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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3150 — Building Research-Clinical Partnerships from the Ground Up: Frontline Perspectives on VA Quality Improvement

Klap RSHamilton AB, and Oishi SM, VA Greater Los Angeles Healthcare System; Carney D, VA Palo Alto Healthcare System; Canelo IChow B, and Yano EM, VA Greater Los Angeles Healthcare System; Frayne S, VA Palo Alto Healthcare System;

VA health services research has substantial potential to generate evidence-based practice and policy, especially when investigators partner with VA policy and operations leadership. Quality improvement (QI) research, however, has demonstrated the vital importance of both top-down and bottom-up engagement. Most partnership research has focused on national and network priorities, resulting in limited knowledge of the perspectives of frontline staff with the greatest experience of what it takes to implement innovations in the context of day-to-day care. We sought to remedy this gap within a new VA practice based research network (PBRN).

We conducted 31 semi-structured interviews with frontline clinicians and other staff at three sites within the VA Women’s Health PBRN (Palo Alto, Durham, Iowa City). Interviews included questions about staff/clinician experiences with research and QI initiatives, and healthcare delivery challenges that they thought could be addressed through research or QI. Interviews were transcribed and analyzed using the constant comparison method.

On average, most frontline staff had low levels of experience with research or QI, with a few notable exceptions. Participants resonated with the idea that the VA was trying to address women’s healthcare issues. Interests in research and QI topics were quite varied, with some respondents suggesting very specific clinical topics (e.g., study of cancers, sexual dysfunction, eating disorders), while others suggested operational or management-related topics (e.g., no-shows, attrition from VA, coordination of care).

Without exception, VA clinicians and staff were supportive of the PBRN’s potential to improve women Veterans’ health care, and were open to partnering with PBRN leaders to further women’s health research and QI.

Engaging frontline clinicians and staff not only in the conduct of research but in helping to generate quality improvement ideas holds promise for continuing to accelerate VA’s movement toward being a learning organization that builds on effective research-clinical partnerships.

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