82 Chapter 3 Adherence rate & costs Seventeen studies (35%) described health professionals’ adherence to FPIs. The median adherence rate was 65% (IQR 29 – 87). Adherence data such as the rate of completed fall risk screening, fall documentation, and medication review was mostly gathered through electronic health records. Other ways were audits, for instance to check if nursing rounds were performed correctly. Three studies reported about the costs of implementing an FPI; mentioning cost savings from $10,000 up to $406,000,000 [29, 50, 64]. Table 3 Summary of the provided details on the prerequisites of Proctor [13]. Prerequisites Definition Provided details n=350 (%) Published in or before 2013 n=112 (%) Published after 2013 n=238(%) Actor Identify who enacts the strategy 163 (47%) 50 (45%) 113 (47%) Action Specific actions, steps, or processes that need to be enacted 350 (100%) 112 (100%) 238 (100%) Action target 1) Specify targets according to conceptual models of implementation 2) Identify unit of analysis for measuring implementation outcomes 107 (31%) 36 (32%) 71 (30%) Temporality Specify when the strategy is used 122 (35%) 40 (36%) 82 (34%) Dose Specify dosage of implementation 39 (11%) 8 (7%) 31 (13%) Implementation outcome affected Implementation outcome affected. Identify and measure the implementation outcome(s) that are affected by each strategy 18 (5%) 5 (4%) 13 (5%) Justification Justification for choice of implementation strategies 62 (18%) 20 (18%) 42 (18%) Discussion This systematic review examined 1) which implementation strategies for FPIs were used, and 2) which prerequisites, as recommended by Proctor et al., were reported. We identified 45 ERIC strategies from 350 unique strategies in 48 studies. Strategies from the implementation domain ‘train and educate the stakeholders’ were employed by almost all studies. The operationalization of implementation strategies was lacking in the majority of the studies. Performing a meta-analysis was not possible due to the lack of controlled studies comparing similar implementation strategies and similar FPIs, which made it impossible to discern a set of effective implementation strategies. Ten years since the systematic review of Hempel et al. we conducted a similar systematic review with a broader population, than limited to US hospitals [11]. We found similar findings concerning the documentation of the implementation strategies. According to
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