Implementation laboratories
cancer or stroke, cerebral palsy, Cerebral Palsy
CEREBRAL PALSY, PREMATURE DELIVERY, CEREBRAL PALSY
Trials offer opportunities to optimise the effectiveness of existing implementation interventions, in much the same way that clinical research has continually pushed marginal gains in the effective management of conditions such as cancer or stroke. Yet, establishing the infrastructure for each new trial can be costly and time-consuming. There are opportunities for implementation researchers to learn from and adapt methodologies from clinical fields, such as oncology; innovations such as ‘master protocols’ are based upon a single overarching design to evaluate multiple hypotheses with the goal of improving efficiency and standardising the development and evaluation of different interventions [Large-scale programmes offer opportunities for embedded trials. The PRevention of Cerebral Palsy in Pre-Term labour (PReCePT) programme aimed to reduce cerebral palsy by promoting the use of magnesium sulphate in pregnant women at risk of premature delivery in England. The programme included a nested trial comparing two approaches to quality improvement [The next evolutionary step is to create a learning health system which makes small, incremental changes supported by tightly focused evaluations, and thereby cumulatively improves patient care whilst developing the underpinning evidence base. Such ‘radical incrementalism’ offers a potentially cost-effective if under-utilised approach to embedding learning within large scale improvement programmes [Implementation laboratories several further advantages. First, they can reduce research waste [