The Oxford Implementation Index

DSPI PI: Paul Montgomery

Medical researchers have drawn distinctions between two types of tests for medical technology: tests of efficacy determine how a medical technology performs under ideal circumstances such as those observed in clinical trials, whereas tests of effectiveness determine how the technology performs in usual circumstances such as those found in actual practice. Both answer important questions, but the distinctions between these two types of tests have become blurred. As a result, when a new medical technology is found to be no better than its alternative, we may have no way of determining whether this is due to the technology itself or to the way it was implemented. As an example, when patients fail to adhere to treatment regimens, they may suffer adverse outcomes that are related not to the efficacy of their treatments but, rather, to the effectiveness of their use.

While there have been several attempts to develop and test methods for assessing implementation fidelity within specific domains (e.g. behaviour change research), the Oxford Implementation Index is the first attempt to develop a general methodology that can be applied to many domains. It identifies four implementation components that may affect treatment fidelity: (1) treatment design, (2) treatment delivery by clinicians, (3) treatment uptake by patients, and (4) context factors. By using this framework, researchers can determine whether system failures are due directly to the interventions themselves or to problems with implementation, and identify areas for improvement.

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Journal of the American Medical Informatics Association