BACKGROUND Health systems in Australia and worldwide are increasingly expected to conduct research and quality improvement activities in addition to delivering clinical care and training health professionals. This study aims to inform a research impact evaluation at a regional Australian Hospital and Health Service by developing a programme theory showing how research investment is expected to have impact. METHODS This qualitative study, representing the first phase of a larger mixed methods research impact evaluation at the Townsville Hospital and Health Service (THHS), adopts a realist-informed design involving the development of a programme theory. Data were obtained between February and May 2019 from strategic documentation and interviews with six current and former health service executives and senior employees. Inductive themes were integrated into a conceptual framework to visually represent the programme theory. RESULTS Research at THHS has developed organically as the service has matured into a regional tertiary referral service serving a diverse rural and remote population across northern Queensland. Throughout this journey, individual THHS leaders often adopted a research development mantle despite disincentives arising from a performance-driven reporting and activity-based funding service context. Impact expectations from research investment at THHS were identified in the categories of enhanced research activity and capacity among clinicians, and improved clinical practice, health workforce capability and stability, and patient and population health. Seven contextual factors were identified as potential enablers or obstacles to these impact expectations and ambitions. CONCLUSIONS By identifying both relevant impact types and key contextual factors, this study offers programme theory to inform a planned research impact evaluation at THHS. The conceptual framework may be useful in other regionally based health service settings. More broadly, there are opportunities for future research to test and refine hybrid versions of linear and realist research impact evaluation models that combine resource-intensive, theory-driven approaches with policy practicality.

中文翻译：

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评估澳大利亚区域医院和卫生服务机构的研究投资和影响：计划理论和概念框架。

背景技术除了提供临床护理和培训卫生专业人员以外，越来越期望澳大利亚和世界范围内的卫生系统进行研究和质量改进活动。这项研究的目的是通过制定计划理论，说明预期的研究投资将如何产生影响，从而为澳大利亚区域医院和卫生服务局的研究影响评估提供参考。方法这项定性研究代表汤斯维尔医院和卫生服务局（THHS）进行的较大的混合方法研究影响评估的第一阶段，采用了基于现实主义的设计，涉及程序理论的发展。数据是在2019年2月至2019年5月之间从战略文件以及与六名现任和前任卫生服务主管和高级员工的访谈中获得的。归纳主题被集成到一个概念框架中，以直观地表示程序理论。结果随着THHS的服务逐渐发展成为区域性第三级推荐服务，该服务已为昆士兰州北部的各种农村和偏远人口提供了有机服务。在此过程中，尽管基于绩效驱动的报告和基于活动的资金服务环境产生了不利因素，但THHS的领导者通常还是采用了研究开发的方式。在提高临床医生的研究活动和能力，改善临床实践，卫生人力和稳定性以及患者和人群健康的类别中，确定了THHS研究投资的预期影响。七个环境因素被确定为这些影响预期和抱负的潜在促成因素或障碍。结论通过确定相关的影响类型和关键的背景因素，本研究提供了计划理论，以为THHS的计划研究影响评估提供依据。概念框架在其他基于区域的卫生服务设置中可能很有用。更广泛地说，未来的研究有机会测试和完善线性和现实研究影响评估模型的混合版本，这些模型将资源密集型，理论驱动的方法与政策实用性相结合。概念框架在其他基于区域的卫生服务设置中可能很有用。更广泛地说，未来的研究有机会测试和完善线性和现实研究影响评估模型的混合版本，这些模型将资源密集型，理论驱动的方法与政策实用性相结合。概念框架在其他基于区域的卫生服务设置中可能很有用。更广泛地说，未来的研究有机会测试和完善线性和现实研究影响评估模型的混合版本，这些模型将资源密集型，理论驱动的方法与政策实用性相结合。