Evidence-Based Quality Improvement (EBQI) in the pre-implementation phase: key steps and activities

Taren Swindle; Jure Baloh; Sara J Landes; Nakita N Lovelady; Jennifer L Vincenzo; Alison B Hamilton; Melissa J Zielinski; Benjamin S Teeter; Margaret M Gorvine; Geoffrey M Curran

doi:10.3389/frhs.2023.1155693

Evidence-Based Quality Improvement (EBQI) in the pre-implementation phase: key steps and activities

Front Health Serv. 2023 May 24:3:1155693. doi: 10.3389/frhs.2023.1155693. eCollection 2023.

Authors

Taren Swindle^{1

2}, Jure Baloh^{2

3}, Sara J Landes^{2

4

5}, Nakita N Lovelady⁶, Jennifer L Vincenzo⁷, Alison B Hamilton^{8

9}, Melissa J Zielinski^{5

10}, Benjamin S Teeter^{2

11}, Margaret M Gorvine⁶, Geoffrey M Curran^{2

11

12}

Affiliations

¹ Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
² Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
³ Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
⁴ Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, Little Rock, AR, United States.
⁵ Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
⁶ Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
⁷ Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, AR, United States.
⁸ Center for the Study of Healthcare Innovation, Implementation, & Policy; VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.
⁹ Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States.
¹⁰ Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States.
¹¹ Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
¹² Central Arkansas Veterans Healthcare System, Little Rock, AR, United States.

Abstract

Background: Evidence-Based Quality Improvement (EBQI) involves researchers and local partners working collaboratively to support the uptake of an evidence-based intervention (EBI). To date, EBQI has not been consistently included in community-engaged dissemination and implementation literature. The purpose of this paper is to illustrate the steps, activities, and outputs of EBQI in the pre-implementation phase.

Methods: The research team applied comparative case study methods to describe key steps, activities, and outputs of EBQI across seven projects. Our approach 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.

Results: The cases selected included five distinct settings (e.g., correction facilities, community pharmacies), seven EBIs (e.g., nutrition promotion curriculum, cognitive processing therapy) and five unique lead authors. Case examples include both community-embedded and clinically-oriented projects. Key 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 activities are included to illustrate how each step was achieved. Outputs included prioritized determinants, EBI adaptations, and implementation strategies.

Conclusions: A primary contribution of our comparative case study is the delineation of various steps and activities of EBQI, which may contribute to the replicability of the EBQI process across other implementation research projects.

Keywords: community engagement; comparative case study; implementation science; implementation strategies; pre-implementation; quality improvement.

Abstract

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