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Table 3 The role of organizational research in QUERI

From: The role of organizational research in implementing evidence-based practice: QUERI Series

6-step QUERI process

Role of organizational research

 

Organizational (or practice) level

#1: Select diseases/conditions/populations:

• Identify and prioritize high-risk/high-burden clinical conditions

• Identify high-priority clinical practices/outcomes within a selected condition

• Evaluate disease prevalence among member organizations or individual practices to ascertain how salient target conditions are system-wide (i.e., related to organizational readiness to change)

#2: Identify evidence-based guidelines and clinical recommendations:

• Identify evidence-based practice guidelines

• Identify evidence-based clinical recommendations

• Begin to consider implications of organizational settings where efficacy and effectiveness studies were conducted vs. where evidence will subsequently be applied

#3: Measure and diagnose quality gaps:

• Measure existing practice patterns and outcomes across VHA, identify variations

• Identify determinants of current practices

• Diagnose quality gaps and identify barriers and facilitators to improvement

• Measure general organizational determinants of variations relative to the targeted condition/practice

• Include measures of organizational structure and processes when diagnosing quality gaps

• Determine general organizational factors that serve as barriers and facilitators to improvement to implementation in general and specific to the targeted condition/practice

#4: Implement improvement programs (strategy, program, program components or tools) to address quality gaps

• Identify QI interventions (e.g., per literature reviews)

• Develop or adapt QI interventions (e.g., educational resources, decision support)

• Implement QI interventions

• Assess/diagnose local needs, gaps, and capacities in target sites

• Use organizational characteristics to facilitate site selection for implementation

• Evaluate organizational readiness to change

• Design and evaluate additional intervention components based on local context (tailoring)

#5: Evaluate improvement programs

• Assess improvement program feasibility, implementation, and impacts on patient, family and system outcomes

• Determine organizational facilitators that may be leveraged (e.g., leadership support) and barriers that may be amenable to resolution during the study (e.g., non-supportive process) or that may aide interpretation of findings

#6: Evaluate improvement programs

• Assess improvement program impacts on health-related quality of life (HRQOL)

• Evaluate organizational structure, process and behaviours related to adoption and penetration

• Analyze site and system-level effects and costs

• Inform policy development for sustainability and spread to different organizational types and levels of complexity