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

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 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 March 2020, and updated literature search for studies published between January 2020 to October 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 systematic review. 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. Conclusion: 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.

Contextualizing evidence‐based nurse‐led interventions for reducing 30‐day hospital readmissions using GRADE evidence to decision framework: A Delphi study

“…According to a recently published SR, implementing interventions for reducing hospital readmissions usually faces a number of common challenges across different health system contexts (Fu et al, 2023). These common challenges include limited resources, incompatibility between new interventions with existing work routines, poor communication among team members, complex implementation processes, and insufficient understanding of the content and effectiveness of the new interventions (Fu et al, 2023). These challenges are well documented in case studies originating from health systems in developed countries.…”

“…In Hong Kong, nongovernmental organizations (NGO) provide a large portion of community care and support for older people, either independently or with funding from the Government's Social Welfare Department (2021) (Lau et al, 2018). As fragmentation of the health and social care system could result in poor patient outcomes, how to enhance medico-social collaboration has also been discussed (Chan According to a recently published SR, implementing interventions for reducing hospital readmissions usually faces a number of common challenges across different health system contexts (Fu et al, 2023). These common challenges include limited resources, incompatibility between new interventions with existing work routines, poor communication among team members, complex implementation processes, and insufficient understanding of the content and effectiveness of the new interventions (Fu et al, 2023).…”

“…As fragmentation of the health and social care system could result in poor patient outcomes, how to enhance medico-social collaboration has also been discussed (Chan According to a recently published SR, implementing interventions for reducing hospital readmissions usually faces a number of common challenges across different health system contexts (Fu et al, 2023). These common challenges include limited resources, incompatibility between new interventions with existing work routines, poor communication among team members, complex implementation processes, and insufficient understanding of the content and effectiveness of the new interventions (Fu et al, 2023). These challenges are well documented in case studies originating from health systems in developed countries.…”

Implementing coaching programmes for healthcare professionals—A review of the barriers and facilitators

“…While extractions from qualitative studies were coded directly against the CFIR constructs, quantitative data was first narratively synthesised and then analysed together with the extractions from qualitative studies. The number of included studies describing a particular CFIR construct was reported, yielding a reporting frequency (RF) 39 . Barriers and facilitators described in three or more included studies were considered ‘commonly reported’.…”

“…The number of included studies describing a particular CFIR construct was reported, yielding a reporting frequency (RF). 39 Barriers and facilitators described in three or more included studies were considered 'commonly reported'. Lastly, given the context dependency of barriers and facilitators, especially within complex health and social systems, 36 inductive analysis focused on identifying emerging themes among these commonly reported barriers and facilitators.…”