Additionally, randomized controlled trials should build on previous work that characterized context and intervention development, Batalden said. The gap between technical knowledge limits and the needs of the particular applications of knowledge must be bridged.

The focus of quality improvement projects should also be clarified, suggested Davidoff. Projects often do not distinguish between the goals of determining the efficacy of the clinical intervention itself and of assessing the effectiveness of the care system in delivering the intervention. Different types of evidence may be required for the different goals, Davidoff noted. With a greater emphasis on clearly defining the focus of studies, the field could produce useful, generalizable knowledge that is actually needed, Grimshaw said.

Understanding the ethical issues is also an important, tangible change that can help improve the state of quality improvement research, Davidoff said.

LONG TERM

One long-term solution to improving quality improvement and quality improvement research would be to provide training in research methods to people doing work in quality improvement, Davidoff suggested. This could help fix the aforementioned mismatch between training and practice. Davidoff also noted that changes should be made to professional education. Examples of such changes would include teaching collaborative skills, training physicians in the manner that health care should be delivered, and encouraging provider partnerships.

Academic and editorial cultures also need to change in order for quality improvement and quality improvement research to develop. These stakeholders need to recognize the social and intellectual values of quality improvement work, Davidoff said. Other opportunities include learning more about experiential learning and leveraging other research disciplines. Davidoff noted that other research disciplines, such as social sciences and economics, could be useful in moving forward. One important step in achieving this could be recognizing that quality improvement research, as an interdisciplinary field, will require special attention, Pincus noted.

THE IMPORTANCE OF STRATEGIES FOR CHANGE

Strategies should be developed to take action on these opportunities, Pincus said. He proposed six strategies to help advance



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