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      Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory

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          Abstract

          Background

          The use of implementation strategies is an active and purposive approach to translate research findings into routine clinical care. The Expert Recommendations for Implementing Change (ERIC) identified and defined discrete implementation strategies, and Proctor and colleagues have made recommendations for specifying operationalization of each strategy. We use empirical data to test how the ERIC taxonomy applies to a large dissemination and implementation initiative aimed at taking cardiac prevention to scale in primary care practice.

          Methods

          EvidenceNOW is an Agency for Healthcare Research and Quality initiative that funded seven cooperatives across seven regions in the USA. Cooperatives implemented multi-component interventions to improve heart health and build quality improvement capacity, and used a range of implementation strategies to foster practice change. We used ERIC to identify cooperatives’ implementation strategies and specified the actor, action, target, dose, temporality, justification, and expected outcome for each. We mapped and compiled a matrix of the specified ERIC strategies across the cooperatives, and used consensus to resolve mapping differences. We then grouped implementation strategies by outcomes and justifications, which led to insights regarding the use of and linkages between ERIC strategies in real-world scale-up efforts.

          Results

          Thirty-three ERIC strategies were used by cooperatives. We identified a range of revisions to the ERIC taxonomy to improve the practical application of these strategies. These proposed changes include revisions to four strategy names and 12 definitions. We suggest adding three new strategies because they encapsulate distinct actions that were not described in the existing ERIC taxonomy. In addition, we organized ERIC implementation strategies into four functional groupings based on the way we observed them being applied in practice. These groupings show how ERIC strategies are, out of necessity, interconnected, to achieve the work involved in rapidly taking evidence to scale.

          Conclusions

          Findings of our work suggest revisions to the ERIC implementation strategies to reflect their utilization in real-work dissemination and implementation efforts. The functional groupings of the ERIC implementation strategies that emerged from on-the-ground implementers will help guide others in choosing among and linking multiple implementation strategies when planning small- and large-scale implementation efforts.

          Trial registration

          Registered as Observational Study at www.clinicaltrials.gov ( NCT02560428).

          Electronic supplementary material

          The online version of this article (10.1186/s13012-019-0876-4) contains supplementary material, which is available to authorized users.

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          Most cited references20

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          PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice

          Background The Promoting Action on Research Implementation in Health Services, or PARIHS framework, was first published in 1998. Since this time, work has been ongoing to further develop, refine and test it. Widely used as an organising or conceptual framework to help both explain and predict why the implementation of evidence into practice is or is not successful, PARIHS was one of the first frameworks to make explicit the multi-dimensional and complex nature of implementation as well as highlighting the central importance of context. Several critiques of the framework have also pointed out its limitations and suggested areas for improvement. Discussion Building on the published critiques and a number of empirical studies, this paper introduces a revised version of the framework, called the integrated or i-PARIHS framework. The theoretical antecedents of the framework are described as well as outlining the revised and new elements, notably, the revision of how evidence is described; how the individual and teams are incorporated; and how context is further delineated. We describe how the framework can be operationalised and draw on case study data to demonstrate the preliminary testing of the face and content validity of the revised framework. Summary This paper is presented for deliberation and discussion within the implementation science community. Responding to a series of critiques and helpful feedback on the utility of the original PARIHS framework, we seek feedback on the proposed improvements to the framework. We believe that the i-PARIHS framework creates a more integrated approach to understand the theoretical complexity from which implementation science draws its propositions and working hypotheses; that the new framework is more coherent and comprehensive and at the same time maintains it intuitive appeal; and that the models of facilitation described enable its more effective operationalisation. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0398-2) contains supplementary material, which is available to authorized users.
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            A compilation of strategies for implementing clinical innovations in health and mental health.

            Efforts to identify, develop, refine, and test strategies to disseminate and implement evidence-based treatments have been prioritized in order to improve the quality of health and mental health care delivery. However, this task is complicated by an implementation science literature characterized by inconsistent language use and inadequate descriptions of implementation strategies. This article brings more depth and clarity to implementation research and practice by presenting a consolidated compilation of discrete implementation strategies, based on a review of 205 sources published between 1995 and 2011. The resulting compilation includes 68 implementation strategies and definitions, which are grouped according to six key implementation processes: planning, educating, financing, restructuring, managing quality, and attending to the policy context. This consolidated compilation can serve as a reference to stakeholders who wish to implement clinical innovations in health and mental health care and can facilitate the development of multifaceted, multilevel implementation plans that are tailored to local contexts.
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              Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study

              Background Poor terminological consistency for core concepts in implementation science has been widely noted as an obstacle to effective meta-analyses. This inconsistency is also a barrier for those seeking guidance from the research literature when developing and planning implementation initiatives. The Expert Recommendations for Implementing Change (ERIC) study aims to address one area of terminological inconsistency: discrete implementation strategies involving one process or action used to support a practice change. The present report is on the second stage of the ERIC project that focuses on providing initial validation of the compilation of 73 implementation strategies that were identified in the first phase. Findings Purposive sampling was used to recruit a panel of experts in implementation science and clinical practice (N = 35). These key stakeholders used concept mapping sorting and rating activities to place the 73 implementation strategies into similar groups and to rate each strategy’s relative importance and feasibility. Multidimensional scaling analysis provided a quantitative representation of the relationships among the strategies, all but one of which were found to be conceptually distinct from the others. Hierarchical cluster analysis supported organizing the 73 strategies into 9 categories. The ratings data reflect those strategies identified as the most important and feasible. Conclusions This study provides initial validation of the implementation strategies within the ERIC compilation as being conceptually distinct. The categorization and strategy ratings of importance and feasibility may facilitate the search for, and selection of, strategies that are best suited for implementation efforts in a particular setting. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0295-0) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                perryci@ohsu.edu
                ldamschroder@gmail.com
                hemlerje@rwjms.rutgers.edu
                woodson@ohsu.edu
                onos@ohsu.edu
                cohendj@ohsu.edu
                Journal
                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central (London )
                1748-5908
                21 March 2019
                21 March 2019
                2019
                : 14
                : 32
                Affiliations
                [1 ]ISNI 0000 0000 9758 5690, GRID grid.5288.7, School of Nursing, , Oregon Health & Science University, ; 3455 SW US Veterans Hospital Rd, Portland, OR 97239 USA
                [2 ]Implementation Pathways, LLC, Ann Arbor, MI USA
                [3 ]ISNI 0000 0000 8603 8958, GRID grid.497654.d, VA Center for Clinical Management Research, ; Ann Arbor, MI USA
                [4 ]ISNI 0000 0004 1936 8796, GRID grid.430387.b, Department of Family Medicine and Community Health, , Rutgers University--Robert Wood Johnson Medical School, ; 112 Paterson Street, New Brunswick, NJ 08901 USA
                [5 ]ISNI 0000 0000 9758 5690, GRID grid.5288.7, Department of Family Medicine, , Oregon Health & Science University, ; 3181 SW Sam Jackson Park Rd, Portland, OR 97239 USA
                Author information
                http://orcid.org/0000-0002-8167-5936
                Article
                876
                10.1186/s13012-019-0876-4
                6429753
                30898133
                03265b99-968f-4218-931e-d26e9571b7a9
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 January 2019
                : 28 February 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000133, Agency for Healthcare Research and Quality;
                Award ID: 1R01HS023940-01
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Medicine
                implementation strategy mapping,implementation strategies,large-scale initiative,capacity building,implementation facilitation

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