Table 1 Implementation strategy taxonomy according to the EPOC classification system

Professional

1. Distribution of educational materials

Distribution of published or printed recommendations for clinical care, including clinical practice guidelines, audio-visual materials and electronic publications. The materials may have been delivered personally or through mass mailings.

2. Educational meetings

Conferences, lectures, workshops or traineeships.

3. Local consensus processes

Inclusion of participating providers in discussion to ensure that they agreed that the chosen clinical problem was important and the approach to managing the problem was appropriate.

4. Outreach visits

Use of a trained person who met with providers in their practice settings to give information with the intent of changing the provider’s practice. The information given may have included feedback on the performance of the provider(s).

5. Local opinion leader

Use of providers nominated and explicitly identified by their colleagues as educationally influential.

6. Patient-mediated intervention

New, previously unavailable clinical information collected directly from patients and given to the provider; for example, patient depression scores from a survey instrument.

7. Audit and feedback

Any summary of clinical performance of health care over a specified period of time. The summary may also have included recommendations for clinical action. The information may have been obtained from medical records, computerized databases, or observations from patients.

8. Reminders

Patient or encounter-specific information, provided verbally, on paper or on a computer screen, which is designed or intended to prompt a health professional to recall information. This would usually be encountered through their general education; in the medical records or through interactions with peers, and so remind them to perform or avoid some action to aid individual patient care. Computer-aided decision support and drugs dosage are included.

9. Marketing / Tailored interventions

Use of personal interviewing, group discussion (focus groups), or a survey of targeted providers to identify barriers to change and subsequent design of an intervention that addresses identified barriers.

10. Mass media

(1) Varied use of communication that reached great numbers of people including television, radio, newspapers, posters, leaflets, and booklets, alone or in conjunction with other interventions; (2) targeted at the population level.

Organizational

11. Provider oriented interventions

Revision of professional roles, for example, expansion of role to include new tasks; creation of clinical multidisciplinary teams who work together; formal integration of services; skill mix changes (changes in numbers, types or qualifications of staff); arrangements for follow up; satisfaction of providers with the conditions of work and the material and psychic rewards (for example, interventions to boost morale); communication and case discussion between distant health professionals

12. Patient oriented interventions

Mail order pharmacies (for example, compared to traditional pharmacies); presence and functioning of adequate mechanisms for dealing with patients’ suggestions and complaints; consumer participation in governance of health care organization; other categories

13. Structural interventions

Changes to the setting/site of service delivery; changes in physical structure, facilities and equipment; changes in medical records systems (for example, changing from paper to computerized records); changes in scope and nature of benefits and services; presence and organization of quality monitoring mechanisms; ownership, accreditation, and affiliation status of hospitals and other facilities; staff organization

Financial

14. Provider or patient interventions

In summary: patient or provider is financially supported to execute specific actions. For detailed definitions, see reference [10]

Regulatory

15. Changes in medical liability

Any intervention that aims to change health services delivery or costs by regulation or law (these interventions may overlap with organizational and financial interventions).

16. Management of patient complaints

17. Peer review or Licensure