BACKGROUND The objective was to conduct a systematic review of toolkit evaluations intended to spread interventions to improve healthcare quality. We aimed to determine the components, uptake, and effectiveness of publicly available toolkits. METHODS We searched PubMed, CINAHL, and the Web of Science from 2005 to May 2018 for evaluations of publicly available toolkits, used a forward search of known toolkits, screened references, and contacted topic experts. Two independent reviewers screened publications for inclusion. One reviewer abstracted data and appraised the studies, checked by a second reviewer; reviewers resolved disagreements through discussion. Findings, summarized in comprehensive evidence tables and narrative synthesis addressed the uptake and utility, procedural and organizational outcomes, provider outcomes, and patient outcomes. RESULTS In total, 77 studies evaluating 72 toolkits met inclusion criteria. Toolkits addressed a variety of quality improvement approaches and focused on clinical topics such as weight management, fall prevention, vaccination, hospital-acquired infections, pain management, and patient safety. Most toolkits included introductory and implementation material (e.g., research summaries) and healthcare provider tools (e.g., care plans), and two-thirds included material for patients (e.g., information leaflets). Pre-post studies were most common (55%); 10% were single hospital evaluations and the number of participating staff ranged from 17 to 704. Uptake data were limited and toolkit uptake was highly variable. Studies generally indicated high satisfaction with toolkits, but the perceived usefulness of individual tools varied. Across studies, 57% reported on adherence to clinical procedures and toolkit effects were positive. Provider data were reported in 40% of studies but were primarily self-reported changes. Only 29% reported patient data and, overall, results from robust study designs are missing from the evidence base. CONCLUSIONS The review documents publicly available toolkits and their components. Available uptake data are limited but indicate variability. High satisfaction with toolkits can be achieved but the usefulness of individual tools may vary. The existing evidence base on the effectiveness of toolkits remains limited. While emerging evidence indicates positive effects on clinical processes, more research on toolkit value and what affects it is needed, including linking toolkits to objective provider behavior measures and patient outcomes. TRIAL REGISTRATION PROSPERO registration number: PROSPERO 2014: CRD42014013930 .

中文翻译：

---

传播工具：对质量改进工具包的组成部分、采用情况和有效性进行系统审查。

背景 目的是对旨在传播干预措施以提高医疗保健质量的工具包评估进行系统审查。我们的目的是确定公开可用的工具包的组成部分、使用情况和有效性。方法 我们从 2005 年到 2018 年 5 月检索了 PubMed、CINAHL 和 Web of Science，以评估公开可用的工具包，使用已知工具包的前向搜索，筛选参考文献，并联系主题专家。两名独立审稿人筛选了出版物以供纳入。一位评审员提取数据并评估研究，由另一位评审员检查；审稿人通过讨论解决分歧。研究结果以综合证据表和叙述性综合的形式总结，涉及吸收和效用、程序和组织结果、提供者结果和患者结果。结果 总共有 77 项研究评估了 72 个工具包，符合纳入标准。工具包解决了各种质量改进方法，并重点关注体重管理、跌倒预防、疫苗接种、医院获得性感染、疼痛管理和患者安全等临床主题。大多数工具包包括介绍性和实施材料（例如，研究摘要）和医疗保健提供者工具（例如，护理计划），三分之二包括针对患者的材料（例如，信息传单）。事前事后研究最为常见（55%）；10% 是单一医院评估，参与的工作人员人数从 17 名到 704 名不等。使用数据有限，工具包的使用情况变化很大。研究普遍表明对工具包的满意度很高，但对各个工具的实用性的感知各不相同。在所有研究中，57% 的人报告说，遵守临床程序和工具包的效果是积极的。40% 的研究报告了提供者数据，但主要是自我报告的变化。只有 29% 报告了患者数据，总体而言，证据库中缺少稳健研究设计的结果。结论 审查记录了公开可用的工具包及其组件。可用的摄取数据有限，但表明存在差异。可以实现对工具包的高度满意度，但各个工具的实用性可能会有所不同。关于工具包有效性的现有证据仍然有限。虽然新出现的证据表明对临床过程有积极影响，但需要对工具包的价值及其影响因素进行更多研究，包括将工具包与客观的提供者行为测量和患者结果联系起来。试用注册 PROSPERO 注册号：PROSPERO 2014：CRD42014013930。