School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA.
Implementation Pathways, LLC, Ann Arbor, MI, USA.
Implement Sci. 2019 Mar 21;14(1):32. doi: 10.1186/s13012-019-0876-4.
The use of implementation strategies is an active and purposive approach to translate research findings into routine clinical care. The Expert Recommendations for Implementing Change (ERIC) identified and defined discrete implementation strategies, and Proctor and colleagues have made recommendations for specifying operationalization of each strategy. We use empirical data to test how the ERIC taxonomy applies to a large dissemination and implementation initiative aimed at taking cardiac prevention to scale in primary care practice.
EvidenceNOW is an Agency for Healthcare Research and Quality initiative that funded seven cooperatives across seven regions in the USA. Cooperatives implemented multi-component interventions to improve heart health and build quality improvement capacity, and used a range of implementation strategies to foster practice change. We used ERIC to identify cooperatives' implementation strategies and specified the actor, action, target, dose, temporality, justification, and expected outcome for each. We mapped and compiled a matrix of the specified ERIC strategies across the cooperatives, and used consensus to resolve mapping differences. We then grouped implementation strategies by outcomes and justifications, which led to insights regarding the use of and linkages between ERIC strategies in real-world scale-up efforts.
Thirty-three ERIC strategies were used by cooperatives. We identified a range of revisions to the ERIC taxonomy to improve the practical application of these strategies. These proposed changes include revisions to four strategy names and 12 definitions. We suggest adding three new strategies because they encapsulate distinct actions that were not described in the existing ERIC taxonomy. In addition, we organized ERIC implementation strategies into four functional groupings based on the way we observed them being applied in practice. These groupings show how ERIC strategies are, out of necessity, interconnected, to achieve the work involved in rapidly taking evidence to scale.
Findings of our work suggest revisions to the ERIC implementation strategies to reflect their utilization in real-work dissemination and implementation efforts. The functional groupings of the ERIC implementation strategies that emerged from on-the-ground implementers will help guide others in choosing among and linking multiple implementation strategies when planning small- and large-scale implementation efforts.
Registered as Observational Study at www.clinicaltrials.gov ( NCT02560428 ).
实施策略的使用是将研究结果转化为常规临床护理的一种积极有目的的方法。专家推荐实施变革（ERIC）确定并定义了离散的实施策略，而 Proctor 及其同事已经为每个策略的操作化指定提出了建议。我们使用实证数据来测试 ERIC 分类法如何适用于一项旨在将心脏预防措施大规模推广到基层医疗实践的大型传播和实施计划。
证据 NOW 是美国医疗保健研究与质量局的一项倡议，该倡议资助了美国七个地区的七个合作社。合作社实施了多组件干预措施，以改善心脏健康并建立质量改进能力，并使用了一系列实施策略来促进实践变革。我们使用 ERIC 来确定合作社的实施策略，并指定每个策略的参与者、行动、目标、剂量、时间、理由和预期结果。我们对合作社的指定 ERIC 策略进行了映射和编制，并使用共识解决了映射差异。然后，我们根据结果和理由对实施策略进行分组，这为实际规模扩大工作中 ERIC 策略的使用和联系提供了一些见解。
合作社使用了 33 种 ERIC 策略。我们发现需要对 ERIC 分类法进行一系列修订，以提高这些策略的实际应用。这些建议的修订包括对四个策略名称和 12 个定义的修订。我们建议增加三个新策略，因为它们包含了现有 ERIC 分类法中未描述的独特行动。此外，我们根据观察到的实际应用方式，将 ERIC 实施策略组织成四个功能组。这些分组展示了 ERIC 策略是如何在必要时相互关联的，以实现快速将证据推广到大规模应用的工作。
我们的研究结果表明，需要对 ERIC 实施策略进行修订，以反映它们在实际传播和实施工作中的应用。从实地实施者那里得出的 ERIC 实施策略的功能分组将有助于指导其他人在规划小规模和大规模实施工作时选择和链接多个实施策略。
在 www.clinicaltrials.gov 上注册为观察性研究（NCT02560428）。
