1. Quality Improvement at the Crossroads AcademyHealth Annual Research Meeting Washington, DC - June 9, 2008

2. Quality Improvement at the Crossroads Francis Chesley, MD Francis Chesley, MD Carolyn Clancy, MD Carolyn Clancy, MD Neil R. Powe, MD, MPH, MBA Neil R. Powe, MD, MPH, MBA Donald Goldman, MD Donald Goldman, MD

3. Session Overview Session Introductions Session Introductions Federal Perspective: QI Research and Challenges in Moving Research to Practice Federal Perspective: QI Research and Challenges in Moving Research to Practice Complexity of QI Research and Challenges in Research Methods Complexity of QI Research and Challenges in Research Methods Research, Research Process and Ethical and Human Subjects Protection Considerations Research, Research Process and Ethical and Human Subjects Protection Considerations Audience Discussion and Qs & As Audience Discussion and Qs & As

4. Improving Health Care for All Americans Research Creation Research Creation Synthesis & Dissemination Synthesis & Dissemination Implementation & Use Implementation & Use How do We Move the Needle on Quality? How do We Move the Needle on Quality?

5. The Confluence of Research and QI Research QI

6. Hastings Center Report Definition of QI Systematic data-guided activities designed to bring about immediate improvements in health care delivery in particular settings (Hastings Center Report). Systematic data-guided activities designed to bring about immediate improvements in health care delivery in particular settings (Hastings Center Report). An intrinsic part of healthcare operations. An intrinsic part of healthcare operations.

7. Common Rule Definition of Research A systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge A systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge Activities that meet this definition constitute research whether or not they are conducted or supported under a program which is considered research for other purposes Activities that meet this definition constitute research whether or not they are conducted or supported under a program which is considered research for other purposes

8. The Confluence of Research, Improvement, and Management QI Healthcare Management QI Research

9. Important Considerations Given the overlapping domains of quality improvement research, quality improvement practice, and routine healthcare management, and the critical need to improve healthcare quality now, how can we move QI research to practice in order to move the needle on quality? Given the overlapping domains of quality improvement research, quality improvement practice, and routine healthcare management, and the critical need to improve healthcare quality now, how can we move QI research to practice in order to move the needle on quality? How do we understand potential risks, burdens and harms (to patients, providers and systems)? How do we understand potential risks, burdens and harms (to patients, providers and systems)? What is the role of research in demonstrating the effectiveness of QI interventions? When is evidence enough to act? When is the efficacy of a QI intervention proven such that it can be widely disseminated/implemented? What is the role of research in demonstrating the effectiveness of QI interventions? When is evidence enough to act? When is the efficacy of a QI intervention proven such that it can be widely disseminated/implemented?