Implementing Improvements: Opportunities to Integrate Quality Improvement and Implementation Science.
Implementing Improvements: Opportunities to Integrate Quality Improvement and Implementation Science.
复制标题
DOI：
10.1542/hpeds.2020-002246
复制
发表时间：
2021-05-01
影响因子：
--
通讯作者：
Glasgow, Russell E
中科院分区：
文献类型：
--
作者：
Tyler, Amy;Glasgow, Russell E
在医院中，改进者和实施者使用质量改进科学 (QIS) 和较少使用的实施研究 (IR) 来改善医疗保健和健康结果。 QIS 指导下的狭义质量改进 (QI) 侧重于转变医疗保健系统，以提高医疗保健质量和服务提供，而 IR 则侧重于开发方法来缩小已知（研究结果）与实践（临床医生）之间的差距。然而，QI 经常涉及实施证据，而 IR 始终致力于解决组织和环境层面的因素。这些学科有一个共同的最终目标，即改善健康结果，并努力理解和改变在相同环境中经常遇到和解决相同挑战的相同参与者。 QIS 起源于工业，IR 起源于行为科学和健康服务研究。尽管目的重叠，这两门科学却各自发展。 QIS 和 IR 领域的思想领袖认为需要加强学科之间的合作。退伍军人健康管理局的质量增强研究计划已成功采用 QIS 方法，将循证实践更快地实施到临床实践中，但 QIS 和 IR 之间类似的正式合作在其他医疗保健系统中并不普遍。急症护理团队处于有利地位，可以改善护理服务并实施最新证据。我们提供 QIS 和 IR 的概述；检查 QIS 和 IR 的关键特征，包括每个学科的优势和局限性；并提出关于这两种方法之间的整合和协作的具体建议，以提高 QI 的影响和医院环境中的实施工作。
In hospitals, improvers and implementers use quality improvement science (QIS) and less frequently implementation research (IR) to improve health care and health outcomes. Narrowly defined quality improvement (QI) guided by QIS focuses on transforming systems of care to improve health care quality and delivery and IR focuses on developing approaches to close the gap between what is known (research findings) and what is practiced (by clinicians). However, QI regularly involves implementing evidence and IR consistently addresses organizational and setting-level factors. The disciplines share a common end goal, namely, to improve health outcomes, and work to understand and change the same actors in the same settings often encountering and addressing the same challenges. QIS has its origins in industry and IR in behavioral science and health services research. Despite overlap in purpose, the 2 sciences have evolved separately. Thought leaders in QIS and IR have argued the need for improved collaboration between the disciplines. The Veterans Health Administration's Quality Enhancement Research Initiative has successfully employed QIS methods to implement evidence-based practices more rapidly into clinical practice, but similar formal collaborations between QIS and IR are not widespread in other health care systems. Acute care teams are well positioned to improve care delivery and implement the latest evidence. We provide an overview of QIS and IR; examine the key characteristics of QIS and IR, including strengths and limitations of each discipline; and present specific recommendations for integration and collaboration between the 2 approaches to improve the impact of QI and implementation efforts in the hospital setting.