accessible tools and partnerships and embedding experiential knowledge. Practice recommendations are offered to support CDSS implementation teams, including setting up regular feedback channels, using memoranda of understanding, and checklists for implementation.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A501.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"574-589"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-surgical pain management among adult cancer patients in a multidisciplinary surgical unit: a best practice implementation project.","authors":"Feruza Saduyeva, Zhuldyz Kuanysh, Jamilya Zainulina, Ainash Sadvokassova, Alma Syzdykova, Anargul Kuntuganova, Dmitriy Viderman, Paolo C Colet","doi":"10.1097/XEB.0000000000000529","DOIUrl":"10.1097/XEB.0000000000000529","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to improve post-surgical pain management among adult cancer patients in a multidisciplinary surgical unit in Kazakhstan.</p><p><strong>Methods: </strong>The study followed the JBI Evidence Implementation Framework and was conceptually guided by the JBI Model of Evidence-Based Healthcare. Eight audit criteria were used to assess compliance with best practices in a baseline audit. JBI's Getting Research into Practice (GRiP) approach was used to identify barriers and strategies for improvement. A follow-up audit measured any improvements in compliance with the recommended practices.</p><p><strong>Results: </strong>In the follow-up audit, increased compliance was noted for Criterion 7 (0% to 96.03%). Similarly, increased compliance was noted for Criteria 2 to 6. Criterion 8 scored 100% at both baseline and follow-up. However, Criterion 1 scored 0% compliance in both audit cycles.</p><p><strong>Conclusions: </strong>This study demonstrated a modest improvement in compliance with best practices for post-surgical pain management among adult cancer patients in a multidisciplinary surgical unit. Despite our efforts to improve the unit's practices through training, pre-operative patient education, patient documentation records, and interprofessional collaboration, Criterion 1 received 0% compliance. Our findings highlight the need for a multimodal post-surgical pain management approach incorporating policy change, resource allocation, and dedicated pain management specialists.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A402.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":"24 3","pages":"486-495"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discharge planning and guidance for preterm newborns: a best practice implementation project.","authors":"Karina Faria de Souza, Denise Gomes Miyazato, Bárbara Barros Pereira Lobo, Silvia Maria Ibidi, Luiza Campos Carneiro, Patricia Tereza Cardoso de Camargo Severa, Ana Paula Almeida Brito, Kelli Borges Dos Santos, Vilanice Alves de Araújo Püschel","doi":"10.1097/XEB.0000000000000627","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000627","url":null,"abstract":"<p><strong>Introduction: </strong>Prematurity, affecting approximately 10% of births, is a leading cause of neonatal morbidity and mortality. It is associated with neurological, respiratory, feeding, visual, and auditory problems; developmental delays; and chronic disease risks. The earlier the birth, the greater the risks. Lack of proper discharge planning can impair the health care team's assessment of a family's readiness, increasing morbidity. Although guidelines have been developed to support clinical discharge practices for preterm infants, gaps remain between evidence and practice.</p><p><strong>Aim: </strong>This project aimed to improve discharge planning and guidance for families or legal guardians of preterm newborns; assess compliance with evidence-based discharge criteria; standardize documentation; and unify discharge guidance provided to families of preterm infants admitted to the neonatal unit of a teaching hospital in São Paulo, Brazil.</p><p><strong>Methods: </strong>A quasi-experimental before-and-after study was conducted using the JBI Evidence Implementation Framework, which combines clinical audits with a structured process to address barriers and enablers to evidence-based practice. The methodology includes identifying the practice area, engaging change agents, assessing context and readiness, baseline audits, implementing changes, follow-up audits, and evaluating sustainability.</p><p><strong>Results: </strong>No statistically significant differences were found between the baseline and follow-up audits. Two criteria were already fully met. Four of the nine audited criteria showed improved compliance. Changes were supported by multimodal strategies, including an Institutional Care Guideline, an illustrated booklet with clear language for families, flowcharts to guide discharge planning, dissemination via AI-powered video and social media.</p><p><strong>Conclusions: </strong>The project enhanced discharge practices and guidance for families through multidisciplinary collaboration. Sustaining improvements will require ongoing attention.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A645.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communication and training interventions to improve dementia care in daycare centers: a best practice implementation project.","authors":"Wen-Yi Chiu, Cheng-Yu Chang","doi":"10.1097/XEB.0000000000000629","DOIUrl":"10.1097/XEB.0000000000000629","url":null,"abstract":"<p><strong>Objectives: </strong>This evidence implementation project aimed to enhance communication practices in dementia care by assessing staff adherence to evidence-based criteria, identifying barriers and facilitators to best practices, and evaluating the effectiveness of tailored training strategies.</p><p><strong>Methods: </strong>Using the JBI Model of Evidence-Based Health care and its seven-phase implementation framework, a baseline audit was conducted in three community dementia daycare centers in Yilan County, Taiwan. Thirty staff members and 80 dementia care records were evaluated against six JBI-derived best practice criteria. Following a gap analysis, a multimodal dementia communication training program was implemented using the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools. A follow-up audit was conducted 8 months later, involving 15 staff members and 40 records.</p><p><strong>Results: </strong>Baseline concordance with best practices was low, with two criteria scoring 0%. Post-implementation, compliance markedly improved: four criteria exceeded 80%, and two (structured staff training and multimodal approaches) reached 100%. Staff demonstrated enhanced ability to identify communication difficulties, utilize validated tools such as the Holden Communication Scale and Mini-Mental State Examination, and document care communication plans.</p><p><strong>Conclusion: </strong>Embedding structured training, validated assessment tools, and family engagement strategies substantially improved staff competence and adherence to evidence-based dementia communication standards. This project underscores the effectiveness of structured evidence implementation and ongoing audit-feedback mechanisms in promoting sustainable, person-centered dementia care.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A644.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the implementation of a liver disease stratification pathway in primary care: a qualitative study.","authors":"Astha Dhingra, Holly Knight, Neil I Guha, Joanne R Morling","doi":"10.1097/XEB.0000000000000624","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000624","url":null,"abstract":"<p><strong>Introduction: </strong>Liver disease is a major cause of morbidity and mortality in the UK, with general practitioners (GPs) playing a critical role in early detection and management. Despite the existence of non-invasive markers for liver fibrosis, such as transient elastography and blood marker panels, referral rates to liver disease pathways vary across practices.</p><p><strong>Methods: </strong>This study aimed to identify barriers and facilitators for implementing a liver disease identification and referral pathway in primary care, using the Theoretical Domains Framework (TDF). Semi-structured interviews were conducted with 11 practitioners, including GPs and a specialist nurse, in Nottinghamshire, UK. The interviews were analyzed across 14 TDF domains to understand factors affecting professional behavior change.</p><p><strong>Results: </strong>Nine key TDF domains were identified as influencing pathway implementation, with knowledge being the most significant. Practitioners demonstrated varying levels of understanding regarding liver disease and the referral criteria. Other factors included environmental and organizational barriers, such as resource constraints and unclear professional roles, which hindered screening and referral practices. Practitioners also raised concerns about the efficiency of the pathway, long waiting times, and the limited success of lifestyle interventions.</p><p><strong>Conclusion: </strong>To improve pathway adoption, the study recommends enhanced training, streamlined referral processes, and addressing systemic challenges. Continuous evaluation and engagement with stakeholders are essential for successful integration into primary care.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A641.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arterial catheter maintenance in children: a best practice implementation project.","authors":"Yuxia Yang, Weijie Shen, Yuqing Wang, Jing Hu, Ju Shen, Ying Gu","doi":"10.1097/XEB.0000000000000626","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000626","url":null,"abstract":"<p><strong>Introduction: </strong>Arterial catheters are widely used in intensive care units for continuous hemodynamic monitoring and blood collection. Evidence-based practices for arterial catheter maintenance are not strictly followed by all medical staff in the pediatric intensive care unit.</p><p><strong>Objective: </strong>This study aimed to improve compliance with evidence-based practices for arterial catheter management in critically ill children in a Chinese pediatric intensive care unit.</p><p><strong>Methods: </strong>The JBI Evidence Implementation Framework was used to translate evidence into practice. The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was used to identify barriers to compliance with best practices. An arterial catheter management strategy for critically ill children was developed based on the identified barriers, along with a simulation training module and a supply of 10-ml prefilled normal saline flush syringe. Field observations, a review of medical records, and interviews with medical staff and patients were used to assess baseline and follow-up audit compliance with best practices.</p><p><strong>Results: </strong>Thirteen criteria were audited in the baseline and follow-up audits using 220 and 212 peripheral arterial catheters, respectively. In the follow-up audit, compliance with all criteria increased and the indwelling time of the peripheral arterial catheter was prolonged.</p><p><strong>Conclusions: </strong>The JBI Evidence Implementation Framework was used to improve compliance with the best practices. Future audits should be conducted to sustain the evidence-based behavior of all medical staff.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A642.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of aggression in psychiatric patients in five psychiatric hospitals in China: a best practice implementation project.","authors":"Ying Ma, Jieying Xie, Dan Xu, Zhichun Xia, Aiping Deng, Sili Luo, Xianglin Wang, Jinling Jia, Zhaojun Huang, Lulu Huang, Lijun Liu, Yuan Liang, Shuling He, Jiawei Chen, Chaoyu Liu, Long Hu, Jie Long, Jinlong Xu, Mengzhao Shen, Shunnan Feng, Xiangyu Bu, Chao Zhai, Xiurong Yuan, Jun Le, Yue Qi, Maolin Meng, Lijing Ju, Yuzhen Liu, Yanni Wu","doi":"10.1097/XEB.0000000000000611","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000611","url":null,"abstract":"<p><strong>Introduction: </strong>Violent behavior remains prevalent in psychiatric settings and has serious negative impacts on the physical and mental well-being of health care professionals. Although evidence suggests that systematic risk assessment, patient engagement, and individualized care plans are effective preventive measures, a significant gap persists between such evidence-based prevention strategies and clinical practice in adult psychiatric inpatient units in China.</p><p><strong>Objectives: </strong>This project aimed to promote evidence-based practices for the prevention and management of violence among psychiatric adult inpatients in five psychiatric hospitals in China.</p><p><strong>Methods: </strong>This project applied the JBI Evidence Implementation Framework. Using an audit-feedback strategy, we conducted a baseline audit using six evidence-based audit criteria. Identified barriers informed tailored implementation strategies. A follow-up audit then measured changes in clinical practice compliance.</p><p><strong>Results: </strong>The baseline audit showed that families' ability to recognize and manage aggressive behavior was poor and the use of individualized care plans was 0%. The follow-up audit revealed improvements, with three indicators reaching 100%. Moreover, the implementation rate of individualized care plans increased from 14.67% to 86% and was successfully integrated into the clinical pathway.</p><p><strong>Conclusion: </strong>This evidence implementation project produced beneficial shifts. A standardized prevention protocol for aggression is now active; personalized care plans and the level of family involvement have both improved to varying degrees; and staff members' knowledge and skills have been strengthened. Future efforts are needed to sustain these achievements and further enhance adherence to best practices.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A607.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applicability of the Consolidated Framework for Implementation Research to integrated care: insights from three case studies.","authors":"Nada Vidic, Joseph Elias, Elizabeth Emma Palmer, Ben Harris-Roxas, Natalie Taylor","doi":"10.1097/XEB.0000000000000619","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000619","url":null,"abstract":"<p><strong>Background: </strong>Complex systems, such as health care systems, are inherently fragmented. To address persistent problems that arise, research that operates across organizational boundaries is needed.</p><p><strong>Objective: </strong>This study aimed to evaluate the applicability of the Consolidated Framework for Implementation Research (CFIR) to identify factors influencing the implementation of integrated care. Specifically, we determine whether conceptual gaps exist within the current CFIR constructs and, if so, propose additional constructs to address these gaps.</p><p><strong>Methods: </strong>This study followed a four-stage iterative process of literature review and theory-based definition development, transcript application, expert deliberation, and case study validation. Testing was conducted through application to transcripts and case studies from three clinical contexts involving integrated care: pediatric cancer survivorship, rare disease, and community palliative care. Case studies are presented as illustrative examples.</p><p><strong>Results: </strong>The CFIR brings together many of the domains and constructs from prior studies and the framework remains useful. However, because much of its use has focused on single, bounded organizational settings, the need to explicitly incorporate sub-constructs that focus on the interplay between the innovation and context is essential for integrated care research. We present additional CFIR-Integrated Care sub-constructs under Partnerships and Connections; Between Systems Mission Alignment (Functional and Normative); Relational Connections; Communications; Roles and Responsibilities (Interorganizational).</p><p><strong>Conclusions: </strong>This methodological study provides a theoretically informed, generalizable framework for assessing the relational and contextual interplay between settings to rigorously evaluate implementation gaps across integrated care. The framework needs to be further tested and refined in different contexts.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A623.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}