Improving Quality: A Steeplechase of Sorts? The Necessity of Science for Practice and Science for the Public

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Improving Quality A Steeplechase of Sorts?
The Necessity of Science for Practice and
Science for the Public

• Junius J. Gonzales, MD
• Symposium Expanding Research and Evaluation
  Designs and Methods
• September 14, 2005

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Improving Quality

• Steeple chase, a race across country between a
  number of horsemen, to see which can first reach
  some distant object, as a church steeple hence,
  a race over a prescribed course obstructed by
  such obstacles as one meets in riding across
  country, as hedges, walls, etc.

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We Are Not Alone Findings from a December 6,
2003 BMJ Report

• All groups feel an urgent need to reconnect the
  funders, users, and providers of research
• Users and researchers unanimously agree
• Responsibility for dissemination of findings and
  supporting its application does not rest with
  them
• Context, culture and credibility issues

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The PLAYERS
ACADEMIC RESEARCH
BUSINESS
POLICY
Practice
Communities
Communities
Patients Families
SOCIETY
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Design/Methods Issues

• Randomization vs. Ecological Realities
• Goals (tensions in validity)
• Reduce error variance
• Increase signal to noise ratio
• Decrease chances of type I and II errors

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Process To Describe or to Quantify?

• Can process data and theorizing help make the
  business case?
• Variance and Process Theories (Langley 1999)
• Balancing accuracy, generality and simplicity
• Can analytic strategies such as alternate
  templates or temporal bracketing help?
• Tensions in levels of evidence

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Challenges Opportunities

• Learning from the terrific VA Experience how to
  apply to other settings, populations?
• What do we need?
• Understanding modifiable mechanisms of change and
  not just identifying patterns?
• Better utilizing and studying types of transfer?
• Building research infrastructure in real world
  settings

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The Science to Services ChallengeIntervention
(i.e. an evidence-based-practice) is only one
piece of the implementation puzzle
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The difficulty lies, not in the new ideas, but
in escaping from the old ones.

• John Maynard Keynes