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QUERI Implementation Guide
Section I Part 4: Formative Evaluation
Terminology
Within the realm of QUERI activities there are two types of evaluation – formative and summative. Both evaluations are equally important. Summative evaluations generally address the resultant success or effectiveness of a program or intervention and often receive much more attention. However, QUERI project proposals are expected to include plans to complete both types of evaluations. Study designs appropriate to summative evaluation are discussed in Section I, Part 3 of this QUERI Guide, and are more familiar to most health services researchers as designs for intervention studies.
Both definitions and terminology abound for formative evaluation and terms are interchangeable. Definitions abound for formative evaluation, butFor for QUERI purposes these terms are interchangeable and this type of workthe general intent of formative evaluation is used to describe and monitor the development and progress of an intervention or program. It also provides information with which to adjust the process, as needed, to maximize the effect of the translation strategy. Furthermore, formative evaluation activities can be employed either before or during implementation of the intervention or program.
An example of summative and formative evaluations is seen in a Spinal Cord Injury (SCI) QUERI initiative to improve increase deliveryuse of flu vaccine to veteran patients with SCI and disease by implementing four different interventionsstrategies:
- Patient reminder letters with educational component,
- Provider education,
- Computerized clinical reminders, and
- Nurse standing orders.
Summative evaluations, collected from several sources, examined immunization rates annuallyon an annual basis whether the rates of immunization improved. The formative evaluations examined the process of implementing the four interventionsstrategies. Some of the formative evaluations examined: provider knowledge and attitudes about flu shots, difficulties in using the clinical reminder (and whether adjustments were implemented toand better meet staff needs), variation in provider use of the clinical reminder,difficulties in reaching patients, as well as patient attitudes and knowledge about flu shots.
Information about the process of implementation also may be linked to the summative evaluation that examinesto answer specific questions. For example, the process evaluation may could find that patient contact appears to make the most difference because clinicians never use the computer reminders.
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