The challenge of transferring an implementation strategy from academia to the field: a process evaluation of local quality improvement collaboratives in Dutch primary care using the normalization process theory.

Rationale, Aims And Objectives: A quality improvement strategy consisting of comparative feedback and peer review embedded in available local quality improvement collaboratives proved to be effective in changing the test-ordering behaviour of general practitioners. However, implementing this strategy was problematic. We aimed for large-scale implementation of an adapted strategy covering both test ordering and prescribing performance.

The balanced incomplete block design is not suitable for the evaluation of complex interventions.

Objectives: In quality of care research, the balanced incomplete block (BIB) design is regularly claimed to have been used when evaluating complex interventions. In this article, we reflect on the appropriateness of using this design for evaluating complex interventions.

Study Design And Setting: Literature study using PubMed and handbooks.

A cluster randomized controlled trial aimed at implementation of local quality improvement collaboratives to improve prescribing and test ordering performance of general practitioners: study protocol.

Background: The use of guidelines in general practice is not optimal. Although evidence-based methods to improve guideline adherence are available, variation in physician adherence to general practice guidelines remains relatively high. The objective for this study is to transfer a quality improvement strategy based on audit, feedback, educational materials, and peer group discussion moderated by local opinion leaders to the field.