Health Services Research & Development Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
J Gen Intern Med. 2010 Jan;25 Suppl 1(Suppl 1):38-43. doi: 10.1007/s11606-009-1155-x.
The Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) seeks to develop partnerships between VA health services researchers and clinical managers, with the goal of designing and evaluating interventions to improve the quality of VA health care.
In the present report we describe one such initiative aimed at enhancing the continuum of colorectal cancer (CRC) care, including diagnosis, treatment and surveillance-the Colorectal Cancer Care Collaborative (C4).
We describe the process and thinking that led to two parallel quality improvement "collaboratives" that addressed (1) CRC screening and diagnostic follow-up and (2) the guideline concordance and timeliness of CRC treatment. Additionally, we discuss ongoing effort to spread lessons learned during the first stages of the project, which initially occurred at only a subset of VA facilities, throughout the VA health care system. The description of this initiative is organized around key questions that must be answered when developing, sustaining and spreading multi-component quality improvement interventions.
We conclude with a discussion of lessons learned that we believe would apply to similar initiatives elsewhere, even if they address different clinical issues in health care settings with different organizational structures.
退伍军人事务部（VA）质量增强研究倡议（QUERI）旨在建立 VA 卫生服务研究人员和临床管理人员之间的伙伴关系，旨在设计和评估干预措施，以提高 VA 医疗保健的质量。
在本报告中，我们描述了一个旨在增强结直肠癌（CRC）护理连续性的倡议，包括诊断、治疗和监测 - 结直肠癌护理协作（C4）。
我们描述了导致两个平行质量改进“协作”的过程和思维，这些协作解决了（1）CRC 筛查和诊断随访以及（2）CRC 治疗的指南一致性和及时性问题。此外，我们还讨论了正在进行的努力，即将项目早期阶段的经验教训传播到 VA 医疗保健系统中的所有 VA 设施。该倡议的描述围绕着开发、维持和传播多组件质量改进干预措施时必须回答的关键问题展开。
我们以讨论经验教训结束，我们认为这些经验教训将适用于其他地方的类似倡议，即使它们在具有不同组织结构的医疗保健环境中解决不同的临床问题。
