Learning Evaluation: blending quality improvement and implementation research methods to study healthcare innovations.

Bijal A Balasubramanian,L Miriam Dickinson,Melinda M Davis,William L Miller,Rose Gunn,Deborah J Cohen,Kurt C Stange,Benjamin F Crabtree

doi:10.1186/s13012-015-0219-z

Abstract

BackgroundIn healthcare change interventions, on-the-ground learning about the implementation process is often lost because of a primary focus on outcome improvements. This paper describes the Learning Evaluation, a methodological approach that blends quality improvement and implementation research methods to study healthcare innovations.MethodsLearning Evaluation is an approach to multi-organization assessment. Qualitative and quantitative data are collected to conduct real-time assessment of implementation processes while also assessing changes in context, facilitating quality improvement using run charts and audit and feedback, and generating transportable lessons. Five principles are the foundation of this approach: (1) gather data to describe changes made by healthcare organizations and how changes are implemented; (2) collect process and outcome data relevant to healthcare organizations and to the research team; (3) assess multi-level contextual factors that affect implementation, process, outcome, and transportability; (4) assist healthcare organizations in using data for continuous quality improvement; and (5) operationalize common measurement strategies to generate transportable results.ResultsLearning Evaluation principles are applied across organizations by the following: (1) establishing a detailed understanding of the baseline implementation plan; (2) identifying target populations and tracking relevant process measures; (3) collecting and analyzing real-time quantitative and qualitative data on important contextual factors; (4) synthesizing data and emerging findings and sharing with stakeholders on an ongoing basis; and (5) harmonizing and fostering learning from process and outcome data. Application to a multi-site program focused on primary care and behavioral health integration shows the feasibility and utility of Learning Evaluation for generating real-time insights into evolving implementation processes.ConclusionsLearning Evaluation generates systematic and rigorous cross-organizational findings about implementing healthcare innovations while also enhancing organizational capacity and accelerating translation of findings by facilitating continuous learning within individual sites. Researchers evaluating change initiatives and healthcare organizations implementing improvement initiatives may benefit from a Learning Evaluation approach.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0219-z) contains supplementary material, which is available to authorized users.

Highlights

In response to the landmark Institute of Medicine Report, Crossing the Quality Chasm—A New Health System for the 21st Century [1], there have been widespread attempts to transform the US healthcare system to achieve the triple aim of improved health, improved patient experience, and reduced cost of care [2]
Primary care practices across the US are engaged in improvement initiatives, including demonstration projects to implement patient-centered medical home principles [3,4] or new models of care delivery, such as integrating primary and behavioral healthcare [5,6,7]
Demonstration projects are evaluated, making sense of outcomes can be challenging because of differing and changing contexts in which improvements are implemented [18,19]. This is because traditional quantitative approaches used to evaluate healthcare innovations are guided by a priori specification of hypotheses, sampling, measures, and randomization; standards that are often hard to attain in the changing contexts of real-world settings

Summary

Introduction

Demonstration projects are evaluated, making sense of outcomes can be challenging because of differing and changing contexts in which improvements are implemented [18,19]. In part, this is because traditional quantitative approaches used to evaluate healthcare innovations are guided by a priori specification of hypotheses, sampling, measures, and randomization; standards that are often hard to attain in the changing contexts of real-world settings. On-the-ground learning about the implementation process is often lost because of a primary focus on outcome improvements. This paper describes the Learning Evaluation, a methodological approach that blends quality improvement and implementation research methods to study healthcare innovations

Methods

Results

Discussion

Conclusion