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  1. Article ; Online: Progress with the Learning Health System 2.0: a rapid review of Learning Health Systems' responses to pandemics and climate change.

    Smith, Carolynn L / Fisher, Georgia / Dharmayani, Putu Novi Arfirsta / Wijekulasuriya, Shalini / Ellis, Louise A / Spanos, Samantha / Dammery, Genevieve / Zurynski, Yvonne / Braithwaite, Jeffrey

    BMC medicine

    2024  Volume 22, Issue 1, Page(s) 131

    Abstract: Background: Pandemics and climate change each challenge health systems through increasing numbers and new types of patients. To adapt to these challenges, leading health systems have embraced a Learning Health System (LHS) approach, aiming to increase ... ...

    Abstract Background: Pandemics and climate change each challenge health systems through increasing numbers and new types of patients. To adapt to these challenges, leading health systems have embraced a Learning Health System (LHS) approach, aiming to increase the efficiency with which data is translated into actionable knowledge. This rapid review sought to determine how these health systems have used LHS frameworks to both address the challenges posed by the COVID-19 pandemic and climate change, and to prepare for future disturbances, and thus transition towards the LHS2.0.
    Methods: Three databases (Embase, Scopus, and PubMed) were searched for peer-reviewed literature published in English in the five years to March 2023. Publications were included if they described a real-world LHS's response to one or more of the following: the COVID-19 pandemic, future pandemics, current climate events, future climate change events. Data were extracted and thematically analyzed using the five dimensions of the Institute of Medicine/Zurynski-Braithwaite's LHS framework: Science and Informatics, Patient-Clinician Partnerships, Continuous Learning Culture, Incentives, and Structure and Governance.
    Results: The search yielded 182 unique publications, four of which reported on LHSs and climate change. Backward citation tracking yielded 13 additional pandemic-related publications. None of the climate change-related papers met the inclusion criteria. Thirty-two publications were included after full-text review. Most were case studies (n = 12, 38%), narrative descriptions (n = 9, 28%) or empirical studies (n = 9, 28%). Science and Informatics (n = 31, 97%), Continuous Learning Culture (n = 26, 81%), Structure and Governance (n = 23, 72%) were the most frequently discussed LHS dimensions. Incentives (n = 21, 66%) and Patient-Clinician Partnerships (n = 18, 56%) received less attention. Twenty-nine papers (91%) discussed benefits or opportunities created by pandemics to furthering the development of an LHS, compared to 22 papers (69%) that discussed challenges.
    Conclusions: An LHS 2.0 approach appears well-suited to responding to the rapidly changing and uncertain conditions of a pandemic, and, by extension, to preparing health systems for the effects of climate change. LHSs that embrace a continuous learning culture can inform patient care, public policy, and public messaging, and those that wisely use IT systems for decision-making can more readily enact surveillance systems for future pandemics and climate change-related events.
    Trial registration: PROSPERO pre-registration: CRD42023408896.
    MeSH term(s) United States ; Humans ; Learning Health System ; Pandemics ; Climate Change ; COVID-19/epidemiology ; Patient Care
    Language English
    Publishing date 2024-03-22
    Publishing country England
    Document type Review ; Journal Article
    ZDB-ID 2131669-7
    ISSN 1741-7015 ; 1741-7015
    ISSN (online) 1741-7015
    ISSN 1741-7015
    DOI 10.1186/s12916-024-03345-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: The rise of direct-to-consumer telemedicine services in Australia: implications for primary care and future research.

    Foo, Darran / Spanos, Samantha / Dammery, Genevieve / Ellis, Louise A / Willcock, Simon M / Braithwaite, Jeffrey

    The Medical journal of Australia

    2023  Volume 219, Issue 8, Page(s) 344–347

    Language English
    Publishing date 2023-09-04
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 186082-3
    ISSN 1326-5377 ; 0025-729X
    ISSN (online) 1326-5377
    ISSN 0025-729X
    DOI 10.5694/mja2.52097
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The journey to a learning health system in primary care: a qualitative case study utilising an embedded research approach.

    Dammery, Genevieve / Ellis, Louise A / Churruca, Kate / Mahadeva, Janani / Lopez, Francisco / Carrigan, Ann / Halim, Nicole / Willcock, Simon / Braithwaite, Jeffrey

    BMC primary care

    2023  Volume 24, Issue 1, Page(s) 22

    Abstract: Background: Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which ... ...

    Abstract Background: Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to establish which elements of the learning health system were being realised within a university-based general practice and determine acceptability from staff to embrace further the transition towards a learning health system.
    Methods: Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the learning health system model. Interviews were transcribed and thematically analysed based on the National Academy of Medicine's framework of learning health systems.
    Results: In total, 32 (91%) practice staff were interviewed, comprising general practitioners (n = 15), nurses (n = 3), administrative staff (n = 13), and a psychologist (n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system (e.g., emphasising science and informatics; focusing on patient-clinician partnerships; applying incentives; supporting a continuous learning culture; and establishing structures and governance for learning). These measures were supported by the university-based setting, and resultant culture of learning. Nevertheless, there were areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice.
    Conclusion: Although the idea of a learning health system has been gaining traction in recent years, there are comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework.
    MeSH term(s) Humans ; Learning Health System ; Qualitative Research ; General Practitioners ; General Practice ; Primary Health Care
    Language English
    Publishing date 2023-01-19
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2731-4553
    ISSN (online) 2731-4553
    DOI 10.1186/s12875-022-01955-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: The Patient Activation Measure (PAM) and the pandemic: Predictors of patient activation among Australian health consumers during the COVID-19 pandemic.

    Dammery, Genevieve / Vitangcol, Kathryn / Ansell, James / Ellis, Louise A / Smith, Carolynn L / Carrigan, Ann / Braithwaite, Jeffrey / Zurynski, Yvonne

    Health expectations : an international journal of public participation in health care and health policy

    2023  Volume 26, Issue 3, Page(s) 1107–1117

    Abstract: Background: Preventative healthcare is crucial for improving individual patient outcomes and is integral to sustainable health systems. The effectiveness of prevention programs is enhanced by activated populations who are capable of managing their own ... ...

    Abstract Background: Preventative healthcare is crucial for improving individual patient outcomes and is integral to sustainable health systems. The effectiveness of prevention programs is enhanced by activated populations who are capable of managing their own health and are proactive to keep themselves well. However, little is known about the level of activation among people drawn from general populations. We used the Patient Activation Measure (PAM) to address this knowledge gap.
    Methods: A representative, population-based survey of Australian adults was conducted in October 2021 during the Delta strain outbreak of the COVID-19 pandemic. Comprehensive demographic information was collected, and the participants completed the Kessler-6 psychological distress scale (K6) and PAM. Multinomial and binomial logistic regression analyses were performed to determine the effect of demographic factors on PAM scores, which are categorised into four levels: 1-participants disengaged with their health; 2-becoming aware of how to manage their health; 3-acting on their health; and 4-engaging with preventative healthcare and advocating for themselves.
    Results: Of 5100 participants, 7.8% scored at PAM level 1; 13.7% level 2, 45.3% level 3, and 33.2% level 4. The mean score was 66.1, corresponding to PAM level 3. More than half of the participants (59.2%) reported having one or more chronic conditions. Respondents aged 18 to 24 years old were twice as likely to score PAM level 1 compared with people aged 25-44 (p < .001) or people aged over 65 years (p < .05). Speaking a language other than English at home was significantly associated with having low PAM (p < .05). Greater psychological distress scores (K6) were significantly predictive of low PAM scores (p < .001).
    Conclusion: Overall, Australian adults showed high levels of patient activation in 2021. People with lower incomes, of younger age, and those experiencing psychological distress were more likely to have low activation. Understanding the level of activation enables targeting sociodemographic groups for extra support to increase the capacity to engage in prevention activities. Conducted during the COVID-19 pandemic, our study provides a baseline for comparison as we move out of the pandemic and associated restrictions and lockdowns.
    Patient or public contribution: The study and survey questions were co-designed with consumer researchers from the Consumers Health Forum of Australia (CHF) as equal partners. Researchers from CHF were involved in the analysis of data and production of all publications using data from the consumer sentiment survey.
    MeSH term(s) Adolescent ; Adult ; Humans ; Young Adult ; Australia/epidemiology ; Communicable Disease Control ; COVID-19/epidemiology ; Pandemics ; Patient Participation/psychology
    Language English
    Publishing date 2023-02-21
    Publishing country England
    Document type Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2119434-8
    ISSN 1369-7625 ; 1369-6513
    ISSN (online) 1369-7625
    ISSN 1369-6513
    DOI 10.1111/hex.13725
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Psychological distress and digital health service use during COVID-19: A national Australian cross-sectional survey.

    Ellis, Louise A / Dammery, Genevieve / Wells, Leanne / Ansell, James / Smith, Carolynn L / Tran, Yvonne / Braithwaite, Jeffrey / Zurynski, Yvonne

    Frontiers in psychiatry

    2022  Volume 13, Page(s) 1028384

    Abstract: Background: Previous research suggests that the COVID-19 pandemic caused significant disruption to the lives and mental health of Australians. In response, health services adapted rapidly to digital modes of treatment, prevention and care. Although a ... ...

    Abstract Background: Previous research suggests that the COVID-19 pandemic caused significant disruption to the lives and mental health of Australians. In response, health services adapted rapidly to digital modes of treatment, prevention and care. Although a large amount of research emerged in the first year of the pandemic, the longer-term mental health impacts, contributing factors, and population-level utilization of digital health services are unknown.
    Methods: A population-based online survey of 5,100 Australians adults was conducted in October 2021. Psychological distress was assessed with the Kessler 6-item Psychological Distress Scale. Additional survey questions included use and satisfaction with digital health services. Where available, data were compared with our previous survey conducted in 2018, permitting an examination of pre- and post-pandemic digital health service utilization.
    Results: In 2021, almost a quarter (
    Conclusion: Rates of serious psychological distress during the second year of the pandemic remained high, providing further evidence for the serious impact of COVID-19 on the mental health of the general population. Those with psychological distress accessed digital mental health services and were satisfied with the care they received. The results highlight the continued need for mental health support and digital health services, particularly for people living with chronic conditions, younger adults and people most impacted by the COVID-19 pandemic, both in the short term and beyond.
    Language English
    Publishing date 2022-10-20
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564218-2
    ISSN 1664-0640
    ISSN 1664-0640
    DOI 10.3389/fpsyt.2022.1028384
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: High-performing primary care: reinvigorating general practice as a learning health system.

    Foo, Darran / Mahadeva, Janani / Lopez, Francisco / Ellis, Louise A / Churruca, Kate / Dammery, Genevieve / Willcock, Simon / Braithwaite, Jeffrey

    The British journal of general practice : the journal of the Royal College of General Practitioners

    2022  Volume 73, Issue 726, Page(s) 8–9

    MeSH term(s) Humans ; Learning Health System ; General Practice ; Family Practice ; Primary Health Care
    Language English
    Publishing date 2022-12-21
    Publishing country England
    Document type Editorial
    ZDB-ID 1043148-2
    ISSN 1478-5242 ; 0035-8797 ; 0960-1643
    ISSN (online) 1478-5242
    ISSN 0035-8797 ; 0960-1643
    DOI 10.3399/bjgp23X731505
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: How can the healthcare system deliver sustainable performance? A scoping review.

    Zurynski, Yvonne / Herkes-Deane, Jessica / Holt, Joanna / McPherson, Elise / Lamprell, Gina / Dammery, Genevieve / Meulenbroeks, Isabelle / Halim, Nicole / Braithwaite, Jeffrey

    BMJ open

    2022  Volume 12, Issue 5, Page(s) e059207

    Abstract: Background: Increasing health costs, demand and patient multimorbidity challenge the sustainability of healthcare systems. These challenges persist and have been amplified by the global pandemic.: Objectives: We aimed to develop an understanding of ... ...

    Abstract Background: Increasing health costs, demand and patient multimorbidity challenge the sustainability of healthcare systems. These challenges persist and have been amplified by the global pandemic.
    Objectives: We aimed to develop an understanding of how the sustainable performance of healthcare systems (SPHS) has been conceptualised, defined and measured.
    Design: Scoping review of peer-reviewed articles and editorials published from database inception to February 2021.
    Data sources: PubMed and Ovid Medline, and snowballing techniques.
    Eligibility criteria: We included articles that discussed key focus concepts of SPHS: (1) definitions, (2) measurement, (3) identified challenges, (4) identified solutions for improvement and (5) scaling successful solutions to maintain SPHS.
    Data extraction and synthesis: After title/abstract screening, full-text articles were reviewed, and relevant information extracted and synthesised under the five focus concepts.
    Results: Of 142 included articles, 38 (27%) provided a definition of SPHS. Definitions were based mainly on financial sustainability, however, SPHS was also more broadly conceptualised and included acceptability to patients and workforce, resilience through adaptation, and rapid absorption of evidence and innovations. Measures of SPHS were also predominantly financial, but recent articles proposed composite measures that accounted for financial, social and health outcomes. Challenges to achieving SPHS included the increasingly complex patient populations, limited integration because of entrenched fragmented systems and siloed professional groups, and the ongoing translational gaps in evidence-to-practice and policy-to-practice. Improvement strategies for SPHS included developing appropriate workplace cultures, direct community and consumer involvement, and adoption of evidence-based practice and technologies. There was also a strong identified need for long-term monitoring and evaluations to support adaptation of healthcare systems and to anticipate changing needs where possible.
    Conclusions: To implement lasting change and to respond to new challenges, we need context-relevant definitions and frameworks, and robust, flexible, and feasible measures to support the long-term sustainability and performance of healthcare systems.
    MeSH term(s) Delivery of Health Care ; Health Services ; Humans ; Pandemics ; Workforce
    Language English
    Publishing date 2022-05-24
    Publishing country England
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2021-059207
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Mapping continuous learning using social network research: a social network study of Australian Genomics as a Learning Health System.

    Ellis, Louise A / Long, Janet C / Pomare, Chiara / Mahmoud, Zeyad / Lake, Rebecca / Dammery, Genevieve / Braithwaite, Jeffrey

    BMJ open

    2022  Volume 12, Issue 10, Page(s) e064663

    Abstract: Objectives: To explore a macrolevel Learning Health System (LHS) and examine if an intentionally designed network can foster a collaborative learning community over time. The secondary aim was to demonstrate the application of social network research to ...

    Abstract Objectives: To explore a macrolevel Learning Health System (LHS) and examine if an intentionally designed network can foster a collaborative learning community over time. The secondary aim was to demonstrate the application of social network research to the field of LHS.
    Design: Two longitudinal online questionnaires of the Australian Genomics learning community considering relationships between network members at three time points: 2016, 2018, 2019. The questionnaire included closed Likert response questions on collaborative learning patterns and open-response questions to capture general perceptions of the community. Social network data were analysed and visually constructed using Gephi V.0.9.2 software, Likert questions were analysed using SPSS, and open responses were analysed thematically using NVivo.
    Setting: Australian Genomic Health Alliance.
    Participants: Clinicians, scientists, researchers and community representatives.
    Results: Australian Genomics members highlighted the collaborative benefits of the network as a learning community to foster continuous learning in the ever-evolving field of clinical genomics. The learning community grew from 186 members (2016), to 384 (2018), to 439 (2019). Network density increased (2016=0.023, 2018=0.043), then decreased (2019=0.036). Key players remained consistent with potential for new members to achieve focal positions in the network. Informal learning was identified as the most influential learning method for genomic practice.
    Conclusions: This study shows that intentionally building a network provides a platform for continuous learning-a fundamental component for establishing an LHS. The Australian Genomics learning community shows evidence of maturity and sustainability in supporting the continuous learning culture of clinical genomics. The network provides a practical means to spread new knowledge and best practice across the entire field. We show that intentionally designed networks provide the opportunity and means for interdisciplinary learning between diverse agents over time and demonstrate the application of social network research to the LHS field.
    MeSH term(s) Australia ; Education, Continuing ; Genomics ; Humans ; Learning Health System ; Social Networking
    Language English
    Publishing date 2022-10-05
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2022-064663
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Transition models of care for type 1 diabetes: a systematic review.

    Zurynski, Yvonne / Carrigan, Ann / Meulenbroeks, Isabelle / Sarkies, Mitchell N / Dammery, Genevieve / Halim, Nicole / Lake, Rebecca / Davis, Elizabeth / Jones, Timothy W / Braithwaite, Jeffrey

    BMC health services research

    2023  Volume 23, Issue 1, Page(s) 779

    Abstract: Background: Managing the care regimen for Type 1 Diabetes is challenging for emerging adults, as they take on greater responsibility for self-management. A diverse range of models of care have been implemented to improve safety and quality of care ... ...

    Abstract Background: Managing the care regimen for Type 1 Diabetes is challenging for emerging adults, as they take on greater responsibility for self-management. A diverse range of models of care have been implemented to improve safety and quality of care during transition between paediatric and adult services. However, evidence about acceptability and effectiveness of these is limited. Our aim was to synthesise the evidence for transition models and their components, examine the health related and psychosocial outcomes, and to identify determinants associated with the implementation of person-centred models of transition care.
    Method: We searched Medline, CINAHL, EMBASE and Scopus. Peer reviewed empirical studies that focused on T1D models of care published from 2010 to 2021 in English, reporting experimental, qualitative, mixed methods, and observational studies were included.
    Results: Fourteen studies reported on health and psychosocial outcomes, and engagement with healthcare. Three key models of care emerged: structured transition education programs (6 studies), multidisciplinary team transition support (5 studies) and telehealth/virtual care (3 studies). Compared with usual practice, three of the six structured transition education programs led to improvements in maintenance of glycaemic control, psychological well-being, and engagement with health services. Four MDT transition care models reported improved health outcomes, and improved engagement with health services, however, three studies reported no benefit. Reduced diabetes related stress and increased patient satisfaction were reported by two studies, but three reported no benefit. Telehealth and virtual group appointments improved adherence to self-management and reduced diabetes distress but did not change health outcomes.
    Conclusions: Although some health and psychosocial benefits are reported, the results were mixed. No studies reported on T1D transition model implementation outcomes such as acceptability, adoption, and appropriateness among clinicians or managers implementing these models. This gap needs to be addressed to support future adoption of successful models.
    MeSH term(s) Adult ; Child ; Humans ; Diabetes Mellitus, Type 1/therapy ; Diabetes Mellitus, Type 1/psychology ; Transition to Adult Care
    Language English
    Publishing date 2023-07-20
    Publishing country England
    Document type Systematic Review ; Journal Article
    ZDB-ID 2050434-2
    ISSN 1472-6963 ; 1472-6963
    ISSN (online) 1472-6963
    ISSN 1472-6963
    DOI 10.1186/s12913-023-09644-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Built to last? Barriers and facilitators of healthcare program sustainability: a systematic integrative review.

    Zurynski, Yvonne / Ludlow, Kristiana / Testa, Luke / Augustsson, Hanna / Herkes-Deane, Jessica / Hutchinson, Karen / Lamprell, Gina / McPherson, Elise / Carrigan, Ann / Ellis, Louise A / Dharmayani, Putu Novi Arfirsta / Smith, Carolynn L / Richardson, Lieke / Dammery, Genevieve / Singh, Nehal / Braithwaite, Jeffrey

    Implementation science : IS

    2023  Volume 18, Issue 1, Page(s) 62

    Abstract: Objective: To identify barriers and facilitators associated with the sustainability of implemented and evaluated improvement programs in healthcare delivery systems.: Data sources and study setting: Six academic databases were searched to identify ... ...

    Abstract Objective: To identify barriers and facilitators associated with the sustainability of implemented and evaluated improvement programs in healthcare delivery systems.
    Data sources and study setting: Six academic databases were searched to identify relevant peer-reviewed journal articles published in English between July 2011 and June 2022. Studies were included if they reported on healthcare program sustainability and explicitly identified barriers to, and facilitators of, sustainability.
    Study design: A systematic integrative review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Study quality was appraised using Hawker's Quality Assessment Tool.
    Data collection/extraction methods: A team of reviewers screened eligible studies against the inclusion criteria and extracted the data independently using a purpose-designed Excel spreadsheet. Barriers and facilitators were extracted and mapped to the Integrated Sustainability Framework (ISF). Frequency counts of reported barriers/facilitators were performed across the included studies.
    Results: Of the 124 studies included in this review, almost half utilised qualitative designs (n = 52; 41.9%) and roughly one third were conducted in the USA (n = 43; 34.7%). Few studies (n = 29; 23.4%) reported on program sustainability beyond 5 years of program implementation and only 16 of them (55.2%) defined sustainability. Factors related to the ISF categories of inner setting (n = 99; 79.8%), process (n = 99; 79.8%) and intervention characteristics (n = 72; 58.1%) were most frequently reported. Leadership/support (n = 61; 49.2%), training/support/supervision (n = 54; 43.5%) and staffing/turnover (n = 50; 40.3%) were commonly identified barriers or facilitators of sustainability across included studies. Forty-six (37.1%) studies reported on the outer setting category: funding (n = 26; 56.5%), external leadership by stakeholders (n = 16; 34.8%), and socio-political context (n = 14; 30.4%). Eight studies (6.5%) reported on discontinued programs, with factors including funding and resourcing, poor fit, limited planning, and intervention complexity contributing to discontinuation.
    Conclusions: This review highlights the importance of taking into consideration the inner setting, processes, intervention characteristics and outer setting factors when sustaining healthcare programs, and the need for long-term program evaluations. There is a need to apply consistent definitions and implementation frameworks across studies to strengthen evidence in this area.
    Trial registration: https://bmjopen.bmj.com/content/7/11/e018568 .
    MeSH term(s) Humans ; Program Evaluation ; Delivery of Health Care ; Health Facilities ; Leadership
    Language English
    Publishing date 2023-11-13
    Publishing country England
    Document type Systematic Review ; Journal Article ; Review
    ZDB-ID 2225822-X
    ISSN 1748-5908 ; 1748-5908
    ISSN (online) 1748-5908
    ISSN 1748-5908
    DOI 10.1186/s13012-023-01315-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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