Evidence based implementation of complex interventions

  title={Evidence based implementation of complex interventions},
  author={Richard G. Thomson},
  journal={BMJ : British Medical Journal},
  • R. Thomson
  • Published 12 August 2009
  • Medicine
  • BMJ : British Medical Journal
Multi-method evaluation and high quality reporting are essential 
Developing and evaluating a complex intervention in stroke : using very early mobilisation as an example
Patients who underwent VEM were 3-times more likely to be independent at 3 months than were standard care (SC) patients and the incremental cost-effectiveness ratio associated with VEM in comparison to SC indicated VEM to be potentially cost-effective from a societal perspective.
Are emergency department clinical pathway interventions adequately described, and are they delivered as intended? A systematic review
The underreporting of intervention elements may present a barrier to both the evaluation and accurate replication of clinical pathway interventions.
Personalized modeling for medical decision support
Implementing a Complex Intervention to Support Personal Recovery: A Qualitative Study Nested within a Cluster Randomised Controlled Trial
This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting, and recommended the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs.
An empirical study series to investigate the research synthesis of complex health care interventions and related methodological issues
Results suggested that many of the techniques used in psycho-educational interventions appear to be well matched with patients’ experiences of successful interventions, and questions remain about how to distinguish characteristics of an effective intervention.
Evidence-based medicine and the physician-patient dyad.
It is argued that EBM must be closely evaluated and critically appraised because it is subject to its own set of defects and would be best implemented in a context that maintains sensitivity to individuality and to physician–patient interactions.
Impact of the QOF and the NICE guideline in the diagnosis and management of depression: a qualitative study.
Organisational barriers to the implementation of the NICE guideline and the limited scope of the QOF highlight the need for policy makers to work more effectively with the complex realities of general practice in order to systematically improve the quality and delivery of 'managed' care for depression.
The myth of complexity
Thompson’s comment on Bessen and colleagues’ attempt to encourage uptake of the Ottawa ankle rules perpetuates the ubiquitous misuse of the term complex.1 2 Referring to the clinical decision tool as
Standards for reporting randomized controlled trials in medical informatics: a systematic review of CONSORT adherence in RCTs on clinical decision support
The overall quality of reporting RCTs was low and there is a need to develop standards for reporting R CTs in medical informatics.
Medication and symptom management in persons living with HIV. perceptions and collaboration of persons living with HIV, their close support persons and healthcare providers
This review summarizes the evidence resulting of randomised controlled trials which were conducted to enhance medication adherence to antiretroviral therapy and shows that effective programs need to c ombine several methods.


Planning and Studying Improvement in Patient Care: The Use of Theoretical Perspectives
It is demonstrated how different theories can be used to generate testable hypotheses regarding factors that influence the implementation of change, and it shows how different theoretical assumptions lead to different quality-improvement strategies.
Diffusion of innovations in service organizations: systematic review and recommendations.
A parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, clear knowledge gaps where further research should be focused, and a robust and transferable methodology for systematically reviewing health service policy and management are discussed.
Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings
Systematic reviews of rigorous studies provide the best evidence on the effectiveness of different strategies to promote the implementation of research findings and to assess the quality of the systematic reviews.
An implementation research agenda
The high level group made recommendations to the CMO to address possible ways forward to improve clinical effectiveness in the UK National Health Service (NHS) and promote clinical engagement to deliver this.
Healthcare professionals' intentions and behaviours: A systematic review of studies based on social cognitive theories
The TPB appears to be an appropriate theory to predict behaviour whereas other theories better capture the dynamic underlying intention, which should be given to methodological issues, especially to better define the context of behaviour performance.
The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration
The purpose of the SQUIRE E & E document is to assist authors along the path from completion of a quality improvement project to its publication and provides one or two examples from the published improvement literature, followed by an analysis of the ways in which the example expresses the intent of the guideline item.
Implementation of clinical decision rules in the emergency department.
  • I. Stiell, C. Bennett
  • Medicine
    Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
  • 2007
Four implementation studies demonstrated that the implementation of CDRs in the emergency department (ED) safely reduced the use of radiography for ankle, knee, and cervical spine injuries, but a recent trial failed to demonstrate an impact on computed tomography imaging rates.
A multifaceted strategy for implementation of the Ottawa ankle rules in two emergency departments
A multifaceted change strategy including a problem specific radiography request form can improve the selection of patients for radiography and improve the application of Ottawa ankle rules.
A new structure for quality improvement reports
The editorial team are aware that many people are involved in useful and informative quality improvement projects that could have valuable messages for others and one of the reasons for this dearth of published quality improvement reports may be that people are simply too busy improving care to have time to write.
Ottawa ankle rules for the injured ankle
Patients with ankle injury constitute approximately 5% of all patients who visit emergency departments, although fewer than 15% of these patients will have clinically significant fractures.