Overview of the VA Quality Enhancement Research Initiative (QUERI) and QUERI theme articles: QUERI Series

doi:10.1186/1748-5908-3-8

Implement Sci. 2008; 3: 8.

Published online 2008 February 15. doi: 10.1186/1748-5908-3-8

PMCID: PMC2289837

Overview of the VA Quality Enhancement Research Initiative (QUERI) and QUERI theme articles: QUERI Series

Cheryl B Stetler,¹ Brian S Mittman,² and Joseph Francis³

¹Independent Consultant, Amherst, Massachusetts, USA

²VA Center for the Study of Healthcare Provider Behavior, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA

³Office of Research and Development, Department of Veterans Affairs, Washington, DC, USA

Corresponding author.

Cheryl B Stetler: Cheryl.Stetler/at/comcast.net; Brian S Mittman: Brian.Mittman/at/va.gov; Joseph Francis: Joe.Francis/at/va.gov

Received August 22, 2006; Accepted February 15, 2008.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC.

Abstract

Background

Continuing challenges to timely adoption of evidence-based clinical practices in healthcare have generated intense interest in the development and application of new implementation methods and frameworks. These challenges led the United States (U.S.) Department of Veterans Affairs (VA) to create the Quality Enhancement Research Initiative (QUERI) in the late 1990s. QUERI's purpose was to harness VA's health services research expertise and resources in an ongoing system-wide effort to improve the performance of the VA healthcare system and, thus, quality of care for veterans. QUERI in turn created a systematic means of involving VA researchers both in enhancing VA healthcare quality, by implementing evidence-based practices, and in contributing to the continuing development of implementation science.

The efforts of VA researchers to improve healthcare delivery practices through QUERI and related initiatives are documented in a growing body of literature. The scientific frameworks and methodological approaches developed and employed by QUERI are less well described. A QUERI Series of articles in Implementation Science will illustrate many of these QUERI tools. This Overview article introduces both QUERI and the Series.

Methods

The Overview briefly explains the purpose and context of the QUERI Program. It then describes the following: the key operational structure of QUERI Centers, guiding frameworks designed to enhance implementation and related research, QUERI's progress and promise to date, and the Series' general content. QUERI's frameworks include a core set of steps for diagnosing and closing quality gaps and, simultaneously, advancing implementation science. Throughout the paper, the envisioned involvement and activities of VA researchers within QUERI Centers also are highlighted. The Series is then described, illustrating the use of QUERI frameworks and other tools designed to respond to implementation challenges.

Conclusion

QUERI's simultaneous pursuit of improvement and research goals within a large healthcare system may be unique. However, descriptions of this still-evolving effort, including its conceptual frameworks, methodological approaches, and enabling processes, should have applicability to implementation researchers in a range of health care settings. Thus, the Series is offered as a resource for other implementation research programs and researchers pursuing common goals in improving care and developing the field of implementation science.

Background

Improving the quality and performance of healthcare delivery systems represents one of the most significant challenges facing government and society in the U.S. and internationally. A promising strategy for improving healthcare quality is the systematic implementation of research findings and related practices known to generate better outcomes than prevailing practices. Unfortunately, barriers to successful implementation of effective practices are considerable and not fully understood; and reliable, effective strategies to facilitate implementation, particularly on a routine basis, are underutilized.

In 1998, the U.S. Department of Veterans Affairs' (VA) Quality Enhancement Research Initiative (QUERI) was established to improve the quality of VA healthcare through the use of research-derived best practices. During QUERI's initial development, new organizational structures, roles and procedures were established to facilitate active participation and collaboration among a large, multi-disciplinary group of VA researchers, managers and other key stakeholders. For their part, QUERI researchers employed concepts and approaches from what has become known as implementation science, also encompassed in the literature by terms such as knowledge utilization, knowledge translation, and knowledge transfer [1,2]. They quickly discovered challenges both to implementation and the effective conduct of implementation research – challenges that continue to be encountered today. These included the need for new research designs, methods and instruments [3-6];better reporting templates [6,7]; and increasing recognition that implementation is often incredibly complex [7]. Additionally, it was noted that "while there are several theoretical or conceptual models to pursue for guidance, there remain [ed] a need for the literature to document... [related] field-level successes and failures [p. 173, [7]]."

Given the limited guidance available to implementation researchers in the Program's early years, QUERI researchers tried not only well-known interventions and models from various fields but also innovative approaches [8-11]. Consideration of such diverse sources enabled QUERI researchers to better understand and address methodological issues and barriers to adoption and sustainability. Resultant QUERI implementation projects, with their "field-level successes and failures" [7] related to the use of such approaches, have produced a myriad of insights and refinements as described in the QUERI Series.

This Overview article introduces the QUERI Program and its guiding frameworks. The Overview also summarizes QUERI's progress and promise. Finally, it introduces the QUERI Series, which presents and illustrates QUERI's implementation research frameworks, as well as a range of other conceptual and practical tools designed to address the challenges of implementation and related research. Overall, this content offers insights for other health systems and researchers seeking to effectively apply research to improve the care of patients.

The QUERI program

QUERI was created within the context of an internationally recognized transformation of the VA's healthcare delivery system. This transformation had at its core a "quality improvement lens" [12,13], and involved a major redesign of organizational structures and policies, including implementation of innovative information technology and a new performance management/accountability program [14]. Within this overall transformation, QUERI was established inside the Health Services and Research Development (HSR&D) arm of the VA to "purposely link research activities (which generate scientific evidence) to clinical care in as close to real time as possible [p. I-14, [15]]," in order to enhance the "rapid adoption of best clinical practices and improvement in patient outcomes [p. I-14, [15]]."

Even prior to QUERI, the VA had recognized the value of research to improving patient care by supporting an intramural research program whose statutory mission was to enhance the health of veterans [14]. By embedding investigators within a fully integrated delivery system with a stable patient population and robust electronic health records, VA had unparalleled opportunities to translate clinical questions into research studies and research findings into clinical actions. For instance, since 1946, VA has conducted multi-site clinical trials and has maintained a network of regional support centers that facilitate the evaluation of both standard and novel therapies [16]. VA's ability to conduct clinical trials of practical significance to the population it serves was well recognized as a resource that could generate evidence "ripe" for implementation [17]. In fact, the VA has served to generate a good deal of the clinical evidence currently considered "best practice," such as the routine use of aspirin for acute coronary artery syndromes [18].

Additional VA work, primarily in the field of health services research, laid further groundwork for implementation by using electronic administrative and clinical data to identify both variations in practice patterns across VA facilities and the considerable gap between ideal and actual clinical practice. VA work also had identified the reality that doing the right research and disseminating its findings was insufficient to transform health care [19]. In response, QUERI was created to generate research-driven initiatives to directly and rapidly achieve quality improvements, including measurable progress in system performance and health-related outcomes. Although "research-driven," QUERI activity was in reality to occur within the context of collaboration and cooperation among researchers, policy makers, and local leaders within VA's decentralized, geographically-based clinical delivery networks.

QUERI has been described previously in detail [20,21] and findings from various QUERI projects have been published [8,22-24]. To date, however, the implementation science frameworks and methodological approaches developed and employed by QUERI have not been well documented.

QUERI Centers and guiding frameworks

The core QUERI approach was designed by key VA health system and research leaders exploring new strategies for achieving rapid VA quality improvements [personal communication, J Demakis]. The original design included the need to involve researchers more directly and systematically in promoting guideline-based practice and reducing the gaps between routine practice and the best available evidence. Through QUERI, VA leadership envisioned a proactive, interactive and multi-faceted implementation role for health services researchers in the context of close collaboration between research, quality improvement (QI) and clinical leadership.

Key elements of the QUERI Program evolved over time. These include a set of disease or problem-focused QUERI Centers, a core set of program-wide goals, and a complex 6-step framework, or "process," that guides each Center's activities. A QUERI Center is an organizational structure that provides dedicated infrastructure support, including a core team consisting of a research coordinator, clinical coordinator and implementation research coordinator. This core team shares operational responsibility to implement the QUERI process (described below). QUERI Centers may be housed within a single VA facility or organized "virtually" across several sites, but each is tasked with system-wide, rather than solely local responsibility. These duties include: 1) establishing a network of affiliated researchers, 2) making contacts with local and national clinical and policy leaders, and 3) directing the work of the Center strategically by focusing on system-wide priorities for improvement [20,21].

Each QUERI Center focuses on a specific patient population or condition that has been identified by VA leadership as a high-risk/high-volume priority for the health care system. There are currently nine such Centers (Chronic Heart Failure, Diabetes, HIV/Hepatitis, Ischemic Heart Disease, Mental Health, Polytrauma/Blast-Related Injuries, Spinal Cord Injury, Stroke, and Substance Use Disorders) [25]. Each QUERI Center is guided by a multidisciplinary Executive Committee comprised of experts and key stakeholders. This group helps their respective Center develop strategic plans to prioritize and initiate activities addressing their designated clinical condition. Overall, each QUERI Center aims to create the following:

1. A structured program of implementation research

This aim focuses on implementing evidence-based "best practices" and improving current patient and system outcomes for their patient population, as close to real time as possible, through the use of active, evidence-based implementation approaches.

2. New implementation research findings and insights

This aim focuses on the implementation process both in general and relative to a Center's specific patient population in order to: a) continually strengthen VA's ability to accelerate routine, rapid uptake and spread of evidence-based practices throughout the health care system, and b) contribute to the field of implementation science for the benefit of implementation stakeholders within and outside the VA.

With those aims in mind, QUERI Centers are responsible for monitoring, understanding, evaluating, and acting upon both emerging clinical research findings and implementation research findings that provide strategies for improving their target populations' care and outcomes. Therefore, QUERI researchers are involved in both investigating a broad spectrum of implementation issues and, simultaneously, pursuing significant improvements within participating study sites – and, if appropriate, working to subsequently spread improvements across the system and to study that aspect of implementation as well. Consistent with the overall VA transformation, QUERI Centers are held accountable for their performance related to these goals.

The research activities of QUERI Centers include a broad range of implementation projects, as well as variation and outcomes studies to document and understand current clinical practices and quality gaps. QUERI Centers also work to identify, develop and/or refine implementation approaches (e.g., individual adoption interventions or measurement tools) that are then incorporated into implementation projects. All of this activity is guided by a QUERI framework or core 6-step process that has evolved since QUERI's inception in 1998. This core conceptualization of the implementation process offers an explicit series of steps for diagnosing and closing quality gaps, and, simultaneously, advancing knowledge in implementation science. This core process consists of the following steps:

1) Identifying high-risk/high-volume diseases or problems,

2) Identifying best practices,

3) Defining existing practice patterns and outcomes across the VA and current variation from best practices,

4) Identifying and implementing interventions to promote best practices,

5) Documenting that best practices improve outcomes, and

6) Documenting that outcomes are associated with improved health-related quality of life.

Steps 4 through 6 usually co-occur within individual implementation projects. Details regarding these steps, which have evolved and been clarified over time, are provided in Table Table1.1. It should be noted that two additional steps have been added to the core process: 1) preliminary efficacy/effectiveness studies of highly promising clinical/delivery system interventions, at times needed as pre-implementation work; and 2) development and/or evaluation of needed tools and measurements.

Table 1

Summary and description of expanded six-step QUERI process model

The expanded 6-step process also has been supplemented with additional frameworks and other implementation tools over time. These include various documents that provide general guidance for enacting and enhancing the usefulness of the 6-step process as well as a comprehensive glossary to facilitate communication and consistency within QUERI (See Additional File 1 Key QUERI Definitions). Some of these tools have been adopted or refined from prior research, although given QUERI's early start (1998), relevant guidance was frequently not available or was insufficient to meet the pragmatic needs of QUERI researchers. Three tools, designed for Step 4 of the process and highlighted below, are particularly central to QUERI and are described or illustrated in various Series articles:

A 4-phase pipeline framework that facilitates the expected programmatic progression of QUERI Center implementation activity. Based on previously-developed phase models, the QUERI 4-phase framework describes a sequence of implementation projects from initial feasibility assessment to national roll-out. As noted above, targeted pre-implementation activity (e.g., critical measurement development or affirmation of promising interventions) also may occur within a QUERI Center to feed and enhance this pipeline. See Table Table22 for more detail.

Table 2

QUERI phases of implementation projects/QUERI pipeline

A Service Directed Project (SDP) program and template involving a) an innovative funding mechanism supported by clinical operations funds rather than research monies {an exceptional arrangement within the VA} and b) a set of explicit study design recommendations. The design template has encouraged researchers to employ a more active, hands-on approach to implementation and its study [26] (Also see Additional File 2 VA QUERI Service Directed Projects: Proposal Review). More specifically, SDPs encourage the following: explicit exploration of the black box of implementation; optimal implementation of the change intervention during the study to enhance successful "uptake" and outcomes improvement in the targeted study sites – or at least assessment of the potential to do so; and development and clear articulation of a replicable implementation program.

An approach to QUERI proposal review (closely linked to the SDP concept), which includes a uniquely crafted process for peer-review of scientific and policy/practice merit. This process incorporates unique considerations of implementation science along with more traditional methodological criteria. Using this approach, review committees are constituted to include the appropriate range of scientific expertise along with clinical program leaders that can speak to relevant policy and practice issues. These issues include the importance of the implementation target relative to other organizational priorities, the business case for the proposed implementation program, and the likelihood for long-term sustainability after project completion. Additional file 2 reproduces critical aspects of a checklist provided to QUERI reviewers to emphasize implementation-oriented criteria (See Additional File 2 VA QUERI Service Directed Projects: Proposal Review).

Progress and promise

Seven of the QUERI Centers have been in existence for several years, and two were established more recently. Each Center has a program of research encompassing QUERI Steps 1 through 5/6. Development of a full portfolio of implementation-related research for each QUERI Center has taken time, given the following:

The need for the QUERI Program to develop an understanding of its mission and to develop effective practice-oriented research activities and approaches for QUERI researchers and other stakeholders.

The need for many QUERI researchers to obtain grounding in the field of implementation science and related disciplines (e.g., organizational science and anthropology), as well as in unfamiliar methods (e.g., formative evaluation and qualitative methods).

Funding, proposal review and ethics review (Institutional Review Board) timelines.

The need to develop frameworks and other tools to guide the envisioned implementation activity and research.

To develop and implement a comprehensive strategic plan, each QUERI Center has established a rich set of collaborative relationships involving numerous national and regional (VA and non-VA) stakeholder groups. These include, for example, VA's Office of Quality and Performance (responsible for VA's extensive performance measurement and feedback system) and directors of VA's 21 regional healthcare networks, each within a defined geographical area of the US. These networks comprise VA's full spectrum of healthcare delivery facilities, including primary, tertiary, long-term, and other specialized care. An additional file illustrates partnerships for one QUERI Center (See Additional File 3 Key Stroke QUERI Collaborators Diagram). These relationships form the basis for partnering with key policy and clinical stakeholders, recognized as critical to making implementation a "system" rather than solely a "research" or "researcher" issue.

Although QUERI should still be considered a work in progress, much like the overall field of implementation science, the results of QUERI efforts to study and improve VA healthcare delivery practices are documented in a growing body of journal articles and reports [27-32]. In particular, QUERI-related publications and presentations reflect the steps of the QUERI process, as follows (see Table Table1):1): pre-implementation intervention studies establishing best practices or measurement tools, per Steps M and C [33-40]; research and related activities relevant to QUERI Steps 1 to 3, e.g., regarding best and current practices [41-47]; activity relevant to QUERI Step 4/5/6 projects, including implementation trials and studies employing non-experimental designs [8,22,48-55]; and specific outcomes of overall QUERI efforts [19]. In terms of the latter, for example, the following have been demonstrated: improvement in evidence-based alcohol screening; expansion of the number of methadone clinics within VA for veterans with opioid dependence; increase in the proportion of veterans with spinal cord injury receiving influenza and pneumococcal vaccinations; and a change in a prevailing performance measure to improve eye care in diabetics by focusing policy on the needs of veterans at high risk for blindness [23,24,50,55,56]. Finally, a large regional-level demonstration project, guided by the Mental Health QUERI Center, is accumulating knowledge and laying the groundwork and support for the national spread and sustainability of evidence-based collaborative care for depression. This effort has achieved an unprecedented level of researcher involvement and linkage to stakeholders within an implementation project and has already led to a nationally-supported program to enhance primary care/mental health collaboration across the VA healthcare system [48,57].

QUERI Series

The implementation approaches underlying QUERI successes are just beginning to be documented and disseminated, particularly in relation to specific Step 4 demonstration projects and general contributions to implementation science. Some of these build upon the work of others in the field of implementation science, while others reflect innovations developed by QUERI. For example, previously published articles present a refined view of formative evaluation within implementation [9]; the interconnection between theories, models, strategies, other tools, and planning [10]; and an exploration of the concept of facilitation within the PARIHS (Promoting Action on Research Implementation in Health Systems) framework [11]. However, the general use of such approaches in QUERI has not, up to now, been illustrated, and other QUERI-related frameworks have yet to be explicated. Describing these tools and their integration within QUERI projects is relevant for the field of implementation science, other healthcare delivery systems, and researchers interested in replicating or exploring QUERI's improvement model and insights. The purpose of this QUERI Series for Implementation Science is to document and share this information in the context of its use within QUERI Centers' programmatic implementation research (Tables (Tables11 and and2).2). Thus, the Series articles demonstrate how QUERI conceptualizes, designs, enables and conducts implementation research, and, consequently, how it develops new insights into implementation science.

The QUERI Series opens with this Overview, describing the QUERI program, its operational QUERI Centers, and its key, overarching Frameworks. These articles are followed by papers that primarily represent QUERI Centers' work and then a set of responsive commentaries. The former papers focus on a range of QUERI implementation research approaches, implementation study issues and needs, implementation barriers and enabling factors at both micro and macro levels, and illustrative cases demonstrating the use of various implementation tools including the core 6-step process. Cumulatively, this Series describes a broad array of implementation research challenges, as well as potential approaches explored by QUERI researchers to meet those challenges. The commentaries at the end of the Series provide reflections on the potential value of QUERI and its related approaches from the perspective of both VA (non-QUERI) leadership and non-VA stakeholders.

Conclusion

Development and use of QUERI's implementation science frameworks and methodological approaches have generated excitement and frustration, enjoyed successes and encountered barriers, and continuously enhanced progress in the understanding of implementation concepts and strategies. Insights gained to date regarding implementation science are now being incorporated into the next phases of QUERI Center programmatic research. The full potential and influence of QUERI should emerge over the next few years a) as all Centers continue to progress from early pilots and demonstration projects to large-scale regional trials and b) as the organizational template for national implementation under development by the Mental Health QUERI Center is evaluated and replicated by others.

VA and QUERI are not unique in their efforts to employ research-based approaches to accelerate routine implementation of evidence into practice within an integrated delivery system, although QUERI's simultaneous pursuit of improvement and implementation research goals may be unique. However, the richly detailed descriptions of this still-evolving effort and its frameworks, other tools, and enabling processes should have applicability to implementation researchers as well as health system leaders. With this Series, publications appearing elsewhere, and considerable work-in-progress, QUERI is pleased to share its evidence-based implementation experiences and evolving conceptual knowledge with colleagues also engaged on the journey to close the gaps in implementation knowledge and clinical practice.

Competing interests

Brian Mittman is Co-Editor-in-Chief of Implementation Science; Joe Francis is a member of the Editorial Board. All editorial decisions regarding this article and all subsequent articles in the QUERI Series were made independently by Martin Eccles, Co-Editor-in-Chief, and Ian Graham, a member of the Editorial Board serving as special co-editor of the Series. The articles in the QUERI Series describe implementation research conducted within the Health Services Research and Development (HSR&D) Service of the U.S. Department of Veterans Affairs. VA HSR&D provides in-kind support for the journal Implementation Science, including salary support for Brian Mittman and support for editorial and copy editing services. VA HSR&D staff played no role in editorial decisions for the QUERI Series manuscripts. The primary author (CBS) has worked as a QUERI consultant for several years.

Authors' contributions

CBS drafted the initial form and all revisions of this manuscript. BSM has read and drafted substantial refinements, and JF has provided input, feedback and refinements to the initial and final versions. All authors agreed to the final manuscript.

Supplementary Material

Additional file 1

Key QUERI Definitions. A glossary developed to facilitate communication and consistency within QUERI.

Click here for file^{(28K, PDF)}

Additional file 2

VA QUERI Service Directed Projects: Proposal Review. Critical aspects of a proposal review checklist developed to emphasize implementation-oriented criteria.

Click here for file^{(33K, PDF)}

Additional file 3

Key Stroke QUERI Collaborators Diagram. Sample of the type of partnerships established by a QUERI Center.

Click here for file^{(38K, PDF)}

Acknowledgements

The views expressed in this article are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs.

References

Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26:13–24. doi: 10.1002/chp.47. [PubMed] [Cross Ref]
Estabrooks CA, Thompson DS, Lovely JJ, Hofmeyer A. A guide to knowledge translation theory. J Contin Educ Health Prof. 2006;26:25–36. doi: 10.1002/chp.48. [PubMed] [Cross Ref]
Sussman S, Valente TW, Rohrbach LA, Skara S, Pentz MA. Translation in the health professions: converting science into action. Eval Health Prof. 2006;29:7–32. doi: 10.1177/0163278705284441. [PubMed] [Cross Ref]
Dzewaltowski D, Estabrooks P, Glasgow RE, Klesges L. Workgroup to evaluate and enhance the Reach and Dissemination of Health promotion interventions. http://www.re-aim.org/2003/whoweare.html Accessed 7-9-2005.
Rabin BA, Brownson RC, Kerner JF, Glasgow RE. Methodologic challenges in disseminating evidence-based interventions to promote physical activity. Am J Prev Med. 2006;31:S24–S34. doi: 10.1016/j.amepre.2006.06.009. [PubMed] [Cross Ref]
Glasgow RE, Lichtenstein E, Marcus AC. Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. Am J Public Health. 2003;93:1261–1267. [PubMed]
Phillips SD, Allred CA. Organizational management: what service providers are doing while researchers are disseminating interventions. J Behav Health Serv Res. 2006;33:156–175. doi: 10.1007/s11414-006-9016-4. [PubMed] [Cross Ref]
Curran GM, Thrush CR, Smith JL, Owen RR, Ritchie M, Chadwick D. Implementing research findings into practice using clinical opinion leaders: barriers and lessons learned. Jt Comm J Qual Patient Saf. 2005;31:700–707. [PubMed]
Stetler CB, Legro MW, Wallace CM, Bowman C, Guihan M, Hagedorn H, Kimmel B, Sharp ND, Smith JL. The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006;21 Suppl 2:S1–S8. [PMC free article] [PubMed]
Sales A, Smith J, Curran G, Kochevar L. Models, strategies, and tools. Theory in implementing evidence-based findings into health care practice. J Gen Intern Med. 2006;21 Suppl 2:S43–S49. [PMC free article] [PubMed]
Stetler CB, Legro MW, Rycroft-Malone J, Bowman C, Curran G, Guihan M, Hagedorn H, Pineros S, Wallace CM. Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration. Implement Sci. 2006;1:23. doi: 10.1186/1748-5908-1-23. [PMC free article] [PubMed] [Cross Ref]
Oliver A. The Veterans Health Administration: an American success story? Milbank Q. 2007;85:5–35. doi: 10.1111/j.1468-0009.2007.00475.x. [PubMed] [Cross Ref]
Fooks C, Decter M. The transformation experience of the Veterans Health Administration and its relevance to Canada. Healthc Pap. 2005;5:60–64. [PubMed]
Feussner JR, Kizer KW, Demakis JG. The Quality Enhancement Research Initiative (QUERI): from evidence to action. Med Care. 2000;38:I1–I6. doi: 10.1097/00005650-200006001-00001. [PubMed] [Cross Ref]
Kizer KW, Demakis JG, Feussner JR. Reinventing VA health care: systematizing quality improvement and quality innovation. Med Care. 2000;38:I7–16. doi: 10.1097/00005650-200006001-00002. [PubMed] [Cross Ref]
Development OR. Cooperative Studies Program (CSP) 2007. http://www.research.va.gov/programs/csrd/csp.cfm Accessed 2-27-2008.
Tunis SR, Stryer DB, Clancy CM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003;290:1624–1632. doi: 10.1001/jama.290.12.1624. [PubMed] [Cross Ref]
Lewis HD, Jr., Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE, III, Schnaper HW, LeWinter MM, Linares E, Pouget JM, Sabharwal SC, Chesler E, DeMots H. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1983;309:396–403. [PubMed]
Francis J, Perlin JB. Improving performance through knowledge translation in the Veterans Health Administration. J Contin Educ Health Prof. 2006;26:63–71. doi: 10.1002/chp.52. [PubMed] [Cross Ref]
McQueen L, Mittman BS, Demakis JG. Overview of the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) J Am Med Inform Assoc. 2004;11:339–343. doi: 10.1197/jamia.M1499. [PMC free article] [PubMed] [Cross Ref]
Demakis JG, McQueen L, Kizer KW, Feussner JR. Quality Enhancement Research Initiative (QUERI): A collaboration between research and clinical practice. Med Care. 2000;38:I17–I25. doi: 10.1097/00005650-200006001-00003. [PubMed] [Cross Ref]
Fremont AM, Joyce G, Anaya HD, Bowman CC, Halloran JP, Chang SW, Bozzette SA, Asch SM. An HIV collaborative in the VHA: do advanced HIT and one-day sessions change the collaborative experience? Jt Comm J Qual Patient Saf. 2006;32:324–336. [PubMed]
Weaver FM, Smith B, Lavela S, Wallace C, Evans CT, Hammond M, Goldstein B. Interventions to increase influenza vaccination rates in veterans with spinal cord injuries and disorders. J Spinal Cord Med. 2007;30:10–19. [PMC free article] [PubMed]
Bradley KA, Williams EC, Achtmeyer CE, Volpp B, Collins BJ, Kivlahan DR. Implementation of evidence-based alcohol screening in the Veterans Health Administration. Am J Manag Care. 2006;12:597–606. [PubMed]
QUERI VA. QUERI's Clinical and Co-Chairs http://www.hsrd.research.va.gov/queri/program.cfm Accessed 4-17-2007.
Development OR. QUERI Special Solicitation for Projects: Implementing Research into Practice to Improve Care Delivery. 2005. http://www.research.va.gov/funding/solicitations/docs/SDP-1005-final.pdf Accessed 8-1-2005.
Feussner JR, Demakis JG, Kizer KW. VA's Quality Enhancement Research Initiative. Med Care. 2000;38:VA QUERI Supplement. doi: 10.1097/00005650-200006001-00001. [Cross Ref]
Kiefe CI, Sales A. A state-of-the-art conference on implementing evidence in health care. Reasons and recommendations. J Gen Intern Med. 2006;21 Suppl 2:S67–S70. [PMC free article] [PubMed]
Hagedorn H, Hogan M, Smith JL, Bowman C, Curran GM, Espadas D, Kimmel B, Kochevar L, Legro MW, Sales AE. Lessons learned about implementing research evidence into clinical practice. Experiences from VA QUERI. J Gen Intern Med. 2006;21 Suppl 2:S21–S24. [PMC free article] [PubMed]
Hynes DM, Perrin RA, Rappaport S, Stevens JM, Demakis JG. Informatics resources to support health care quality improvement in the veterans health administration. J Am Med Inform Assoc. 2004;11:344–350. doi: 10.1197/jamia.M1548. [PMC free article] [PubMed] [Cross Ref]
Owen RR, Thrush CR, Cannon D, Sloan KL, Curran G, Hudson T, Austen M, Ritchie M. Use of electronic medical record data for quality improvement in schizophrenia treatment. J Am Med Inform Assoc. 2004;11:351–357. doi: 10.1197/jamia.M1498. [PMC free article] [PubMed] [Cross Ref]
Young AS, Mintz J, Cohen AN, Chinman MJ. A network-based system to improve care for schizophrenia: the Medical Informatics Network Tool (MINT) J Am Med Inform Assoc. 2004;11:358–367. doi: 10.1197/jamia.M1492. [PMC free article] [PubMed] [Cross Ref]
Dobscha SK, Corson K, Hickam DH, Perrin NA, Kraemer DF, Gerrity MS. Depression decision support in primary care: a cluster randomized trial. Ann Intern Med. 2006;145:477–487. [PubMed]
Birkmeyer JD, Kerr E, Dirnick J. Improving the quality of quality measurement. In: Committee on Redesigning Health Insurance Performance Measures PPIP, editor. Performance Measurement: Accelerating Improvement. Washington, D.C., The National Academies Press; 2006. pp. 177–203.http://books.nap.edu/openbook.php?record_id=11517&page=177 Accessed 2-27-2008.
Heidenreich PA, Spertus JA, Jones PG, Weintraub WS, Rumsfeld JS, Rathore SS, Peterson ED, Masoudi FA, Krumholz HM, Havranek EP, Conard MW, Williams RE. Health status identifies heart failure outpatients at risk for hospitalization or death. J Am Coll Cardiol. 2006;47:752–756. doi: 10.1016/j.jacc.2005.11.021. [PubMed] [Cross Ref]
Williams LS, Kroenke K, Bakas T, Plue LD, Brizendine E, Tu W, Hendrie H. Care management of poststroke depression: a randomized, controlled trial. Stroke. 2007;38:998–1003. doi: 10.1161/01.STR.0000257319.14023.61. [PubMed] [Cross Ref]
An LC, Zhu SH, Nelson DB, Arikian NJ, Nugent S, Partin MR, Joseph AM. Benefits of telephone care over primary care for smoking cessation: a randomized trial. Arch Intern Med. 2006;166:536–542. doi: 10.1001/archinte.166.5.536. [PubMed] [Cross Ref]
Tiet QQ, Byrnes HF, Barnett P, Finney JW. A practical system for monitoring the outcomes of substance use disorder patients. J Subst Abuse Treat. 2006;30:337–347. doi: 10.1016/j.jsat.2006.03.002. [PubMed] [Cross Ref]
Bakas T, Champion V, Perkins SM, Farran CJ, Williams LS. Psychometric testing of the revised 15-item Bakas Caregiving Outcomes Scale. Nurs Res. 2006;55:346–355. doi: 10.1097/00006199-200609000-00007. [PubMed] [Cross Ref]
Rubenstein LV, Meredith LS, Parker LE, Gordon NP, Hickey SC, Oken C, Lee ML. Impacts of evidence-based quality improvement on depression in primary care: a randomized experiment. J Gen Intern Med. 2006;21:1027–1035. doi: 10.1111/j.1525-1497.2006.00549.x. [PMC free article] [PubMed] [Cross Ref]
Frayne SM, Halanych JH, Miller DR, Wang F, Lin H, Pogach L, Sharkansky EJ, Keane TM, Skinner KM, Rosen CS, Berlowitz DR. Disparities in diabetes care: impact of mental illness. Arch Intern Med. 2005;165:2631–2638. doi: 10.1001/archinte.165.22.2631. [PubMed] [Cross Ref]
Greenberg JD, Tiwari A, Rajan M, Miller D, Natarajan S, Pogach L. Determinants of sustained uncontrolled blood pressure in a national cohort of persons with diabetes. Am J Hypertens. 2006;19:161–169. doi: 10.1016/j.amjhyper.2005.06.032. [PubMed] [Cross Ref]
Ko DT, Tu JV, Masoudi FA, Wang Y, Havranek EP, Rathore SS, Newman AM, Donovan LR, Lee DS, Foody JM, Krumholz HM. Quality of care and outcomes of older patients with heart failure hospitalized in the United States and Canada. Arch Intern Med. 2005;165:2486–2492. doi: 10.1001/archinte.165.21.2486. [PubMed] [Cross Ref]
Maynard C, Lowy E, Rumsfeld J, Sales AE, Sun H, Kopjar B, Fleming B, Jesse RL, Rusch R, Fihn SD. The prevalence and outcomes of in-hospital acute myocardial infarction in the Department of Veterans Affairs Health System. Arch Intern Med. 2006;166:1410–1416. doi: 10.1001/archinte.166.13.1410. [PubMed] [Cross Ref]
Gironda RJ, Clark ME, Massengale JP, Walker RL. Pain among veterans of Operations Enduring Freedom and Iraqi Freedom. Pain Med. 2006;7:339–343. doi: 10.1111/j.1526-4637.2006.00146.x. [PubMed] [Cross Ref]
Collins EG, Langbein WE, Smith B, Hendricks R, Hammond M, Weaver F. Patients' perspective on the comprehensive preventive health evaluation in veterans with spinal cord injury. Spinal Cord. 2005;43:366–374. doi: 10.1038/sj.sc.3101708. [PubMed] [Cross Ref]
Peacock F, Morris DL, Anwaruddin S, Christenson RH, Collinson PO, Goodacre SW, Januzzi JL, Jesse RL, Kaski JC, Kontos MC, Lefevre G, Mutrie D, Sinha MK, Uettwiller-Geiger D, Pollack CV. Meta-analysis of ischemia-modified albumin to rule out acute coronary syndromes in the emergency department. Am Heart J. 2006;152:253–262. doi: 10.1016/j.ahj.2005.12.024. [PubMed] [Cross Ref]
Felker BL, Chaney E, Rubenstein LV, Bonner LM, Yano EM, Parker LE, Worley LL, Sherman SE, Ober S. Developing Effective Collaboration Between Primary Care and Mental Health Providers. Prim Care Companion J Clin Psychiatry. 2006;8:12–16. [PubMed]
Fortney JC, Pyne JM, Edlund MJ, Robinson DE, Mittal D, Henderson KL. Design and implementation of the telemedicine-enhanced antidepressant management study. Gen Hosp Psychiatry. 2006;28:18–26. doi: 10.1016/j.genhosppsych.2005.07.001. [PubMed] [Cross Ref]
Krein SL, Kerr E, Vijan S, Hayward R. Improving eye care for veterans with diabetes: an example of using the QUERI steps to move from evidence to implementation. Implement Sci. 2008 [Article in QUERI Series] [PMC free article] [PubMed]
Willenbring ML, Postier AC, Kenny M, Hagedorn H. Journal of Maintenance in the Addictions. Vol. 3. The Haworth Press Inc.; 2006. Innovative approaches to measuring outcomes and providing feedback: The Opioid Agonist Therapy Effecitveness (OpiATE) Initiative. pp. 13–32.https://www.haworthpress.com/store/ArticleAbstract.asp?sid=QRWGJ9DE226B9K1G2RLTU79WA5UV07S7&ID=68975 Accessed 2-27-2008. [Cross Ref]
Patterson ES, Nguyen AD, Halloran JP, Asch SM. Human factors barriers to the effective use of ten HIV clinical reminders. J Am Med Inform Assoc. 2004;11:50–59. doi: 10.1197/jamia.M1364. [PMC free article] [PubMed] [Cross Ref]
Heisler M, Piette JD. "I help you, and you help me": facilitated telephone peer support among patients with diabetes. Diabetes Educ. 2005;31:869–879. doi: 10.1177/0145721705283247. [PubMed] [Cross Ref]
Hudson TJ, Owen RR, Thrush CR, Han X, Pyne JM, Thapa P, Sullivan G. A pilot study of barriers to medication adherence in schizophrenia. J Clin Psychiatry. 2004;65:211–216. [PubMed]
Weaver FM, Goldstein B, Hammond M. Improving respiratory vaccination rates in veterans with spinal cord injury/disorders: lessons learned. SCI Nurs. 2004;21:143–148. [PubMed]
Willenbring ML, Hagedorn H, Postier AC, Kenny M. The opiate agonist therapy effectiveness initiative: Improving treatment for opioid dependence. Poster Presented at the Veterans Affairs' Health Services Research and Development, National Conference. 2003. http://www.hsrd.research.va.gov/meetings/2003/abstracts/2045.htm Accessed 2-27-2008.
Owen RR, Rubenstein LV, Chaney EF, Smith JL. Bringing Evidence-Based Practices into Regional and National Use: The ReTIDES Example. 2007. http://www.hsrd.research.va.gov/meetings/2007/display_abstract.cfm?RecordID= 393 Accessed 2-27-2008.

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