Leeman Jennifer, Rohweder Catherine, Lee Matthew, Brenner Alison, Dwyer Andrea, Ko Linda K, O'Leary Meghan C, Ryan Grace, Vu Thuy, Ramanadhan Shoba
School of Nursing, The University of North Carolina at Chapel Hill, CB #7460, Chapel Hill, NC, 27599, USA.
Center for Health Promotion & Disease Prevention, The University of North Carolina at Chapel Hill, CB #7424, Carrboro, NC, 27510, USA.
Implement Sci Commun. 2021 Sep 8;2(1):99. doi: 10.1186/s43058-021-00201-1.
In several recent articles, authors have called for aligning the fields of implementation and improvement science. In this paper, we call for implementation science to also align with improvement practice. Multiple implementation scholars have highlighted the importance of designing implementation strategies to fit the existing culture, infrastructure, and practice of a healthcare system. Worldwide, healthcare systems are adopting improvement models as their primary approach to improving healthcare delivery and outcomes. The prevalence of improvement models raises the question of how implementation scientists might best align their efforts with healthcare systems' existing improvement infrastructure and practice.
We describe three challenges and five benefits to aligning implementation science and improvement practice. Challenges include (1) use of different models, terminology, and methods, (2) a focus on generalizable versus local knowledge, and (3) limited evidence in support of the effectiveness of improvement tools and methods. We contend that implementation science needs to move beyond these challenges and work toward greater alignment with improvement practice. Aligning with improvement practice would benefit implementation science by (1) strengthening research/practice partnerships, (2) fostering local ownership of implementation, (3) generating practice-based evidence, (4) developing context-specific implementation strategies, and (5) building practice-level capacity to implement interventions and improve care. Each of these potential benefits is illustrated in a case study from the Centers for Disease Control and Prevention's Cancer Prevention and Control Research Network.
To effectively integrate evidence-based interventions into routine practice, implementation scientists need to align their efforts with the improvement culture and practice that is driving change within healthcare systems worldwide. This paper provides concrete examples of how researchers have aligned implementation science with improvement practice across five implementation projects.
在最近的几篇文章中，作者呼吁将实施科学和改进科学领域相结合。在本文中，我们呼吁实施科学也应与改进实践相结合。多位实施科学学者强调了设计实施策略以适应医疗系统现有文化、基础设施和实践的重要性。在全球范围内，医疗系统正在采用改进模式作为改善医疗服务提供和结果的主要方法。改进模式的普及引发了一个问题，即实施科学家如何才能最好地使其工作与医疗系统现有的改进基础设施和实践保持一致。
我们描述了将实施科学与改进实践相结合的三个挑战和五个益处。挑战包括：（1）使用不同的模式、术语和方法；（2）关注可推广知识与本地知识；（3）支持改进工具和方法有效性的证据有限。我们认为实施科学需要克服这些挑战，并努力与改进实践实现更大程度的结合。与改进实践相结合将使实施科学受益，具体体现在以下方面：（1）加强研究/实践伙伴关系；（2）促进实施的本地自主性；（3）产生基于实践的证据；（4）制定针对具体情境的实施策略；（5）建立实践层面实施干预措施和改善护理的能力。美国疾病控制与预防中心癌症预防与控制研究网络的一个案例研究说明了这些潜在益处中的每一项。
为了有效地将基于证据的干预措施整合到常规实践中，实施科学家需要使其工作与推动全球医疗系统变革的改进文化和实践保持一致。本文提供了研究人员如何在五个实施项目中将实施科学与改进实践相结合的具体示例。
