This article is part of a series on U.S. Department of Veterans Affairs Quality Enhancement Research Initiative (QUERI), edited by (Internal Series) Cheryl B Stetler, Brian S Mittman, Joseph Francis. (Journal Series) Martin P Eccles, Ian Graham .

Research article

Improving eye care for veterans with diabetes: An example of using the QUERI steps to move from evidence to implementation: QUERI Series

Sarah L Krein^1,2 , Steven J Bernstein^1,2 , Carol E Fletcher² , Fatima Makki² , Caroline L Goldzweig³ , Brook Watts⁴ , Sandeep Vijan^1,2 and Rodney A Hayward^1,2

¹  Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA

²  Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

³  General Internal Medicine and Clinical Informatics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA

⁴  Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA

author email corresponding author email

Implementation Science 2008, 3:18doi:10.1186/1748-5908-3-18

Published:	19 March 2008

Abstract

Background

Despite being a critical part of improving healthcare quality, little is known about how best to move important research findings into clinical practice. To address this issue, the Department of Veterans Affairs (VA) developed the Quality Enhancement Research Initiative (QUERI), which provides a framework, a supportive structure, and resources to promote the more rapid implementation of evidence into practice.

Methods

This paper uses a practical example to demonstrate the use of the six-step QUERI process, which was developed as part of QUERI and provides a systematic approach for moving along the research to practice pipeline. Specifically, we describe a series of projects using the six-step framework to illustrate how this process guided work by the Diabetes Mellitus QUERI (DM-QUERI) Center to assess and improve eye care for veterans with diabetes.

Results

Within a relatively short time, DM-QUERI identified a high-priority issue, developed evidence to support a change in the diabetes eye screening performance measure, and identified a gap in quality of care. A prototype scheduling system to address gaps in screening and follow-up also was tested as part of an implementation project. We did not succeed in developing a fully functional pro-active scheduling system. This work did, however, provide important information to help us further understand patients' risk status, gaps in follow-up at participating eye clinics, specific considerations for additional implementation work in the area of proactive scheduling, and contributed to a change in the prevailing diabetes eye care performance measure.

Conclusion

Work by DM-QUERI to promote changes in the delivery of eye care services for veterans with diabetes demonstrates the value of the QUERI process in facilitating the more rapid implementation of evidence into practice. However, our experience with using the QUERI process also highlights certain challenges, including those related to the hybrid nature of the research-operations partnership as a mechanism for promoting rapid, system-wide implementation of important research findings. In addition, this paper suggests a number of important considerations for future implementation work, both in the area of pro-active scheduling interventions, as well as for implementation science in general.