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

Melinda M. Davis, Rose Gunn, Erin Kenzie, Caitlin Dickinson, Cullen Conway, Alex Chau, Le Ann Michaels, Steven Brantley, Devon K. Check, Nancy Elder

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1503-1513
Number of pages11
JournalJournal of general internal medicine
Volume36
Issue number6
DOIs
StatePublished - Jun 2021

Keywords

  • implementation science
  • practice-based research
  • pragmatic research
  • primary care
  • quality improvement
  • rural health services

ASJC Scopus subject areas

  • Internal Medicine

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