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Improving eye care for veterans with diabetes: an example of using the QUERI steps to move from evidence to implementation: QUERI Series.

Krein SL, Bernstein SJ, Fletcher CE, Makki F, Goldzweig CL, Watts B, Vijan S, Hayward RA - Implement Sci (2008)

Bottom Line: We did not succeed in developing a fully functional pro-active scheduling system.However, our experience with using the QUERI process also highlights certain challenges, including those related to the hybrid nature of the research-operations partnership as a mechanism for promoting rapid, system-wide implementation of important research findings.In addition, this paper suggests a number of important considerations for future implementation work, both in the area of pro-active scheduling interventions, as well as for implementation science in general.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. sarah.krein@va.gov

ABSTRACT

Background: Despite being a critical part of improving healthcare quality, little is known about how best to move important research findings into clinical practice. To address this issue, the Department of Veterans Affairs (VA) developed the Quality Enhancement Research Initiative (QUERI), which provides a framework, a supportive structure, and resources to promote the more rapid implementation of evidence into practice.

Methods: This paper uses a practical example to demonstrate the use of the six-step QUERI process, which was developed as part of QUERI and provides a systematic approach for moving along the research to practice pipeline. Specifically, we describe a series of projects using the six-step framework to illustrate how this process guided work by the Diabetes Mellitus QUERI (DM-QUERI) Center to assess and improve eye care for veterans with diabetes.

Results: Within a relatively short time, DM-QUERI identified a high-priority issue, developed evidence to support a change in the diabetes eye screening performance measure, and identified a gap in quality of care. A prototype scheduling system to address gaps in screening and follow-up also was tested as part of an implementation project. We did not succeed in developing a fully functional pro-active scheduling system. This work did, however, provide important information to help us further understand patients' risk status, gaps in follow-up at participating eye clinics, specific considerations for additional implementation work in the area of proactive scheduling, and contributed to a change in the prevailing diabetes eye care performance measure.

Conclusion: Work by DM-QUERI to promote changes in the delivery of eye care services for veterans with diabetes demonstrates the value of the QUERI process in facilitating the more rapid implementation of evidence into practice. However, our experience with using the QUERI process also highlights certain challenges, including those related to the hybrid nature of the research-operations partnership as a mechanism for promoting rapid, system-wide implementation of important research findings. In addition, this paper suggests a number of important considerations for future implementation work, both in the area of pro-active scheduling interventions, as well as for implementation science in general.

No MeSH data available.


Related in: MedlinePlus

Logic Map of the Progressive Reminder and Scheduling System (PRSS).
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Figure 2: Logic Map of the Progressive Reminder and Scheduling System (PRSS).

Mentions: A cornerstone of the eye care intervention was a system for automatically tracking patients based on risk status – "Progressive Reminder and Scheduling System (PRSS)" (Figure 2). The PRSS required three basic pieces of information: 1) risk status, which is assigned by the eye care provider following a clinical exam; 2) follow-up interval, which is the recommended time for the patient's next visit; and, 3) appointment status, which includes whether an appointment is scheduled, whether a visit is made, or if the appointment is cancelled or missed.


Improving eye care for veterans with diabetes: an example of using the QUERI steps to move from evidence to implementation: QUERI Series.

Krein SL, Bernstein SJ, Fletcher CE, Makki F, Goldzweig CL, Watts B, Vijan S, Hayward RA - Implement Sci (2008)

Logic Map of the Progressive Reminder and Scheduling System (PRSS).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2277434&req=5

Figure 2: Logic Map of the Progressive Reminder and Scheduling System (PRSS).
Mentions: A cornerstone of the eye care intervention was a system for automatically tracking patients based on risk status – "Progressive Reminder and Scheduling System (PRSS)" (Figure 2). The PRSS required three basic pieces of information: 1) risk status, which is assigned by the eye care provider following a clinical exam; 2) follow-up interval, which is the recommended time for the patient's next visit; and, 3) appointment status, which includes whether an appointment is scheduled, whether a visit is made, or if the appointment is cancelled or missed.

Bottom Line: We did not succeed in developing a fully functional pro-active scheduling system.However, our experience with using the QUERI process also highlights certain challenges, including those related to the hybrid nature of the research-operations partnership as a mechanism for promoting rapid, system-wide implementation of important research findings.In addition, this paper suggests a number of important considerations for future implementation work, both in the area of pro-active scheduling interventions, as well as for implementation science in general.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. sarah.krein@va.gov

ABSTRACT

Background: Despite being a critical part of improving healthcare quality, little is known about how best to move important research findings into clinical practice. To address this issue, the Department of Veterans Affairs (VA) developed the Quality Enhancement Research Initiative (QUERI), which provides a framework, a supportive structure, and resources to promote the more rapid implementation of evidence into practice.

Methods: This paper uses a practical example to demonstrate the use of the six-step QUERI process, which was developed as part of QUERI and provides a systematic approach for moving along the research to practice pipeline. Specifically, we describe a series of projects using the six-step framework to illustrate how this process guided work by the Diabetes Mellitus QUERI (DM-QUERI) Center to assess and improve eye care for veterans with diabetes.

Results: Within a relatively short time, DM-QUERI identified a high-priority issue, developed evidence to support a change in the diabetes eye screening performance measure, and identified a gap in quality of care. A prototype scheduling system to address gaps in screening and follow-up also was tested as part of an implementation project. We did not succeed in developing a fully functional pro-active scheduling system. This work did, however, provide important information to help us further understand patients' risk status, gaps in follow-up at participating eye clinics, specific considerations for additional implementation work in the area of proactive scheduling, and contributed to a change in the prevailing diabetes eye care performance measure.

Conclusion: Work by DM-QUERI to promote changes in the delivery of eye care services for veterans with diabetes demonstrates the value of the QUERI process in facilitating the more rapid implementation of evidence into practice. However, our experience with using the QUERI process also highlights certain challenges, including those related to the hybrid nature of the research-operations partnership as a mechanism for promoting rapid, system-wide implementation of important research findings. In addition, this paper suggests a number of important considerations for future implementation work, both in the area of pro-active scheduling interventions, as well as for implementation science in general.

No MeSH data available.


Related in: MedlinePlus