BACKGROUND/RATIONALE:
The need to identify effective methods for improving healthcare quality and outcomes is well-established, and has led to a large volume of research evaluating strategies and programs for quality improvement via implementation of evidence-based clinical practices. Unfortunately, this research has produced relatively few reliable and robust insights and findings regarding effective implementation strategies and processes, and consistent success in improvement efforts is rare. Research synthesis offers valuable methods for combining findings and comparing outcomes across multiple implementation projects, to overcome sample size limitations and other shortcomings of individual studies and, as a result, to develop higher quality evidence and insights.
OBJECTIVE(S):
This project will synthesize findings and conduct comparative analyses across multiple studies of implementation strategies conducted within the Veterans Health Administration's Quality Enhancement Research Initiative (QUERI), in order to better assess (1) the impacts and effectiveness of these strategies, (2) the multiple factors influencing their effectiveness, and (3) the fundamental organizational processes and professional behaviors and behavior change processes contributing to successful healthcare quality and outcome improvement.
METHODS:
The project adapts and extends methods for conducting research synthesis in the clinical and social sciences developed and applied by groups such as the US Preventive Services Task Force and Cochrane and Campbell Collaborations. The refined methods are optimized for application to the mixed qualitative/quantitative research designs commonly used in implementation studies. Data collection methods include reviews of study protocols and reports and interviews with key study staff, relying on newly-developed typologies and classification schemes to abstract and code key study features and outcomes. The synthesis sample will includes approximately 50 studies evaluating strategies for implementing evidence-based clinical practices within VHA for the eight QUERI clinical conditions. Quantitative meta-analytic techniques (including meta-regression) and qualitative synthesis techniques (including meta-synthesis) will be used to combine findings and conduct comparative analyses.
FINDINGS/RESULTS:
Data collection is ongoing.
IMPACT:
We expect this research synthesis project to contribute to research, practice and policy in two ways. First, the development and application of an approach for synthesizing research on strategies for implementing evidence-based clinical practice will yield a valuable new tool for researchers to apply to derive new insights and conclusions from the large body of research in this area. Second, the application of this method to implementation studies conducted within VHA should produce valuable policy- and practice-relevant insights and recommendations regarding effective implementation strategies, contributing to VHA's ongoing efforts to improve the quality, safety and outcomes of its healthcare services.
PUBLICATIONS:
Journal Articles
- Ward MM, Yankey JW, Vaughn TE, BootsMiller BJ, Flach SD, Welke KF, Pendergast JF, Perlin J, Doebbeling BN. Physician process and patient outcome measures for diabetes care: relationships to organizational characteristics. Medical Care. 2004; 42(9): 840-50.
