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Understanding health care organization needs and context

Beyond performance gaps

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Abstract

Significant efforts have been invested in improving our understanding of how to accelerate and magnify the impact of research on clinical practice. While approaches to fostering translation of research into practice are numerous, none appears to be superior and the evidence for their effectiveness is mixed. Lessons learned from formative evaluation have given us a greater appreciation of the contribution of context to successful implementation of quality improvement interventions. While formative evaluation is a powerful tool for addressing context effects during implementation, lessons learned from the social sciences (including management and operations research, sociology, and public health) show us that there are also powerful preimplementation tools available to us. This paper discusses how we might integrate these tools into implementation research. We provide a theoretical framework for our need to understand organizational contexts and how organizational characteristics can alert us to situations where preimplementation tools will prove most valuable.

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Author information

Authors and Affiliations

  1. VA Colorectal Cancer QUERI and Center for Chronic Disease Outcomes Research Minneapolis VAMC, Minneapolis, MN, USA

    Laura K. Kochevar PhD

  2. VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA, USA

    Elizabeth M. Yano PhD, MSPH

  3. Department of Health Services, UCLA School of Public Health, Los Angeles, CA, USA

    Elizabeth M. Yano PhD, MSPH

Authors
  1. Laura K. Kochevar PhD
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  2. Elizabeth M. Yano PhD, MSPH
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Corresponding author

Correspondence to Laura K. Kochevar PhD.

Additional information

The authors have no conflict of interest to declare for this article.

See Editorial by Catarina I. Kiefe and Anne Sales, p. S67.

This paper was provided as background material for the VA State of the Art Conference on Implementation Research, August 30–September 1, 2004. This work has been supported by VA HSR&D grants CAN 01-133, CRS 02-162, CRT 02-059, and CRS 02-163-1. The authors wish to thank the Colorectal Cancer QUERI Executive Committee and research affiliates and the VA HSR&D QUERI Director’s office, Research Coordinators, and Implementation Research Coordinators for their valuable input.

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Kochevar, L.K., Yano, E.M. Understanding health care organization needs and context. J Gen Intern Med 21 (Suppl 2), S25–S29 (2006). https://doi.org/10.1007/s11606-006-0271-0

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