Context in Implementation Science

Changing health care delivery systems and processes of care to improve health care quality is complex. What is done (intervention) is equally important as how it is done (implementation) and where it is done (context). Furthermore, it has been consistently observed that among groups participating in...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2022-03, Vol.149 (Suppl 3), p.1
Main Authors: Kaplan, Heather C, Walsh, Kathleen E
Format: Article
Language:English
Subjects:
Care and treatment
Company business management
Delivery of Health Care
Health care
Health care delivery
Humans
Implementation Science
Management
Patient care
Patients
Pediatrics
Quality control
Quality Improvement
Quality of care
Quality of Health Care
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Summary:Changing health care delivery systems and processes of care to improve health care quality is complex. What is done (intervention) is equally important as how it is done (implementation) and where it is done (context). Furthermore, it has been consistently observed that among groups participating in multisite quality improvement (QI) efforts and implementation studies, significant heterogeneity in the improvements is seen. Our objective is to provide a step-by-step guide to assist both researchers and groups practicing QI on the frontlines in addressing context in planning, implementing, and disseminating their QI and implementation interventions. We discuss in depth a sample of the >60 available dissemination and implementation frameworks that consider context. We then provide an approach to addressing context in QI and implementation initiatives and discuss an application of this approach, using a published study as an example. Finally, we discuss next steps for the field of context and implementation science. Data from networks of health systems working together on QI are needed on both network-wide rates of process and outcome measures. Also needed are segmented/stratified data that inform our understanding of the influence of context on successful implementation in subgroups. Finally, multisite prospective studies are needed to develop an in-depth understanding of how specific context and implementation factors affect the successful spread of proven interventions.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2020-045948C