Leveraging implementation science and quality improvement to ensure high-quality cancer care: An analysis of quality certification projects at an academic medical center.

Implementation Science in Suicide Prevention.

Editors’ Note and Prologue

Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

Using Project-Based Learning to Teach Advanced Practice Nurses About Quality Improvement

Implementation science (IS) and quality improvement (QI) inhabit distinct areas of scholarly literature, but are often blended in practice. Because practice-based research networks (PBRNs) draw from both traditions, their experience could inform opportunities for strategic IS-QI alignment. To systematically examine IS, QI, and IS/QI projects conducted within a PBRN over time to identify similarities, differences, and synergies. Longitudinal, comparative case study of projects conducted in the Oregon Rural Practice-based Research Network (ORPRN) from January 2007 to January 2019. We reviewed documents and conducted staff interviews. We classified projects as IS, QI, IS/QI, or other using established criteria. We abstracted project details (e.g., objective, setting, theoretical framework) and used qualitative synthesis to compare projects by classification and to identify the contributions of IS and QI within the same project. Almost 30% (26/99) of ORPRN's projects included IS or QI elements; 54% (14/26) were classified as IS/QI. All 26 projects used an evidence-based intervention and shared many similarities in relation to objective and setting. Over half of the IS and IS/QI projects used randomized designs and theoretical frameworks, while no QI projects did. Projects displayed an upward trend in complexity over time. Project used a similar number of practice change strategies; however, projects classified as IS predominantly employed education/training while all IS/QI and most QI projects used practice facilitation. Projects including IS/QI elements demonstrated the following contributions: QI provides the mechanism by which the principles of IS are operationalized in order to support local practice change and IS in turn provides theories to inform implementation and evaluation to produce generalizable knowledge. Our review of projects conducted over a 12-year period in one PBRN demonstrates key synergies for IS and QI. Strategic alignment of IS/QI within projects may help improve care quality and bridge the research-practice gap.

Implementation Science (IS) is a growing field that provides tools to understand and facilitate the uptake of research and policies into healthcare delivery to improve quality and outcomes. Genetic counselors are uniquely positioned as the implementers of genomic medicine, with many seeking to learn about and incorporate IS into genetic counseling education and practice. We propose that genetic counselors can utilize IS in many areas of their practice and research, such as when applying new evidence or integrating guidelines into practice and when leading or assisting with quality improvement or research projects. Our goal with this paper is to provide a general overview of IS and to introduce the basics of theories, models, and frameworks, study designs and methods, and measuring IS outcomes. In addition, we briefly discuss IS tools useful for understanding and eliminating disparities and inequities, and how IS can assist genetic counselors with policy or clinical guideline implementation. It is our belief that incorporating IS tools into practice and teaching IS approaches will add to the value of genetic counselors. To that end, our hope is that this paper becomes a starting point for the integration of IS into the profession to improve the impact of our services in every context, demonstrate the value we add in the practice of genomic medicine, and contribute to the growth and evolution of our profession.

Translational research: The ingredients are only the start of the recipe for better dietetic practice

Measuring and Evaluating Clinical Context in Implementation Science Research.

Introduction & Objective: Implementation science (IS) offers rigorous methods to increase use of evidence-based practices (EBPs) in standard care. It is unclear how much and what types of IS research have been conducted in pediatric type 1 (T1D) and type 2 diabetes (T2D). The current scoping review aimed to identify IS-focused research in pediatric diabetes, evaluate integration of IS theory, methods, and terminology, and offer guidance to expand implementation research in pediatric diabetes medical, psychosocial, and education care. Methods: Following the JBI guidelines and PRISMA-ScR checklist for scoping reviews, a search of PubMed, Scopus, PsychINFO, Emcare, CINAHL, and Cochrane Trials Register databases was conducted on 1/31/2023 for English language articles and repeated in 11/2023. Identified articles were uploaded into Covidence. Two independent reviewers screened articles and completed data extraction. Results: 156 studies were identified in the initial search, 62 reached full-text review, and 23 were included in analyses. Of the 23 included papers, 19 were published between 2017 and 2023 and 21 focused on T1D. Most studies involved medical EBPs (n=15), whereas fewer focused on psychosocial (n=7) and diabetes education (n=2) EBPs. Most studies (n=11) identified barriers and facilitators of implementing an EBP or were implementation trials (n=11); fewer studies documented gaps in use of an EBP in standard clinical practice (n=7). Only one paper detailed development of an implementation strategy. Five papers employed implementation science theories/models/frameworks. Conclusions: This scoping review identified a young literature examining implementation of EBPs in pediatric diabetes. Few studies employed IS theory and terminology and few described implementation strategies. Guidance for future work to increase use of EBPs across medical, psychosocial, and education care for pediatric diabetes is offered. Disclosure J. Price: None. J.M. Hawkins: None. D.J. Amante: None. R. James: None. D. Haire-Joshu: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (5K23DK125666); National Institute of Diabetes and Digestive and Kidney Diseases (5K01DK131318)

Across the world, in medical journals, news media, social media, and personal discussions, one of the hottest topics of discussion is the coronavirus disease 2019 (COVID-19) vaccine. The rapid development of effective vaccines for COVID-19 is a remarkable success story of modern science, and it is a reminder for all of us about the significant health benefits of vaccines in general, benefits we often take for granted. Although the COVID-19 vaccine is the media star of the day, children receive numerous other routine vaccinations, including the hepatitis B vaccine, which significantly reduces the risk of hepatitis B virus infection. However, with all vaccines, including the hepatitis B vaccine, there are significant gaps in coverage, with high percentages of eligible children either not receiving the vaccine at all or receiving it late, thus exposing them to the risk of infectious diseases. A quotation from Orenstein1 has recently surfaced in discussions about the COVID-19 vaccine: “vaccines don’t save lives, vaccinations save lives.” Gaps in vaccine coverage generate the need for quality improvement (QI) projects to close these gaps. In this issue of the journal, Sarathy et al2 describe the results of a QI project in which they aimed to increase the monthly percentage of eligible newborn infants receiving the first dose of the hepatitis B vaccine within 24 hours of life to ≥80% within 9 months of project initiation. This article contains some important lessons that deserve to be highlighted about the conduct, description, and publication of QI projects. In 2008, the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines were first published. They were updated in 2015 as the SQUIRE …

Sustaining evidence-based practice (EBP) in nursing faces systemic and workforce barriers. Implementation science (IS) offers structured approaches to support EBP integration. Under Saudi Arabia's Vision 2030, scalable nurse-led models are critical to bridging the research-to-practice gap. To evaluate the Evidence-Based Quality Improvement Project (EQUIP), a nurse-led model grounded in IS, by assessing its implementation through frontline implementation lead (IL) nurses. A mixed-methods formative evaluation was conducted across multiple healthcare facilities. Two IL nurse-led quality improvement (QI) projects were used as illustrative examples. Data sources included QI documentation, clinical metrics, and researcher field notes. EQUIP enabled IL nurses to apply EBP in routine care and proved adaptable across diverse settings. However, inconsistent engagement and competing workload demands were the most influential barriers, underscoring the need for structured support. EQUIP presents a scalable IS-based initiative to embed EBP in nursing. Institutional support is essential for sustained implementation.

The purpose of this scoping review is to provide a synthesis of the available literature on implementation science in critical care settings. Specifically, we aimed to identify the evidence-based practices selected for implementation, the frequency and type of implementation strategies used to foster change, and the process and clinical outcomes associated with implementation. A librarian-assisted search was performed using three electronic databases. Articles that reported outcomes aimed at disseminating, implementing, or sustaining an evidence-based intervention or practice, used established implementation strategies, and were conducted in a critical care unit were included. Two reviewers independently screened titles, abstracts, and full text of articles to determine eligibility. Data extraction was performed using customized fields established a priori within a systematic review software system. Of 1,707 citations, 82 met eligibility criteria. Studies included prospective research investigations, quality improvement projects, and implementation science trials. The most common practices investigated were use of a ventilator-associated pneumonia bundle, nutritional support protocols, and the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility bundle. A variety of implementation strategies were used to facilitate evidence adoption, most commonly educational meetings, auditing and feedback, developing tools, and use of local opinion leaders. The majority of studies (76/82, 93%) reported using more than one implementation strategy. Few studies specifically used implementation science designs and frameworks to systematically evaluate both implementation and clinical outcomes. The field of critical care has experienced slow but steady gains in the number of investigations specifically guided by implementation science. However, given the exponential growth of evidence-based practices and guidelines in this same period, much work remains to critically evaluate the most effective mechanisms to integrate and sustain these practices across diverse critical care settings and teams.

What Anesthesiology Has to Learn from Implementation Science and Quality Improvement.

Clinicians are often familiar with quality improvement (QI) and evidence-based practice (EBP) processes, which provides guidance into what evidence should be implemented; however, these processes do not address how to successfully implement evidence. Clinicians would benefit from a deeper understanding of implementation science, along with practical tools for how to use these principles in QI and EBP projects. We provide a brief background of the principles of implementation science, an overview of current implementation science models and a toolkit to facilitate choosing and using common implementation science strategies. In addition, the toolkit provides guidance for measuring the success of an implementation science project and a case study showing how implementation science strategies can be used successfully in clinical practice. Using an implementation science toolkit for designing, conducting, and evaluating a QI or EBP project improves the quality and generalizability of results.

National Comprehensive Cancer Network Guidelines: Who Makes Them? What Are They? Why Are They Important?