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      Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature

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          Abstract

          Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines. To reflect the breadth of knowledge and experience in the field, we solicited input from a wide variety of authors, editors and improvement professionals during the guideline revision process. This Explanation and Elaboration document (E&E) is a companion to the revised SQUIRE guidelines, SQUIRE 2.0. The product of collaboration by an international and interprofessional group of authors, this document provides examples from the published literature, and an explanation of how each reflects the intent of a specific item in SQUIRE. The purpose of the guidelines is to assist authors in writing clearly, precisely and completely about systematic efforts to improve the quality, safety and value of healthcare services. Authors can explore the SQUIRE statement, this E&E and related documents in detail at http://www.squire-statement.org.

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          Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

          Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
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            The behaviour change wheel: A new method for characterising and designing behaviour change interventions

            Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.
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              The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

              Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalizability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover 3 main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors, to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Eighteen items are common to all 3 study designs and 4 are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available at http://www.annals.org and on the Web sites of PLoS Medicine and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.
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                Author and article information

                Journal
                BMJ Qual Saf
                BMJ Qual Saf
                qhc
                bmjqs
                BMJ Quality & Safety
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-5415
                2044-5423
                December 2016
                27 April 2016
                : 25
                : 12
                : e7
                Affiliations
                [1 ]Department of Obstetrics and Gynecology, Dartmouth Hitchcock Medical Center , Lebanon, New Hampshire, USA
                [2 ]Department of Education, Veterans Health Administration , White River Jct, Vermont, USA
                [3 ]Department of Surgery, Veterans Health Administration , White River Jct, Vermont, USA
                [4 ]Health Policy, Management and Evaluation, University of Toronto , Toronto, Ontario, Canada
                [5 ]Department of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania, USA
                [6 ]Department of Pediatrics, Cleveland Clinic Children's Hospital , Cleveland, Ohio, USA
                [7 ]Department of Pediatrics, Colorado Children's Hospital , Aurora, Colorado, USA
                [8 ]Division of Healthcare Delivery Science, New York University , New York, USA
                [9 ]Perinatal Institute and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA
                [10 ]Department of Medicine, University of Toronto , Toronto, Ontario, Canada
                [11 ]Department of Medicine, Dartmouth Hitchcock Medical Center , Lebanon, New Hampshire, USA
                [12 ]Department of Clinical, Educational and Health Psychology, University College , London, UK
                [13 ]Department of Nursing, University of Alabama , Birmingham, Alabama, USA
                [14 ]National Center for Patient Safety, Veterans Health Administration, White River Junction , NH USA
                [15 ]Department of Psychiatry and Community and Family Medicine, Geisel School of Medicine , Hanover, New Hampshire, USA
                [16 ]Department of Pediatrics,University of Michigan Medical Center , Ann Arbor, Michigan, USA
                [17 ]Department of Nursing,MGH Institute of Health Professions, Boston, Massachusetts, USA
                [18 ]Department of Pediatrics, Seattle Children's Hospital , Seattle, Washington, USA
                [19 ]Institute of Health and Society, Newcastle University , Newcastle upon Tyne, UK
                [20 ]Jönköping Academy for Improvement of Health and Welfare, Jönköping University , Jönköping, Sweden
                Author notes
                [Correspondence to ] Dr Daisy Goodman, Department of Obstetrics and Gynecology, Dartmouth Hitchcock Medical Center, 1 Hospital drive, Lebanon, New Hampshire 03766, USA; daisy.j.goodman@ 123456hitchcock.org
                Author information
                http://orcid.org/0000-0003-1814-4478
                Article
                bmjqs-2015-004480
                10.1136/bmjqs-2015-004480
                5256235
                27076505
                aad595ee-dfd4-47d1-9fec-b31d2ac2327c
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 10 June 2015
                : 5 February 2016
                : 29 February 2016
                Funding
                Funded by: Robert Wood Johnson Foundation, http://dx.doi.org/10.13039/100000867;
                Funded by: Health Foundation, http://dx.doi.org/10.13039/501100000724;
                Categories
                1506
                Electronic Pages
                Research and reporting methodology
                Custom metadata
                unlocked

                Public health
                health services research,implementation science,quality improvement,quality improvement methodologies,statistical process control

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