Applicability of the Consolidated Framework for Implementation Research to integrated care: insights from three case studies
Nada Vidic, Joseph Elias, Elizabeth Emma Palmer, Ben Harris-Roxas, Natalie TaylorABSTRACT
Background:
Complex systems, such as health care systems, are inherently fragmented. To address persistent problems that arise, research that operates across organizational boundaries is needed.
Objective:
This study aimed to evaluate the applicability of the Consolidated Framework for Implementation Research (CFIR) to identify factors influencing the implementation of integrated care. Specifically, we determine whether conceptual gaps exist within the current CFIR constructs and, if so, propose additional constructs to address these gaps.
Methods:
This study followed a four-stage iterative process of literature review and theory-based definition development, transcript application, expert deliberation, and case study validation. Testing was conducted through application to transcripts and case studies from three clinical contexts involving integrated care: pediatric cancer survivorship, rare disease, and community palliative care. Case studies are presented as illustrative examples.
Results:
The CFIR brings together many of the domains and constructs from prior studies and the framework remains useful. However, because much of its use has focused on single, bounded organizational settings, the need to explicitly incorporate sub-constructs that focus on the interplay between the innovation and context is essential for integrated care research. We present additional CFIR-Integrated Care sub-constructs under
Conclusions:
This methodological study provides a theoretically informed, generalizable framework for assessing the relational and contextual interplay between settings to rigorously evaluate implementation gaps across integrated care. The framework needs to be further tested and refined in different contexts.
Spanish abstract:
http://links.lww.com/IJEBH/A623