The time has come: Embedded implementation research for health care improvement
The time has come: Embedded implementation research for health care improvement
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DOI：
10.1111/jep.13100
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发表时间：
2019-06-01
影响因子：
2.4
通讯作者：
Braithwaite, Jeffrey
中科院分区：
文献类型：
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作者：
Churruca, Kate;Ludlow, Kristiana;Braithwaite, Jeffrey
实施科学领域的发展是为了应对将证据转化为实践的缓慢和不一致。尽管采用了越来越复杂的执行办法，包括采用复杂性科学透镜和进行现实主义评价，但在取得执行工作所希望的成果方面仍然存在挑战。其中包括获得实施变革者的参与和支持，并考虑到当地环境的影响。一个新兴的方法来解决这些挑战是嵌入式实施研究-一个合作的，适应性的改进方法。它涉及研究人员和执行人员从一个执行项目的一开始和整个过程中在现场共同工作。这两个小组都可以从合作中受益：它提高了评价的严谨性，提供了通过直接反馈改进干预措施的机会，并促进了对变革进程的更好的实地了解。我们的目的是研究增加嵌入性的潜在好处和一些挑战。方法我们进行了多案例分析的实施研究项目，不同程度的嵌入性。结果嵌入式实施研究可以提供一系列的优势，二分法的研究实践设计，包括更好地了解当地的情况和直接反馈，以改善实施沿着。我们提出了一个模型，跨越四种方法：二分法的研究实践，协作连接起来，部分嵌入式和深度沉浸。结论嵌入式实施的研究方法相比，传统的二分法研究实践设计，其中的研究是外部的实施，并进行总结性评价的承诺。我们才刚刚开始了解这种伙伴关系在实践中如何运作，以及是什么使它们取得成功。我们的分析表明，现在是考虑这些方法的时候了。
Rationale, aims, and objectives The field of implementation science has developed in response to slow and inconsistent translation of evidence into practice. Despite utilizing increasingly sophisticated approaches to implementation, including applying a complexity science lens and conducting realist evaluations, challenges remain to getting the kinds of outcomes hoped for by implementation efforts. These include gaining access and buy-in from those implementing the change and accounting for the influence of local context. One emerging approach to address these challenges is embedded implementation research-a collaborative, adaptive approach to improvement. It involves researchers and implementers working together in situ from the outset of, and throughout, an implementation project. Both groups can benefit from the collaboration: it increases the rigor of evaluation, provides opportunities to improve the intervention through direct feedback, and promotes better on-the-ground understanding of the change process. We aimed to examine the potential benefits, and some of the challenges, of increased embeddedness. Method We performed a multi-case analysis of implementation research projects that varied by degree of embeddedness. Results Embedded implementation research may offer a range of advantages over dichotomized research-practice designs, including better understanding of local context and direct feedback to improve the implementation along the way. We present a model that spans four approaches: dichotomized research-practice, collaborative linking-up, partially-embedded, and deep immersion. Conclusion Embedded implementation research approaches hold promise in comparison to traditional dichotomized-research practice designs, where the research is external to the implementation and conducts a summative evaluation. We are only beginning to understand how such partnerships operate in practice and what makes them successful. Our analysis suggests the time has come to consider such approaches.