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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="author" content="Lucia Rojas Smith, Mahima Ashok, Sydney Morss Dy, Roberta C Wines, Stephanie Teixeira-Poit" /><meta name="citation_title" content="Contextual Frameworks for Research on the Implementation of Complex System Interventions" /><meta name="citation_publisher" content="Agency for Healthcare Research and Quality (US)" /><meta name="citation_date" content="2014/03" /><meta name="citation_author" content="Lucia Rojas Smith" /><meta name="citation_author" content="Mahima Ashok" /><meta name="citation_author" content="Sydney Morss Dy" /><meta name="citation_author" content="Roberta C Wines" /><meta name="citation_author" content="Stephanie Teixeira-Poit" /><meta name="citation_pmid" content="24783308" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK196199/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Contextual Frameworks for Research on the Implementation of Complex System Interventions" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="Agency for Healthcare Research and Quality (US)" /><meta name="DC.Contributor" content="Lucia Rojas Smith" /><meta name="DC.Contributor" content="Mahima Ashok" /><meta name="DC.Contributor" content="Sydney Morss Dy" /><meta name="DC.Contributor" content="Roberta C Wines" /><meta name="DC.Contributor" content="Stephanie Teixeira-Poit" /><meta name="DC.Date" content="2014/03" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK196199/" /><meta name="DC.Language" content="en" /><meta name="description" content="This report presents the adaptation of the Consolidated Framework for Implementation Research (CFIR) to three complex system interventions involving (1) process redesign for improved efficiency and reduced costs (PR); (2) patient-centered medical homes (PCMH); and (3) care transitions. The purpose of the adapted frameworks— the PR Framework, PCMH Framework, and Care Transitions Framework—is to guide research on how, why, and where these interventions succeed or fail to achieve intended outcomes." /><meta name="og:title" content="Contextual Frameworks for Research on the Implementation of Complex System Interventions" /><meta name="og:type" content="book" /><meta name="og:description" content="This report presents the adaptation of the Consolidated Framework for Implementation Research (CFIR) to three complex system interventions involving (1) process redesign for improved efficiency and reduced costs (PR); (2) patient-centered medical homes (PCMH); and (3) care transitions. The purpose of the adapted frameworks— the PR Framework, PCMH Framework, and Care Transitions Framework—is to guide research on how, why, and where these interventions succeed or fail to achieve intended outcomes." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK196199/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-methrescontext-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/methrescontext/toc/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK196199/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="methodscollect" />
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p></div><div class="pagination bk_noprnt"><span class="inactive page_link prev">< Prev</span><a class="active page_link next" href="/books/n/methrescontext/fm.s1/" title="Next page in this title">Next ></a></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="https://effectivehealthcare.ahrq.gov" title="Agency for Healthcare Research and Quality (US)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-methrescontext-lrg.png" alt="Cover of Contextual Frameworks for Research on the Implementation of Complex System Interventions" /></a><div class="icnblk_cntnt"><h1 id="_NBK196199_"><span itemprop="name">Contextual Frameworks for Research on the Implementation of Complex System Interventions</span></h1><p><i>Methods Research Reports</i></p><p class="contrib-group">Investigators: <span itemprop="author">Lucia Rojas Smith</span>, DrPH, MPH, <span itemprop="author">Mahima Ashok</span>, PhD, MS, <span itemprop="author">Sydney Morss Dy</span>, MD, MSc, <span itemprop="author">Roberta C Wines</span>, MPH, and <span itemprop="author">Stephanie Teixeira-Poit</span>, MS.</p><a data-jig="ncbitoggler" href="#__NBK196199_ai__" style="border:0;text-decoration:none">Author Information and Affiliations</a><div style="display:none" class="ui-widget" id="__NBK196199_ai__"><p class="contrib-group"><h4>Authors</h4>Investigators: <span itemprop="author">Lucia Rojas Smith</span>, DrPH, MPH, <span itemprop="author">Mahima Ashok</span>, PhD, MS, <span itemprop="author">Sydney Morss Dy</span>, MD, MSc, <span itemprop="author">Roberta C Wines</span>, MPH, and <span itemprop="author">Stephanie Teixeira-Poit</span>, MS.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center</div></div><div class="half_rhythm">Rockville (MD): <a href="https://effectivehealthcare.ahrq.gov" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">Agency for Healthcare Research and Quality (US)</span></a>; <span itemprop="datePublished">2014 Mar</span>.<div class="small">Report No.: 14-EHC014-EF</div></div><div class="half_rhythm"><ul class="inline_list"><li><span class="label"><a data-jig="ncbidialog" href="#_ncbi_dlg_cpyrght_NBK196199" data-jigconfig="modal:true">Copyright and
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Permissions</a></span></li></ul></div><div id="_ncbi_dlg_cpyrght_NBK196199" style="display:none" title="Copyright and Permissions"><div>This publication is in the public domain. For more information, see the <a href="/books/about/copyright/">Bookshelf Copyright Notice</a>.</div></div><div class="bk_noprnt"><form method="get" action="/books/n/methrescontext/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div itemprop="description"><h2>Structured Abstract</h2><div id="objectives"><h4 class="inline">Objectives:</h4><p>This report presents the adaptation of the Consolidated <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d5/">Framework</a> for <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d6/">Implementation</a> Research (CFIR) to three complex system interventions involving (1) <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d11/">process</a> redesign for improved efficiency and reduced costs (<a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d9/">PR</a>); (2) patient-centered medical homes (<a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d8/">PCMH</a>); and (3) care transitions. The purpose of the adapted frameworks— the PR Framework, PCMH Framework, and Care Transitions Framework—is to guide research on <i>how, why</i>, and <i>where</i> these interventions succeed or fail to achieve intended outcomes.</p></div><div id="data_sources"><h4 class="inline">Data sources:</h4><p>MEDLINE™. Additional studies were identified through the gray literature and technical experts.</p></div><div id="method"><h4 class="inline">Methods:</h4><p>The adaptation was informed by the findings from a scan of selected literature on <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d9/">PR</a>, <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d8/">PCMH</a>, and care transitions, which included articles in MEDLINE, the published and gray literature, and recommendations of content experts at the Agency for Healthcare Research and Quality. A Technical Expert Panel (TEP) for each topic reviewed the draft of the contextual frameworks and provided input on the structure and content through a series of 2-hour calls. In addition, the PR and PCMH Frameworks were reviewed by two separate TEPs for usability. In total, five TEPs were convened for this work.</p></div><div id="results"><h4 class="inline">Results:</h4><p>While retaining much of the CFIR's original structure and most of its original concepts, the revised frameworks address distinctive features of each of the three interventions. We added concepts relevant to each topic area, and more explicitly addressed the iterative and interactive nature of complex system change. We also modified nearly all the definitions of the CFIR <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d2/">constructs</a> to incorporate terminology and examples tailored to the specific interventions. Two new <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d4/">domains</a> were added to each of the frameworks—one for intermediary outcomes related to the <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d6/">implementation</a> and one for outcomes of the interventions themselves. Several CFIR domains and constructs were renamed to be more resonant with the <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d7/">intervention</a>'s research target group. None of the original CFIR constructs were dropped, but several dozen new constructs were added across the three new frameworks. As these were iterative products, with initial <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d9/">PR</a> and <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d8/">PCMH</a> Frameworks informing the Care Transitions <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d5/">Framework</a>, many of these new constructs overlap across the frameworks.</p></div><div id="conclusion"><h4 class="inline">Conclusions:</h4><p>These contextual frameworks provide a foundational taxonomy and conceptualization of key <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d6/">implementation</a> <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d2/">constructs</a> that researchers can use across studies to enhance their comparability and synthesis, thereby better informing the generalizability and replicability of specific interventions. In adapting the CFIR for complex system interventions, we thought it critical to include input from both research and practice stakeholders to ensure that the content is understandable and applicable to the <a class="def" href="/books/n/methrescontext/glossary.gl1/def-item/glossary.gl1-d7/">intervention</a> strategy of interest.</p></div></div><div><h2>Contents</h2><div class="bktoc_all_cntnr top align_right" style="display:none"><ul class="inline_list_right"><li><a class="bktoc_all_exp" href="#">Expand All</a></li><li style="margin-left:.8em"><a class="bktoc_all_clps" href="#">Collapse All</a></li></ul></div><ul id="toc_tllNBK196199_fm_s1" class="simple-list toc toc-toggle"><li class="half_rhythm" id="toc_itm_NBK196199_fm_s1"><a href="/books/n/methrescontext/fm.s1/" class="toc-item">Preface</a></li><li class="half_rhythm" id="toc_itm_NBK196199_fm_ack"><a href="/books/n/methrescontext/fm.ack/" class="toc-item">Acknowledgments</a></li><li class="half_rhythm" id="toc_itm_NBK196199_fm_s2"><a href="/books/n/methrescontext/fm.s2/" class="toc-item">Senior Advisors</a></li><li class="half_rhythm" id="toc_itm_NBK196199_fm_s3"><a href="/books/n/methrescontext/fm.s3/" class="toc-item">Technical Expert Panels</a></li><li class="half_rhythm" id="toc_itm_NBK196199_fm_s9"><a href="/books/n/methrescontext/fm.s9/" class="toc-item">Peer Reviewers</a></li><li class="half_rhythm" id="toc_itm_NBK196199_fm_s10"><a href="/books/n/methrescontext/fm.s10/" class="toc-item">Executive Summary</a></li><li class="half_rhythm" id="toc_itm_NBK196199_introduction"><a href="/books/n/methrescontext/introduction/" class="toc-item">Introduction</a><ul id="toc_lst_NBK196199_introduction_s1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK196199_introduction_s1"><a href="/books/n/methrescontext/introduction/#introduction.s1" class="toc-item">Background</a></li><li class="half_rhythm" id="toc_itm_NBK196199_introduction_s2"><a href="/books/n/methrescontext/introduction/#introduction.s2" class="toc-item">Scope</a></li><li class="half_rhythm" id="toc_itm_NBK196199_introduction_s3"><a href="/books/n/methrescontext/introduction/#introduction.s3" class="toc-item">Organization of the Report</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK196199_methods"><a href="/books/n/methrescontext/methods/" class="toc-item">Methods</a><ul id="toc_lst_NBK196199_methods_s1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK196199_methods_s1"><a href="/books/n/methrescontext/methods/#methods.s1" class="toc-item">Literature Scan</a></li><li class="half_rhythm" id="toc_itm_NBK196199_methods_s2"><a href="/books/n/methrescontext/methods/#methods.s2" class="toc-item">Content and Use Technical Expert Panels</a></li><li class="half_rhythm" id="toc_itm_NBK196199_methods_s3"><a href="/books/n/methrescontext/methods/#methods.s3" class="toc-item">Usability Technical Expert Panels</a></li><li class="half_rhythm" id="toc_itm_NBK196199_methods_s4"><a href="/books/n/methrescontext/methods/#methods.s4" class="toc-item">Self-Assessment</a></li><li class="half_rhythm" id="toc_itm_NBK196199_methods_s5"><a href="/books/n/methrescontext/methods/#methods.s5" class="toc-item">Peer and Public Review</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK196199_processredesign"><a href="/books/n/methrescontext/processredesign/" class="toc-item">Process Redesign Framework</a><ul id="toc_lst_NBK196199_processredesign_s1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK196199_processredesign_s1"><a href="/books/n/methrescontext/processredesign/#processredesign.s1" class="toc-item">Overview</a></li><li class="half_rhythm" id="toc_itm_NBK196199_processredesign_s2"><a href="/books/n/methrescontext/processredesign/#processredesign.s2" class="toc-item">Organization of the Process Redesign Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_processredesign_s3"><a href="/books/n/methrescontext/processredesign/#processredesign.s3" class="toc-item">Modifications in the Process Redesign Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_processredesign_s4"><a href="/books/n/methrescontext/processredesign/#processredesign.s4" class="toc-item">Graphic Representation of the Process Redesign Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_processredesign_s5"><a href="/books/n/methrescontext/processredesign/#processredesign.s5" class="toc-item">How To Use the Process Redesign Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_processredesign_s6"><a href="/books/n/methrescontext/processredesign/#processredesign.s6" class="toc-item">Content of the Process Redesign Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_processredesign_s7"><a href="/books/n/methrescontext/processredesign/#processredesign.s7" class="toc-item">Applying the Process Redesign Framework: A Case Study</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK196199_patientcentered"><a href="/books/n/methrescontext/patientcentered/" class="toc-item">Patient-Centered Medical Home Framework</a><ul id="toc_lst_NBK196199_patientcentered_s1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK196199_patientcentered_s1"><a href="/books/n/methrescontext/patientcentered/#patientcentered.s1" class="toc-item">Overview</a></li><li class="half_rhythm" id="toc_itm_NBK196199_patientcentered_s2"><a href="/books/n/methrescontext/patientcentered/#patientcentered.s2" class="toc-item">Organization of the Patient-Centered Medical Home Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_patientcentered_s3"><a href="/books/n/methrescontext/patientcentered/#patientcentered.s3" class="toc-item">Modifications in the Patient-Centered Medical Home Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_patientcentered_s4"><a href="/books/n/methrescontext/patientcentered/#patientcentered.s4" class="toc-item">Graphic Representation of the Patient-Centered Medical Home Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_patientcentered_s5"><a href="/books/n/methrescontext/patientcentered/#patientcentered.s5" class="toc-item">How To Use the Patient-Centered Medical Home Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_patientcentered_s6"><a href="/books/n/methrescontext/patientcentered/#patientcentered.s6" class="toc-item">Content of the Patient-Centered Medical Home Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_patientcentered_s7"><a href="/books/n/methrescontext/patientcentered/#patientcentered.s7" class="toc-item">Applying the Patient-Centered Medical Home Framework: A Case Study</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK196199_caretransitions"><a href="/books/n/methrescontext/caretransitions/" class="toc-item">Care Transitions Framework</a><ul id="toc_lst_NBK196199_caretransitions_s1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK196199_caretransitions_s1"><a href="/books/n/methrescontext/caretransitions/#caretransitions.s1" class="toc-item">Overview</a></li><li class="half_rhythm" id="toc_itm_NBK196199_caretransitions_s2"><a href="/books/n/methrescontext/caretransitions/#caretransitions.s2" class="toc-item">Organization of the Care Transitions Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_caretransitions_s3"><a href="/books/n/methrescontext/caretransitions/#caretransitions.s3" class="toc-item">Modifications in the Care Transitions Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_caretransitions_s4"><a href="/books/n/methrescontext/caretransitions/#caretransitions.s4" class="toc-item">Graphic Representation of the Care Transitions Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_caretransitions_s5"><a href="/books/n/methrescontext/caretransitions/#caretransitions.s5" class="toc-item">How To Use the Care Transitions Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_caretransitions_s6"><a href="/books/n/methrescontext/caretransitions/#caretransitions.s6" class="toc-item">Content of the Care Transitions Framework</a></li><li class="half_rhythm" id="toc_itm_NBK196199_caretransitions_s7"><a href="/books/n/methrescontext/caretransitions/#caretransitions.s7" class="toc-item">Applying the Care Transitions Framework: A Case Study</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK196199_discussion"><a href="/books/n/methrescontext/discussion/" class="toc-item">Discussion</a><ul id="toc_lst_NBK196199_discussion_s1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK196199_discussion_s1"><a href="/books/n/methrescontext/discussion/#discussion.s1" class="toc-item">Similarities and Differences Among the Frameworks</a></li><li class="half_rhythm" id="toc_itm_NBK196199_discussion_s2"><a href="/books/n/methrescontext/discussion/#discussion.s2" class="toc-item">Crosscutting Issues</a></li><li class="half_rhythm" id="toc_itm_NBK196199_discussion_s3"><a href="/books/n/methrescontext/discussion/#discussion.s3" class="toc-item">Limitations</a></li><li class="half_rhythm" id="toc_itm_NBK196199_discussion_s4"><a href="/books/n/methrescontext/discussion/#discussion.s4" class="toc-item">Next Steps</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK196199_conclusions"><a href="/books/n/methrescontext/conclusions/" class="toc-item">Conclusion</a></li><li class="half_rhythm" id="toc_itm_NBK196199_references_rl1"><a href="/books/n/methrescontext/references.rl1/" class="toc-item">References</a></li><li class="half_rhythm" id="toc_itm_NBK196199_glossary_gl1"><a href="/books/n/methrescontext/glossary.gl1/" class="toc-item">Glossary</a></li><li class="half_rhythm" id="toc_itm_NBK196199_appa"><a href="/books/n/methrescontext/appa/" class="toc-item">Appendix A Detailed Methods and Results of the Literature Scans</a></li><li class="half_rhythm" id="toc_itm_NBK196199_appb"><a href="/books/n/methrescontext/appb/" class="toc-item">Appendix B Included Articles From Literature Scans</a></li><li class="half_rhythm" id="toc_itm_NBK196199_appc"><a href="/books/n/methrescontext/appc/" class="toc-item">Appendix C Technical Expert Panel Composition, Methods, and Input on Usability</a></li></ul><div class="bktoc_all_cntnr align_right" style="display:none"><ul class="inline_list_right"><li><a class="bktoc_all_exp" href="#">Expand All</a></li><li style="margin-left:.8em"><a class="bktoc_all_clps" href="#">Collapse All</a></li></ul></div></div><div><p><b>Prepared for:</b>
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Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services<a class="bk_pop" href="#address1"><sup>1</sup></a>,
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<b>Contract No.</b>
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290-2007-10056-I. <b>Prepared by:</b>
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RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center, Research Triangle Park, NC</p></div><div><h4 class="inline">Suggested citation:</h4><p>Rojas Smith L, Ashok M, Dy SM, Wines RC, Teixeira-Poit S. Contextual Frameworks for Research on the Implementation of Complex System Interventions. Methods Research Report. (Prepared by the RTI International– University of North Carolina at Chapel Hill Evidence-based Practice Center under Contract No. 290-2007-10056-I.) AHRQ Publication No. 14-EHC014-EF. Rockville, MD: Agency for Healthcare Research and Quality; March 2014. <a href="http://www.effectivehealthcare.ahrq.gov/reports/final.cfm" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www.effectivehealthcare.ahrq.gov/reports/final.cfm</a>.</p></div><div><p>This report is based on research conducted by the RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10056-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.</p><p>The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.</p><p>This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.</p><p>None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.</p></div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="address1"><p class="no_top_margin">540 Gaither Road, Rockville, MD 20850; <a href="http://www.ahrq.gov" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www<wbr style="display:inline-block"></wbr>.ahrq.gov</a></p></div></dd></dl></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK196199/?report=reader">PubReader</a></li><li><a href="/books/NBK196199/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK196199" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK196199" style="display:none" title="Cite this Page"><div class="bk_tt">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. <span class="bk_cite_avail"></span></div></div></li><li><a href="/books/n/methrescontext/pdf/">PDF version of this title</a> (1.5M)</li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Other titles in these collections</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/methodscollect/">AHRQ Methods for Effective Health Care</a></li><li><a href="/books/n/hstatcollect/">Health Services/Technology Assessment Texts
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