Developing Effective Partnerships for 

Implementation Research and 

Evaluations of Quality Improvement 

Programs

Amanda M. Midboe, PhD, VA Palo Alto Health Care System, HIV/Hepatitis 

QUERI

Christian D. Helfrich, PhD, VA Puget Sound Health Care System, IHD QUERI
Acknowledgements

• Catherine Rongey, Steve Asch, Chris Koenig at San 

Francisco & Palo Alto VAMCs

• Susan Kirsh, Michael Doukas, Omar Cardenas and 

members of the Specialty Care Transformational 

Initiatives

• Mike Ho, David Au and Denver-Seattle Specialty Care 

Evaluation Center Team

• Julie Lowery, Dave Aron and Ann Arbor-Cleveland 

Specialty Care Evaluation Center Team
Poll

What is your role in the VA? (please select all 

that apply)

- Research 

- Operations

- Quality Improvement

- Clinical

- Other
Presentation goals

• Understand the importance of partnerships in 

implementation research (IR) and quality improvement 

(QI)

• Find resources for developing partnerships

• Increase knowledge about key aspects of a successful 

partnership 

• Develop partnered-IR and QI
Implementation Research vs. Quality 

Improvement

• Implementation Research (IR)

– Focused on testing falsifiable hypotheses, 

intended to generate generalizable knowledge, 

usually prioritizes internal validity

• Quality Improvement (QI)

– Continuous, rapid, and focused on addressing 

practical issues; needs a p<.50; generalizability 

often valued over internal validity.
Partnerships

• Increasing emphasis on partnerships across 

VHA

• What do we mean by partners?

– Who will “own” the evidence-based clinical 

practice when it is implemented?

– Org Chart can be a starting place - 

http://vaww.ush.va.gov/docs/VHAOrgChart10311

3.pdf



Initiating Partnerships

• Start early

– For those applying for grants, this means several months in 

advance of the grant deadline

• Have to start somewhere but best partnerships measured in tree rings

– For those conducting QI, this means as soon as you are thinking 

about the project and there is a high likelihood of initiation

• Gather information about offices related to your 

research/evaluation questions

– Use existing resources - 

http://vaww1.va.gov/health/programs.asp

• For more detail, see http://www.valu.va.gov/Home/GetPDF/57

– Ask colleagues

– For IR, get in touch with relevant QUERI centers

• Review their strategic plan
http://vaww1.va.gov/health/programs.asp

http://www.valu.va.gov/Home/GetPDF/57
...Initiating

• Contact your partners

– Communication should include:

• Clear description of aims of IR or QI

• Who you are

• What you hope your partner can help you with

• Discuss relative priorities explicitly

– How will your work help your partner?

• How will it benefit Veterans’ well-being?

– How will your partner contribute to your work?

– Understand different time horizons of researchers and partners

• Explicit communication between each side

• Set a shared timeline with flexibility

• Draft a letter of support early and send to partners
Maintaining Partnerships

• Communicate regularly 

– Schedule regular update calls

– Include them on monthly project update emails

• Design flexible studies 

– As changes in policy or care practices occur, it may be important to 

change study design

• Provide interim results to partners; plan early wins

– Communicate with partners about types of results they would like and 

provide preliminary results

– Be open to conducting unplanned analyses

• Partners provide updates on policy/operations changes

– These updates may shape your questions and analysis

• Trust, credibility, and mutual respect are key

– Be open and honest; don’t promise something you can’t deliver
The curse of knowledge

• Researchers seek abstraction

• Operations needs concrete examples

• Example of communicating customer service 

focus at Nordstrom’s

– The Nordie who gift-wraps a customer’s Macy’s 

purchase 

• “True But Useless”

Source: Made to Stick by Dan & Chip Heath
A CASE STUDY

Partnerships
Poll

Have you participated or viewed any of the 

following clinical sessions?

- Telehealth

- SCAN-ECHO (or ECHO outside the VA)

- e-consult
Development of SCAN-ECHO

• Specialty Care Access Networks (SCAN) – Extension for 

Community Health Outcomes (ECHO)

– Based on the successful Project ECHO (Extension for Community 

Healthcare Outcomes) at the University of New Mexico

– Model of knowledge transfer from specialists to PCPs/PACT team in a 

case-based format using live, group tele-health sessions

• Developed from a partnership between Rural Health and Office of 

Specialty Care Services

• Coverage of 10% of time for physician to participate

• Developed Specialty Care Evaluation Centers to assess impact

• One disease area was patients with Hepatitis C Virus (original focus 

of Project ECHO)
Anatomy of SCAN-ECHO model

• Focused on a specific condition or issue, e.g., Hep-C,

dementia, diabetes mellitus

• Team of specialty care providers (e.g., infectious disease 

specialist, hepatologist, substance use specialist, mental 

health specialist, primary care nurse) hold regular tele- health meetings w/ primary care providers (PCPs)

• Sessions include case presentations

– PCPs identify patients they want help with and specialty team 

reviews and discusses

• Sessions also include didactic presentations by specialty 

team members, e.g., new therapies that are available
Goals of HCV SCAN-ECHO

• Create a network of specialist-generalist colleagues

• Empower the primary provider

– PCP provides increasingly sophisticated care

– CME, textbooks, meetings, create didactics

• Empower the CBOC or VAMC

– If CBOC provider is interested in HCV therapy, 

educate the CBOC pharmacist, nurse, etc. too.

• Help coordinate care
Program Offices
HCV SCAN-ECHO & Patient Care 

Services

Primary Care 

Program Office

Office of Specialty 

Care Services

Office of Mental 

Health Services
HCV SCAN-ECHO & Clinical Public 

Health

Clinical Public Health 

group
How Partnerships Formed:

VISN 21 HCV SCAN-ECHO 

• Evaluators/researchers gathered information about the role of 

different offices in HCV SCAN-ECHO

• Early and regular discussions between evaluators/researchers and 

key program offices and groups implementing HCV SCAN-ECHO

• Discussed priorities and planned initially developed QI project, 

which led to an eventual service-directed project (SDP) proposal

• Interim results given to partners throughout

– IT is a major challenge (e.g., 18% of SCAN-ECHO calls focus on IT 

issues)

– Resources (e.g., not a good time to decrease funds)

– Contracting 

– Knowledge gaps 
Results of Successful Partnerships

• Changes in communication between providers

– E.g., formulation of initial consult to be more clear

• Development of quality indices for provider 

communication

– i.e., what makes provider communication high quality?

• PI Catherine Rongey now splits her time between 

Clinical Public Health and research at the San Francisco 

VA

• Findings from this research-operations partnership will 

eventually be funded and supported by “the field” 

(e.g., local VISNs, facilities)
Key take-aways

• Many opportunities for implementation research (IR) and 

quality improvement (QI) to partner

• Key aspects of a successful partnership

– Identifying the right partners/stakeholders: 

who will “own” the clinical change?

– Partnerships are long-term (tree-rings)

– Researchers’ goals and the curse of 

knowledge

• SCAN-ECHO is prime example of type of partnered-IR and 

QI that is likely to be more common in future
Questions/Comments?

Christian Helfrich 

(Christian.Helfrich@va.gov) 

Amanda Midboe (Amanda.Midboe@va.gov)