Evidence-based quality improvement (EBQI) in the pre-implementation phase: key functions and forms

Authors: SWINDLE, TAREN - University Arkansas For Medical Sciences (UAMS); BALOH, JURE - University Arkansas For Medical Sciences (UAMS); LANDES, SARA - University Arkansas For Medical Sciences (UAMS); LOVELADY, NAKITA - University Arkansas For Medical Sciences (UAMS); VINCEZO, JENNIFER - University Arkansas For Medical Sciences (UAMS); HAMILTON, ALISON - University Of California (UCLA); ZIENINSKI, MELISSA - University Arkansas For Medical Sciences (UAMS); TEETER, BENJAMIN - University Arkansas For Medical Sciences (UAMS); GORVINE, MARGARET - University Arkansas For Medical Sciences (UAMS); CURRAN, GEOFFRY - University Arkansas For Medical Sciences (UAMS)

Submitted to: Frontiers in Health Services
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/4/2023
Publication Date: 5/24/2023
Citation: Swindle, T., Baloh, J., Landes, S., Lovelady, N., Vincezo, J., Hamilton, A., Zieninski, M., Teeter, B., Gorvine, M., Curran, G. 2023. Evidence-based quality improvement (EBQI) in the pre-implementation phase: key functions and forms. Frontiers in Health Services. https://doi.org/10.3389/frhs.2023.1155693.
DOI: https://doi.org/10.3389/frhs.2023.1155693

Interpretive Summary: Program implementation decisions are best made with partners who will be involved in or impacted by implementation. However, standard steps to engage partners in implementation decisions are lacking. This paper uses seven case studies to illustrate key steps and activities in a process to involve key partners in implementation decisions.

Technical Abstract: Background Evidence-based Quality Improvement (EBQI) involves implementation science researchers and local partners working collaboratively to adapt interventions and develop and tailor implementation strategies to support the uptake of an evidence-based intervention (EBI). Curran and colleagues described key steps of EBQI to include (1) formative evaluation and (2) formation of local teams to develop implementation strategies. The goal of EBQI is to improve system processes and, in turn, health outcomes. To date, EBQI has not been consistently included in community-engaged dissemination and implementation or implementation strategy literature. The purpose of this paper is to illustrate the forms, functions, and outputs of EBQI across seven projects to illustrate common elements and variations in the application of EBQI. We focus explicitly on pre-implementation activities to prepare for an implementation effort. Methods The research team applied steps of comparative case study methods to describe key forms, functions, and best practices of EBQI. These steps included: (1) specification of research questions, (2) selection of cases, (3) construction of a case codebook, (4) coding of cases using the codebook, and (5) comparison of cases. We aimed to capture how each case co-created implementation strategies and/or EBI adaptations to improve the uptake of an EBI that would be subsequently tested in a research study. Results The cases selected included five distinct settings (e.g., early care and education, correction facilities, community pharmacies), seven EBIs (e.g., nutrition promotion curriculum, cognitive processing therapy, violence prevention program) and five unique lead authors. Case examples include both community-embedded and clinically oriented projects. Case studies ranged in the number of EBQI meetings from 2 to 5 (Mean = 4). Key functions (i.e., steps in the EBQI process) included: (1) forming a local team of partners and experts, (2) prioritizing implementation determinants based on existing literature/data, (3) selecting strategies and/or adaptations in the context of key determinants, (4) specifying selected strategies/adaptations, and (5) refining strategies/adaptations. Examples of forms (i.e., how the function was achieved) are included for each function. Outputs included prioritized barriers and facilitators, innovation adaptations, and implementation plans/strategies. Conclusions This study expands on the two-step EBQI process originally described by Curran and colleagues to delineate five distinct functions of the EBQI process. A primary contribution of our case study series is the delineation of various forms and functions of EBQI, which may contribute to the replicability of the EBQI process across other implementation research projects.