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The Quality Enhancement Research Initiative (QUERI) Impact Framework: Measuring the Real-world Impact of
Melissa Z Braganza1, Amy M Kilbourne2,3
1Quality Enhancement Research Initiative, Health Services Research and Development, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA. Melissa.Braganza@va.gov.
Background:
Measuring the health, economic, and cultural gains generated by scientific investments is crucial to reducing waste and improving quality of care. To date, there is no comprehensive framework for assessing the multi-faceted contributions of implementation and quality improvement sciences towards quality, cost, and patient and provider experiences in health systems.
Objective:
We describe the Quality Enhancement Research Initiative (QUERI) Impact Framework and its application to QUERI investments.
Methods:
The QUERI Impact Framework adapts and expands on metrics from the National Academy of Medicine, incorporating lessons learned from QUERI initiatives. The cross-cutting impact metrics reflect QUERI's strategic methodology across five domains of impact (Alignment, Commitment, Tailoring, Informing the field, Observing healthcare changes and generating New questions/projects or ACTION). Key impact metrics, including the number of implementation facilities, number of staff trained, and number of patients served, were derived directly from health system performance plan goals. QUERI applied the Framework by conducting iterative rapid assessments of impacts for QUERI Program centers, which are implementation laboratories that support 3-7 initiatives aligned with a cross-disciplinary goal addressing a national priority.
Key Results:
From October 2015 to September 2019, QUERI Programs supported implementation of 49 evidence-based practices and promising innovations across 465 facilities, including 15 facilities that are experiencing quality gaps. As part of these implementation efforts, the programs worked with 71 operations partners to develop 71 tools/toolkits/manuals and support training of 5147 VA staff, serving 250,159 Veterans.
Conclusions:
The QUERI Impact Framework aligns multiple stakeholders at different levels of a health system around common metrics, which cross implementation science and quality improvement boundaries. The Framework supports a comprehensive assessment of the short-term and distal impacts of implementation efforts in a health system, allowing both research and operations leadership to understand the value of implementation and quality improvement investments to inform program and policy decisions.
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