It can take years for a fraction of effective health care practices to reach patients who need them the most, potentially wasting millions of research dollar investments. This research-to-practice gap is attributed to lack of involvement of frontline health care clinicians and limited user-friendly tools to enable them to overcome barriers to uptake of effective practices in real-world settings, especially when faced with organizational constraints. The VA Quality Enhancement Research Initiative (QUERI) Roadmap for Implementation and Quality Improvement is a practical guide for clinicians and researchers to plan and deploy methods to support uptake of effective practices in routine care settings. The three phases of the QUERI Roadmap are Pre-implementation, Implementation, and Sustainment. Pre-implementation identifies high-priority needs, selects effective practices to address the needs, engages stakeholders to build implementation capacity, specifies practice adaptations and evaluation goals, and activates leadership support. Implementation focuses on involving clinical and research leaders to use implementation or quality improvement strategies that support, motivate, and inspire frontline clinicians to adopt and “own” the uptake of effective practices. Sustainment includes business case analyses and knowledge translation methods for practitioners to support ongoing implementation maintenance and improvement of effective practices over time. Integrating key literature and terminology, the QUERI Roadmap de-mystifies the application of implementation strategies and rigorous evaluation of these efforts to support practitioners and inform policy and population health improvements. Combining real-world experience with state-of-the art implementation and quality improvement science, the QUERI Roadmap ultimately makes implementation science usable and practical for investigators and practitioners alike.

Contents

• The QUERI Roadmap
• Foreword
• Introduction
  • Who Is This Guide For?
  • How Do I Use this Guide?
  • Resources
  • Why a Roadmap?
  • Applying the Roadmap
• Pre-Implementation
  • Identify a Problem and a Solution
  • Engage Stakeholders
  • Develop Measures and Data
• Pre-Implementation Check List
• Implementation
  • Implement an Intervention
  • Activate Implementation Teams
  • Monitor Implementation Progress
• Implementation Check List
• Sustainment
  • Sustain an Intervention
  • Transition Ownership to Stakeholders
  • Ongoing Evaluation and Reflection
• Sustainment Check List
• Case Studies
  • The National Hepatitis C Innovation Team Collaborative
  • Tailoring Implementation of a Medical Home Model to Meet Women Veterans’ Needs Using Evidence-based Quality Improvement
  • The Department of Veterans Affairs Rapid Naloxone Initiative: National Diffusion of a Promising Practice
• VA Resources for Implementation & Quality Improvement
  • VA RESOURCE CENTERS
  • QUERI Implementation Strategy Learning Hubs
• General Resources for Implementation and Quality Improvement
  • Implementation Science Versus Quality Improvement?
  • Adaptation Guidance Tool
  • Iterative Decision-making for Evaluation of Adaptations (IDEA) Decision Tree
  • Conducting Adaptation Interviews
  • Framework for Reporting Adaptations and Modifications-Enhanced (FRAME)
  • What’s a Barrier and Facilitator Framework?
  • Expert Recommendations for Implementing Change (ERIC)
• Evaluation and Study Designs for Implementation and Quality Improvement
  • Designs in Implementation Science
  • Hybrid Effectiveness-Implementation Designs
  • Experimental or Randomized Designs
  • Quasi-experimental Designs
  • Other Implementation Resources
• Glossary of Terms
• References