Paeds · professional-practice-and-evidence
Implementation science and translating evidence into practice
Also known as Implementation science paediatrics · Translating evidence into child health practice · Knowledge translation in paediatrics · Research-to-practice gap child health · CFIR and RE-AIM in paediatric care
Fellowship guide to implementation science: the research-to-practice gap, why evidence takes about 17 years to reach children, the frameworks (CFIR, RE-AIM, Cabana, knowledge-to-action), Proctor implementation outcomes, the ERIC strategy compilation, designing and judging paediatric implementation projects, and defending evidence and equity at viva.
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Red flags
- Choosing an implementation strategy before you have assessed the local barriers
- Measuring the clinical outcome but never the implementation outcome — you cannot explain why a project failed
- No fidelity measure — you cannot tell a poor intervention from poor delivery
- Dissemination mistaken for implementation: publishing a guideline and assuming behaviour will change
- No sustainability plan: adoption decays the moment the champion rotates
- Average reach improves while an Indigenous, migrant or disadvantaged subgroup is untouched
- Pilot-itis: a stream of successful small projects that never scale
Life stages
Care settings
Clinical exam formats
Board mappings
- Professional qualities
- Quality and safety
- Evidence-based practice
- Learning goal 15 essential general paediatrics
- Quality improvement and patient safety
- Scholar and teacher
- Clinical Applications
- Professional Qualities
- Communication
- Long Cases
- Short Cases
- Quality improvement
- Patient safety
- Leadership and team working
- Safeguarding in practice
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- History
- Clinical
- General Pediatrics Content Outline — Systems-based practice and quality improvement
- General Pediatrics EPA: Apply evidence to improve care
- Systems-Based Practice 1: Patient Safety and Quality Improvement
- Practice-Based Learning and Improvement 1: Evidence-Based Practice
- Practice-Based Learning and Improvement 2: Reflective Practice
- Professionalism
- Medical Expert
- Leader
- Scholar
- Health Advocate
Overview & Definition
A paediatric emergency department has a sepsis guideline that works — proven by trials, endorsed by the college — yet only half of eligible children receive the first antibiotic within the recommended hour. A community mental health service offers a therapy shown to halve adolescent depression, yet most young people get something looser instead. These are not research failures and they are not single errors; they are implementation failures, the gap between what we know and what we actually do. This leaf teaches you how to close that gap for children. The deeper evidence appraisal lives on the EBM page and the PDSA change engine on the quality-improvement page; this leaf is about moving proven practice into routine use. [1] [9]
Implementation science is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine care. Bauer and colleagues frame it for the non-specialist as a young, method-driven field that grew up precisely because publishing a guideline was never enough to change practice. [1]
The central fact that justifies the whole discipline is the time lag. Morris, Wooding and Grant estimated that it takes about seventeen years for original research to reach routine practice, and that even then only a minority of evidence is fully adopted. For a child born today, that is an entire generation of preventable under-treatment. This is the problem implementation science exists to solve. [2]
References11ShowHide
- [1]Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM An introduction to implementation science for the non-specialist. BMC Psychology, 2015.PMID 26376626
- [2]Morris ZS, Wooding S, Grant J The answer is 17 years, what is the question: understanding time lags in translational research. Journal of the Royal Society of Medicine, 2011.PMID 22179294
- [3]Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA, 1999.PMID 10535437
- [4]Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 2009.PMID 19664226
- [5]Glasgow RE, Vogt TM, Boles SM Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American Journal of Public Health, 1999.PMID 10474547
- [6]Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly, 2004.PMID 15595944
- [7]Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health, 2011.PMID 20957426
- [8]Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, Proctor EK, Kirchner JE A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 2015.PMID 25889199
- [9]Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE Knowledge translation of research findings. Implementation Science, 2012.PMID 22651257
- [10]Tabak RG, Khoong EC, Chambers DA, Brownson RC Bridging research and practice: models for dissemination and implementation research. American Journal of Preventive Medicine, 2012.PMID 22898128
- [11]Aarons GA, Ehrhart MG, Farahnak LR The Implementation Leadership Scale (ILS): development of a brief measure of unit level implementation leadership. Implementation Science, 2014.PMID 24731295