title: Implementation Science Supports Core Clinical Competencies: An Overview and Clinical Example.
abstract: OBJECTIVE
  Instead of asking clinicians to work faster or longer to improve quality of care, implementation science provides another option. Implementation science is an emerging interdisciplinary field dedicated to studying how evidence-based practice can be adopted into routine clinical care. This article summarizes principles and methods of implementation science, illustrates how they can be applied in a routine clinical setting, and highlights their importance to practicing clinicians as well as clinical trainees.
  
  
  METHODS
  A hypothetical clinical case scenario is presented that explains how implementation science improves clinical practice. The case scenario is also embedded within a real-world implementation study to improve metabolic monitoring for individuals prescribed antipsychotics.
  
  
  RESULTS
  Context, recipient, and innovation (ie, the evidence-based practice) factors affected improvement of metabolic monitoring. To address these factors, an external facilitator and a local quality improvement team developed an implementation plan involving a multicomponent implementation strategy that included education, performance reports, and clinician follow-up. The clinic remained compliant with recommended metabolic monitoring at 1-year follow up.
  
  
  CONCLUSIONS
  Implementation science improves clinical practice by addressing context, recipient, and innovation factors and uses this information to develop and utilize specific strategies that improve clinical practice. It also enriches clinical training, aligning with core competencies by the Accreditation Council for Graduate Medical Education and American Boards of Medical Specialties. By learning how to change clinical practice through implementation strategies, clinicians are more able to adapt in complex systems of practice.
authors.affiliation: Central Arkansas Veterans Healthcare System, QUERI for Team-Based Behavioral Healthcare, 2200 Fort Roots Drive, Bldg 58, 16MIR/NLR, North Little Rock, AR 72114. Joann.kirchner@va.gov.|VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Kirchner
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.|South Central Mental Illness Research Education and Clinical Centers (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.
authors.forename: Eva N
authors.initials: EN
authors.lastname: Woodward
authors.affiliation: VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.|Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Smith
authors.affiliation: Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.|Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Curran
authors.affiliation: Quality Enhancement Research Initiative (QUERI), US Department of Veterans Affairs, Ann Arbor, Michigan, USA.|Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.|Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Owen
authors.affiliation: VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA.|Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Boston, Massachusetts, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bauer
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002983:Clinical Competence; D019317:Evidence-Based Medicine / Q000379:methods*; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D008297:Male; D012559:Schizophrenia / Q000628:therapy
chemical_list: D014150:Antipsychotic Agents