As an extension to the improvement cycles used to test multiple solutions, implementation cycles can be used to test implementation approaches for a single solution, such as shared medical appointments, and iterative improvements to implementation can be made until a satisfactory implementation model suitable to the context of the clinic is achieved.
There are several limitations to the application of the model for improvement to optimise implementation.
The quality improvement facilitator introduced a structured template for the quality improvement plans and provided a short introduction to using the model of improvement to guide implementation of the plans.
The proposed improvements relate to implementation of the interventions in both the experimental and control group, determining which elements are preferably omitted during the intervention (such as guidance by the instructor, extra elements that consist of substantive information) and which elements would be aloud (e.g., procedural help, training session).
First, because information concerning barriers and facilitators experienced during the implementation may be able to guide improvements to the implementation plan and the intervention itself [ 10, 11].
The results of this study will help inform improvements to the implementation of primary prevention of vascular disease and inform the implementation of other preventive health initiatives which involve referral to group programs outside general practice, such as the 45-year-old health check and the diabetes risk assessment in Australian general practice.
We used the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), to monitor and inform continuous improvements to our implementation [ 21, 22].
In Buczak et al. [ 22], some improvements to this implementation were presented.
Further improvements to our implementation, possibly requiring a major redesign, may be achievable.
There are some possible algorithmic improvements to our implementation that could be tried without a major redesign.
