title: Learning Evaluation: blending quality improvement and implementation research methods to study healthcare innovations.
abstract: BACKGROUND
  In healthcare change interventions, on-the-ground learning about the implementation process is often lost because of a primary focus on outcome improvements. This paper describes the Learning Evaluation, a methodological approach that blends quality improvement and implementation research methods to study healthcare innovations.
  
  
  METHODS
  Learning Evaluation is an approach to multi-organization assessment. Qualitative and quantitative data are collected to conduct real-time assessment of implementation processes while also assessing changes in context, facilitating quality improvement using run charts and audit and feedback, and generating transportable lessons. Five principles are the foundation of this approach: (1) gather data to describe changes made by healthcare organizations and how changes are implemented; (2) collect process and outcome data relevant to healthcare organizations and to the research team; (3) assess multi-level contextual factors that affect implementation, process, outcome, and transportability; (4) assist healthcare organizations in using data for continuous quality improvement; and (5) operationalize common measurement strategies to generate transportable results.
  
  
  RESULTS
  Learning Evaluation principles are applied across organizations by the following: (1) establishing a detailed understanding of the baseline implementation plan; (2) identifying target populations and tracking relevant process measures; (3) collecting and analyzing real-time quantitative and qualitative data on important contextual factors; (4) synthesizing data and emerging findings and sharing with stakeholders on an ongoing basis; and (5) harmonizing and fostering learning from process and outcome data. Application to a multi-site program focused on primary care and behavioral health integration shows the feasibility and utility of Learning Evaluation for generating real-time insights into evolving implementation processes.
  
  
  CONCLUSIONS
  Learning Evaluation generates systematic and rigorous cross-organizational findings about implementing healthcare innovations while also enhancing organizational capacity and accelerating translation of findings by facilitating continuous learning within individual sites. Researchers evaluating change initiatives and healthcare organizations implementing improvement initiatives may benefit from a Learning Evaluation approach.
authors.affiliation: Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center Houston School of Public Health, Dallas Regional Campus, 5323 Harry Hines Blvd, V8.112, Dallas, TX, 75390, USA. bijal.a.balasubramanian@uth.tmc.edu.|Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA. bijal.a.balasubramanian@uth.tmc.edu.
authors.forename: Bijal A
authors.initials: BA
authors.lastname: Balasubramanian
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA. cohendj@ohsu.edu.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA. davismel@ohsu.edu.
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Davis
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA. gunnr@ohsu.edu.
authors.forename: Rose
authors.initials: R
authors.lastname: Gunn
authors.affiliation: Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA. miriam.dickinson@UCdenver.edu.
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.affiliation: Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA, USA. William.Miller@lvhn.org.
authors.forename: William L
authors.initials: WL
authors.lastname: Miller
authors.affiliation: Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA. crabtrbf@rwjms.rutgers.edu.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
authors.affiliation: Departments of Family Medicine and Community Health, Epidemiology and Biostatistics, and Sociology, Case Western Reserve University, Cleveland, OH, USA. kcs@case.edu.
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
mesh_terms: D004059:Diffusion of Innovation; D006296:Health Services / Q000592:standards; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D016730:Program Development / Q000379:methods; D058996:Quality Improvement / Q000458:organization & administration