BACKGROUND Effective implementation strategies might facilitate patient-centered medical home (PCMH) uptake and spread by targeting barriers to change. Evidence-based quality improvement (EBQI) is a multi-faceted implementation strategy that is based on a clinical-researcher partnership. It promotes organizational change by fostering innovation and the spread of those innovations that are successful. Previous studies demonstrated that EBQI accelerated PCMH adoption within Veterans Health Administration primary care practices, compared with standard PCMH implementation. Research to date has not documented fidelity to the EBQI implementation strategy, limiting usefulness of prior research findings. This paper develops and assesses clinical participants' fidelity to three core EBQI elements for PCMH (EBQI-PCMH), explores the relationship between fidelity and successful QI project completion and spread (the outcome of EBQI-PCMH), and assesses the role of the clinical-researcher partnership in achieving EBQI-PCMH fidelity. METHODS Nine primary care practice sites and seven across-sites, topic-focused workgroups participated (2010-2014). Core EBQI elements included leadership-frontlines priority-setting for QI, ongoing access to technical expertise, coaching, and mentoring in QI methods (through a QI collaborative), and data/evidence use to inform QI. We used explicit criteria to measure and assess EBQI-PCMH fidelity across clinical participants. We mapped fidelity to evaluation data on implementation and spread of successful QI projects/products. To assess the clinical-researcher partnership role in EBQI-PCMH, we analyzed 73 key stakeholder interviews using thematic analysis. RESULTS Seven of 9 sites and 3 of 7 workgroups achieved high or medium fidelity to leadership-frontlines priority-setting. Fidelity was mixed for ongoing technical expertise and data/evidence use. Longer duration in EBQI-PCMH and higher fidelity to priority-setting and ongoing technical expertise appear correlated with successful QI project completion and spread. According to key stakeholders, partnership with researchers, as well as bi-directional communication between leaders and QI teams and project management/data support were critical to achieving EBQI-PCMH fidelity. CONCLUSIONS This study advances implementation theory and research by developing measures for and assessing fidelity to core EBQI elements in relationship to completion and spread of QI innovation projects or tools for addressing PCMH challenges. These results help close the gap between EBQI elements, their intended outcome, and the finding that EBQI-PCMH resulted in accelerated adoption of PCMH.

中文翻译：

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评估退伍军人卫生管理局对以证据为基础的质量改进的忠诚度，作为以患者为中心的医疗之家转型的实施策略。

背景技术有效的实施策略可以通过针对改变的障碍来促进以患者为中心的医疗之家（PCMH）的吸收和传播。循证质量改进（EBQI）是基于临床研究人员合作关系的多方面实施策略。它通过促进创新和成功传播的创新来促进组织变革。先前的研究表明，与标准PCMH实施相比，EBQI加快了VMH在退伍军人健康管理局初级保健实践中采用PCMH的速度。迄今为止的研究尚未证明对EBQI实施策略的忠诚度，从而限制了先前研究结果的实用性。本文开发并评估了临床参与者对PCMH的三个核心EBQI要素（EBQI-PCMH）的忠诚度，探索了保真度与成功的QI项目完成和传播（EBQI-PCMH的结果）之间的关系，并评估了临床研究人员合作伙伴关系在实现EBQI-PCMH保真度方面的作用。方法参加了9个初级保健实践站点和7个跨站点，主题为重点的工作组（2010-2014年）。EBQI的核心要素包括为QI设置领导层前线优先级，持续获取技术专长，通过QI方法进行辅导和指导（通过QI协作）以及使用数据/证据来告知QI。我们使用明确的标准来衡量和评估临床参与者之间的EBQI-PCMH保真度。我们将保真度映射到有关成功QI项目/产品的实施和传播的评估数据。为了评估临床研究人员在EBQI-PCMH中的伙伴关系，我们使用主题分析对73个主要利益相关者访谈进行了分析。结果9个站点中的7个和7个工作组中的3个对领导前线优先级设置的忠诚度达到中或高。富达在不断发展的技术专长和数据/证据使用方面参差不齐。EBQI-PCMH的持续时间更长，对优先级确定的更高保真度和持续的技术专长似乎与QI项目的成功完成和传播有关。根据主要利益相关者的观点，与研究人员的合作关系以及领导者与QI团队之间的双向沟通​​以及项目管理/数据支持对于实现EBQI-PCMH保真度至关重要。结论本研究通过制定和评估与EB创新项目的完成和传播有关的EBQI核心要素的保真度和评估措施，从而推进了实施理论和研究，以解决PCMH挑战。这些结果有助于弥合EBQI元素，预期结果以及EBQI-PCMH导致PCMH加速采用的发现。