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Quality Enhancement Research Initiative


Measuring implementation impacts on health systems

Measuring the health, economic, and cultural impacts generated by scientific investments is crucial to informing the sustainment of effective innovations for improving quality of care for Veterans. QUERI has a new comprehensive framework for assessing research impacts, especially for implementation and quality improvement initiatives.

The QUERI ACTION framework (Alignment, Commitment, Tailoring, Informing the field, Observing healthcare changes, and generating New questions/projects) provides measures of impact for scientific implementation and policy initiatives.

The ACTION framework is based on a comprehensive review of key impact frameworks, such as the National Academy of Medicine Degrees of Impact and CDC Science Impact Framework, and results from a recent national evaluation of QUERI.


Key examples of ACTION Impact Measures

Alignment: How is the initiative linked to health system operations and research priorities?

  • Number of research innovations implemented in routine care
  • Alignment of innovation goals with metrics derived from health system priorities

Commitment: How effective is the research-operations partnership?

  • Amount of funding or non-monetary sources (FTE, data) provided to implementers by health partners; Non-monetary resources contributed
  • Tools and strategies developed by the innovation or implementation process (e.g., implementation playbook) and whether they are used by the health system after the study and number of patents/invention disclosures

Tailoring to local context: To what extent were specific strategies and tools adopted into routine practice?

  • Number of sites adopting the innovation
  • Number of providers trained to use the innovation (and number of providers using the innovation)
  • Number of patients receiving or being served by the innovation

Informing the field: How are the project results being communicated to key stakeholders and organizations?

  • Extent to which results were disseminated to health system leadership or decisionmakers with authority and financial resources
  • Number of times and extent to which innovation was mentioned in popular and social media outlets

Observing healthcare changes: improvements in quality of care and health outcomes?

  • Whether the innovation led to patient health improvements and improved provider experience
  • Whether the innovation provided value (improved quality, cost efficiency)

Generating New questions: was there a “halo effect” of the innovation dissemination?

  • Extent to which end-users of the innovation create improvements to the existing innovation?
  • Whether the innovation led to new programs or policies or shaped/improved existing ones

To learn more about the QUERI ACTION Framework, see the full article here and/or contact