Evidence map›Paper›PMID 29370791›Full record

SynthesisBMC health services research2018

The use of external change agents to promote quality improvement and organizational change in healthcare organizations: a systematic review.

Esra Alagoz, Ming-Yuan Chih, Mary Hitchcock, Randall Brown, Andrew Quanbeck

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Trial
  4. Trial
  5. Trial
  6. Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Review
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Esra AlagozWisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792-1690, USA. ealagoz@wisc.edu.ORCID 0000-0001-7046-006X
Ming-Yuan ChihDepartment of Clinical Sciences, University of Kentucky College of Health Sciences, Room 209 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA.
Mary HitchcockSenior Academic Librarian, Ebling Library for the Health Sciences, University of Wisconsin- Madison, Madison, USA.
Randall BrownDepartment of Family Medicine, University of Wisconsin School of Medicine & Public Health, 1100 Delaplaine Ct, Madison, WI, 53715, USA.
Andrew QuanbeckDepartment of Family Medicine & Community Health, Research Scientist- Center for Health Enhancement Systems Studies, Department of Industrial & Systems Engineering, University of Wisconsin-Madison, 4115 Mechanical Engineering Building, 1513 University Avenue, Madison, WI, 53706, USA.

Funding

Conceptualizing the problem of implementation: a systems engineering perspective applied in substance abuse treatmentK01DA039336 · NIDA · UNIVERSITY OF WISCONSIN-MADISON · PI QUANBECK, ANDREW · 2015 to 2019
$741k
Physician coaching to reduce opioid-related harmsR34DA036720 · NIDA · UNIVERSITY OF WISCONSIN-MADISON · PI BROWN, RANDALL T, QUANBECK, ANDREW · 2014 to 2016
$683k
NIDA NIH HHS K01 DA039336NIDA NIH HHS R34 DA036720NIDA NIH HHS R34-DA-036720-01
6 · The paper itself

Abstract

backgroundExternal change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings.

methodsWe searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies. The review was conducted according to PRISMA guidelines. A total of 477 abstracts were identified and screened by 2 authors. Full text articles of 113 studies were reviewed. Twenty-one of these studies were selected for inclusion.

resultsAcademic detailing (AD) is the most prevalently used organizational change strategy employed as part of multi-component implementation strategies. Out of 21 studies, nearly all studies integrate some form of audit and feedback into their interventions. Eleven studies that included practice facilitation into their intervention reported significant effects in one or more primary outcomes.

conclusionsOur results demonstrate that practice facilitation with regular, tailored follow up is a powerful component of a successful organizational change strategy. Academic detailing alone or combined with audit and feedback alone is ineffective without intensive follow up. Provision of educational materials and use of audit and feedback are often integral components of multifaceted implementation strategies. However, we didn't find examples where those relatively limited strategies were effective as standalone interventions. System-level support through technology (such as automated reminders or alerts) is potentially helpful, but must be carefully tailored to clinic needs.

Indexed as

Delivery of Health CareHealth ServicesHumansOrganizational InnovationQuality ImprovementAcademic detailingExternal change agentsOrganizational changePractice facilitationQuality improvement

Identifiers

PMID29370791
PMCPMC5785888

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.