Table 2 QUERI phases of implementation projects/QUERI pipeline

◆ Small scale study within a single clinic or facility

◆ Used with a substantiated clinical or delivery best practice

◆ Identifies potential issues relative to routine integration of best practice such as acceptability of the recommendation, process barriers, and needed toolkit elements

Phase 2: Small clinical trials to further refine and evaluate an improvement/implementation program

◆ Relatively modest but multi-site evaluation (e.g., 4-6 facilities within one or two VA regions)

◆ Conducted within a formal research and evaluation framework, e.g., an experimental design. Usually is a hybrid design, i.e., a traditional intervention design plus a descriptive formative evaluation [9]

◆ Requires active research team support and involvement, plus modest real-time refinements to maximize the likelihood of success and to study the process for replication requirements

◆ Enables refinement before larger-scale implementation

Phase 3: "Regional roll-out" projects

◆ Test of large-scale adoption program prior to full VA implementation with 10-20 facilities in 3-5 VA regions

◆ Decreased research team support at local sites and greater involvement of stakeholders, both nationally and locally

◆ Should require less need for real-time refinements of the implementation strategy

◆ Preparation for hand-off at national level

Phase 4: "National roll-out" effort

◆ Implementation of a tested, refined strategy throughout the VA

◆ Existing operations or designated leadership entity deliver the program

◆ Research team support as determined per Phase 3 evaluation

◆ Concurrent and ongoing evaluation, per methodology determined/refined in Phase 3