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Table 1 Description of EBQI-PCMH core elements and criteria for assessing EBQI-PCMH fidelity

From: Assessing fidelity to evidence-based quality improvement as an implementation strategy for patient-centered medical home transformation in the Veterans Health Administration

EBQI-PCMH core elements Fidelity assessment criteria
Leadership and frontlines (e.g., top-down, bottom-up) priority-setting process for focusing QI efforts
Four rounds of priority-setting (1/year, 2011–2014), engaging interdisciplinary regional and healthcare system leaders, frontline providers, staff
Quality councils (including Veteran patients) and across-site workgroups submitted 2-page project proposals for QI projects for review/approval
Regional Steering Committee (multidisciplinary regional and local healthcare system executive leaders) reviewed/rated, discussed at in-person meeting, and re-rated
Seven to 8 highest rated projects approved per round received seed funding, support from VAIL HSRs, completed progress and final reports on their QI projects
Sum of number of proposals submitted and number approved: high = 8 or more; medium = 4–7; low = 1–3
Ongoing technical expertise and coaching/mentoring in QI methods by HSRs, delivered through a QI collaborative
Quality council leaders participated in bi-weekly support calls with two or three HSRs (87 calls, 2010–14)
HSRs provided one-on-one mentoring/support for workgroup projects by joining the individual workgroup project meetings
Semi-annual in-person conferences (7 total, 2010–14), attended by the QI teams, HSRs, regional and healthcare system leaders, patient representatives, frontline providers and staff at EBQI-PACT sites, and subject matter experts.
   Plenary sessions providing training in QI and the PCMH model, workshops on PCMH topics, and presentations by QI teams on QI projects
   Formative feedback presentations of PC practice-level data from the PCMH evaluation, including provider and staff burnout and patient satisfaction
   “Round table” sessions for QI teams to plan and strategize PCMH improvement
Bi-weekly phone calls: high = participated in 75% or more with an average representation of 2 or more people per call; medium = participated in 75% or more with an average participation of 1–2 representatives per call; low or none = participated in less than 75% with an average participation of less than 1 representative per call
Bi-annual in-person learning sessions: high = 10 or more participants per learning session; medium = 5–9 participants; low/none = less than 5 participants
Use of data and evidence to inform QI efforts with project management support provided by internal coordinators
5 HSRs (LR, SS, SV, JD, BS) supported by 2 statistical analysts (AL, MW) and 5 program support staff (NS, AS, ALH, NS, DE)
1 FTE internal coordinator for each of 3 local healthcare systems that began in phase 1
   Bachelor’s Degree training, little/no previous exposure to quality improvement methods
   Trained in QI by and support for data/measures from VAIL HSRs
Rapid reviews of literature pertaining to QI project topics [24]
Voluntary participation in/use of data/measures support group bi-weekly meetings, and privacy/ethics reviews of QI project activities
A SharePoint site for housing toolkits from successful QI projects, support for toolkit development
Proportion of projects using data to diagnose QI problem and track QI project feasibility/acceptability/effectiveness for all approved projects: high = used evidence/data to diagnose QI problem and track progress for 100% of projects; medium = used evidence/data to diagnose and track for more than 60% of QI projects; low = used evidence/data to diagnose and track for 60% or less of QI projects.
EBQI-PCMH Outcome—implementation and spread of locally developed and initiated QI projects
Implement Steering Committee approved projects, using Plan-Do-Study-Act cycles
Complete interim and final reports with data to track/monitor progress on achieving QI project objectives
Briefings, presentations at QI collaborative in-person learning sessions to promote adoption by other sites
Package QI project tools and materials into toolkits, with assistance from the VAIL project staff
Number of final reports + toolkits completed: high = 4 or more; medium = 2–3; low = 1; none = 0