Table 2 QUERI phases of implementation projects/QUERI pipeline
Phase 1: Pilot project to develop/refine an improvement/implementation program and assess basic feasibility: |
|---|
â—† Small scale study within a single clinic or facility |
â—† Used with a substantiated clinical or delivery best practice |
â—† 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 |
â—† Relatively modest but multi-site evaluation (e.g., 4-6 facilities within one or two VA regions) |
â—† 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] |
â—† 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 |
â—† Enables refinement before larger-scale implementation |
Phase 3: "Regional roll-out" projects |
â—† Test of large-scale adoption program prior to full VA implementation with 10-20 facilities in 3-5 VA regions |
â—† Decreased research team support at local sites and greater involvement of stakeholders, both nationally and locally |
â—† Should require less need for real-time refinements of the implementation strategy |
â—† Preparation for hand-off at national level |
Phase 4: "National roll-out" effort |
â—† Implementation of a tested, refined strategy throughout the VA |
â—† Existing operations or designated leadership entity deliver the program |
â—† Research team support as determined per Phase 3 evaluation |
â—† Concurrent and ongoing evaluation, per methodology determined/refined in Phase 3 |