Barriers and Facilitators to Implementing Interventions for Reducing Avoidable Hospital Readmission: Systematic Review of Qualitative Studies

Document Type : Review Article

Authors

1 Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong

2 School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong

3 Department of Medicine, Health and Caring Sciences, Linköping University, Sweden

4 Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China

Abstract

Background 
Avoidable hospital readmission is a major problem among health systems. Although there are effective peri-discharge interventions for reducing avoidable hospital readmission, successful implementation is challenging. This systematic review(SR) of qualitative studies aimed to identify barriers and facilitators to implementing peri-discharge interventions from providers’ and service users’ perspectives.

Methods 
We searched four databases for potentially eligible qualitative studies from databases’ inception to Mar 2020, and updated literature search for studies published between 2020 to Oct 2021. Barriers and facilitators to implementing peri-discharge interventions were identified and mapped onto the Consolidated Framework for Implementation Research(CFIR) constructs. Inductive analysis of the CFIR constructs was performed to yield thematic areas that illustrated the relationship between various facilitators and barriers, generating practical insights to key implementation issues.

Results 
Thirteen qualitative studies were included in this SR. Key issues were clustered in the CFIR constructs of Design Quality and Complexity of the intervention, strength of Network and Communication, being responsive to Patient Needs with sufficient Resource support, and External Incentives. The three thematic areas were rationality of the interventions, readiness  and effort of multidisciplinary implementation teams, and influence of external stakeholders. Common barriers included i) limited resources, ii) poor communication among team members, iii) incompatibility between the new intervention and existing work routine, iv) complicated implementation process, v) low practicality of supporting instruments, and vi) lack of understanding about the content and effectiveness of the new interventions. Common facilitators were i) information sharing via regular meetings on implementation issues, ii) organizational culture that values quality and accountability, iii) financial penalties for hospitals with high avoidable readmissions rates, iv) external support offered via quality improvement programs and community resources, and v) senior leadership support.

Conclusions 
This study synthesized commonly-presenting barriers and facilitators to implementing peri-discharge interventions among different healthcare organizations. Findings may inform development of implementation strategies in different health systems after appropriate tailoring, based on a consensus-based formative research process.

Keywords


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Articles in Press, Accepted Manuscript
Available Online from 08 January 2023
  • Receive Date: 11 February 2022
  • Revise Date: 03 August 2022
  • Accept Date: 04 January 2023
  • First Publish Date: 08 January 2023