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Design of Implementation Studies for Quality Improvement Programs: An Effectiveness–Cost-Effectiveness Framework
Author(s) -
Ken Cheung,
Naihua Duan
Publication year - 2014
Publication title -
american journal of public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.284
H-Index - 264
eISSN - 1541-0048
pISSN - 0090-0036
DOI - 10.2105/ajph.2013.301579
Subject(s) - generalization , computer science , quality (philosophy) , preference , sample (material) , sample size determination , management science , data science , risk analysis (engineering) , medicine , mathematics , statistics , mathematical analysis , philosophy , chemistry , epistemology , chromatography , economics
Translational research applies basic science discoveries in clinical and community settings. Implementation research is often limited by tremendous variability among settings; therefore, generalization of findings may be limited. Adoption of a novel procedure in a community practice is usually a local decision guided by setting-specific knowledge. The conventional statistical framework that aims to produce generalizable knowledge is inappropriate for local quality improvement investigations. We propose an analytic framework based on cost-effectiveness of the implementation study design, taking into account prior knowledge from local experts. When prior knowledge does not indicate a clear preference between the new and standard procedures, local investigation should guide the choice. The proposed approach requires substantially smaller sample sizes than the conventional approach. Sample size formulae and general guidance are provided.

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