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.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Mittman BS. Creating the evidence base for quality improvement collaboratives. Annals of internal medicine. 2004 Jun 1; 140(11):897-901. [view]
2. 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 Sep 1; 42(9):840-50. [view]
3. Rubenstein LV, Pugh J. Strategies for promoting organizational and practice change by advancing implementation research. Journal of general internal medicine. 2006 Feb 1; 21 Suppl 2:S58-64. [view]
4. Doebbeling BN, Pekny J. The role of systems factors in implementing health information technology. Journal of general internal medicine. 2008 Apr 1; 23(4):500-1. [view]

Conference Presentations

1. Kochevar LK, Mittman B, Stetler C. Advanced Implementation Research Issues. Paper presented at: VA HSR&D National Meeting; 2005 Feb 1; Baltimore, MD. [view]
2. Wang M, Mittman BS, Rubenstein LV. An expert panel approach to developing a curriculum for implementation science. Paper presented at: AcademyHealth Annual Research Meeting; 2006 Jun 1; Seattle, WA. [view]
3. Schneider JE, Kazis LE, Huang Y, Yankey J, Vaughn T, Doebbeling BN. Analyzing the Relationship between Organizational Performance and Health Status in the VA System. Paper presented at: VA HSR&D National Meeting; 2004 Mar 1; Washington, DC. [view]
4. Doebbeling BN. Attributes of an Ideal Integrated Informatics System that Supports Implementation of Evidence. Paper presented at: VA ORD State of the Art (SOTA) Conference; 2004 Aug 1; Washington, DC. [view]
5. Mittman BS. Developing Multi-Level Strategies for Chronic Disease TRIP Initiatives. Paper presented at: Agency for Healthcare Research and Quality Translating Research Into Practice and Policy Annual Meeting; 2005 Jun 1; Washington, DC. [view]
6. Chou AF, Vaughn TE, McCoy KD, Doebbeling BN. Effects of Provider Participation in Implementation and Performance Feedback on Practice. Poster session presented at: VA QUERI National Meeting; 2003 Dec 1; Washington, DC. [view]
7. Doebbeling N, Saleem J, Flanagan E, Yano EM. Extent of Implementation of Clinical Decision Support in VHA: Results of a National Survey. Poster session presented at: VA HSR&D National Meeting; 2008 Feb 13; Baltimore, MD. [view]
8. Mittman BS. Frameworks, Steps and Phases: Tools for Designing and Conducting Implementation Research. Paper presented at: VA HSR&D National Meeting; 2005 Feb 1; Baltimore, MD. [view]
9. Mittman BS. Improving the Quality and Value of Healthcare Quality Improvement Research: Foundations for a Template for Study Design and Reporting. Paper presented at: University of Pittsburgh Center for Research on Health Care / Pittsburgh VAMC CHERP / RAND Annual Seminar Series; 2005 Apr 1; Pittsburgh, PA. [view]
10. Doebbeling BN. Informatics Strategies to Support Healthcare Quality Improvement. Paper presented at: VA QUERI National Meeting; 2003 Nov 1; Washington, DC. [view]
11. Pearson ML, Parkerton PH, Takahashi NY, Smith NZY, Mittman BS. Measuring TRIP Implementation. Paper presented at: Agency for Healthcare Research and Quality Translating Research Into Practice and Policy Annual Meeting; 2004 Jul 12; Washington, DC. [view]
12. Doebbeling BN, Tripp-Reimer T. Qualitative Analytic Methods in Translational Research. Paper presented at: Advancing Quality Care Through Translation Research Annual Conference; 2003 Oct 1; Iowa City, IA. [view]
13. Mittman BS. Research on TRIP: Progress, Problems and Prospects. Paper presented at: Agency for Healthcare Research and Quality Translating Research Into Practice and Policy Annual Meeting; 2005 Jun 1; Washington, DC. [view]
14. Mittman BS. Research Synthesis for Implementation Research. Paper presented at: VA HSR&D National Meeting; 2005 Feb 1; Baltimore, MD. [view]
15. Mittman BS, Pearson ML, Parkerton PH, Takahashi NY, Smith NZY. Synthesizing Quality Improvement Research: Methodological and Empirical Challenges and Solutions. Paper presented at: AcademyHealth Annual Research Meeting; 2005 Jun 1; Boston, MA. [view]
16. Parkerton PH, Mittman BS, Takahashi NY, Pearson ML. TRIP Research Design Options. Paper presented at: Agency for Healthcare Research and Quality Translating Research Into Practice and Policy Annual Meeting; 2004 Jul 12; Washington, DC. [view]
17. Doebbeling BN. Variation in Informatics Technology Implementation in VHA to Improve Care. Paper presented at: VA HSR&D National Meeting; 2004 Mar 1; Washington, DC. [view]

DRA: Health Systems
DRE: none
Keywords: Translation
MeSH Terms: none