Table 1 |
|
Summary and description of expanded six-step QUERI process model |
| CORE STEPS |
| Step 1: Select conditions per patient populations associated with high risk of disease
and/or disability and/or burden of illness for veterans |
| 1A. Identify and prioritize (via a formal ranking procedure) |
| 1B. Identify high-priority clinical practices and outcomes within a selected condition |
| ▪ Overall conditions addressed by QUERI Coordinating Centers are selected by the VHA
[Veterans Health Administration; also referred to as VA in this Series] and national
QUERI leadership. QUERI Center Executive Committee then assigns priorities to specific
sub-topics within each clinical area selected to provide the greatest possible impact
on veteran health. |
| ▪ QUERI groups seek opportunities for collaboration on overlapping priorities, such
as relevant coexisting diagnoses (e.g., mental illness and substance use disorder). |
| ▪ Epidemiological and outcomes studies may be conducted or, if available, used to facilitate
decision making. |
| Step 2: Identify evidence-based guidelines, recommendations and best practices |
| 2A. Identify evidence-based clinical practice guidelines |
| 2B. Identify evidence-based clinical recommendations |
| 2C. Identify evidence-based clinical practices |
| ▪ Can include systematic reviews and/or a consensus process |
| Step 3: Measure and diagnose quality and performance gaps |
| 3A. Measure existing practice patterns and outcomes across VA and identify variations
from evidence-based practices ("quality/performance gaps") |
| 3B. Identify determinants of current practices |
| 3C. Diagnose quality/performance gaps |
| 3D. Identify barriers and facilitators to improvement |
| ▪ Includes variations studies to a) measure care processes related to clinical conditions
and related deviations from best practices, and b) explain various influences on practices. |
| ▪ Studies focus on general, VA-wide gaps relative to a targeted condition or issue. |
| Step 4: Implement improvement programs |
| 4A. Identify improvement/implementation strategies, programs and program components
or tools |
| 4B. Develop or adapt improvement/implementation strategies, programs and program components
or tools |
| 4C. Implement improvement/implementation strategies/programs to address quality gaps |
| ▪ Requires literature searches for evidence-based implementation interventions, change
strategies and related tools. |
| ▪ Includes development and evaluation of implementation or practice support toolkits,
such as educational materials or clinical reminder content. |
| ▪ Researchers expected to consider relevant methodological approaches, e.g., a conceptual
framework, an appropriate study design and facilitation [11]. |
| Step 5/6: Evaluate improvement programs |
| 5. Assess improvement program feasibility, implementation and impacts on patient,
family and healthcare system processes and outcomes |
| 6. Assess improvement program impacts on health related quality of life (HRQOL) |
| ▪ Should consider both formative and summative evaluation. |
| ▪ As part of formative evaluation [FE], would include a developmental-stage local diagnostic
analysis to affirm generically identified barriers in study sites; would also consider
other FE stages [9]. |
| ▪ Should consider a cost- or business case analysis. |
| SUPPLEMENTAL RESEARCH ACTIVITIES |
| Step M: Develop measures, methods and data resources |
| M1. Develop, refine and validate patient registries and databases documenting healthcare
organizational features, clinical practices and utilization, and outcomes. |
| M2. Develop and/or evaluate case-finding and screening tools. |
| M3. Develop and/or evaluate measures of healthcare structures, processes and outcomes. |
| Step C: Develop clinical evidence |
| C1. Develop and evaluate evidence-based clinical practices and recommendations (clinical
research). |
| C2. Develop and evaluate evidence-based health services interventions (health services
research). |
| ▪ Step M and C projects are considered to be outside the core QUERI process, although
they support implementation research. Such projects are generally funded through regular
VHA or external clinical science and health services research funding programs. |
|
|
|
Stetler et al. Implementation Science 2008 3:8 doi:10.1186/1748-5908-3-8 |
