Publishing Implementation Science and QI from Learning Health

Publishing Implementation Science and QI from Learning Health Care Systems Steven M. Asch MD MPH National Academy of Medicine May 22, 2019

Basic Science Clinical Trials Clinical Epidemiology Health Services Research Implementation Science Quality Improvement Learning Healthcare Systems Lean Right on Translation Spectrum

Basic Science Clinical Trials Clinical Epidemiology Health Services Research Implementation Science Quality Improvement Generalizablity > Internal Validity

Clinical trials actively try to eliminate and control for context; implementation science and quality improvement instead take context, especially organizational context, as an important object of study. Translation: LHS want to learn about themselves. May CR: Implementation Science 2016 11: 141

Analytic capacity no longer (even mostly) the domain of researchers

Doctors Like You Ordered Things Like These on Patients Like Yours…

A Data Consult Service Given a specific case, provides a report summarizing similar patients in Stanford’s clinical data warehouse, the common treatment choices made, and the observed outcomes. greenbutton. stanford. edu What do we do when LHS want to publish this work?

Reporting standards for implementation science/QI SQUIRE (Standards for Quality Improvement Reporting Excellence) Sta. RI (Standards for Reporting Implementation Studies) QI-MCS (Quality Improvement Minimum Quality Criteria Set) Ogrinc C: BMJ Quality & Safety 2016; 25: 986 -992 Pinnock H: BM J 2017; 356: i 6795 Hempel S: BMJ Qual Saf 2015; 24: 796– 804

Discussion Points • Much of what learning health care systems study is themselves • Puts much of their intellectual product in the domains of implementation science and quality improvement • Context is king of that domain, but dissemination still important • Need rigorous reporting standards that guide field but take context into account