The State Of Quality Improvement And Implementation Research

The Institute of Medicine (IOM) workshop "The Conduct of Health Care Quality Improvement and Implementation Research" was held on May 24-25, 2007, in Irvine, CA. The purpose of this workshop was to gain a better understanding of what is known and not known about quality improvement and implementation research. Experts were asked to identify current methods and best practices as well as areas where future efforts should be concentrated to propel the field. As with its previous workshop, the Forum on the Science of Health Care Quality Improvement and Implementation invited speakers from other disciplines to share their experiences in their respective fields. Although many disciplines are relevant to this topic, not all views could be incorporated because of workshop time constraints, but will be incorporated in the forum's future activities. The State of Quality Improvement and Implementation Research: Expert Views, Workshop Summary describes and summarizes workshop presentations and discussions.

The Institute of Medicine (IOM) workshop "The Conduct of Health Care Quality Improvement and Implementation Research" was held on May 24-25, 2007, in Irvine, CA. The purpose of this workshop was to gain a better understanding of what is known and not known about quality improvement and implementation research. Experts were asked to identify current methods and best practices as well as areas where future efforts should be concentrated to propel the field. As with its previous workshop, the Forum on the Science of Health Care Quality Improvement and Implementation invited speakers from other disciplines to share their experiences in their respective fields. Although many disciplines are relevant to this topic, not all views could be incorporated because of workshop time constraints, but will be incorporated in the forum's future activities. The State of Quality Improvement and Implementation Research: Expert Views, Workshop Summary describes and summarizes workshop presentations and discussions.

v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.

The Institute of Medicine's Forum on the Science of Health Care Quality Improvement and Implementation held a workshop on January 16, 2007, in Washington, DC. The workshop had its roots in an earlier forum meeting when forum members discussed what is meant by the terms "quality improvement" and "implementation science" and became convinced that they mean different things to different people. At the time, the members also discussed the need to identify barriers to quality improvement research and to implementation science. Thus the purpose of this workshop was to bring people together from various arenas to discuss what quality improvement is, and what barriers exist in the health care industry to quality improvement and also to research about quality improvement. The summary that ensues is thus limited to the presentations and discussions during the workshop itself. We realize that there is a broader scope of issues pertaining to this subject area but are unable to address them in this summary document. The workshop's first session was devoted to experiences that various institutions have had with quality improvement. Recognizing the wealth of experiences available outside of health care services, the workshop included presenters from outside the health care service industry as well as from inside. This includes discussions from a variety of perspectives: non-health care services, health plans, hospitals, and nursing. Advancing Quality Improvement Research: Challenges and opportunities - Workshop Summary describes the events of the workshop.

Interest in implementation research is growing, largely in recognition of the contribution it can make to maximizing the beneficial impact of health interventions. As a relatively new and, until recently, rather neglected field within the health sector, implementation research is something of an unknown quantity for many. There is therefore a need for greater clarity about what exactly implementation research is, and what it can offer. This Guide is designed to provide that clarity. Intended to support those conducting implementation research, those with responsibility for implementing programs, and those who have an interest in both, the Guide provides an introduction to basic implementation research concepts and language, briefly outlines what it involves, and describes the many opportunities that it presents. The main aim of the Guide is to boost implementation research capacity as well as demand for implementation research that is aligned with need, and that is of particular relevance to health systems in low- and middle-income countries (LMICs). Research on implementation requires the engagement of diverse stakeholders and multiple disciplines in order to address the complex implementation challenges they face. For this reason, the Guide is intended for a variety of actors who contribute to and/or are impacted by implementation research. This includes the decision-makers responsible for designing policies and managing programs whose decisions shape implementation and scale-up processes, as well as the practitioners and front-line workers who ultimately implement these decisions along with researchers from different disciplines who bring expertise in systematically collecting and analyzing information to inform implementation questions. The opening chapters (1-4) make the case for why implementation research is important to decision-making. They offer a workable definition of implementation research and illustrate the relevance of research to problems that are often considered to be simply administrative and provide examples of how such problems can be framed as implementation research questions. The early chapters also deal with the conduct of implementation research, emphasizing the importance of collaboration and discussing the role of implementers in the planning and designing of studies, the collection and analysis of data, as well as in the dissemination and use of results. The second half of the Guide (5-7) detail the various methods and study designs that can be used to carry out implementation research, and, using examples, illustrates the application of quantitative, qualitative, and mixed-method designs to answer complex questions related to implementation and scale-up. It offers guidance on conceptualizing an implementation research study from the identification of the problem, development of research questions, identification of implementation outcomes and variables, as well as the selection of the study design and methods while also addressing important questions of rigor.

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

In early 2003, the Institute of Medicine (IOM) released its report, Priority Areas for National Action: Transforming Health Care Quality. The report listed 20 clinical topics for which best practice treatment guidelines are strongly supported by clinical evidence. Unfortunately, the report and a substantial quantity of other scientific literature show best practice implementation rates in the United States have been disappointing low, and at an annual cost of many thousands of lives. To bring data to bear on the quality improvement opportunities laid out in the IOM's 2003 report, the Agency for Healthcare Research and Quality (AHRQ) asked the Stanford–UCSF Evidence-based Practice Center (EPC) to perform a critical analysis of the existing literature on quality improvement strategies for a number of the 20 disease and treatment priorities noted in the IOM Report. Rather than concentrating on the specific clinical practices that appear to improve health outcomes, these analyses focus on the effort of translating research into practice–identifying those activities that increase the rate at which effective practices are applied to patient care in real world settings. The goal is one of narrowing the quality gap that is largely responsible for suboptimal health care practices and outcomes. This is the first volume in a series of reports intended to support these goals. A carefully designed methodology will be applied to the scientific literature for a number of medical conditions characterized by the IOM as high-level threats to health and longevity. It is AHRQ's hope that the series will stimulate ideas for ongoing quality improvement activity nationally, as well as in individual health systems and among individual caregivers. Closing the Quality Gap is intended to assist a wide range of users: Policymakers can use the detailed evidence review to prioritize quality improvement strategies and choose how best to close the quality gaps in their organizations; Researchers can find detailed information about well-scrutinized areas of treatment, while learning of other areas in need of further exploration; Clinicians and trainees can see a broad spectrum of approaches to improving the quality of care. Some of these approaches fall within the control of individual practitioners, while others will require major systemic changes at the local level or beyond; Patients can learn quality improvement strategies that they can help to promote, while gaining a deeper understanding of the nature and extent of quality gaps, as well as the systemic changes necessary to close them; Groups and individuals charged with funding research will be able to identify high-yield areas of concern that warrant future research support. The purpose of this report is to help readers assess whether the evidence suggests that a quality improvement strategy would work in their specific practice setting or with their specific patient population. Three important questions should be considered: 1. Are the studies of the strategy valid? A study has validity (sometimes called “internal validity”) if its findings are likely to be true in the population in which the study was performed. The primary determinant of validity is the design and conduct of the study. 2. For each quality improvement strategy that has been evaluated in multiple studies with sufficient validity, does the weight of evidence indicate that the strategy is effective? 3. Can the conclusions of a body of evidence be applied to a specific practice setting or population of interest?

Creating a Business Case for Quality Improvement Research focuses on issues related to improving the science supporting health care quality and eliminating communication barriers that prevent advances in the field. In 2007, the Institute of Medicine convened a workshop designed to identify the economic and business disciplines that encourage sustained efforts to improve the quality of health care. Workshop presenters and participants included representatives from academia, government and industry. A business case for quality improvement depends heavily on the progress made in the following areas: systems change and leadership, data transparency, funding, enhanced training programs and ongoing dialogue between industry officials, patients and their families. They identified a major barrier to these efforts as the nationwide institutional reluctance to invest in quality improvement and documentation of outcomes, due largely to limited resources and competing priorities as to how these resources are spent in the industry. Too often priorities are placed on creating highly-visible technology-driven programs, with less emphasis in meeting the needs and expectations of the patients. In Creating a Business Case for Quality Improvement Research, a diverse group of stakeholders identifies and assesses these and other challenges to attain a better understanding of how to create a high-value health care system for the general population.