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Systematic Reviews
Published in: Systematic Reviews 1/2015

Open Access 01-12-2015 | Methodology

Intervention Component Analysis (ICA): a pragmatic approach for identifying the critical features of complex interventions

Authors: Katy Sutcliffe, James Thomas, Gillian Stokes, Kate Hinds, Mukdarut Bangpan

Published in: Systematic Reviews | Issue 1/2015

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Abstract

Background

In order to enable replication of effective complex interventions, systematic reviews need to provide evidence about their critical features and clear procedural details for their implementation. Currently, few systematic reviews provide sufficient guidance of this sort.

Methods

Through a worked example, this paper reports on a methodological approach, Intervention Component Analysis (ICA), specifically developed to bridge the gap between evidence of effectiveness and practical implementation of interventions. By (a) using an inductive approach to explore the nature of intervention features and (b) making use of trialists’ informally reported experience-based evidence, the approach is designed to overcome the deficiencies of poor reporting which often hinders knowledge translation work whilst also avoiding the need to invest significant amounts of time and resources in following up details with authors.

Results

A key strength of the approach is its ability to reveal hidden or overlooked intervention features and barriers and facilitators only identified in practical application of interventions. It is thus especially useful where hypothesised mechanisms in an existing programme theory have failed. A further benefit of the approach is its ability to identify potentially new configurations of components that have not yet been evaluated.

Conclusions

ICA is a formal and rigorous yet relatively streamlined approach to identify key intervention content and implementation processes. ICA addresses a critical need for knowledge translation around complex interventions to support policy decisions and evidence implementation.
Literature
1.
2.
Glasziou P, Chalmers I, Green S, Michie S. Intervention synthesis: a missing link between a systematic review and practical treatment(s). PLoS Med. 2014;11(8), e1001690.CrossRefPubMedPubMedCentral
3.
Hoffmann T, Erueti C, Glasziou P. Poor description of non-pharmacological interventions: analysis of consecutive sample of randomised trials. BMJ Open. 2013;347:f3755.CrossRef
4.
5.
Hooper R, Froud R, Bremner S, Perera R, Eldridge S. Cascade diagrams for depicting complex interventions in randomised trials. BMJ. 2013;347:f6681.CrossRefPubMed
6.
Wells M, Williams B, Treweek S, Coyle J, Taylor J. Intervention description is not enough: evidence from an in-depth multiple case study on the untold role and impact of context in randomised controlled trials of seven complex interventions. Trials. 2012;13:95.CrossRefPubMedPubMedCentral
7.
8.
9.
Schulz K, Altman D, Moher D, the CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.CrossRefPubMedPubMedCentral
10.
Hoffmann T, Glasziou P, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:1687.CrossRef
11.
Langhorne P, Pollock A. What are the components of effective stroke unit care? Age Ageing. 2002;31:365–71.CrossRefPubMed
12.
MRC. Developing and evaluating complex interventions: Medical Research Council. 2008.
13.
14.
Cook T, Cooper H, Cordray D, Hartmann H, Hedges L, Light R, et al. Meta-analysis for explanation. New York: Russell Sage Foundation; 1994.
15.
Cooper H, Hedges L, Valentine J. The handbook of research synthesis and meta-analysis, second edition. New York: Russell Sage Foundation; 2009.
16.
Thomas J, Harden A, Newman M. Synthesis: combining results systematically and appropriately. In: Gough D, Oliver S, Thomas J, editors. An introduction to systematic reviews. London: Sage; 2012.
17.
Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review: a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005;10 Suppl 1:21–34.CrossRefPubMed
18.
Baxter S, Blank L, Woods H, Payne N, Rimmer M, Goyder E. Using logic model methods in systematic review synthesis: describing complex pathways in referral management interventions. BMC Med Res Methodol. 2014;14:62.CrossRefPubMedPubMedCentral
19.
Anderson LM, Petticrew M, Rehfuess E, Armstrong R, Ueffing E, Baker P, et al. Using logic models to capture complexity in systematic reviews. Res Synth Methods. 2011;2(1):33–42. doi:10.​1002/​jrsm.​32.CrossRefPubMed
20.
Horwick J, Glasziou P, Aronson J. Problems with using mechanisms to solve the problem of extrapolation. Theor Med Bioeth. 2013;34(4):275–91.CrossRef
21.
Hawe P. Lessons from complex interventions to improve health. Annu Rev Public Health. 2015;36:307–23.CrossRefPubMed
22.
Petticrew M, E R, Noyes J, Higgins J, Mayhew A, Pantoja T, et al. Synthesizing evidence on complex interventions: how meta-analytical, qualitative, and mixed-method approaches can contribute. J Clin Epidemiol. 2013;66(11):1230–43.CrossRefPubMed
23.
Anderson L, Oliver S, Michie S, Rehfuess E, Noyes J, Shemilt I. Investigating complexity in systematic reviews of interventions by using a spectrum of methods. J Clin Epidemiol. 2013;66(11):1223–9.CrossRefPubMed
24.
Thomas J, Harden A, Oakley A, Oliver S, Sutcliffe K, Rees R, et al. Integrating qualitative research with trials in systematic reviews. BMJ. 2004;328(7446):1010–2.CrossRefPubMedPubMedCentral
25.
Wierenga D, Engbers L, Van Empelen P, Duijts S, Hildebrandt V, Van Mechelen W. What is actually measured in process evaluations for worksite health promotion programs: a systematic review. BMC Public Health. 2013;13:1190.CrossRefPubMedPubMedCentral
26.
Murta S, Sanderson K, Oldenburg B. Process evaluation in occupational stress management programs: a systematic review. Am J Health Promot. 2007;21:248–54.CrossRefPubMed
27.
28.
Cordero L, Kuehn L, Kumar R, Mekhjian H. Impact of computerized physician order entry on clinical practice in a newborn intensive care unit. J Perinatol. 2004;24:88–93.CrossRefPubMed
29.
Barnes M. The impact of computerized provider order entry on pediatric medication errors. USA: Missouri State University; 2009.
30.
Del Beccaro M, Jeffries H, Eisenberg M, Harry E. Computerized provider order entry implementation: no association with increased mortality rates in an intensive care unit. Pediatrics. 2006;118:290–5.CrossRefPubMed
31.
Han Y, Carcillo J, Venkataraman S, Clark R, Watson R, Nguyen T, et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2005;116:1506–12.CrossRefPubMed
32.
Holdsworth M, Fichtl R, Raisch D, Hewryk A, Behta M, Mendez-Rico E, et al. Impact of computerized prescriber order entry on the incidence of adverse drug events in pediatric inpatients. Pediatrics. 2007;120:1058–66.CrossRefPubMed
33.
Jani Y, Barber N, Wong I. Paediatric dosing errors before and after electronic prescribing. Qual Saf Health Care. 2010;19:337–40.CrossRefPubMed
34.
Kadmon G, Bron-Harlev E, Nahum E, Schiller O, Haski G, Shonfeld T. Computerized order entry with limited decision support to prevent prescription errors in a PICU. Pediatrics. 2009;124:935–40.CrossRefPubMed
35.
Kazemi A, Ellenius J, Pourasghar F, Tofighi S, Salehi A, Amanati A, et al. The effect of computerized physician order entry and decision support system on medication errors in the neonatal ward: experiences from an Iranian teaching hospital. J Med Syst. 2011;35:25–37.CrossRefPubMed
36.
Keene A, Ashton L, Shure D, Napoleone D, Katyal C, Bellin E. Mortality before and after initiation of a computerized physician order entry system in a critically ill pediatric population. Pediatr Crit Care Med. 2007;8:268–71.CrossRefPubMed
37.
King W, Paice N, Rangrej J, Forestell G, Swartz R. The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients. Pediatrics. 2003;112:506–9.CrossRefPubMed
38.
Lehmann C, Conner K, Cox J. Preventing provider errors: online total parenteral nutrition calculator. Pediatrics. 2004;113:748–53.CrossRefPubMed
39.
Lehmann C, Kim G, Gujral R, Veltri M, Clark J, Miller M. Decreasing errors in pediatric continuous intravenous infusions. Pediatr Crit Care Med. 2006;7:225–30.CrossRefPubMed
40.
Maat B, Rademaker C, Oostveen M, Krediet T, Egberts T, Bollen C. The effect of a computerized prescribing and calculating system on hypo- and hyperglycemias and on prescribing time efficiency in neonatal intensive care patients. J Parenter Enter Nutr. 2013;37:85–91.CrossRef
41.
Potts A, Barr F, Gregory D, Wright L, Patel N. Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics. 2004;113:59–63.CrossRefPubMed
42.
Sowan A, Gaffoor M, Soeken K, Johantgen M, Vaidya V. Impact of computerized orders for pediatric continuous drug infusions on detecting infusion pump programming errors: a simulated study. J Pediatr Nurs. 2010;25:108–18.CrossRefPubMed
43.
Sullins A, Richard A, Manasco K, Phillips M, Gomez T. Which comes first, CPOE or eMAR? A retrospective analysis of health information technology implementation. Hosp Pharm. 2012;47:863–70.CrossRef
44.
Upperman J, Staley P, Friend K, Neches W, Kazimer D, Benes J, et al. The impact of hospitalwide computerized physician order entry on medical errors in a pediatric hospital. J Pediatr Surg. 2005;40:57–9.CrossRefPubMed
45.
Vardi A, Efrati O, Levin I, Matok I, Rubinstein M, Paret G, et al. Prevention of potential errors in resuscitation medications orders by means of a computerised physician order entry in paediatric critical care. Resuscitation. 2007;73:400–6.CrossRefPubMed
46.
Walsh K, Landrigan C, Adams W, Vinci R, Chessare J, Cooper M, et al. Effect of computer order entry on prevention of serious medication errors in hospitalized children. Pediatrics. 2008;121:e421–e7.CrossRefPubMed
47.
Warrick C, Naik H, Avis S, Fletcher P, Franklin B, Inwald D. A clinical information system reduces medication errors in paediatric intensive care. Intensive Care Med. 2011;37:691–4.CrossRefPubMed
48.
Sutcliffe K, Stokes G, O’Mara-Eves A, Caird J, Hinds K, Bangpan M et al. Paediatric medication error: a systematic review of the extent and nature of the problem in the UK and international interventions to address it. EPPI-Centre, Social Science Research Unit, Institute of Education, University of London. London. 2014. http://​eppi.​ioe.​ac.​uk/​cms/​Default.​aspx?​tabid=​3466.
49.
Wright A, Sittig D, Ash J, Feblowitz J, Meltzer S, McMullen C, et al. Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of frontend tools in commercial and internally developed electronic health record systems. J Am Med Inform Assoc. 2011;18:232–42.CrossRefPubMedPubMedCentral
50.
Wong I, Conroy S, Collier J, Haines L, Sweis D, Yeung V, et al. Cooperative of safety of medicines in children (COSMIC): scoping study to identify and analyse interventions used to reduce errors in calculation of paediatric drug doses: report to the Patient Safety Research Programme. London: Policy Research Programme of the Department of Health; 2007. http://​www.​birmingham.​ac.​uk/​Documents/​collegemds/​haps/​projects/​cfhep/​psrp/​finalreports/​PS026COSMICFinal​Report.​pdf Accessed 4 August 2014.
51.
Thomas J, O’Mara-Eves A, Brunton G. Using qualitative comparative analysis (QCA) in systematic reviews of complex interventions: a worked example. Syst Rev. 2014;3:67.CrossRefPubMedPubMedCentral
52.
Candy B, King M, Jones L, Oliver S. Using qualitative evidence on patients’ views to help understand variation in effectiveness of complex interventions: a qualitative comparative analysis. Trials. 2013;14:179.CrossRefPubMedPubMedCentral
53.
54.
Sackett DL, Rosenberg WMC, Muir Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. Br Med J. 1996;312:71–2.CrossRef
55.
Meyer J. An introduction to deployable recovery systems: Sandia report. 1985.
56.
Lipton P. Inference to the best explanation. 2nd ed. Abingdon: Routledge; 2004.
57.
Metadata
Title
Intervention Component Analysis (ICA): a pragmatic approach for identifying the critical features of complex interventions
Authors
Katy Sutcliffe
James Thomas
Gillian Stokes
Kate Hinds
Mukdarut Bangpan
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2015
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-015-0126-z

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