Practice-based research networks add value to evidence-based quality improvement.
Karen M Goldstein, Dawne Vogt, Alison Hamilton, Susan M Frayne, Jennifer Gierisch, Jill Blakeney, Anne Sadler, Bevanne M Bean-Mayberry, Diane Carney, Brooke DiLeone, Annie B Fox, Ruth Klap, Ellen Yee, Yasmin Romodan, Holly Strehlow, Julia Yosef, Elizabeth M Yano
Author Information
Karen M Goldstein: VA HSR&D Center for Health Services Research in Primary Care, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA; Duke University School of Medicine, Division of General Internal Medicine, USA. Electronic address: karen.goldstein@duke.edu.
Dawne Vogt: Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
Alison Hamilton: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
Susan M Frayne: Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA; Women's Health Section, VA Palo Alto Health Care System, Palo Alto, CA, USA; Division of Primary Care and Population Health and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
Jennifer Gierisch: VA HSR&D Center for Health Services Research in Primary Care, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA; Duke University School of Medicine, Division of General Internal Medicine, USA.
Jill Blakeney: VA HSR&D Center for Health Services Research in Primary Care, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA.
Anne Sadler: VA HSR&D Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, USA; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Bevanne M Bean-Mayberry: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Medicine, University of California Los Angeles (UCLA), USA.
Diane Carney: Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.
Brooke DiLeone: Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA.
Annie B Fox: Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA, USA.
Ruth Klap: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Ellen Yee: VA Medical Center-New Mexico, Albuquerque, NM, USA.
Yasmin Romodan: Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.
Holly Strehlow: VA HSR&D Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, USA.
Julia Yosef: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Elizabeth M Yano: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
Background: Evidence-Based Quality Improvement (EBQI) is a systematic, multilevel approach to implementing research evidence into clinical settings. Little is known about EBQI effectiveness in the context of Practice-Based Research Networks (PBRNs), which are themselves designed to foster practice-based change. We evaluated EBQI implementation in a PBRN setting to determine the extent to which the PBRN infrastructure added value. METHODS: We conducted a four-site cluster randomized trial of an EBQI approach to tailoring an evidence-based gender awareness curriculum in the VA Women’s Health PBRN (WH-PBRN). After curriculum implementation, site teams identified impacts of the WH-PBRN context on EBQI processes using qualitative methods, including a formal review of project call minutes, post-project debriefing calls, and structured site team input. WH-PBRN site feedback was mapped to the Replicating Effective Programs implementation phases: pre-condition, pre-implementation, implementation, and maintenance/evolution. RESULTS: The pre-condition phase benefited from the existing WH-PBRN research-clinician relationships to facilitate stakeholder engagement and build project buy-in at local sites. During pre-implementation, differences across WH-PBRN sites offered variations in local tailoring of EBQI elements. The WH-PBRN Coordinating Center helped resolve process complexities stemming from local resource differences and the sharing of mid-project adaptations during implementation. Local efforts were amplified in the maintenance phase by WH-PBRN dissemination of findings. Conclusions: The PBRN strengthened multi-site EBQI activities across all implementation phases. Implications: PBRNs contribute to the uptake of evidence into everyday practice, and may serve as an important component of the future implementation of evidence-based initiatives. Level of evidence: V.
