Since the Institute of Medicine's landmark report To Err Is Human, extensive efforts to improve patient safety have been undertaken. However, wide-scale improvement has been limited, sporadic, and inconsistent. Implementation of evidence-based interventions remains a challenge, resulting in unwarranted variations in care. Three main categories of problems in healthcare delivery are defined as overuse, underuse, and misuse of medical services, resulting in inappropriate care, inefficiencies, and poor quality. Although broad acknowledgement that these categories of quality problems exist, there are limited standards for measuring their overall impact. This article aims to discuss the important role of implementation science in advancing evidence-based practice, using neonatal therapeutic hypothermia for the treatment of hypoxic-ischemic encephalopathy as an exemplar for examining appropriateness of care.
Goldfarb School of Nursing at Barnes–Jewish College, St Louis, Missouri (Dr Smith); St Louis Children's Hospital and the Department of Nursing and Professional Practice, St Louis, Missouri (Dr Smith), St Louis Children's Hospital and the Department of Nursing and the Newborn Intensive Care Unit, St Louis, Missouri (Dr Smith and Mss Donze and Wolf); Departments of Neurology (Dr Smyser) and Pediatrics (Drs Smyser and Mathur), and Division of Newborn Medicine (Dr Mathur), Washington University School of Medicine, St Louis, Missouri; and George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Dr Proctor).
Corresponding Author: Joan R. Smith, PhD, RN, NNP-BC, Goldfarb School of Nursing at Barnes–Jewish College, 4483 Duncan Ave, St Louis, MO 63110 (email@example.com).
Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
Submitted for publication: October 29, 2014; accepted for publication: May 30, 2015.