A framework and tools to develop effective quality improvement programs in european healthcare

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We will collect, develop and evaluate tools to facilitate the design, implementation, evaluation and reporting of quality improvement randomised, controlled trails (RCTs). The tools will include: - Guidelines for identifying barriers to quality improvement - Guidelines for tailoring quality improvement interventions to specific barriers - Guidelines for efficient data collection - An interactive tool to support the design of quality improvement RCTs, including economic evaluations and process evaluations - A sample size calculator - A database of intra-cluster correlation coefficients - Algorithms to help ensure the appropriate analysis of the results of quality improvement RCTs - Standards for reporting the results of quality improvement RCTs - Guidelines for developing and maintaining research-based quality improvement programs The majority of these tools are packaged into a Windows Help or browser-based system called NorthStar. NorthStar will help both users and providers of healthcare continuing education and quality improvement initiatives. It provides a range of information, checklists, examples and tools based on current research on how to best plan, use and evaluate continuing education and quality improvement work. It is a practical tool rather than an electronic textbook. NorthStar has been developed as a Microsoft Windows Help system, which allows us to make use of off-the-shelf functions provided by Windows. But we can also generate a platform-independent version of NorthStar directly from the Windows Help version, which means that NorthStar can be used with any modern browser. NorthStar now contains content and work from every aspect of the ReBEQI project, which has been linked to a wide range of other examples and resources from our own work and that of other groups. In this way NorthStar becomes a single tool for holding a huge amount of knowledge about quality improvement in healthcare. NorthStar is flexible and dynamic and initially in English, French and Italian.

There are many theories related to behaviour change in use in healthcare research, which is confusing for researchers and clinicians alike. Many theories have little or no empirical basis for use (as shown in one of ReBEQIs reviews). One theory for which there is some experimental evidence in its favour is the theory of planned behaviour (TPB). A great deal of ReBEQIs work has made use of this theory and a practical manual has been developed to support others in using the theory to design healthcare interventions. The manual, is designed to assist researchers or health workers involved in quality assurance to produce a questionnaire that can be used to assess the attitudes and beliefs underlying health-related behaviour. Responses to these questionnaires can be used to plan the development of interventions. This manual is a response to a request from health services researchers wishing to predict and understand behaviour, in particular, researchers throughout the European Union involved in the ReBEQI project (Research-Based Education and Quality Improvement). It is based on a psychological model of behaviour change, the Theory of Planned Behaviour (TPB; Ajzen, 1988), which evolved from the Theory of Reasoned Action (Fishbein, 1967) and is designed to assist psychologists and non- psychologists involved in health services research to produce an effective questionnaire to measure the TPB constructs. Advice from the TPB literature (e.g. Ajzen, 1988; Conner & Sparks, 1995; Godin & Kok, 1996) has been integrated, resulting in a guide to writing questionnaires that is based on current practice among TPB researchers. Questionnaires based on the TPB can be used to investigate the attitudes and beliefs underlying health-related behaviour. In implementation (or knowledge transfer) research with health care professionals, these questionnaires have been used to investigate the uptake of evidence-based practice. The Theory of Planned Behaviour is the explicit theoretical basis for 222 studies published in the Medline database, and 610 studies published in the PsycINFO database, from 1985 to January 2004. Apparently, hundreds of researchers have used this theory and have gone about the fascinating but time consuming task of reading the source materials and considering current debates about measurement strategies, before constructing a questionnaire to investigate their topic of interest. The manual is a tool that may help researchers to fast-track through this process. The manual has been subjected to a wide range of reviewing and trialling procedures. It has been tested in both the UK and the Netherlands, looking at the management of diabetes to support the development of methods of prioritising and choosing components of interventions. It is also the most popular part of the ReBEQI website, having being downloaded over 6400 times since 1st June 2004, when we first started collecting website usage statistics.

Welcome to Implementation Science Editors-in-Chief Martin Eccles, Professor of Clinical Effectiveness, University of Newcastle upon Tyne, United Kingdom Brian Mittman, Senior Social Scientist, VA Greater Los Angeles Healthcare System, United States of America Implementation Science is an Open Access, peer-reviewed, online journal soon to be launched by BioMed Central. Implementation Science will encompass all aspects of research relevant to the scientific study of methods to promote the uptake of research findings into routine healthcare in both clinical and policy contexts. Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings and other evidence-based practices into routine practice, and hence to improve the quality and effectiveness of health care. It includes the study of influences on healthcare professional and organisational behaviour. Submitted articles will be reviewed by two or more experts. Peer reviewers will have four possible options: accept; accept after minor revision; ask author(s) to make revisions and resubmit; reject because scientifically unsound. When asking for revisions, reviewers have three possible goals: to tighten the arguments based on existing data, to identify where more data are needed and to improve the clarity and coherence of the paper. Implementation Science is now accepting submissions; please use our online submission system or contact the Editors-in-Chief for more information. Implementation Science is published by BioMed Central, an independent publishing house committed to ensuring peer-reviewed biomedical research is Open Access - immediately and permanently available online without charge or any other barriers to access. For further information about the journal or to submit an article, contact the Editors-in-Chief at implementationscience.editors@ncl.ac.uk. Learn more about bringing your journal to BioMed Central, the Open Access publisher.

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