Table 3 The role of organizational research in QUERI
From: The role of organizational research in implementing evidence-based practice: QUERI Series
6-step QUERI process | Role of organizational research |
|---|---|
Organizational (or practice) level | |
#1: Select diseases/conditions/populations: • Identify and prioritize high-risk/high-burden clinical conditions • Identify high-priority clinical practices/outcomes within a selected condition | • Evaluate disease prevalence among member organizations or individual practices to ascertain how salient target conditions are system-wide (i.e., related to organizational readiness to change) |
#2: Identify evidence-based guidelines and clinical recommendations: • Identify evidence-based practice guidelines • Identify evidence-based clinical recommendations | • Begin to consider implications of organizational settings where efficacy and effectiveness studies were conducted vs. where evidence will subsequently be applied |
#3: Measure and diagnose quality gaps: • Measure existing practice patterns and outcomes across VHA, identify variations • Identify determinants of current practices • Diagnose quality gaps and identify barriers and facilitators to improvement | • Measure general organizational determinants of variations relative to the targeted condition/practice • Include measures of organizational structure and processes when diagnosing quality gaps • Determine general organizational factors that serve as barriers and facilitators to improvement to implementation in general and specific to the targeted condition/practice |
#4: Implement improvement programs (strategy, program, program components or tools) to address quality gaps • Identify QI interventions (e.g., per literature reviews) • Develop or adapt QI interventions (e.g., educational resources, decision support) • Implement QI interventions | • Assess/diagnose local needs, gaps, and capacities in target sites • Use organizational characteristics to facilitate site selection for implementation • Evaluate organizational readiness to change • Design and evaluate additional intervention components based on local context (tailoring) |
#5: Evaluate improvement programs • Assess improvement program feasibility, implementation, and impacts on patient, family and system outcomes | • Determine organizational facilitators that may be leveraged (e.g., leadership support) and barriers that may be amenable to resolution during the study (e.g., non-supportive process) or that may aide interpretation of findings |
#6: Evaluate improvement programs • Assess improvement program impacts on health-related quality of life (HRQOL) | • Evaluate organizational structure, process and behaviours related to adoption and penetration • Analyze site and system-level effects and costs • Inform policy development for sustainability and spread to different organizational types and levels of complexity |