Avoiding unnecessary hospitalisation for patients with chronic conditions: a systematic review of implementation determinants for hospital avoidance programmes

Abstract

Background Studies of clinical effectiveness have demonstrated the many benefits of programmes that avoid unnecessary hospitalisations. Therefore, it is imperative to examine the factors influencing implementation of these programmes to ensure these benefits are realised across different healthcare contexts and settings. Numerous factors may act as determinants of implementation success or failure (facilitators and barriers), by either obstructing or enabling changes in healthcare delivery. Understanding the relationships between these determinants is needed to design and tailor strategies that integrate effective programmes into routine practice. Our aims were to describe the implementation determinants for hospital avoidance programmes for people with chronic conditions and the relationships between these determinants. Methods An electronic search of four databases was conducted from inception to October 2019, supplemented by snowballing for additional articles. Data were extracted using a structured data extraction tool and risk of bias assessed using the Hawker Tool. Thematic synthesis was undertaken to identify determinants of implementation success or failure for hospital avoidance programmes for people with chronic conditions, which were categorised according to the Consolidated Framework for Implementation Research (CFIR). The relationships between these determinants were also mapped. Results The initial search returned 3537 articles after duplicates were removed. After title and abstract screening, 123 articles underwent full-text review. Thirteen articles (14 studies) met the inclusion criteria. Thematic synthesis yielded 23 determinants of implementation across the five CFIR domains. ‘Availability of resources’, ‘compatibility and fit’, and ‘engagement of interprofessional team’ emerged as the most prominent determinants across the included studies. The most interconnected implementation determinants were the ‘compatibility and fit’ of interventions and ‘leadership influence’ factors. Conclusions Evidence is emerging for how chronic condition hospital avoidance programmes can be successfully implemented and scaled across different settings and contexts. This review provides a summary of key implementation determinants and their relationships. We propose a hypothesised causal loop diagram to represent the relationship between determinants within a complex adaptive system. Trial registration PROSPERO 162812

Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons

“…Patients with mental disorders (MD) including substance-related disorders (SRD) and with chronic physical illnesses (CPI) are high ED users, which contributes substantially to ED overcrowding (7)(8)(9). They are also hospitalized and readmitted more often than patients without MD or CPI (10)(11)(12)(13). Co-occurring CPI frequently occurs among patients with MD (14)(15)(16)(17)(18).…”

Evidence-based practice implementation in healthcare in China: a living scoping review

“…15 In addition, we also recognized the interrelations between barriers or facilitators across the four domains in our review, for example, lack of multidisciplinary collaboration often interlinked with poor communication and unclear division of responsibility; leadership support often associated with high motivation of healthcare professionals. Such patterns imply that a system approach to understand the complex relationships between implementation determinants, which has been practiced in some reviews, 57 58 might help us identify key factors and gain an in-depth understanding of the structural problems in implementation process.…”

Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review

“…Self-scheduling cannot be implemented and scaled without a comprehensive understanding of these factors. In contrast to the focus on dissecting individual components defined by the CFIR, the success of an implementation by a complex, adaptive health care organization is informed by the interdependence of the determinants [ 94 ]. The exploration of enablers and obstacles by examining the contingent and reciprocal relationships within health care organizations may better illuminate the implementation determinants for self-scheduling.…”