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Background: GPs at the Deep End first started in Scotland and brought together Scottish general practitioners (GPs) working in the 100 most deprived practices in the country. The group continues to provide peer support, advocacy, training and research opportunities to learn more about general practice in disadvantaged areas. In 2016, Canberra GPs came together to form a local Deep End group, supported by the Scottish initiators., Objective: To describe the process and benefits of beginning a local Deep End group in the Canberra region., Discussion: The Canberra Deep End group includes GPs working with a diverse group of patients from disadvantaged areas. Since its inception, the group has met regularly to discuss local issues, advocate for change in local government policy, and provide peer support and learning opportunities. We highlight this powerful movement to Australian GPs working in areas of disadvantage and encourage others to develop their own Deep End group.

This study focuses on access to prenatal care and quality of care in the Family Health Strategy in Brazil as a whole and in the North region, through evaluation of infrastructure characteristics in the health units, management, and supply of care provided by the teams, from the perspective of regional and state inequalities. A cross-sectional evaluative and normative study was performed, drawing on the external evaluation component of the second round of the Program for Improvement of Access and Quality of Primary Care, in 2013-2014. The results revealed the inadequacy of the primary healthcare network's infrastructure for prenatal care, low adequacy of clinical actions for quality of care, and the teams' low management capacity to guarantee access and quality of care. In the distribution according to geopolitical regions, the findings pertaining to the units' infrastructure indicate a direct relationship between the infrastructure's adequacy and social contexts with higher municipal human development indices and income. For the clinical actions in patient care, the teams in all the regions scored low on adequacy, with slightly better results in the North and South regions of the country. There were important differences between the states of the North, and the states with higher mean income and human development scored higher on adequacy. The results indicate important organizational difficulties in both access and quality of care provided by the health teams, in addition to visible insufficiency in management activities aimed to improve access and quality of prenatal care.

Study Objective: Policymakers increasingly regard centralization of emergency care as a useful measure to improve quality. However, the clinical studies that are used to justify centralization, arguing that volume indicators are a good proxy for quality of care ("practice makes perfect"), have significant shortcomings. In light of the introduction of a new centralization policy in the Netherlands, we show that the use of volume indicators in emergency care is problematic and does not do justice to the daily care provided in emergency departments (EDs)., Methods: We conducted an ethnographic study in 3 EDs, a primary care facility, and an ambulance call center in the Netherlands, including 109 hours of observation, more than 30 ethnographic interviews with professionals and managers, and 5 semistructured follow-up interviews., Results: We argue that emergency care is a complex, multilayered practice and distinguish 4 different repertoires: acute and complex care, uncertain diagnostics, basic care, and physical, social, and mental care. A "repertoire" entails a definition of what good care is, what professional skills are needed, and how emergency care should be organized., Conclusion: The first repertoire of acute and complex care might benefit from centralization. The other 3 repertoires, however, equally deserve attention but are made invisible in policies that focus on the first repertoire and extrapolate the idea of centralization to emergency care as a whole. Emergency care research and policies should take all repertoires into account and pay more attention to alternative measures and indicators beyond volume, eg, patient satisfaction, professional expertise, and collaboration between EDs and other facilities., (Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

This paper discusses the use of secondments as a tool to increase knowledge translation between academics and policy makers by developing individual capacity. A case study is presented of a reciprocal secondment between a government department and a university. Enablers of knowledge translation included flexibility and support, a prior relationship between the two organisations, and a government culture that values use of research in policy making. Barriers included the lack of a planned approach with agreed outcomes, and a lack of evaluation at the end of the secondment. Recommendations for future secondments include establishing ongoing secondments between organisations; trialling different types of secondments; and having a detailed plan at the beginning of a secondment, including how the success of the secondment will be measured, and a formal evaluation at the end.

Making clinical information available for research is not only relevant for healthcare institutions, but also for regional EHRs, as cross-sectorial information can be made accessible. In the INFOPAT (INFOrmation technology for PATient-oriented health care in the Rhine-Neckar metropolitan region) project we are thus implementing both, a regional personal cross-enterprise electronic health record (PEHR) and a regional research platform (RRP) based on information from the PEHR. IHE profiles are implemented to achieve interoperability between healthcare institutions electronic medical records (EMR) and PEHR on the one hand, as well as PEHR and RRP on the other hand. The use case for the RRP is cross-sectorial quality assessment and improvement for colorectal cancer based on a quality indicator (QI) approach including patients' perspectives. For semantic interoperability the responses are transferred in the form of HL7 CDA L2 documents. The resulting architecture for a RRP shows that implementing a PEHR in combination with a RRP based on international communication standards is possible. Also IHE XDS can be used for integration of patient care and biomedical research infrastructures.

Aim: Rare diseases are a serious public health concern and are a priority in the EU. This study aims to develop policy recommendations for rare disease centres of expertise (CoEs) in order to improve standards and quality of care., Subject and Methods: A modified 3-round Delphi technique was used. Participants included rare diseases patients, carers, patient representatives and healthcare professionals (HCPs) from CoEs in two countries-Denmark and the UK., Results: The results suggest the need to make improvements within current CoE environments, access to CoEs and the need for coordination and cooperation of services within and outside CoEs. It is recommended that CoEs are not overly 'medicalised', while at the same time they should be established as research facilities. The importance of including patient representatives in CoE performance management was also highlighted. Raising awareness and provision of appropriate training amongst non-specialist HCPs is seen as a priority for early and correct diagnosis and ensuring high quality care. Similarly, provision of targeted information about patients' illness and care was considered essential along with access to social assistance within CoEs., Conclusions: Policy recommendations were developed in areas previously recognised as having gaps. Their implementation is expected to strengthen and improve current care provision for rare disease patients. In member states where national plans and strategies are being developed, it is recommended to replicate the methodological approach used in this study as it has proven to be a helpful tool in rare disease centres of expertise policy development., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: The success of practice-based research (PBR) depends on the willingness of clinicians and staff to incorporate meaningful and useful research protocols into already demanding clinic schedules. The impact of participation on those who implement multiple projects and how to address the issues that arise during this complex process remain incompletely described. This article reports a qualitative evaluation of the experiences of primary care clinicians and clinic staff who participated in multiple PBR projects with the Wisconsin Research and Education Network (WREN). Also included are their suggestions to researchers and clinicians for future collaborations., Methods: For program evaluation purposes, WREN conducted 4 focus groups at its 2014 annual meeting. The main focus group question was, "How has participation in PBR affected you and your clinic?" A total of 27 project members from 13 clinics participated in 4 groups (physicians, nurses, managers, and other clinical staff). The 2-hour sessions were recorded, transcribed, and analyzed to identify recurring themes., Results: Five major focus group themes emerged: receptivity to research, outcomes as a result of participation, barriers to implementation, facilitators of success, and advice to researchers and colleagues. Focus group members find research valuable and enjoy participating in projects that are relevant to their practice, even though many barriers exist. They indicated that research participation produces clinical changes that they believe result in improved patient care. They offered ways to improve the research process, with particular emphasis on collaborative early planning, project development, and communication before, during, and after a project., Conclusions: Clinics that participate in WREN projects remain willing to risk potential work constraints because of immediate or impending benefits to their clinical practice and/or patient population. Including a broader array of clinic personnel in the communication processes, especially in the development of relevant research ideas and planning for clinic implementation and ongoing participation in research projects, would address many of the barriers identified in implementing PBR. The themes and supporting quotes identified in this evaluation of WREN projects may inform researchers planning to collaborate with primary care clinics and clinicians and staff considering participating in research endeavors., (© Copyright 2015 by the American Board of Family Medicine.)

Background: Since 1990, the National Cancer Institute (NCI) and Centers for Medicare and Medicaid Services (CMS) have collaborated to create linked data resources to improve our understanding of patterns of care, health care costs, and trends in utilization. However, existing data linkages have not included measures of patient experiences with care., Objective: To describe a new resource for quality of care research based on a linkage between the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) patient surveys and the NCI's Surveillance, Epidemiology and End Results (SEER) data., Design: This is an observational study of CAHPS respondents and includes both fee-for-service and Medicare Advantage beneficiaries with and without cancer. The data linkage includes: CAHPS survey data collected between 1998 and 2010 to assess patient reports on multiple aspects of their care, such as access to needed and timely care, doctor communication, as well as patients' global ratings of their personal doctor, specialists, overall health care, and their health plan; SEER registry data (1973-2007) on cancer site, stage, treatment, death information, and patient demographics; and longitudinal Medicare claims data (2002-2011) for fee-for-service beneficiaries on utilization and costs of care., Participants: In total, 150,750 respondents were in the cancer cohort and 571,318 were in the non-cancer cohort., Main Measures: The data linkage includes SEER data on cancer site, stage, treatment, death information, and patient demographics, in addition to longitudinal data from Medicare claims and information on patient experiences from CAHPS surveys., Key Results: Sizable proportions of cases from common cancers (e.g., breast, colorectal, prostate) and short-term survival cancers (e.g., pancreas) by time since diagnosis enable comparisons across the cancer care trajectory by MA vs. FFS coverage., Conclusions: SEER-CAHPS is a valuable resource for information about Medicare beneficiaries' experiences of care across different diagnoses and treatment modalities, and enables comparisons by type of insurance.

Patient satisfaction (PS) surveys are frequently used evaluation methods to show performance from the customer's view. This approach has some fundamental deficits, especially with respect to theory, methodology and usage. Because of the significant theoretical value of the expectation confirmation/disconfirmation concept in the development of PS, an expectation-based experience typology has been developed and tested to check whether this approach could be a theoretical and practical alternative to the survey of PS. Due to the mainly cognitive-rational process of comparison between expectations and expectation fulfilment, it is easier to make changes in this stage of the process than in the subsequent stage of the development of PS that is mainly based on emotional-affective processes. The paper contains a literature review of the common concept of PS and its causal and influencing factors. Based on the theoretical part of this study, an expectation-based experience typology was developed. In the next step, the typology was subjected to exploratory testing, based on two patient surveys. In some parts of the tested typology explorative differences could be found between hospitals. Despite this rather more complex and unusual approach to expectation-based experience typology, this concept offers the chance to change conditions not only retrospectively (based on data), but also in a prospective way in terms of a "management of expectations"., (Copyright © 2014. Published by Elsevier GmbH.)

Purpose: This commentary argues in favor of international research in the 21st century. Advances in technology, science, communication, transport, and infrastructure have transformed the world into a global village. Industries have increasingly adopted globalization strategies. Likewise, the health sector is more internationalized whereby comparisons between diverse health systems, international best practices, international benchmarking, cross-border health care, and cross-cultural issues have become important subjects in the health care literature. The focus has now turned to international, collaborative, cross-national, and cross-cultural research, which is by far more demanding than domestic studies. In this commentary, we explore the methodological challenges, ethical issues, pitfalls, and practicalities within international research and offer possible solutions to address them., Design/methodology/approach: The commentary synthesizes contributions from four scholars in the field of health care management, who came together during the annual meeting of the Academy of Management to discuss with members of the Health Care Management Division the challenges of international research., Findings: International research is worth pursuing; however, it calls for scholarly attention to key methodological and ethical issues for its success., Originality/value: This commentary addresses salient issues pertaining to international research in one comprehensive account.

Purpose: Health care organizations and hospitals in particular are highly resistant to change. The reasons for this are rooted in professional role behaviors, hierarchical structures and the influence of hidden curricula that inform organizational culture. Action research (AR) has been identified as a promising bottom-up approach that has the potential to address the significant barriers to change. However, to date no systematic review of the field in health care exists. The paper aims to discuss these issues., Design/methodology/approach: A systematic review of the literature was conducted. Studies were reviewed with regard to the four stages of AR; problem identification, planning, implementation and evaluation., Findings: Only 19 studies were identified that fit the inclusion criteria. Results revealed significant heterogeneity with regard to theoretical background, methodology employed and evaluation methods used., Research Limitations/implications: Only studies published and written in the English language were included., Practical Implications: The field of AR interventions would benefit from a theoretical framework that has the ability to guide the methodology and evaluation processes., Originality/value: This is the first systematic review of AR in hospitals.

Background: Health services research investigates the structures and processes of the healthcare system under routine daily conditions. Comprehensive scientific knowledge of healthcare services research is necessary to accomplish a management tailored to the needs of the complex healthcare system., Methods: Under, over and incorrect supply should be avoided and healthcare provision should be further developed in line with supply and demand while remaining financially feasible. Additionally, cooperation should be structurally constructed across sectorial boundaries of health services resulting in the development of a transparent manageable process. A special focus in urology in this process is initially the representation of the quality of results in the reality of treatment of the most commonly occurring urological tumors., Conclusion: The organizational structures and technical instrumentation for these challenges are only rudimentary and the necessary measures are currently also not financially sustained.

Unlabelled: Guideline synopses, i.e. the systematic synthesis of clinical practice guidelines, are used as a basis for Disease Management Programmes (DMPs) in Germany. One of the responsibilities of the German Institute for Quality and Efficiency in Health Care (IQWiG) is the preparation of guideline synopses for DMPs. The article describes the experiences with this methodology., Methods: For the preparation of guideline synopses, a systematic search for evidence-based guidelines is conducted, and their recommendations are extracted and synthesised. In parallel, the quality of the guidelines is assessed using the AGREE instrument. The need for updating or supplementing a DMP is justified by means of the Grade of Recommendation (GoR) or, alternatively, the Level of Evidence (LoE)., Experiences: Since 2006 IQWiG has synthesised recommendations from 256 evidence-based guidelines in 12 guideline synopses for DMPs. The results are then used by the Federal Joint Committee (G-BA) to update DMPs. Using the example of the 12 synopses, several analyses were conducted. It was determined that a search for guidelines in guideline databases is sufficient and that a search in bibliographic databases can be dispensed with. Furthermore, the analyses showed that a large proportion of recommendations in evidence-based guidelines are not clearly linked to a GoR or LoE. If GoR and LoE are provided, only about 42% of recommendations with a strong GoR also refer to a strong LoE. It was also shown that only 21 % of the analysed guideline providers supplied information on the handling of unpublished data. With consistent average to high values, the assessment of the methodological quality across all of the prepared synopses allows for the conclusion of a basically acceptable guideline quality, but with a need for improvement., Outlook: A guideline synopsis is an established tool for identifying health care standards as a basis for developing and updating DMPs. Further methodological development, particularly in collaboration with guideline providers, appears to be reasonable. It should be examined whether guideline synopses are suitable not only for guideline and DMP development, but also for other health care issues., (Copyright © 2014. Published by Elsevier GmbH.)

Background and Objectives: Introducing fixed fees for inpatient hospital care has raised fears of a negative influence on treatment quality. To address these concerns, an external quality assurance was implemented. The results of the quality indicators should indicate changes in the quality of inpatient care between 2004 and 2008., Methods: On the basis of the evaluation data delivered by the Federal Quality Assurance Agency, quality indicators with similar results of at least 3 subsequent years were included. A trend was identified with linear regression as well as with a constant change in the results. 204 quality indicators of 19 health care sectors of 6 diagnosis groups were included., Results: Half of the quality indicators showed a particularly striking quality improvement in the categories "indication" and "process". The lowest number of quality indicators with a quality improvement occurred in the cardiac surgery. To this diagnosis group also belong 13 of the 18 quality indicators with deterioration. Sixteen of the 18 quality indicators rank among the category "result"., Conclusion: The quality of inpatient care improved substantially from 2004 through 2008, measured against the quality indicators of the external comparable quality assurance. This corresponds to other analyses of a similar time period in Germany of the same or different data sources. Those analyses showed additionally that the subjective perceptions of clinicians and of nursing staff are significantly worse., (© Georg Thieme Verlag KG Stuttgart · New York.)

In recent decades, the expansion of health services research has created an opportunity to crate salient, evidence-based guidelines for diagnosis, treatment, and prognosis. However, for many aspects of care, incorporation of new scientific knowledge into clinical practice often lags, particularly among the surgical subspecialties. This article highlights the development of evidence-based medicine, the principles of innovation diffusion, and successes and challenges in developing plastic surgery quality initiatives., (Copyright © 2013 Elsevier Inc. All rights reserved.)

External quality assurance has three main aims: to make service provision in medicine and nursing comparable, to systematically identify deficits in service quality and to support the introduction of measures for quality improvement. This article reflects on three major developments in mandatory external quality assurance in the German healthcare system that took place during the last five years. These developments include the implementation of cross-sectoral quality assurance, the utilisation of new data sources and a new focus on quality deficits and practicability. The article highlights the challenges that come along with these developments., (Copyright © 2013. Published by Elsevier GmbH.)

The aim of the WINHO indicators project is to describe and enhance the quality of outpatient oncology care in Germany with indicators. This paper deals with the development of a set of evidence- and consensus-based meaningful indicators to assess the quality of outpatient oncology care in Germany. These indicators are intended to be applied in assessments of quality of patient care in oncology practices, in quality reports and in peer-to-peer benchmarking. A set of 272 already existing indicators was identified through internet and literature searches. After redundancy reduction and addition of newly developed indicators for areas of ambulatory oncology care that were not yet covered, a preliminary set of 67 indicators was established. The further development of the indicator set was based on a modified version of the two-step RAND/UCLA expert evaluation method, which has been internationally established for developing quality indicator sets. The indicators were modified after the first round of ratings. After completing and assessing the second round of ratings, a set of 46 homogeneously positively rated quality indicators is now available for outpatient oncology care in Germany., (Copyright © 2013. Published by Elsevier GmbH.)

The field of public health services and systems research (PHSSR) has emerged over the past decade to produce the evidence needed to address critical uncertainties about how best to organize, finance, and deliver effective public health strategies to all Americans. To advance these efforts, a national PHSSR research agenda-setting process was used to identify a broad inventory of information needs and uncertainties that public health stakeholders face in the domains of public health workforce, public health system structure and performance, public health financing, and public health information and technology. This paper presents the results of an expert review process used to transform the identified information needs into a concise set of research questions that can be pursued through new scientific inquiry in PHSSR. Established research frameworks were used to specify the contexts, mechanisms of action, and outcomes within the public health system that require further study. A total of 72 research questions were developed from the 113 original items in the PHSSR inventory of information needs. The questions include both persistent problems and newly emerging needs in public health practice and policy. The resulting research agenda provides a starting point for mobilizing the public health scientific enterprise around contemporary, high-priority uncertainties identified by broad cross sections of public health stakeholders. Regular updates to this agenda will be required to achieve continuous improvements in both the science and practice of public health., (Copyright © 2012 American Journal of Preventive Medicine. All rights reserved.)

We examined current processes used to identify, communicate, and adopt "best practices" in the field of elder abuse using an iterative process involving literature and Internet reviews, surveys completed by stakeholders, and key informant interviews. Results indicate minimal research evidence exists to support current assessment and intervention strategies; there is an immediate need for more evaluation and research in this area and for improved knowledge exchange and translation. Two strategic directions are recommended: to (a) build capacity for research and program evaluation to advance knowledge of effective practices, and (b) build capacity for knowledge exchange to enhance professionals' efforts.

Background: Serious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a patient-centered medical home present even greater challenges and require more effective approaches., Methods: Our research team conducted a series of National Institutes of Health funded descriptive and intervention projects to understand organizational change in primary care practice settings, emphasizing a complexity science perspective. The result was a developmental research effort that enabled the identification of critical lessons relevant to enabling practice change., Results: A summary of findings from a 15-year program of research highlights the limitations of viewing primary care practices in the mechanistic terms that underlie current or traditional approaches to quality improvement. A theoretical perspective that views primary care practices as dynamic complex adaptive systems with "agents" who have the capacity to learn, and the freedom to act in unpredictable ways provides a better framework for grounding quality improvement strategies. This framework strongly emphasizes that quality improvement interventions should not only use a complexity systems perspective, but also there is a need for continual reflection, careful tailoring of interventions, and ongoing attention to the quality of interactions among agents in the practice., Conclusions: It is unlikely that current strategies for quality improvement will be successful in transforming current primary care practice to a patient-centered medical home without a stronger guiding theoretical foundation. Our work suggests that a theoretical framework guided by complexity science can help in the development of quality improvement strategies that will more effectively facilitate practice change.

Quality indicators (QIs) are used in many areas of health care in order to measure, compare, and improve quality. QIs are specific, measurable aspects of care that can be used to assess its quality. Assessing the quality of care contributes to quality improvement. Amongst other applications, QIs are used in quality management for comparisons between providers and in pay-for-performance systems. QIs can be developed on the basis of expert opinion, scientific evidence or clinical practice guidelines. For the efficient development of high quality QIs, rigorous, approved, and evidence-based development methods are needed. At present, there is no gold standard for the development of QIs.

Context: The mixed results of success among QI initiatives may be due to differences in the context of these initiatives., Methods: The business and health care literature was systematically reviewed to identify contextual factors that might influence QI success; to categorize, summarize, and synthesize these factors; and to understand the current stage of development of this research field., Findings: Forty-seven articles were included in the final review. Consistent with current theories of implementation and organization change, leadership from top management, organizational culture, data infrastructure and information systems, and years involved in QI were suggested as important to QI success. Other potentially important factors identified in this review included: physician involvement in QI, microsystem motivation to change, resources for QI, and QI team leadership. Key limitations in the existing literature were the lack of a practical conceptual model, the lack of clear definitions of contextual factors, and the lack of well-specified measures., Conclusions: Several contextual factors were shown to be important to QI success, although the current body of literature lacks adequate definitions and is characterized by considerable variability in how contextual factors are measured across studies. Future research should focus on identifying and developing measures of context tied to a conceptual model that examines context across all levels of the health care system and explores the relationships among various aspects of context., (© 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.)

Objectives: Objectives of the Pediatric Emergency Research Network's (PERN's) meeting included (1) learn about each of the participating network's missions, goals, and infrastructure; (2) share important contributions each network has made to the creation of new knowledge; (3) discuss "best practices" to improve each network's effectiveness; and (4) explore the potential for a collaborative research project as proof of concept that would help us promote quality of care of the acutely ill and injured child/youth globally., Methods: In October 2009, a multiday meeting was attended by 18 delegates representing the following pediatric emergency medicine research networks: Pediatric Emergency Medicine Collaborative Research Committee (United States), Pediatric Emergency Care Applied Research Network (United States), Pediatric Emergency Research of Canada (Canada), Paediatric Research in Emergency Departments International Collaborative (Australia and New Zealand), and Research in European Pediatric Emergency Medicine (15 countries in Europe and the Middle East)., Results: The inaugural meeting of PERN demonstrated that there is a common desire for high-quality research and the dissemination of this research to improve health and outcomes of acutely ill and injured children and youths throughout the world. Presently, the PERN group is in the final stages of developing a protocol to assess H1N1 risk factors with the collection of retrospective data., Conclusions: Several members of PERN will be gathering at the International Conference on Emergency Medicine in Singapore, where the group will be presenting information about the H1N1 initiative. The PERN group is planning to bring together all 5 networks later in 2010 to discuss future global collaborations.

Objectives: To understand factors associated with primary care physician research participation in a practice-based research network (PBRN) and to compare perspectives by specialty., Methods: We surveyed primary care internists, family physicians, and pediatricians in Monroe County, New York, regarding their past experience with research and incentives to participate in practice-based research. We performed descriptive and tabular analyses to assess perceptions and used chi(2) and analysis of variance to compare perceptions across the 3 specialties., Results: The response rate was 33%. The most frequently endorsed aspects of collaboration were the opportunity to enact quality improvement (78%), contribution to clinical knowledge (75%), and intellectual stimulation (65%). Significant differences among the primary care specialties were found in 2 aspects: ((1)) internists were more likely to endorse additional source of income as "important," and family medicine physicians were more likely to cite the opportunity to shape research questions, projects, and journal articles as "important.", Conclusion: Physicians across all 3 specialties cited the opportunity to enact quality improvement and contribution to clinical knowledge as important incentives to participating in practice-based research. This supports the importance of strengthening the interface between research and quality improvement in PBRN projects. Further study is needed to assess reasons for differences among specialties if PBRNs are to become successful in research involving adult patients.

This commentary presents data about the emotional, behavioral, and substance abuse disorders of youth in foster care and former recipients of foster care ("alumni") in the United States to underscore the reasons why high quality mental health services are essential.

Article presents problem of healthcare systems evaluation. Definitions of health system and healthcare system are introduced in the first part, which is followed by presentation of basic principles of healthcare systems evaluation, and commonly used and recommended indicators. Specific examples of healthcare systems evaluation methods implemented in selected European countries are described in the last part.

Context: The discussion about improving the efficiency, quality, and long-term sustainability of the U.S. health care system is increasingly focusing on the need to provide better evidence for decision making through comparative effectiveness research (CER). In recent years, several other countries have established agencies to evaluate health technologies and broader management strategies to inform health care policy decisions. This article reviews experiences from Britain, France, Australia, and Germany., Methods: This article draws on the experience of senior technical and administrative staff in setting up and running the CER entities studied. Besides reviewing the agencies' websites, legal framework documents, and informal interviews with key stakeholders, this analysis was informed by a workshop bringing together U.S. and international experts., Findings: This article builds a matrix of features identified from the international models studied that offer insights into near-term decisions about the location, design, and function of a U.S.-based CER entity. While each country has developed a CER capacity unique to its health system, elements such as the inclusiveness of relevant stakeholders, transparency in operation, independence of the central government and other interests, and adaptability to a changing environment are prerequisites for these entities' successful operation., Conclusions: While the CER entities evolved separately and have different responsibilities, they have adopted a set of core structural, technical, and procedural principles, including mechanisms for engaging with stakeholders, governance and oversight arrangements, and explicit methodologies for analyzing evidence, to ensure a high-quality product that is relevant to their system.

While internationally low-effort reporting and quality assurance systems based on routine data for hospitals were implemented a long time ago, the evaluation of the treatment quality in hospitals according to section sign 137 SGB V in Germany still relies on special data collection, which demands considerable extra time and effort for the healthcare providers. The current article starts by addressing the question whether quality analyses using primary data sources should be preferred to analyses using secondary data analyses. Subsequently, current possibilities of measuring outcome quality, using administrative routine data, will be illustrated, referring to the large collaborative project Quality Assurance of Hospital Care with Routine Data (QSR). This project was carried out in order to examine possibilities of measuring quality based on routine administrative data in Germany from 2002-2007. The objectives of this article are to present a summary of the project's current status as well as to provide perspectives of future quality assurance with routine data in Germany. In addition, some general problems in measurement of outcome quality, the volume-prevalence problem and the problem of risk adjustment are presented, and possible solutions are proposed.

In the context of measures to institutionalize the evaluation of primary health care in Brazil, the Ministry of Health proposed a formative and normative evaluation of the implementation of the project entitled Technical Capacity-Building of State Health Departments for Monitoring and Evaluation, as part of the National Policy for the Evaluation of Primary Care. One of the objectives was to develop a self-evaluation model using the rapid evaluation method (REM). This article presents the stages concluded to date in the self-evaluation model, together with the theoretical references. The final self-evaluation proposal was based on a theoretical evaluation model developed for formative evaluation and included the principal actions proposed for State health management, with all the tested indicators, thus increasing the internal validity and consistency. The final perspective is that this instrument, used with a participatory approach as provided in the proposal, helps assess the extent to which the project's objectives and actions are achieved, while identifying situations that can interfere in different contexts.

The Institute of Medicine's comprehensive program for quality improvement is based on many years of data observation, collection, and analysis. This work was performed by practitioner-researchers and efficiency consultants from many disciplines. The resulting recommendations are striking in their straightforward practicality and in their insistence that process factors determine output. According to Leape and colleagues (1991) "most adverse events are preventable...particularly those due to error or negligence." Leape et al. (1991) note that in industry, "an error rate that exceeds defined norms is deemed unacceptable" and urge that similar norms apply in medicine. As knowledge and technology improve, the results of quality undertakings are certain to foster health care's development into an endeavor in which errors are becoming increasingly rare events.

Human subject protection training is required for all research personnel regardless of funding source. This article summarizes recommendations from a discussion about ethics training for community personnel from the practice-based research network (PBRN) listserv sponsored by the Agency for Health Care Research and Quality PBRN Resource Center. PBRN projects can involve community providers and their staff as subjects of the research project or as collaborators with recruitment and data collection. Distinguishing between usual care and research procedures is important for determining if training is required of community-based personnel. The use of research assistants or practice facilitators to collect research-related information is one way of limiting practice involvement to usual care procedures, thereby allowing PBRNs to limit training to dedicated research staff. Key methodologies for human subject protection training of community practice staff include on-site lectures, online modules, videotapes, and paper-based training. Ultimately, a discussion by the PBRN researcher with his or her governing Institutional Review Board is recommended for finding acceptable strategies within a PBRN.

Purpose: The purpose of this paper is to shed some light on the utilization of quality improvement initiatives in healthcare operational environments. In the process, environmental changes and strategic responses are examined for a sample of healthcare organizations., Design/methodology/approach: A survey-based research methodology is utilized in this study. Factor analysis is used to extract relevant factors representing environmental changes and strategic options relevant to healthcare organizations. In addition, simple percentages are utilized to assess the extent of implementation and effectiveness of quality improvement initiatives., Findings: In general, the findings appear to indicate that the studied organizations have achieved both operational and strategic benefits due to the effective implementation of quality improvement initiatives. The implementation of quality improvement initiatives appears to be in response to environmental changes and challenges faced by healthcare organizations., Practical Implications: Based on the findings of this study, decision-makers are encouraged to commit organizational resources toward the effective implementation of quality improvement initiatives. Investing in quality improvement not only is justified, but also appears to be very much needed in a changing competitive environment., Originality/value: This study contributes to enhancing one's practical and theoretical understanding of the competitive impact of quality improvement initiatives in different operational settings.

Background: The purpose of the partnership science subcommittee's collective discussions and reactions to tools and strategies was to promote and support effective management of organizational-based, participatory research (OBPR) partnerships., Research Partnerships: Research partnerships are broadly defined to include interorganizational relationships where resources are shared to advance a collective purpose-in this case, applied, participatory research. Several major funding agencies have recognized their role in supporting research partnerships and have used a "push" strategy via earmarked funds for such activities. OPBR partnerships made possible through support can engage multiple entities to enhance the generalizability and potential for modeling and spread of findings., The Partnership Strength Survey: Effective management of the research partnership should stimulate collaborative problem solving based on organizational priorities for shared learning and spread of research results. Current surveys were drawn on to create a participant survey for continuously improving and monitoring partnership strength and synergy., Implications for Practice: The in-depth exploration of participatory research is intended to move health system-based staff from a passive to an active role in the research process and to encourage executives to support and encourage research participation.

Healthcare systems worldwide strive to improve the quality of care they provide. Securing predictable systemic improvement is, however, a complex task. The imperative to be evidence-based is often constrained by the literature, which is of uneven scientific rigour and neither well-synthesized nor contextualised. This article provides a conceptual framework to guide the translation of the available evidence into policy and managerial decisions for improving quality. The framework has three aspects: a taxonomy to organize the available evidence of potential quality-enhancing interventions; a multi-tier approach to selecting and implementing interventions in a healthcare system; and a model to guide the adoption of professional, governmental and market levers for change.

Background: There is growing recognition that the health care delivery system in the United States must make major changes. Intervention projects focusing on quality and patient safety offer the potential for reshaping the future of medicine. Sustainability of the Partnerships for Quality (PFQ) projects and other patient safety and quality improvement projects that provide evidence of effectiveness is essential if progress is to be made., Methods: For the purposes of these projects, a conceptual framework and a checklist for sustainability were developed. The framework consists of two dimensions: (1) the goals--what is to be sustained--and (2) elements for sustainability--infrastructure, incentives, incremental opportunities for involvement, and integration. The checklist is designed to trigger planning for sustainability early in a project's design. Specific questions about each of the elements can cue planners and project leaders to build in the goals for sustainability and change processes., Results: A pilot test showed that the framework and checklist are relevant and helpful across a variety of projects., Discussion and Conclusion: Two extended examples of planning and action for sustainability from the PFQ projects are described. It is too early to claim sustainability for these project. However, continued monitoring for at least three years with the checklist could result in valuable national data with which to design and implement future projects.

Background: Translating research into practice and policy is a complex process that links the research enterprise and health care delivery system of the United States. The Agency for Healthcare Research and Quality (AHRQ) Partnerships for Quality (PFQ) initiative expanded the scope of research translation beyond clinical practice, highlighting the role of strategic partners. A work group of AHRQ grantees developed a framework for systematic evaluation of the impact of strategic partnerships on research translation., Methods: The evaluation framework posits a hierarchy of impacts that cumulatively lead to observable patient outcomes. The evaluation framework captures (1) health care outcomes improvement, (2) clinical practice changes, (3) policies, procedures, and protocols, and (4) research and knowledge. After the framework and tool were subjected to face-validity critique among PFQ investigators, the concept of synergy was added. PFQ investigators pilot-tested the evaluation framework, and the PFQ tool was refined further., Results: Early feedback from PFQ grantees suggested that the framework is generalizable and potentially useful to guide investigators in capturing impacts of their work that might otherwise go unrecognized or trivialized., Discussion: The PFQ Evaluation Tool, a pragmatic approach for evaluating the impact of partnership-driven translation projects, provides a comprehensive evaluation of impacts, including synergistic outcomes.

Background: Partnerships can facilitate effective implementation of best practices, but literature describing effective and ineffective strategies to address barriers to implementation in partnerships is lacking., Methods: Principal investigators (PIs) were surveyed to identify barriers to best practice implementation, rank their significance, and articulate the success and failure of solutions attempted., Results: The top four categories of barriers to implementation were partnership challenges, practitioner/local organization variables, time frame challenges, and financial concerns. Ninety-eight effective and 38 ineffective solutions used to overcome these barriers were identified. The most common categories of successful solutions were flexibility of interventions to align with unique local characteristics, schedules, and budgets (36.7% of listed successful solutions); communication strategies that emphasize frequent bidirectional information exchange in person (26.5%); and thoughtful use of personnel emphasizing sites' senior leadership and centralized quality and analytic content expertise (16.3%)., Discussion: Despite substantial partnership diversity, consistent themes related to barriers to implementation and solutions to these barriers emerged. The successful and unsuccessful solutions provided should be proactively assessed to enhance the likelihood of future partnership success.

The PFQ projects' experience suggests that partnerships can help the research and practice communities jointly address quality, safety, cost, and outcomes.