A process for developing an implementation intervention: QUERI Series

Geoffrey M Curran, Snigda Mukherjee, Elise Allee, Richard R Owen, Geoffrey M Curran, Snigda Mukherjee, Elise Allee, Richard R Owen

Abstract

Background: This article describes the process used by the authors in developing an implementation intervention to assist VA substance use disorder clinics in adopting guideline-based practices for treating depression. This article is one in a Series of articles documenting implementation science frameworks and tools developed by the U.S. Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI).

Methods: The process involves two steps: 1) diagnosis of site-specific implementation needs, barriers, and facilitators (i.e., formative evaluation); and 2) the use of multi-disciplinary teams of local staff, implementation experts, and clinical experts to interpret diagnostic data and develop site-specific interventions. In the current project, data were collected via observations of program activities and key informant interviews with clinic staff and patients. The assessment investigated a wide range of macro- and micro-level determinants of organizational and provider behavior.

Conclusion: The implementation development process described here is presented as an optional method (or series of steps) to consider when designing a small scale, multi-site implementation study. The process grew from an evidence-based quality improvement strategy developed for - and proven efficacious in - primary care settings. The authors are currently studying the efficacy of the process across a spectrum of specialty care treatment settings.

References

    1. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82:581–630. doi: 10.1111/j.0887-378X.2004.00325.x.
    1. Wagner EH, Glasgow RE, Davis C, Bonomi AE, Provost L, McCulloch D, Carver P, Sixta C. Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001;27:63–80.
    1. Rogers E. Diffusion of Innovations. 5. New York: The Free Press; 1995.
    1. Hagedorn H, Hogan M, Smith JL, Bowman C, Curran GM, Espadas D, Kimmel B, Kochevar L, Legro MW, Sales AE. Lessons learned about implementing research evidence into clinical practice. Experiences from VA QUERI. J Gen Intern Med. 2006;21 Suppl 2:S21–S24.
    1. McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, Seers K. Getting evidence into practice: the meaning of "context". J Adv Nurs. 2002;38:94–104. doi: 10.1046/j.1365-2648.2002.02150.x.
    1. Kochevar LK, Yano EM. Understanding health care organization needs and context. Beyond performance gaps. J Gen Intern Med. 2006;21 Suppl 2:S25–S29.
    1. Sales A, Smith J, Curran G, Kochevar L. Models, strategies, and tools. Theory in implementing evidence-based findings into health care practice. J Gen Intern Med. 2006;21 Suppl 2:S43–S49.
    1. Kiefe CI, Sales A. A state-of-the-art conference on implementing evidence in health care. Reasons and recommendations. J Gen Intern Med. 2006;21 Suppl 2:S67–S70.
    1. Stetler CB, Legro MW, Wallace CM, Bowman C, Guihan M, Hageodorn H, Kimmel B, Sharp ND, Smith JL. The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006;21 Suppl 2:S1–S8.
    1. Bartholomew LK, Parcel GS, Kok G, Gottilieb NH. Changing Behavior and Environment: How to Plan Theory- and Evidence-Based Disease Management Programs. In: Patterson R, editor. Changing Patient Behavior: Improving Outcomes in Health and Disease Management Jossey-Bass. 2001.
    1. Black K, Revere L. Sigma arises from the ashes of TQM with a twist. Int J Health Care Qual Assur Inc Leadersh Health Serv. 2006;19:159–66.
    1. Matchar DB, Patwardhan MB, Samsa GP, Haley WE. Facilitated process improvement: an approach to the seamless linkage between evidence and practice in CKD. Am J Kidney Dis. 2006;47:549–52. doi: 10.1053/j.ajkd.2005.11.016.
    1. Rubenstein LV, Parker LE, Meredith LS, Altschuler A, dePillis E, Hernandes J, Gordon NP. Understanding Team-based Quality Improvement for Depression in Primary Care. HSR. 2002;37:1009–1028.
    1. Grimshaw J, Eccles M, Thomas R, MacLennan G, Ramsay C, Fraser C, Vale L. Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966–1998. J Gen Intern Med. 2006;21 Suppl 2:S14–S20.
    1. Fihn SD. Moving Implementation science forward. J Gen Intern Med. 2006;21 Suppl 2:S65–S66.
    1. Eccles MP, Mittman BS. Welcome to Implementation Science. Implementation Science. 2006;1:1. doi: 10.1186/1748-5908-1-1.
    1. Curran GM, Thrush CR, Smith JL, Owen RR, Ritchie M, Chadwick D. Implementing research findings into practice using clinical opinion leaders: barriers and lessons learned. Jt Comm J Qual Patient Saf. 2005;31:700–7.
    1. McQueen L, Mittman BS, Demakis JG. Overview of the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) J Am Med Inform Assoc. 2004;11:339–343. doi: 10.1197/jamia.M1499.
    1. Stetler C, Legro M, Rycroft-Malone J, Bowman C, Curran G, Guihan M, Hagedorn H, Pineros S, Wallace C. Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration. Implementation Science. 2006;1:23. doi: 10.1186/1748-5908-1-23.
    1. Stetler CB, Mittman BS, Francis J. Overview of the VA Quality Enhancement Research Initiative (QUERI) and QUERI theme articles: QUERI Series. Implementation Science. 2008;3:8. doi: 10.1186/1748-5908-3-8.
    1. Feussner JR, Kizer KW, Demakis JG. The Quality Enhancement Research Initiative (QUERI): from evidence to action. Med Care. 2000;38:I1–6.
    1. Sussman S, Valente TW, Rohrbach LA, Skara S, Pentz MA. Translation in the health professions: converting science into action. Eval Health Prof. 2006;29:7–32. doi: 10.1177/0163278705284441.
    1. Lavis JN, Lomas J, Hamid M, Sewankambo Assessing country-level efforts to link research to action. Bull World Health Organ. 2006;84:620–628. doi: 10.2471/BLT.06.030312.
    1. Green LW, Kreuter MW, Deeds SG, Partridge KB. Health education planning model (PRECEDE) In: Green LW, editor. Health Education Planning: a Diagnostic Approach. Palo Alto, CA: Mayfield Publishing Co; 1980.
    1. Woolf SH. Changing physician practice behavior. J Family Prac. 2000;49:126–129.
    1. Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes. 1991;50:179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Bandura A. Social Learning Theory. New York: General Learning Press; 1977.
    1. Jorgensen DL. Participant observation: a methodology for human studies. Thousand Oaks, CA: Sage; 2001.
    1. Demakis JG, McQueen , Kizer KW, Feussner JR. Quality Enhancement Research Initiative (QUERI): A collaboration between research and clinical practice. Med Care. 2000;38:I17–I25.
    1. McQueen l, Mittman BS, Demakis JGl. Overview of the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) J Am Med Inform Assoc. 2004;11:339–43. doi: 10.1197/jamia.M1499.
    1. Sobo EJ. Parents' perceptions of pediatric day surgery risks: unforeseeable complications, or avoidable mistakes? Soc Science & Med. 2005;60:2341–2350.
    1. Ferguson TB. Continuous quality improvement in medicine: validation of a potential role for medical specialty societies. Am Heart Hosp J. 2003;1:264–72. doi: 10.1111/j.1541-9215.2003.02502.x.
    1. Benedetto AR. Six Sigma: not for the faint of heart. Radiol Manage. 2003;25:40–53.
    1. Rubenstein LR, Pugh J. Strategies for promoting organizational and practice change by advancing implementation research. J Gen Intern Med. 2006;21 Suppl 2:S58–S64.
    1. Wensing M, Wollersheim H, Grol R. Organizational interventions to implement improvements in patient care: a structured review of reviews. Implementation Science. 2006;1:2. doi: 10.1186/1748-5908-1-2.
    1. Bonneti D, Eccles M, Johnston M, Steen N, Grimshaw J, Baker R, Walker A, Pitts N. Guiding the design and selection of interventions to influence the implementation of evidence-based practice: an experimental simulation of a complex intervention trial. Soc Sci Med. 2005;60:2135–47. doi: 10.1016/j.socscimed.2004.08.072.
    1. Shadish WR, Cook TD, Campbell DT. Experimental and Quasi-Experimental Designs for Generalized Causal Inference. Boston, MA: Houghton Mifflin; 2001.
    1. Patton MQ. Qualitative Research & Evaluation Methods. 3. Thousand Oaks, CA: Sage; 2002.
    1. Grimshaw JM, Shittan L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman A, O'Brien MA. An overview of systematic reviews of interventions. Med Care. 2001;39:112–145. doi: 10.1097/00005650-200108002-00002.
    1. Rubenstein LV, Mittman BS, Yano EM, Mulrow DC. From understanding health care provider behavior to improving health care: the QUERI framework for quality improvement. Med Care. 2000;38:I129–I141.
    1. Davis DA, Taylor-Vaisey A. Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ. 1997;157:408–16.
    1. Freemantle N, Harvey EL, Wolf F, Grimshaw JM, Grilli R, Bero LA. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000;2:CD000172.
    1. Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N. Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005;58:113–6. doi: 10.1016/j.jclinepi.2004.10.002.
    1. Stetler CB. Role of the organization in translating research into evidence-based practice. Outcomes Management. 2003;7:97–103.
    1. Glisson C, Schoenwald K. The ARC Organizational and Community Intervention Strategy for Implementing Evidence-Based Children's Mental Health Treatments. Ment Health Serv Res. 2005;7:243–259. doi: 10.1007/s11020-005-7456-1.
    1. Kravitz RL, Duan N, Braslow J. Evidence-Based Medicine, Heterogeneity of Treatment Effects, and the Trouble with Averages. The Milbank Q. 2004;82:661–687. doi: 10.1111/j.0887-378X.2004.00327.x.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅