Table 3.
Description of included articles
| First author, year | Country | Setting | Design | Study participants (age, sex and gender and professions if applicable) | Innovation, Implementation Outcome Measurement (Measure Reliability and Validity) |
|---|---|---|---|---|---|
| Albert, 2012 [47] | USA | Clinic(s) (number not reported) | Cross-sectional study |
Physicians who reported consistent use of standard order programs = 502 Age: Mean (SD) = 50.4 (10.1) years Sex and Gender: Not reported Physicians who consistently use SOPs for influenza vaccine only = 175 Age: Mean (SD) = 50.2 (9.4) years Sex and Gender: Not reported Physicians who consistently use SOPs for influenza and pneumococcal polysaccharide vaccine = 203 Age: Mean (SD) = 51.8 (9.9) years Sex and Gender: Not reported |
Innovation: Standard order programs are facility policies allowing non-physician health care providers to assess patient’s immunization status and administer vaccines without a physician order Study outcome measurement Measure: Single item asking how often non- physician staff utilize a standard order program for administering influenza, pneumococcal polysaccharide vaccine, or both types of vaccines at their clinic. Options range from: a) inexistence or lack of interest in implementing standard order programs; b) inexistence but interest in implementing standard order programs; c) existence but inconsistent use of standard order programs; or d) consistent use of standard order programs Reliability: Not reported; Validity: Not reported |
| Alidina, 2018 [48] | USA | Hospital(s) (number not reported) | Cross-sectional study |
Operating room staff = 368 Age: Not reported Sex & Gender: Not reported Professions: Anesthesiology = 311 (84.5%); Surgery = 13 (3.5%); operating room staff = 24 (6.5%); Other = 20 (5.4%) |
Innovation: Operating room cognitive aids are tools (e.g. checklist or emergency operating procedures) that provide information to facilitate and standardize decision making, action and information sharing between health care providers during crises Study outcome measurement Measure: Single survey item asking operating room staff about the regular use of operating room cognitive aids at their facility on a 5-point Likert scale from “strongly disagree to strongly agree” Reliability: Not reported Validity: The survey was piloted survey with 21 operating room staff to assess readability and comprehensibility of questions |
| Anand, 2017 [49] | 18 European countries | 203 neonatal intensive care units | Prospective cohort study |
Neonatal intensive care patients = 6648 Age: Mean (SD) = 35.0 (4.6) weeks Not specified Sex or Gender: Male = 3753 (56.5%); Female = 2895 (44.5%) Interpreted as: Sex |
Innovation: The use of measurement scales that measure continuous pain proceeding invasive procedures may enhance the quality pain management in neonatal patients (e.g. prevents untreated pain, under or overdosing of analgesics, or the development of drug tolerance) Study outcome measurement Measure: Chart audit to measure the use of pain assessments tools/scales designed to measure continuous pain (e.g. Echelle Douleur Inconfort Nouveau-ne (EDIN) scale, COMFORT scale) for 1 month in participating NICUs Reliability: A random 10% of the data was double checked by a local data quality manager. If 1% or more errors is present, then another random 10% would be double checked. If 1% or more errors continued, then all data entries for that NICU would be double checked Validity: Not reported |
| Ash, 1997 [50] | USA | 65 academic health sciences centres | Cross-sectional study |
Informatics professionals and library workers = 534a Age: Not reported Sex and Gender: Not reported Professions: Informatics professionals = 195 (31% of 629); library workers = 339 (48% of 706) a |
Innovation: Electronic mail is a communication method whereby an individual sends a message to another individual via a computer or other technological devices Study outcome measurement Measures: Two single items scales measuring electronic mail infusion [81] and diffusion [82] on a 4-point scale (low to high). Infusion is the extent of which an innovation is implemented, while diffusion is the breadth of implementation within an organization Reliability: Not reported; Validity: Not reported |
| Ben-David, 2019 [51] | Israel | 24 medical surgical intensive care units | Cross-sectional study | Sample information not reported |
Innovation: Central-line-associated bloodstream infection prevention practice bundles include measures that decreases risk of infection during insertion (e.g. hand hygiene and use of maximal sterile barriers) and measures that minimize infection risk during ongoing catheter use (e.g. aseptic technique for tubing and dressing changes and the prompt removal of central line catheters when no longer necessary) Study outcome measurement Measure: Monthly incidence rates of central-line-associated bloodstream infection collected as part of routine national surveillance in Israel hospitals Reliability: Not reported; Validity: Not reported |
| Bentz, 2007 [52] | USA | 19 (10 intervention, 9 control) clinics | Cluster randomised trial |
(1) Control clinic patients = Not reported Age: Mean (SD) = 50.7 (5.6) years Reported Gender: Male = 33.5%; Female = 76.5% Interpreted as: Sex (2) Physicians in control clinics = 55 Age: Not reported Reported Gender: Male = 49.2%; Female = 50.8% Interpreted as: Sex 3) Intervention clinic patients = Not reported Age: Mean (SD) = 54.2 (6.7) years Reported Gender: Male = 34%; Female = 76% Interpreted as: Sex 4)Physicians in intervention clinics = 57 Age: Not reported Reported Gender: Male = 51.6%; Female = 48.4% Interpreted as: Sex |
Innovation: The delivery of electronic health record generated feedback, rather than peer feedback to health care providers to increase the delivery of tobacco cessation assistance and referrals to the Oregon Tobacco Quitline Study outcome measurement Measure: Monthly rates of clients referred, reached, or counseled regarding tobacco cessation using the Oregon Tobacco Quitline according to electronic health records Reliability: Not reported; Validity: Not reported |
| Bradley, 2012 [53] | USA | 533 hospitals | Cross-sectional study |
Hospitals’ chief executive officers = 533 Age: Not reported Sex & Gender: Not reported Professions: Not reported |
Innovation: There was no specific innovation in this study. The purpose of this study was to identify and determine the relationships between hospital strategies and hospital risk-standardized mortality rates Study outcome measurement Measure: Thirty-day risk-standardized mortality rates: “predicted number of deaths within 30 days of admission at a hospital divided by the expected number of deaths within 30 days of admission at the same hospital multiplied by the overall 30-day mortality rate of the cohort” [53] (p.3) Reliability: Not reported; Validity: Not reported |
| Campbell, 2008 [54] | USA | One hospital | Non-controlled before and after study |
Intensive care unit patients = 120 Age: Range = 32–93 years old Reported Gender: Male = 53%; Female = 47% Interpreted as: Sex |
Innovation: The Keystone ICU Sepsis project aims at improving the quality of care, decreasing length of stay, eliminating unnecessary cost and creating a culture centred on safety in participating Michigan hospital’s intensive care units. The Keystone ICU Sepsis project seeks to increase the identification of patients with or at risk of sepsis and the implementation of appropriate of sepsis protocols Study outcome measurement Measures: Chart documentation of (1) intensive care unit nurses’ compliance with sepsis-screening protocols and (2) the proportion of patients with severe sepsis that physicians initiated the sepsis protocol on Reliability: Not reported; Validity: Not reported |
| Chang, 2012 [40] | USA | 225 primary care practices | Cross-sectional study | Primary care directors: sample details not reported |
Innovation: Depression care improvement models are evidence-based models that guides screening and management of common mental health disorders in a primary care setting. These models include the collocation of mental health specialists, the Translating Initiatives in Depression (TIDES) model and the Behavioural Health Laboratory (BHL) model Study outcome measurement Measure: Primary care directors’ responses to a single item in the 2007 VA Clinical Practice Organization Survey (CPOS) Primary Care [83]. This single item asks the degree of implementation of three depression care improvement models (collocation, TIDES and BHL). The authors dichotomized the responses into fully or partially implemented versus planned but not yet implemented or not implemented. Some clinics may have implemented multiple depression improvement models. The authors used a hierarchal coding system to assign each clinic to only a single model; prioritizing BHL, then TIDES, then collocation Reliability: Not reported; Validity: Not reported |
| Ellerbeck, 2006 [55] | USA | 44 hospitals | Cross-sectional study | Sample details not reported |
Innovation: Consistent use of aspirin and beta-blockers during the hospitalization or at the time of discharge in patients with acute myocardial infarction Study outcome measurement Measures: Audit of hospital records and supplemental Medicare billing records of a random sample of Medicare patients admitted between April 1, 1998, and May 31, 2001, with a principal diagnosis of acute myocardial infarction. Outcome data was the use of aspirin and beta-blockers at admission and at discharge Reliability: Not reported; Validity: Not reported |
| Foster, 2017 [56] | USA and Puerto Rico | 1174 hospitals | Non-controlled before and after study | Sample details not reported |
Innovation: Innovations were not clearly outlined in this paper. The purpose of the paper is to assess the relationships between engagement or knowledge translation strategies and the change in a composite measure of quality of care according to 10 harm topics (e.g. readmissions). Examples of these engagement or knowledge translation strategies includes improvement events targeted to staff, and improvement fellows (a subset of which comprises of champions) Study outcome measurement Measure: A weighted composite score of quality of care calculated by adding a ratio of occurrence of the 10 harm topics for 1 month. A low score means higher quality. These measures are based on self-reports submitted by hospitals Reliability: Not reported; Validity: Not reported |
| Goff, 2019 [57] | USA | 80 pediatric primary care practices | Cross-sectional study |
Practice leaders = 80 Age in years (n (%)): 26–35 = 8 (10%); 36–45 = 17 (21.3%); 46–55 = 17 (21.3%); 56–65 = 31 (38.8%); > 65 = 3 (3.75%); No response = 4 (5%) Reported Gender: Female = 66 (82.5%); Male = 10 (12.5%); Non-binary = 1 (1.25%); No response = 3 (3.75%) Interpreted as: Gender Professions: Practice manager = 58 (72.5%); Nurse manager = 6 (7.5%); Physician owner = 1 (1.25%); Physician leader = 4 (5%); Other = 9 (11.3%); No response = 2 (2.5%) |
Innovation: This study did not have an innovation, rather the study assessed the relationships between the organizational characteristics of primary care practices in the Massachusetts Health Quality Partners and their reported clinical quality and patient experience scores Study outcome measurement Measures: The authors translated clinical quality and patient experience scores from Massachusetts Health Quality Partners website to a scale from zero to three points. Average patient experience scores and clinical quality scores were calculated for practices reporting four or more patient experience or clinical quality scores Reliability: Not reported; Validity: Not reported |
| Granade, 2020 [58] | USA | Primary care clinics and pharmacies (number not reported) | Cross-sectional study |
(1) Clinicians = 4911 Age in years (n (%)): < 40 = 1497 (30.5%); 40–49 = 1503 (26.8%); 50–59 = 1156 (23.4%); ≥ 60 = 736 (19.3%) Reported Sex: Male = 1858 (48.5%); Female = 3053 (51.5%) Interpreted as: Sex Professions: Physician = 2349 (71.5%); Nurse practitioner = 1293 (15.7%); Physician assistant = 1269 (12.8%) (2) Pharmacists = 793 Age in years (n (%)): < 40 = 310 (45.3%); 40–49 = 194 (19.4%); 50–59 = 161 (17.5%); ≥ 60 = 125 (17.7%) Reported Sex: Male = 1858 (48.5%); Female = 3053 (51.5%) Interpreted as: Sex |
Innovation: The Standards for Adult Immunization Practice emphasizes that health care providers should routinely perform assessments, strongly recommend, administer, or provide referrals, and document in electronic health care systems the administration of all necessary vaccines in adult patients Study outcome measurement Measure: A survey developed by Centers for Disease Control and Prevention and Abt Associates Inc. to assess primary care clinicians and pharmacists’ self reported adherence to the Standards for Adult Immunization Practice and factors (e.g. presence of champions) related to implementation of these standards. A composite score of vaccination process standard adherence was calculated by the authors Reliability: Not reported Validity: Survey question phrasing were revised for better readability and comprehension |
| Hsia, 2019 [59] | Taiwan | 119 hospitals | Cross-sectional study |
Top managers = 119 Age: Not reported Sex and Gender: Not reported Professions: Not reported |
Innovation: E-Health innovations are forms of information technology that are designed to aid with the delivery of health care related activities. Examples of E-Health innovations are electronic health record computerized provider order entry, and picture archiving and communication systems Study outcome measurement Measure: A seven-item subscale within a 28-item questionnaire that is intended to measure the extent that hospital medical services and work processes are performed using E-Health technologies. The questionnaire was created by the authors. Scoring of items were on a five-point Likert scale ranging from strongly disagree to strongly agree Reliability: Composite reliability = 0.95; α = 0.934 Validity: Factor loadings range = 0.728–1.053, which is above the 0.707 threshold |
| Hung, 2008 [60] | USA | 57 primary care practice-based research networks | Cross-sectional study |
Patients = 4735 Age in years (n (%)): 18–39 = 1348 (28.9%); 40–54 = 1476 (31.6%); 55–64 = 925 (19.8%); ≥ 65 = 921 (19.7%) Reported Gender: Male = 1319 (27.9%); Female = 3377 (71.3%) Interpreted as: Sex |
Innovation: The Chronic Care Model is a system-level framework consisting of six main areas with a focus on prevention and health behaviour counselling in primary care practices. These six main areas include (1) establishing a health system and organization of care centred on chronic care, (2) supporting patient participation in their own care, (3) a proactive delivery system that identifies and addresses health needs, (4) availability of evidence-based decision supports for health care providers, (5) implementing an electronic health care information system and (6) established networks with community resources to support continuity of care. This study was interested on understanding how the Chronic Care Model related to quality-of-life measures Study outcome measurement Measures: Three survey items based on the Center for Disease Control and Prevention’s Healthy Days core measures [84–86]: (1) number of unhealthy days in the past 30 days, (2) number limiting days in the past 30 days, (3) general health status. Number of unhealthy days and limiting days was measured on a three-point ordinal scale (0 days, 1–13 days and 14–30 days). General health status is rated on a five-point scale from poor to excellent Reliability: Not reported; Validity: Not reported |
| Kabukye, 2020 [61] | Uganda | One tertiary oncology centre | Cross-sectional study |
Survey Participants = 146 Age in years (n (%)): ≤ 30 = 47 (32.2%);31–40 = 58 (39.7%);41–50 = 20 (13.7%); ≥ 50 = 13 (8.9%); Missing = 8 (5.5%) Reported Gender: Female = 86 (58.9%); Male = 53 (36.3%); Missing = 7 (4.8%) Interpreted as: Sex Profession(s): Oncologist = 9 (6.2%); Doctor = 27 (18.5%); Nurse = 24 (16.4%); Allied health worker (lab, imaging, pharmacy, medical records officers) = 61 (41.8%); Biostatistics/Data manager/IT = 13 (8.9%); Administrator = 12 (8.2%) |
Innovation: Electronic health record is the use of information technology to assist with health care related processes Study outcome measurement Measure: A four-item subscale measuring organizational readiness in implementing electronic health records in low- and middle-income countries using a 5-point Likert scale ranging from strongly agree to strongly disagree adapted from a study by Paré et al. [68] Reliability: Dillon- Goldstein’s rho = 0.79; α = 0.64 Validity: Convergent validity: Average variance extracted (AVE) = 0.48 |
| Kenny, 2005 [62] | USA | Three army medical treatment facilities | Cross-sectional study |
Registered nurses = 290 Age: Not reported Reported Gender: Male = 60 (20.7%); Female = 229 (79.0%); Missing = 1 (0.3%) Interpreted as: Sex |
Innovation: This study did not have an explicit innovation. The purpose of this study was to examine individual and organization factors related to research use by nurses. Research use was defined as the use of research findings to guide nursing practice Study outcome measurement Measures: (1) Adapted Research Utilization survey by Estabrooks [87] to measure direct, persuasive and overall research use. All types of research use were single survey items scored using a 7-point Likert scale from "never" to "nearly every shift” Reliability: α (range) = 0.77–0.91; Validity: Not reported |
| Khera, 2018 [63] | USA | 108 transplant centres | Cross-sectional study |
Physicians = 316 Age: Not reported Sex and Gender: Not reported Professions: Physicians = 230 (77.4); Program Medical Director = 67 (22.6) |
Innovation: The findings of a phase three, multicentre randomized control trial titled Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0201 [88] found that the use of bone marrow stem cells for unrelated donor hematopoietic cell transplantation is related to similar survival rates and less chronic graft versus host disease in patients with hematologic malignancies than the use of peripheral blood stem cells Study outcome measurement Measure: A 26-item survey developed by the authors according to the literature and key informant interviews with three researchers from BMT CTN 0201 study [88]. Outcome variables include physician reported personal and facility-level change in preference regarding unrelated donor graft use from peripheral blood source to bone marrow. These survey items were scored on a 5 -point Likert scale from very important to very unimportant Reliability: Not reported; Validity: Not reported |
|
One study—two reports |
Canada | 13 long-term care homes | Cross-sectional study |
Paid care providers = 529 Age in years (n (%)): 20–29 = 42 (7.9%); 30–39 = 87 (16.4%); 40–49 = 149 (28.2%); 50–59 = 187 (35.3%); 60–69 = 46 (8.7%); Missing/unknown = 18 (3.4%) Reported Gender: Female = 474 (89.6%); Male = 40 (7.6%); Missing/unknown = 15 (2.8%) Interpreted as: Sex Professions: Health care assistant/resident care aide = 290 (54.8%); Licensed practical nurse = 84 (15.9%); Registered nurse = 40 (7.6%) Resident care coordinator = 13 (2.4%); Manager = 14 (2.6%); Recreational/occupational/ physiotherapist = 24 (4.5%); Unit/program clerk = 18 (3.4%); Missing/unknown = 49 (9.3%) |
Innovation: Hip protectors are protective undergarments with either a hard shield or soft pads sewn into its sides to cover the skin over the lateral aspects of the proximal femur. The purpose of hip protectors is to minimize the injury to the hip resulting from a fall Study outcome measurement Measures: A 15-item questionnaire titled as C-Hip Index, developed and tested for psychometric properties by authors [64] to measure affective and cognitive, behavioural and overall hip protector commitment Reliability: α (range) = 0.87–0.97 Validity: (1) Construct validity: Authors reported a two-factor structure as the result of an exploratory factor analysis: Factor 1 (affective and cognitive commitment) and Factor 2 (behavioural commitment) which loaded to a higher order factor called "commitment to hip protectors" with an eigen value of 1.386. R2 = 0.693. Both subscales had a factor matrix coefficient of 0.833 (2) Content validity index (CVI): Twelve items in C-Hip index had a CVI = 0.79 for both clarity and relevance. Range of item CVI = 0.55–0.82 (3) Convergent validity: Increase in self reported championing is associated with increase scores for the affective/cognitive, behavioural subscales and the entire C-Hip index (p < 0.01) (4) Concurrent validity: Significant lower median responses for individual subscales or entire C-Hip index amongst participants that responded that they were aware of a resident breaking a hip while wearing a hip protector (p < 0.01). Significant higher median responses for individual subscales or entire C-Hip index amongst individuals who responded that there was a champion at their long-term care home |
| Lago, 2013 [66] | Italy | 103 neonatal intensive care units | Cross-sectional study | Sample details not reported |
Innovation: The implementation of effective neonatal pain prevention programs according to best practice guidelines. These programs should include training and strategies to routinize the assessment of pain and the appropriate use of pharmacological and non-pharmacological therapies to prevent and treat pain Study outcome measurement Measure: A 58- item questionnaire created by the authors assessing neonatal intensive care units’ characteristics, availability pain control guidelines and neonatal intensive care units’ routine use of non-pharmacological and pharmacological pain-relieving interventions during invasive procedures. Frequency of pain-relieving interventions was measured on 4-point Likert scale from never (0–15%) to always (> 90%) Reliability: Not reported; Validity: Not reported |
| Papadakis, 2014 [67] | Canada | 40 family health team clinics | Cross-sectional study |
(1) Health care providers = 288 Age: Mean (SD) = 39.5 (17.3) years Sex and Gender: Not reported Profession(s): Practising physician = 80.7%; Medical resident = 5%; Nurse practitioner = 12.7% (2) Patient = 2501 Age: Mean (SD) = 47.7 (14.7) years Reported Sex: Male = 952 (38.1%); Female = 1549 (61.9%) Interpreted as: Sex |
Innovation: Evidence-based smoking cessation treatments is composed of five strategies (denoted as 5 As): ask patients about their smoking status, advise patients to quit smoking, assess patient’s readiness to quit, assist with a quitting attempt using behavioural counselling or smoking cessation medications, and to arrange follow-up pertaining to smoking cessation Study outcome measurement Measures: (1) A health care provider survey created by the authors to assess family health teams characteristics and providers’ attitudes and believes towards evidence-based smoking cessation treatments (2) A patient evaluation survey created by the authors asking on a binary scale (yes or no) if the patient’s physician or other health care providers asked, advised, or assessed readiness to quit, and if the provider assisted, or arranged follow-up regarding smoking cessation Reliability: Not reported; Validity: Not reported |
| Paré, 2011 [68] | Canada |
(1) Study 1: 11 home care organizations (2) Study 2: one hospital |
Cross-sectional study |
(1) Study 1: Registered nurses = 134 Age in years (%): ≤ 29: 14%; 30–39 = 23%; 40–49 = 35%; 50–59 = 26%; ≥ 60 years = 2% Reported Gender: Male = 2%; Female = 98% Interpreted as: Sex (2) Study 2: Clinicians = 237 Age (%): ≤ 29 years = 10%; 30 to 39 years = 21%; 40 to 49 years = 28% 50 to 59 years = 34%; ≥ 60 years = 7% Reported Gender: Male = 32%; Female = 68% Interpreted as: Sex Professions: Registered nurse = 57%; Social worker = 9%; Occupational therapist = 4%; Clinician (others) = 19%; Physicians = 12% |
Innovation: The innovations in the two studies pertain to the implementation of clinical information system. In study 1, the innovation was a mobile computing project. The mobile computing project contains home care nursing policies and procedures and allows home care nurses to create individualized care plans for their clients and to document the care they provided. The innovation in study two was the electronic medical record. The purpose of this study was to determine the factors related to the readiness of the staff in implementing these technological innovations Study outcome measurement Measures: The authors created a survey according to Holt and colleagues’ conceptual model of organizational readiness [89]. The questionnaire has 39 items. Organizational readiness was measured on 4- item subscale, scored on a 5-point Likert scale ranging from strongly agree to strongly disagree adopted two studies [90, 91] Reliability: (1) Organizational readiness—α: Study 1 = 0.89; Study 2 = 0.88 Validity: (1) Construct validity: exploratory factor analyses showed that all scale items loaded highly (> 0.68) on a single factor (2) Convergent validity: Average variance extracted (study 1 = 0.88; study 2 = 0.86) was higher than inter-construct correlations (3) Discriminant validity: Cross-loadings (study 1 range = 0.85–0.91; study 2 range = 0.78–0.89) loaded more highly on their own factor than on other factors |
| Patton, 2013 [69] | England | 153 emergency departments | Cross-sectional study |
Lead clinicians = 153 Age: Not reported Sex and Gender: Not reported Professions: Not reported |
Innovation: The assessment of alcohol consumption and provision of advice to decrease alcohol use by health care providers in the emergency department is an effective and cost-effective way of decreasing alcohol consumption and alcohol related harm Study outcome measurement Measure: A follow-up survey based on questions from a national emergency survey distributed in England in 2006 [92].The dependent variables were two survey items asking about emergency staff's access to training for screening and brief advice regarding alcohol consumption Reliability: Not reported; Validity: Not reported |
| Sharkey, 2013 [39] | USA | 14 nursing homes | Non-controlled before and after study | Sample details were not reported |
Innovation: The On-Time pressure ulcer quality improvement based on the integration of health information technology tools has three primary objectives: (1) utilize the knowledge and train certified nursing assistants to document and communicate their assessments to licensed staff through an electronic health system; (2) support collaborative and multidisciplinary clinical decision making through clinical decision support systems that summarize resident data from daily staff documentations; and (3) to establish a proactive practice focused on prevention and early treatment of pressure ulcers Study outcome measurement Measures: On-Time facilitators’ reports tracked implementation milestones achieved every 9 months and documented facility team characteristics, team skills and capacity. Milestones were tracked according to three levels: levels 1 to 3. The level equates to the number of process improvements implemented facility wide Reliability: Not reported; Validity: Not reported |
| Shea, 2016 [70] | USA | 37 ambulatory clinics | Cross-sectional study |
Health care providers = 596 Age: Not reported Sex and Gender: Not reported Professions: Not reported |
Innovation: The innovation in this study was the meaningful use of electronic health records, or the ability to maximize the capacity of the electronic health record to improve quality, safety and efficiency of health care services. Meaningful use of the electronic health records is implemented in three stages. However, the authors were interested in the Stage 1 meaningful use because Medicare services must attest to this level of meaningful use 90 days post implementation of the electronic health records to receive monetary incentives. Stage 1 meaningful objective criteria includes 14 required core objectives (e.g. having an updated medication lists for patients) and 5 menu objectives selected from a set of 10 options (e.g. providing patient- specific educational materials) Study outcome measurement Measure: Survey created and administered by authors to clinics’ senior leaders. Meaningful use of electronic health records was quantified as the percentage of eligible providers in each clinic demonstrating all Stage 1 meaningful use objective criteria Reliability: Not reported; Validity: Not reported |
| Sisodia, 2020 [71] | USA | 205 medical, surgical and mental and behavioural health clinics | Retrospective cohort study | Sample details not reported |
Innovation: Patient-reported outcomes are questionnaires that is distributed to patients to assess their general health, quality of life, or health/symptoms pertaining to a specific disease Study outcome measurement Measure: Patient-reported outcomes collection rates were extracted from project logs within an enterprise data warehouse. These logs contained the number and type of patient related questionnaires administered to collect patient related outcomes by participating clinics in the most recent 6 months Reliability: Not reported; Validity: Not reported |
| Slaunwhite, 2009 [72] | Canada |
46 units within one acute care facility 23 units with champions 23 units with no champions |
Case–control study | Sample details not reported |
Innovation: The introduction of unit champions can facilitate the uptake of the influenza vaccine amount hospital staff Study outcome measurement Measure: Annual influenza vaccination rates in matched hospital units (matched according to previous years influenza vaccination rates, physical size and primary function). Secondly, the authors assessed the change in annual influenza vaccination rates from the previous year for each hospital unit Reliability: Not reported; Validity: Not reported |
| Soni, 2016 [73] | India | One neonatal intensive care unit (NICU) | Interrupted time series |
NICU patients = 648 Percentage of sample when KMC champions were absent in the NICU = 43.1% Age: Not reported Not specified Sex and Gender: Female % = 37.3%; Male % = 62.7% Interpreted as: Sex |
Innovation: Kangaroo mother care has two main components: skin-to-skin care and breastfeeding. Kangaroo mother care is a safe and low-cost measure to reduce neonatal mortality Study outcome measurement Measures: Chart audits to determine overall use and initiation rate (neonates/30 days) of skin-to-skin care and breastfeeding documented on standardized forms. Average duration (hours/day) was only measured for skin-to-skin care because of the difficulty in differentiating between breastfeeding attempts and successful breastfeeding Reliability: Not reported; Validity: Not reported |
| Strasser, 2003 [74] | USA | 203 cystic fibrosis care centres | Cross-sectional study |
Clinic directors and coordinators of CF care centres = 289 Age: Not reported Reported Gender: Male: 114 (39.6%); Female: 174 (60.4%); Missing = 1 (0.3%) Interpreted as: Sex Profession(s): Director = 150 (52.1%); Nurse coordinator = 112 (38.9%); Nurse practitioner = 20 (6.9%); Nurse health educator = 6 (2.1%) |
Innovation: The Agency for Healthcare Research and Quality (AHRQ) 5A Smoking Cessation Clinical Practice Guideline refers to five steps: ask, advise, assess readiness to quit, assist patients with quitting and to arrange follow-up regarding smoking cessation Study outcome measurement Measure: A survey developed by authors to examine factors reported by directors and coordinators of cystic fibrosis centres that may affect smoking cessation guideline implementation. The AHRQ 5 A (ask, advise, assess, assist and arrange follow-up) model smoking cessation guideline was the guideline assessed by the survey. The outcome variable was measured with a dichotomous (yes/no) question asking whether the AHRQ 5 A has been implemented to address cystic fibrosis patient’s parentals smoking behaviours Reliability: Test–retest survey reliability (n = first 30 respondents): Kendall’s tau = 1.00, p < .01; Spearman’s r = 1.00, p < .01 Validity: The survey was approved for content validity by an expert panel (a pulmonologist and two doctoral trained researchers in medical education and health behaviour) |
| Tierney, 2003 [75] | USA | Public health clinics and pediatrician practices (number not reported) | Mixed study (generic qualitative and cross-sectional) |
(1) Public Health Clinics providers = 440 (2) Pediatricians = 434 Age: Not reported Sex and Gender: Not reported Profession(s): Not reported |
Innovation: Reminder and recall immunization systems are routine communication processes (via telephone or mail) with children’s parents at preselected ages to remind them of an upcoming or past-due immunization or wellness check up. Routine immunization assessments refer to the measurement of immunization coverage rates at least every 2 years Study outcome measurement Measure: A 21-item survey created by the authors to assess five domains: messages to parents, barriers to implementation of reminder or recall messaging systems, other immunization practices (assessments, feedback), practice attitudes about immunization and characteristics and demographics Reliability: Not reported; Validity: Not reported |
| Ward, 2004 [76] | USA | 109 Veterans Affairs medical centres | Cross-sectional study |
Quality managers = 109 Age: Not reported Sex and Gender: Not reported Profession(s): Not reported Patients = not reported Age: Mean (range) = 66 (59 - 73) years Gender: Males: 96% Females: 4%; Range of males in all centres = 90–99% Interpreted as: Sex |
Innovation: The implementation and health care providers' adherence to diabetes guidelines pertains to glycemic, lipid and blood pressure screening and control Study outcome measurement Measures: (1) A 31-item questionnaire distributed to quality managers assessing organizational context related to diabetes guideline implementation. Provider process measures in the survey included performing the following: HbA1c screen (annually), foot screening (annually), lipid screening (biannually), renal screening (biannually), eye screen (annually) (2) Patient outcome measures include glycemic control (HbA1c < 9.5%), non-smoker status, Lipid control (LDL ≤ 130 md/dL) and hypertension control < 140/90 mm Hg). These data were extracted from the 1999 Veterans Health Survey and the 2001 Veterans Satisfaction Survey Reliability: Not reported; Validity: Not reported |
|
One study, two reports: |
USA | 3 private ambulance companies and 3 public fire departments | Interrupted time series |
Emergency Medical Service workers = 190 [77]; 221 [78] Age: Range = 18–65 years old Sex and Gender: Not reported Professions: Not reported |
Innovation: Patient transfer board or slide board is a foldable board that aids with lateral transfers by bridging the gap between the bed and hospital stretcher and facilitate sliding of the patient from the stretcher to the bed and vice versa Study outcome measurement Measures: This study used scales that the authors formulated according to existing validated instruments: (1) “Intention to use the transfer board” scale (3 item scale) was based on Dishaw and Strong [93] (2) Ergonomic advantage of transfer boards (5 item scale) was based on Moore and Benbasat [94] Reliability: Not reported Validity: Ergonomic advantage- Factor loadings ranged from 0.62 to 0.81. Validity not reported for intention to use scale |
| Westrick, 2009 [79] | USA | 104 community pharmacies | Cross-sectional study |
Pharmacy staff = 104 Age: Not reported Reported Sex: Male = 65 (64.0%); Female = 35 (36.0%) Interpreted as: Sex Professions: Staff pharmacist = 13 (14.1%); Manager = 67 (72.8%); Owner/partner = 12 (13%) |
Innovation: Pharmacy-based in-house immunization services is the administration of vaccines by pharmacists at their designated health care setting Study outcome measurement Measure: A questionnaire created by the authors that assesses pharmacy staff’s perspectives regarding the following criteria relevant to the sustainability of an in-house pharmacy immunization services (5 subscales): champion effectiveness (strategic and operational), formal evaluation, degree of modification, compatibility and sustainability of immunization services. The sustainability scale was based on Goodman and colleagues [95]. The subscales composed of either 4 to 6 items or scored on a 5-point Likert scale except for formal evaluation, which is a single dichotomous item. Reliability: α (range for all five subscales except formal evaluation) = 0.71–0.85. Formal evaluation was not assessed for reliability Validity: Not reported |
| Whitebird, 2014 [41] | USA | 42 clinics from 14 medical groups | Mixed study (Generic qualitative and prospective cohort) |
Patients in the Depression Improvement Across Minnesota: Offering a New Direction (DIAMOND) program at 6 months follow-up = 5258 Age: Not reported Sex and Gender: Not reported |
Innovation: The DIAMOND program aims to provide collaborative depression care and consultive support to primary care clinics throughout Minnesota and Western Wisconsin. The DIAMOND program is composed of six aspects: (1) the use of the Patient Health Questionnaire-9 (PHQ-9) [96] to assess and monitor patient’s condition and progress; (2) systematic tracking of patients; (3) use of evidence-based guidelines to guide treatment; (4) dissemination of relapse prevention education to health care staff; (5) the presence of a care manager whose role is to educate, coordinate and support care services; and (6) the presence of a consulting psychiatrist collaborating with the care manager to review cases and provide treatment change recommendations Study outcome measurement Measure: Standardized monthly data reports regarding the number of eligible patients enrolled into the DIAMOND program (patients with a PHQ-9 ≥ 10) and remission rates (patients with a PHQ-9 < 5) every 6 months Reliability: Not reported; Validity: Not reported |
| Zavalkoff, 2015 [80] | Canada | 1 pediatric intensive care unit (PICU) | Interrupted time series |
Sample: Pediatric patients = 3100 Age: Not reported Sex and Gender: Not reported |
Innovation: The introduction of a champion lead and an interdisciplinary policy dictating health care teams to systematically assess and discuss daily the appropriateness of continued use and/or removal of urinary catheters in patients Study outcome measurement Measures: Secondary data analysis of urinary catheter device utilization ratio in children admitted to the PICU between April 1, 2009, and June 29, 2013, according to hospital acquired surveillance database. Urinary catheter device utilization ratio was calculated by taking the number of days that a patient was exposed to a urinary catheter divided by the number of days that the patient was admitted in the PICU Reliability: Not reported; Validity: Not reported |
a(Ash, 1997 [50]): This is a calculated sample size based on the reported response rate (31 and 48% response rate for informatics professionals (n = 629) and library workers (n = 706)). However, this calculated sample size only equates to 40% response rate, while the authors state having a 41% response rate