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JGIM Supplement Features HSR&D/QUERI Research on the Importance of Implementation Science to Quality Improvement


BACKGROUND:
Sponsored by the Agency for Healthcare Research and Quality (AHRQ), Kaiser Permanente, and VA, this supplemental issue of the Journal of General Internal Medicine (JGIM) on implementation science (IS) and quality improvement (QI) marks the formal addition of IS/QI as an area of emphasis for JGIM. This is important because research without action is incomplete, like composing music that no one plays. The current pandemic is a grim reminder of the importance of acting on new evidence in developing a healthcare system that is always ready to respond to a crisis, particularly a public health emergency. The articles in this supplement are examples of how researchers, including many VA investigators, have worked to effectively implement evidence-based research findings within clinical practice. Hallmarks of this work include attention to how the change process occurs; sensitivity to context (in what setting and with which stakeholders changes will take place); and the interplay of implementation participants with innovations being implemented. Thus, this supplement features innovative research that applied evidence across diverse delivery systems and settings.

Articles in this supplement include (VA articles in bold):

  • Multi-site studies demonstrate how organizational and institutional context exert such profound influence on implementation outcomes. Petrik and colleagues assessed implementation drivers that could explain differences among federally-qualified community health centers in their success implementing a mailed fecal immunochemical test (FIT) to increase colorectal cancer screening.
  • De-implementing low-value care is an essential part of efforts to improve healthcare quality, and one that has sometimes been too-little studied. Presti and colleagues describe efforts to reduce inappropriate PSA screening.
  • Directly addressing concerns of rigor, particularly examples of rigorous non-experimental designs, this supplement also includes Coleman and colleagues’ observational study of institutionalizing collaborative care for depression, and Rattray and colleagues’ rigorous QI project of a web-based hub for audit and feedback to improve care for transient ischemic attacks.
  • Papers that empirically illustrate the application of foundational knowledge and skills from QI and IS to improve general internal medicine include Rikin and colleagues’ stepped-wedge trial of an opt-in eConsult program and its effect on specialty care visits, as well as Keddem and colleagues’ rigorous qualitative study of implementation of patient-engagement toolkits.
  • Kilbourne, Glasgow, and Chambers provide a high-level overview of important contributions for implementation science with selected stories amplifying successes in the field.

Guest Editors for this supplement were Christian Helfrich, MPH, PhD, with HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care, and Lucy Savitz, PhD, MBA, VP, Health Research Kaiser Permanente Northwest Region Director, Center for Health Research.

IMPLICATIONS:

  • In an editorial by Drs. Helfrich and Savitz, they discuss how the IS/QI research featured in this supplement can advance internal medicine care delivery and ensure that the foundational knowledge generated by internal medicine research finds its way into practice.


Advancing Evidence at the Intersection of Health Services Research, Implementation Science & Quality Improvement. Journal of General Internal Medicine. November 2020;35(Suppl 2).

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.


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