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Contents : Quality Enhancement Research Initiative Scale-up and Spread of Evidence-Based Implementation Programs within VA Brian S. Mittman PhD Director VA Center for Implementation Practice and Research Support (CIPRS) VA Greater Los Angeles Healthcare System January 28 2009 Background The Veterans Health Administration (VHA) is a large integrated healthcare delivery system New programs directives guidelines and other innovations emerge continuously QUERI (Quality Enhancement Research Initiative) and other research-based (or informed) programs endeavor to implement (or facilitate implementation) of the innovations Success in local and regional implementation does not lead directly to national implementation Local vs. national implementation Intensive facilitation technical assistance Formative evaluation ongoing monitoring and feedback Hawthorne effect Trained specialized (exclusive) intervention / care staff Site (leadership) commitment support staff enthusiasm He/she is a study patient vs. National directive expectation performance monitoring Established evidence base proof of feasibility value Role models opinion leaders QUERI Four-Phase Implementation Research Framework Phase Study Type Evaluation Pre-trial Conceptual Conceptual design of implementation program and underlying design (logic) model from theory prior empirical research Phase 1 Pilot / Formative Pilot test assess feasibility formative evaluation and refinement develop intervention/evaluation protocols Phase 2 Efficacy Small-scale rigorous trial in controlled settings with ongoing intervention support internal validity Phase 3 Effectiveness Large-scale rigorous trial under routine conditions in varied settings external validity Phase 4 Monitoring Ongoing monitoring and feedback Example: Depression collaborative care Evidence-based care model Care manager telephone assessment and follow-up Algorithm-based treatment plan established by PCP Care manager supervision DCM by a mental health specialist Consultation between specialist and PCP National Dissemination Plan: national clinical practice guidelines performance measures informatics support social marketing supportive national policy initiative (MH-PC integration) Smith JL et al. Developing a national dissemination plan for collaborative care for depression: QUERI Series. Implement Sci. 2008 Dec 31 3:59.

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