Implementation Outcomes and Indicators as a New Challenge in Health Services Research: A Systematic Scoping Review

The aim of this systematic scoping review was to identify and analyze indicators that address implementation quality or success in health care services and to deduce recommendations for further indicator development. This review was conducted according to the Joanna Briggs Manual and the PRISMA Statement. CINAHL, EMBASE, MEDLINE, and PsycINFO were searched. Studies or reviews published between August 2008 and 2018 that reported monitoring of the quality or the implementation success in health care services by using indicators based on continuous variables and proportion-based, ratio-based, standardized ratio–based, or rate-based variables or indices were included. The records were screened by title and abstract, and the full-text articles were also independently double-screened by 3 reviewers for eligibility. In total, 4376 records were identified that resulted in 10 eligible studies, including 67 implementation indicators. There was heterogeneity regarding the theoretical backgrounds, designs, objectives, settings, and implementation indicators among the publications. None of the indicators addressed the implementation outcomes of appropriateness or sustainability. Service implementation efficiency was identified as an additional outcome. Achieving consensus in framing implementation outcomes and indicators will be a new challenge in health services research. Considering the new debates regarding health care complexity, the further development of indicators based on complementary qualitative and quantitative approaches is needed.