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Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory

BACKGROUND: 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 re...

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Autores principales: Perry, Cynthia K., Damschroder, Laura J., Hemler, Jennifer R., Woodson, Tanisha T., Ono, Sarah S., Cohen, Deborah J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429753/
https://www.ncbi.nlm.nih.gov/pubmed/30898133
http://dx.doi.org/10.1186/s13012-019-0876-4
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author Perry, Cynthia K.
Damschroder, Laura J.
Hemler, Jennifer R.
Woodson, Tanisha T.
Ono, Sarah S.
Cohen, Deborah J.
author_facet Perry, Cynthia K.
Damschroder, Laura J.
Hemler, Jennifer R.
Woodson, Tanisha T.
Ono, Sarah S.
Cohen, Deborah J.
author_sort Perry, Cynthia K.
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. TRIAL REGISTRATION: Registered as Observational Study at www.clinicaltrials.gov (NCT02560428). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13012-019-0876-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-64297532019-04-04 Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory Perry, Cynthia K. Damschroder, Laura J. Hemler, Jennifer R. Woodson, Tanisha T. Ono, Sarah S. Cohen, Deborah J. Implement Sci Research BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. TRIAL REGISTRATION: Registered as Observational Study at www.clinicaltrials.gov (NCT02560428). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13012-019-0876-4) contains supplementary material, which is available to authorized users. BioMed Central 2019-03-21 /pmc/articles/PMC6429753/ /pubmed/30898133 http://dx.doi.org/10.1186/s13012-019-0876-4 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Perry, Cynthia K.
Damschroder, Laura J.
Hemler, Jennifer R.
Woodson, Tanisha T.
Ono, Sarah S.
Cohen, Deborah J.
Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory
title Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory
title_full Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory
title_fullStr Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory
title_full_unstemmed Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory
title_short Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory
title_sort specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429753/
https://www.ncbi.nlm.nih.gov/pubmed/30898133
http://dx.doi.org/10.1186/s13012-019-0876-4
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