The Ann Arbor HSR&D Center of Excellence (COE) and the Diabetes Quality Enhancement Research Initiative (QUERI-DM) have been conducting research to translate clinical findings into practice and to understand facilitators and barriers to implementation of research findings. Through collaboration with two known experts, Dr. Jeffrey Alexander and Dr. John Creswell, the HSR&D COE planned to enhanced skills at the Center in mixed methods, qualitative methods, and implementation research.
1) To enhance implementation research through consultation from academic experts in organizational behavior (Dr. Alexander) and qualitative research and integrating qualitative and quantitative methods (Dr. Creswell); 2) To improve internal resources of the COE in specific areas related to implementation research through use of outside mentors and experts; and 3) To increase the quality of research projects and proposals with respect to qualitative methodology, integration of quantitative and qualitative methods, and organizational assessment and change.
Targeted consultations on implementation research and on individual projects have been conducted periodically. Dr. Creswell has provided directed support to Dr. Forman and other staff on the development of center processes for qualitative research design and analysis and use of mixed methods. Dr. Alexander has provided input to COE and QUERI staff in organization and management research and in developing an implementation framework.
General development activities have included: 1) Several workshops on mixed methods were facilitated by Dr. Creswell, a general workshop for staff and a workshop for investigators to develop a proposal for a mixed methods intervention study; 2) Dr. Creswell assisted Dr. Forman on a presentation for VA investigators and staff on qualitative research; 3) Dr. Alexander conducted a workshop on organizational theory for Center staff and several smaller workshops on organizational frameworks and developing an implementation framework for QUERI-DM.
Also, Drs. Creswell and Alexander consulted on specific projects and activities. Dr. Creswell has been an ongoing consultant for Translating Infection Prevention Evidence to Enhance Patient Safety, and Addressing Barriers to Translation for Treatment of Hypertension (ABATe). He provided consultation for several Addressing Intensification of Medication (AIM) proposals. Dr. Alexander consulted with QUERI-DM regarding goverance structure and specific projects. He has been a consultant to the I-Care project and the ABATe project and worked with the QUERI-DM to develop an implementation framework.
Through these and other activities, Drs. Alexander and Creswell have benefitted the research program at the COE. Many center staff have a better understanding of mixed methods and the benefits of using both quantitative and qualitative methods. A working infrastructure for qualitative methods has developed. There is now a core group of staff who have a process for team management and analysis of qualitative data. Both proposals and ongoing projects incorporate more sophisiticated mixed methods in proposals and analysis planning. COE and QUERI investigators have been able to use these experts for consultation on both planned and current projects. A QUERI implementation framework has been developed and is currently being refined.
This project has increased the use of and quality of mixed methods in the COE's research and implementation activities. The use of mixed methods will improve the VA health care system's ability to meet the many challenges to implementing interventions on a broad scale so that they are both effective and self-sustaining. Both these experts have been engaged by the COE for additional consultation after the conclusion of this grant funding.
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