tors that range from severity of disease to patient compliance. After identifying specific barriers to achieving improved outcomes, researchers develop and test strategies for systemic solutions to closing the gap between actual and desired outcomes. Such solutions may range from improving clinician training to changing technical order specifications. In 2001, the initiative focused on modifying clinical databases to measure outcomes directly, rather than relying on chart abstraction, to enable nationwide assessment of the impact of the translation process (Demakis, 2002; Demakis et al., 2000). This research is facilitated by VHA’s system-wide electronic medical record (See Chapter 5).


Research efforts in all the programs have focused on synthesizing the clinical evidence base and translating it into quality improvement strategies. Common research themes emerge among the programs: identification of priority areas, usually involving chronic illness or safety for quality improvement; synthesis of the evidence base around those areas; and development of performance measures from the evidence base.

While the research strategies of the various government programs are similar, the committee believes greater coordination would be beneficial in the development of the research agenda to better support the specific roles of government in quality enhancement processes. Some of the research efforts are duplicative or overlapping. For example, HRSA has established protocols for diabetes management and surveys of patient perceptions even though the DQIP protocols and CAHPS instruments are being used in many other government programs. Appropriate applications of the same instruments in HRSA could provide a richer database for assessing the validity of measures across populations.

Programs that conduct relatively less research would benefit from direct access to the research of other programs or agencies. Such a synergistic relationship cutting across all programs would also permit more testing of implementation approaches by providing a broader array of contexts for demonstration projects—for example, to determine how different payment methodologies could be used to improve quality (Anderson, 2002).

Without such coordination of research, the implementation of standardized tools across the government health programs will be much more difficult, since the tools used may not reflect the experience and responsibilities of the programs. In other words, research coordination is an essential precondition for coordination of implementation. Greater coordination also is needed to conduct more retrospective evaluations of the effects of different quality enhancement strategies across the government health

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