Table 2 Types of Studies to Address Blockages in the Implementation Process

Limited external validity of efficacy/effectiveness studies

• Design clinical interventions ready for implementation earlier in the research pipeline, emphasizing tools, products, and strategies that mitigate variations in uptake across consumer, provider, and or organizational contexts

Quality gaps across systems due to variations in organizational capacity (e.g., resources, leadership)

• Assess variations and customize implementation strategies based on organizational context

• Data infrastructure development to routinely capture or assess implementation fidelity, patient-level processes/outcomes of care, and value/return-on-investment measures

• Further refinement of implementation strategies involving organizational and/or provider behavior change

• Development of provider/practice networks to conduct implementation studies or evaluation of national programs

Frontline provider competing demands (e.g., multiple clinical reminders)

• Refinement of implementation strategies using cross-disciplinary methods that address provider behavior/organizational change (e.g., business, economics, policy, operations research. etc.)

• Positive deviation or adaptation studies especially to improve implementation at lower-resourced, later-adopter sites

Misalignment with national or regional priorities

• National policy/practice roll-outs

• Randomized evaluations of national programs or policies