Integration of Improvement and Implementation Science in Practice-Based Research Networks: a Longitudinal, Comparative Case Study

• Published in: Journal of general internal medicine : JGIM Vol. 36; no. 6; pp. 1503 - 1513
• Main Authors: Davis, Melinda M., Gunn, Rose, Kenzie, Erin, Dickinson, Caitlin, Conway, Cullen, Chau, Alex, Michaels, LeAnn, Brantley, Steven, Check, Devon K., Elder, Nancy
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-06-2021; Springer Nature B.V
• Subjects: Alignment; Case reports; Case studies; Humans; Implementation Science; Internal Medicine; Medicine; Medicine & Public Health; Oregon; Original Research; Practice research; Quality control; Quality Improvement; Quality of Health Care; Similarity; Traditions; Oregon; rural health services; primary care; pragmatic research; quality improvement; practice-based research; implementation science
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-021-06610-1

Background
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.
Objective
To systematically examine IS, QI, and IS/QI projects conducted within a PBRN over time to identify similarities, differences, and synergies.
Design
Longitudinal, comparative case study of projects conducted in the Oregon Rural Practice-based Research Network (ORPRN) from January 2007 to January 2019.
Approach
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.
Key Results
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.
Conclusions
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.