gms | German Medical Science

Implementation interventions are educational, organizational, financial or technological activities/changes, applied to healthcare professionals or healthcare organizations, to improve healthcare practice and outcomes. Almost all implementation are complex interventions. There is little research evidence to guide the choice of methods for developing and evaluating complex interventions. In the ongoing European project ‘Tailored implementation in chronic illness care’ (TICD) we test different methods for tailoring implementation interventions to barriers and enablers for improvement. More complex approaches will be compared with a pragmatic approach. There is a range of options for evaluation of complex interventions, including positivist, realist and participatory approaches. One important issue is that the effectiveness of clinical interventions may be reduced after implementation, because of suboptimal fidelity of both the clinical interventions and the implementation intervention. Another important issue is that the local context may influence the impact of an intervention, although it has been difficult to identify factors which consistently predict outcomes.