Abstract
Background: In recognition of the value and impact of holistic and patient-centred care, clinicians, patients, and healthcare organisations have advocated for practical changes to help integrate existing services. Technology is needed to enable the scale and speed of data organisation and sharing and communication needed to integrate clinical services and sites. Implementing complex or technology-supported interventions is difficult, and has high failure rates, as it requires changes to a number of embedded and interrelated processes, roles, and policies.
Implementation Science (IS), which draws from a multidisciplinary base and has established theories, models, and frameworks (TMF) is increasingly used to improve research translation and efficiency. While there has been a widely reported rapid increase in the number of new TMF, including frameworks specific to either complex or technology-supported interventions, there is no single framework specific to the implementation of complex and technology-supported interventions (which are increasingly used). This paper describes the structured way that Realist Research, the Consolidated Framework for Implementation Science (CFIR), and the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework were combined, applied, and tested to plan, implement, and evaluate a complex technology-supported intervention to integrate existing services.
Aim: The FIT in Integrated Care study aimed, as part of a multi-site Randomised Controlled Trial, to build on existing IS to co-design, test, and evaluate a structured, practical, and comprehensive way to plan, implement, and evaluate the implementation of a complex technology-supported intervention that integrates existing services.
Methods: The FIT in Integrated Care was co-designed in three stages. The first stage defined the function that the new framework needed to fulfil and identified suitable IS theory and practice to inform its structure and content. The second stage involved developing the new framework (structure, content) and applying it to the GERONTE* intervention. Realist research, the CFIR, and the NASSS framework were chosen and combined because of their relevance (to IS and to complex and technology-supported interventions), evidence base, combined comprehensiveness, and compatibility. The new fr↔amework was refined based on end-user feedback. The third stage, which is ongoing, involves the broader and longer-term testing, evaluation, and reporting on the framework’s functionality and user-friendliness in implementing a complex technology-supported intervention to integrate existing care services.
Results: The FIT in Integrated Care study resulted in the combination and application of existing IS theory and practice, into an evidenced-based, structured, practical, user-friendly multi-stakeholder framework to plan, implement, and evaluate the implementation of a complex technology-supported intervention that integrates existing services.
This new framework focuses research and analysis on the ‘context, mechanism of action, and outcomes’ to enable understanding of ‘how, in what context and for who’ the intervention works (so as to support wider adoption and/ or adaptation).
Conclusion: Combining Realist research, the CFIR, and NASSS framework provides an evidence-based, robust, user-friendly way to plan, implement, and evaluate a complex technology-supported intervention that integrates existing healthcare services.