Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

Proctor, Enola K.; Silmere, Hiie; Raghavan, Ramesh; Hovmand, Peter S.; Aarons, Greg; Bunger, Alicia C.; Griffey, Richard T.; Hensley, Melissa

doi:10.1007/s10488-010-0319-7

Cited by 4,898 publications

(6,562 citation statements)

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“…The 5 implementation outcomes identified by Chaudoir et al10 based on a study by Proctor et al9 defined implementation outcomes as “the effects of deliberate and purposive actions to implement new treatments, practices, and services.”10 (p65) Two of the main functions of implementation outcomes are to serve as indicators of implementation success and key intermediate outcomes 9. For illustration, we defined the 5 implementation outcomes as they relate to the DPA evaluation.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…Studies have shown that there are multiple approaches to measuring implementation outcomes including self‐report surveys, observation, and use of archival records archival 7, 9, 10. Proctor et al9 found that developing implementation outcome measures that would be useful in real world settings are needed.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…Proctor et al9 found that developing implementation outcome measures that would be useful in real world settings are needed. As the final DPA evaluation study focused on administering self‐report surveys to school administrators and teachers, this review of PA survey instruments, specifically, represented an important preliminary step to conducting that study.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…However, to evaluate these interventions, policy and program implementation and its determinants must also be assessed. Proctor et al's9 acknowledgment that there appears to be a lack of theoretical understanding of the underlying processes involved in implementation can be expanded to the PA field. It is important that specific implementation outcome measures are identified or developed, to evaluate school‐based PA interventions.…”

Section: Implications For School Healthmentioning

confidence: 99%

“…Therefore, assessing the effectiveness of a program without understanding its implementation process would be limiting. Nonetheless, measuring implementation is challenging in itself, as recent studies suggest that there is a lack of theoretical knowledge of implementation processes 8, 9, 10. In summary, it is important to conceptualize implementation outcomes as distinct from, but related to, policy and program outcomes 9…”

mentioning

confidence: 99%

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A Review of Implementation Outcome Measures of School‐Based Physical Activity Interventions

Shah

Allison

Schoueri-Mychasiw

et al. 2017

Journal of School Health

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BACKGROUNDMeasuring the implementation of school‐based physical activity (PA) interventions is an important prerequisite in assessing their impact. Prior to conducting a study to assess the implementation of the daily physical activity (DPA) policy in Ontario, Canada, a literature review was conducted to identify existing survey instruments to measure 5 implementation outcomes: adoption, fidelity, implementation cost, reach, and sustainability.METHODSA search for survey instruments to assess these implementation outcomes at the teacher and school administrator levels was conducted in 7 bibliographic databases, as well as the gray literature. Each survey instrument was coded as assessing 1 of the 5 implementation outcomes if it included at least 1 item measuring the construct.RESULTSTwenty‐three survey instruments were identified. None of the instruments were specifically developed to measure the implementation outcomes. Fidelity was the most common implementation outcome measured, followed by adoption. The least common implementation outcome measured was sustainability. Thirty‐five percent of survey instruments assessed were previously tested for validity and 26% were previously tested for reliability.CONCLUSIONSBased on this review, a gap in available instruments to measure implementation outcomes of school‐based PA programs was identified. An adapted theoretical framework, presented here, has potential application in future implementation studies.

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Section: Conceptual Frameworkmentioning

confidence: 99%

Section: Conceptual Frameworkmentioning

confidence: 99%

Section: Conceptual Frameworkmentioning

confidence: 99%

Section: Implications For School Healthmentioning

confidence: 99%

mentioning

confidence: 99%

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A Review of Implementation Outcome Measures of School‐Based Physical Activity Interventions

Shah

Allison

Schoueri-Mychasiw

et al. 2017

Journal of School Health

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Moving Toward Evidence-Based Interventions for Trainee and Physician Wellness

Shea

Bellini

2017

JAMA Intern Med

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Association of Rapid Molecular Testing With Duration of Respiratory Isolation for Patients With Possible Tuberculosis in a US Hospital

et al. 2018

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Importance New guidelines recommend that molecular testing replace sputum-smear microscopy to guide discontinuation of respiratory isolation in patients undergoing evaluation for active tuberculosis(TB) in health-care settings. Objective To evaluate the implementation and impact of a molecular-testing strategy to guide discontinuation of isolation. Design Prospective cohort study with a pragmatic, before-and-after-implementation design. Setting Zuckerberg San Francisco General Hospital and Trauma Center. Participants 621 consecutive hospitalized patients undergoing sputum examination for evaluation for active pulmonary TB from January 2014—January 2016. Intervention Implementation of a sputum molecular-testing algorithm using GeneXpert MTB/RIF(Xpert) to guide discontinuation of isolation. Main Outcomes and Measures We measured the proportion of patients with molecular testing ordered and completed; the accuracy of the molecular-testing algorithm in reference to mycobacterial culture; the duration of each component of the testing and isolation processes; length of stay; mean days in isolation and in hospital; and mean cost. We extracted data from hospital records and compared measures before and after implementation. Results Among 320 patients evaluated in the post-implementation period, clinicians ordered molecular testing for 234(73%) patients and received results for 295/302(98%) tests ordered. Median age was 54(interquartile range 44–63), and 161(26%) were women. The molecular-testing algorithm accurately diagnosed all seven patients with culture-confirmed TB and excluded TB in all 251 Mtb-culture-negative patients. Compared to the pre-implementation period, there were significant decreases in median times to final rapid-test result(39.1 vs. 22.4 hours, p<0.001), discontinuation of isolation(2.9 vs. 2.5 days, p=0.001), and hospital discharge(6.0 vs 4.9 days, p=0.003), on average saving $13,347 per isolated non-TB patient. Conclusions and Relevance A sputum molecular-testing algorithm to guide discontinuation of respiratory isolation for patients undergoing evaluation for active TB was safe, feasible, widely and sustainably adopted, and provided substantial clinical and economic benefits. Molecular testing may facilitate more efficient, patient-centered evaluation for possible TB in U.S. hospitals.

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Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

Cited by 4,898 publications

References 54 publications

A Review of Implementation Outcome Measures of School‐Based Physical Activity Interventions

A Review of Implementation Outcome Measures of School‐Based Physical Activity Interventions

Moving Toward Evidence-Based Interventions for Trainee and Physician Wellness

Association of Rapid Molecular Testing With Duration of Respiratory Isolation for Patients With Possible Tuberculosis in a US Hospital

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