Abstract
The mission of the Veterans Health Administration’s (VHA) quality enhancement research initiative (QUERI) is to enhance the quality of VHA health care by implementing clinical research findings into routine care. This paper presents lessons that QUERI investigators have learned through their initial attempts to pursue the QUERI mission. The lessons in this paper represent those that were common across multiple QUERI projects and were mutually agreed on as having substantial impact on the success of implementation. While the lessons are consistent with commonly recognized ingredients of successful implementation efforts, the examples highlight the fact that, even with a through knowledge of the literature and thoughtful planning, unexpected circumstances arise during implementation efforts that require flexibility and adaptability. The findings stress the importance of utilizing formative evaluation techniques to identify barriers to successful implementation and strategies to address these barriers.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
McQueen L, Mittman BS, Demakis JG. Overview of the Veterans Health Administration (VHA) quality enhancement research initiative (QUERI). J Am Med Inform Assoc. 2004;11:339–43.
Demakis JG, McQueen L, Kizer KW, Feussner JR. Quality enhancement research initiative (QUERI): a collaboration between research and clinical practice. Med Care. 2000;38(suppl 1):117–25.
Stetler CB, Legro MW, Wallace CM, et al. The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006;21(suppl 2):S49-S56.
Curran GM, Thrush CR, Smith JL, Owen RR, Ritchie M, Chadwick D. Implementing research findings into practice using clinical opinion leaders: barriers and lessons learned. Jt Comm J Qual Improv. 2005;31:700–7.
Anaya HD, Yano EM, Asch SM. Early adoption of HIV quality improvement in VA Medical Centers: use of organizational surveys to measure readiness to change and adapt interventions to local priorities. Am J Med Qual. 2004;19:137–44.
Korthius PT, Asch S, Mancewicz M, et al. Measuring medication: do interviews agree with medical record and pharmacy data? Med Care. 2002;40:1270–82.
Korthius PT, Asch S, Anaya HD, et al. Lipid screening in HIV-infected veterans. JAIDS. 2004;35:253–60.
Krein SL, Klamerus ML, Vijan S, et al. Case management for patients with poorly controlled diabetes: a randomized trial. Am J Med. 2004;116:732–9.
Owen RR, Thrush CR, Cannon D, et al. Use of electronic medical record data for quality improvement in schizophrenia treatment. J Am Med Inform Assoc. 2004;11:351–7.
Patterson ES, Nguyen AD, Halloran JM, Asch SM. Human factors barriers to the effective use of ten HIV clinical reminders. J Am Med Inform Assoc. 2004;11:50–9.
Pineros SL, Sales AE, Li YF, Sharp ND. Improving care to patients with ischemic heart disease: experiences in a single network of the Veterans Health Administration. Worldviews Evidence-Based Nursing. 2004;1:S33-S40.
Sharp ND, Pineros SL, Hsu C, Starks H, Sales AE. A qualitative study to identify barriers and facilitators to implementation of pilot interventions in the Veterans Health Administration (VHA) Northwest network. Worldviews Evidence-Based Nursing. 2004;1:129–39.
Weaver FM, Goldstein B, Evens CT, et al. Influenza vaccination among veterans with spinal cord injury, part 2: increasing vaccination rates. J Spinal Cord Med. 2003;3:210–9.
Willenbring ML, Hagedorn H. Implementing evidence-based practices in opioid agonist therapy clinics. In: Roberts A, Yeager K, eds. Evidence-Based Practice Manual: Research and Outcome Measures in Health and Human Services. New York: Oxford University Press; 2004:340–7.
Willenbring ML, Hagedorn H, Poster AC, Kenny M. Variations in evidence-based clinical practices in nine United States Veterans Administration opioid agonist therapy clinics. Drug Alcohol Depend. 2004; 75:797–806.
Prochaska JO, DiClemente CC. Toward a comprehensive model of change. In: Miller WR, Heather N, eds. Treating Addictive Behaviors: Processes of Change. New York: Plenum Press; 1986:3–27.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82:581–629.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors have no conflict of interest to declare for this article.
An earlier version of this article was included in materials to support the State of the Art of Implementation Conference, titled “Implementing the Evidence: Transforming Practices, Systems, and Organizations.” The conference was conducted by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service, and was held in Washington, DC, from August 30 to September 1, 2004.
See Editorial by Catarina I. Kiefe and Anne Sales, p. S67.
The VA Quality Enhancement Research Initiative is supported by Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Rights and permissions
About this article
Cite this article
Hagedorn, H., Hogan, M., Smith, J.L. et al. Lessons learned about implementing research evidence into clinical practice. J Gen Intern Med 21 (Suppl 2), S21–S24 (2006). https://doi.org/10.1007/s11606-006-0270-1
Issue Date:
DOI: https://doi.org/10.1007/s11606-006-0270-1