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Rojas Smith L, Ashok M, Morss Dy S, et al. Contextual Frameworks for Research on the Implementation of Complex System Interventions [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Mar.

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Contextual Frameworks for Research on the Implementation of Complex System Interventions [Internet].

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Appendix ADetailed Methods and Results of the Literature Scans

We used 50 search terms singly and in combination to identify potentially relevant process redesign (PR) and patient-centered medical home (PCMH) literature and used 18 terms for care transitions literature. These terms are listed in Table A-1.

Table A-1. Literature search terms.

Table A-1

Literature search terms.

During the title, abstract, and full-text reviews, we excluded articles for any of the reasons listed in Table A-2.

Table A-2. Abstract and full text exclude reasons.

Table A-2

Abstract and full text exclude reasons.

A general set of questions guided the abstraction of the included articles. The questions were tailored to identify content not already captured in the frameworks. The questions we used for abstraction were as follows:

  • What components (inputs, processes, outputs, outcomes) of the model are not included in the Consolidated Framework for Implementation Research (CFIR)?
  • What components are unique or applicable to PCMH, PR, or care transitions features?
  • Are the specified categories/relationships among the components different from those in the CFIR and if so, how?
  • Which components or relationships should be considered for inclusion in the frameworks for PCMH, PR, or Care Transitions?
  • What components and constructs listed in the article are more applicable to models of Care Transitions from hospitals to ambulatory compared with other types of transitions? (For Care Transitions Framework only)

Process Redesign and Patient-Centered Medical Homes

Figure A-1 shows the flow diagram for included articles from the initial literature scan for the PCMH and PR Framework adaptations. After the completion of the literature scan, the project team continued to identify and receive literature that aided in the refinement and adaptations of the frameworks throughout the multiphase process. These additional resources are cited within the report as appropriate, but they are not included in the tallies for the literature scan because they did not go through the same review and data abstraction process as the articles identified by the team during the time period of the literature scan.

Figure A-1 is a flowchart that summarizes the search and selection of articles for the PCMH and PR framework adaptation. A total of 348 articles were identified by searching MEDLINE and tables of contents of selected journals. Technical Expert Panel recommendations and a search of the AHRQ Web site provided 11 more articles. From these 359 references, 253 were excluded at the abstract level. The remaining 106 were screened to identify potentially eligible resources. At the full-text stage, 69 citations were excluded--because they did not include a framework or theory (20), were not directly applicable to PCMH or PR (14), did not include cost or efficiency (for process redesign) (19), were letters to the editor (4), or for other reasons (12). A total of 37 references were identified as relevant to PCMH or PR framework adaptation.

Figure A-1

Flow diagram of included studies for patient-centered medical home and process redesign.

The main MEDLINE search yielded 226 citations and the table of contents search yielded 122 citations after removing duplicates. Technical Expert Panel recommendations and a search of the AHRQ Web site provided 11 more articles. After title and abstract review, we excluded 253 citations. Among the 107 full-text articles reviewed, we included 37 for data abstraction. At the full-text stage, 69 citations were excluded because they did not include a framework or theory, described activities that were not directly applicable to PCMH or PR, did not include cost or efficiency (if a citation pulled for PR), or was a letter to the editor.

Care Transitions

The literature scan for Care Transitions focused on identifying contextual and theoretical frameworks related to transition interventions, specifically hospital-ambulatory transitions, and to medical illnesses. Figure A-2 shows the flow diagram for included articles. The main MEDLINE search yielded 257 citations, and the gray literature search yielded another 31 citations after removing duplicates. After title and abstract review, we excluded 226 citations. Among the 62 full-text articles reviewed, we included 19 for data abstraction. The most common reasons for exclusion were the absence of a framework or theory and a focus on activities not directly applicable to Care Transitions.

Figure A-2 is a flowchart that summarizes the search and selection of articles for the Care Transitions framework adaptation. A total of 257 articles were identified by searching MEDLINE. A grey literature search provided 31 more articles. From these 288 references, 226 were excluded at the abstract level. The remaining 62 were screened to identify potentially eligible resources. At the full-text stage, 43 citations were excluded--because they did not include a framework or theory (42), or they were not directly relevant to Care Transitions (1). A total of 19 references were identified as relevant to Care Transitions framework adaptation.

Figure A-2

Flow diagram of included studies for care transitions.

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