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Kirchner J, Parker LE, Yano EM, Chaney E. Opening up the black box of quality improvement interventions: Lessons from a formative evaluation of routine-care implementation of depression collaborative care. Paper presented at: AcademyHealth Annual Research Meeting; 2006 Jun 25; Seattle, WA.
Spread of new technologies across healthcare organizations is a complex process whose determinants health service researchers are only recently beginning to study systematically. Successful routine-care implementation requires participation of stakeholders from a broad spectrum of professional backgrounds, skill sets, and organizational levels. Further, a variety of individual, organizational, and cultural characteristics may differentially affect stakeholder groups' readiness and ability to embrace evidence-based implementation efforts. Capitalizing on its 25-year investment in health services research, the Veterans Health Administration (VHA) has embarked on a series of research-clinical partnerships through the Quality Enhancement Research Initiative (QUERI). We conducted a formative evaluation of one of these partnerships, the TIDES program (Translating Initiatives for Depression Into Effective Solutions). This panel will be composed of 4 major sections. First, we will briefly describe the TIDES intervention and implementation methodology. Second, we will describe details of the multi-method formative evaluation conducted of this multi-site intervention. This evaluation included managers' and providers' views of the strengths and weaknesses of the implementation process, resulting in practical guidelines for working with busy frontline healthcare staff and critical methodological recommendations for improving the science underlying implementation research. Third, we will describe views of management and frontline staff on how best to establish a two-way dialogue between implementers and QI program participants, which is designed to facilitate program marketing and provide a mechanism for obtaining on-going feedback from local staff. Finally, we will discuss the effects of contextual and organizational characteristics on the extent of intervention penetration across practices.