Considering context in quality improvement interventions and implementation: concepts, frameworks, and application

Acad Pediatr. 2013 Nov-Dec;13(6 Suppl):S45-53. doi: 10.1016/j.acap.2013.04.013.


Growing consensus within the health care field suggests that context matters and needs more concerted study for helping those who implement and conduct research on quality improvement interventions. Health care delivery system decision makers require information about whether an intervention tested in one context will work in another with some differences from the original site. We aimed to define key terms, enumerate candidate domains for the study of context, provide examples from the pediatric quality improvement literature, and identify potential measures for selected contexts. Key sources include the organizational literature, broad evaluation frameworks, and a recent project in the patient safety area on context sensitivity. The article concludes with limitations and next steps for developments in this area.

Keywords: context sensitivity; implementation science; pediatrics; quality improvement interventions; quality of care; realist evaluation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Child
  • Child, Preschool
  • Delivery of Health Care / organization & administration*
  • Health Plan Implementation / organization & administration*
  • Humans
  • Male
  • Organizational Innovation
  • Pediatrics / organization & administration*
  • Quality Assurance, Health Care*
  • Quality Improvement*
  • United States