1. International Journal for Quality in Health Care 2002; Volume 14, Number 3: pp. 233–249
Translating research into practice:
the future ahead
CYNTHIA M. FARQUHAR1, DANIEL STRYER2 AND JEAN SLUTSKY3
1
Center for Practice Technology Assessment, Agency for Healthcare Research and Quality, 2Center for Effectiveness and Outcomes
Research, Agency for Healthcare Research and Quality and 3National Guidelines Clearinghouse, Center for Practice Technology
Assessment, Agency for Healthcare Research and Quality, Rockville, MD, USA
Abstract
Objective. To summarize and analyze the focus and methodologies of the Translating Research into Practice (TRIP) projects
funded in 1999–2000 by the US Agency for Healthcare Research and Quality (AHRQ).
Data sources and study design. An analysis of the successful applications for the TRIP I and II requests for applications
in 1999 and 2000 was produced from the data collected.
Data collection. The following items were abstracted from each of the successful applications: provider focus, patient
population, vulnerable populations, methodologies, interventions for change, outcomes measured, and conceptual framework
used.
Principal findings. AHRQ funded 27 TRIP grants in 1999 and 2000. A wide variety of health care providers, settings, and
patients were the target of the grants. The most common study design was a randomized controlled trial. The most common
TRIP interventions were educational and the most common frameworks were either adult learning theory or organizational
theory. More than half of the projects planned to use information technology and half the projects had a focus on reducing
errors.
Conclusions. The TRIP projects encompass a broad range of providers, environments, patients, and interventions. The
field of applied research and quality improvements should be considerably enhanced by these research projects.
Keywords: applied research, decision aids, evidence-based medicine, guidelines, implementation, quality improvements,
research evidence
Clinicians are increasingly challenged to provide quality health help improve health outcomes if it could be implemented
care in the midst of an environment of increasing health successfully.
care choices, rising expectations, constrained resources, and Although a number of strategies for implementing change
increasing complexity of delivery systems. A definition of have been proposed, research evidence to guide this phase of
quality health care is often elusive, but the key components the process is lacking [4]. These strategies include continuing
are health care that is effective, efficient, up to date, and medical education, self-instructed learning, academic detailing,
timely [1,2]. Providing ‘the right care, at the right time, for audit and feedback, provider reminder systems, incentives,
the right person, in the right way’ is one way of describing local opinion leaders, outreach visits, continuous quality
quality health care [1]. In order to achieve at least some of improvement initiatives, clinical information systems, and
these goals, it is necessary to use the findings of well designed computer decision support systems. Despite a number of
research studies and translate them into everyday practice. randomized controlled trials of quality improvement and
Despite these best efforts to improve access to research implementation initiatives, considerable gaps in the research
information, the impact on clinician behavior or patient evidence remain [2,5–8].
outcomes has been limited. For example, a recent review of Fortunately, some research has already demonstrated that
published studies on the quality of care received by Americans implementation of available research evidence is worthwhile,
found that only 60% of patients with chronic conditions as significant improvements in health outcomes will accrue
received recommended care [3]. In most of these conditions, [9–12]. Although no one successful strategy currently exists,
research evidence of effective strategies exists that could a combination of different strategies may be effective in
Address reprint requests to C. M. Farquhar, Department of Obstetrics and Gynaecology, National Women’s Hospital,
Auckland, New Zealand. E-mail: c.farquhar@auckland.ac.nz
Published by Oxford University Press 233

2. C. M. Farquhar et al.
achieving behavior change. The impact of implementation Methodologies that were sought included qualitative stud-
strategies will depend on the context in which they are ies, quantitative research, and empirical work. In order to
applied, and will be influenced by factors including incentives, monitor and account for secular changes in practice patterns,
health care settings, practitioner and patient perceptions, and studies employing control group designs were strongly en-
the desired behavior change [13]. However, too little is known couraged. It was emphasized that to ensure internal and
about which combinations of implementation strategies are external validity, reliability, and transferability, the evidence
effective in which clinical contexts and for which clinical needs of organizations that might eventually implement sim-
conditions. These realities compound the problem of getting ilar interventions should be considered. Strategies to reduce
evidence into practice. bias such as use of randomization or concurrent comparisons
With these concerns in mind, the Agency for Health Care were recommended. Applicants were further asked to con-
Policy and Research [known since December 1999 as the sider the potential of evidence-based tools. They were also
Agency for Healthcare Research and Quality (AHRQ)] an- encouraged to consider the effect of local circumstances such
nounced its interest in grant applications focusing on trans- as specific populations, diverse health settings, resources
lating research into practice (TRIP) in January 1999 [14]. constraints, and political context on both the implementation
These proposals were known as the TRIP I grants, and were process and the outcomes of care.
awarded late in 1999 and in 2000. A further request for
applications (RFA) for translating research into practice (TRIP
II) was announced in December 1999 and these grants were
Methods
awarded in September 2000 [15]. The overarching goal of
the RFAs was to support the evaluation of interventions
The objective of this paper is to summarize and analyze the
whose aim was to improve the outcomes, quality, effect-
focus and methodologies of the TRIP projects funded in
iveness, efficiency, and/or cost-effectiveness of health care
1999–2000 by the AHRQ. The paper was compiled from
based on findings derived from sound research. The in-
the successful applications for the TRIP I and TRIP II
terventions would be evaluated for their effectiveness at
funding rounds in 1999 and 2000. The following items were
changing processes and/or outcomes of care, as well as on
whether they are sustainable, reproducible, and generalizable. abstracted by one author (CMF) from each of the successful
A second goal was to demonstrate that the translation of applications: provider focus, patient population, vulnerable
research into practice leads to measurable and sustainable populations, methodologies, interventions for change, out-
improvements in health care. comes measured, and conceptual framework used. The ap-
Broadly, these RFAs encouraged research related to in- plications were categorized by this author in consultation
novative strategies for implementing evidence-based tools with the co-authors. Categories for the conceptual frameworks
and information among practitioners caring for diverse popu- included adult learning, social influence, marketing and social
lations in a variety of health care settings. A range of marketing, organizational theory, and behavioral theory [17].
interventions was suggested, including: structural and or- Adult learning theory and health education theory focus
ganizational changes, comprehensive quality improvement on personal motivation to change and active participation of
systems, computerized drug information and dosage, clinician the learner [18,19]. Social influence theories focus on the role
reminders, audit and feedback methods, interactive systems of social support, peer approval, and role models in promoting
to facilitate shared decision making, computer systems to behavior change [20]. Marketing and social marketing theory
deliver educational materials at the point of care, and clinical together provide a framework for identifying factors that
practice guidelines and protocols. In addition, the RFAs drive change and meet the needs of the target group [21].
encouraged applications from studies addressing how or- Organizational theory focuses on the environmental context
ganizational research could be translated into practice, the within which clinicians function as a key determinant of
impact of organizational variables on clinical translation, whether innovations are utilized, and the emphasis is on
and the organizational and structural context of successful organizational and structural factors that may hinder or
interventions needed to facilitate replication. facilitate changes in practice [22]. Behavior theory, which
Applicants were encouraged to address conditions and focuses on environmental cues and reinforcement such as
settings where the most improvement was likely to occur, audit and feedback, is seen to be central in encouraging and
where wide variability in practice currently existed, where maintaining behavioral change [19].
wide disparities in care existed for racial/ethnic minorities, To learn more about the TRIP I and II research projects
and where a large burden of disease and poor quality of life and to promote exchange of ideas among the TRIP re-
were documented. The funding priority also focused on at searchers, the AHRQ designed a series of activities to take
least one of the six specified areas of the President’s Race advantage of the similarities and differences among projects
and Disparities Initiative (infant mortality, cancer screening both in research design and execution of the studies. Previous
and management, cardiovascular disease, diabetes, HIV in- experience had led the AHRQ to believe it was likely that
fection/AIDS, and child and adult immunizations), as well recruitment problems, contamination issues, and problems
as mental health and pediatric asthma [16]. Of particular concerning stability of delivery systems were challenging for
interest were interventions that used the strengths of in- implementation research. Since many of these obstacles can
formation systems for implementing evidence-based strategies be difficult to overcome, it was thought that the investigators,
for health care improvement. the AHRQ, and eventually the research community could
234

3. Table 1 Summary of the TRIP I and II grants
TRIP I
..............................................................................................................................................................................................................................................................................................................
Principal investigator/ Health care Conceptual/
organization/collaborators/ providers Patient population/ theoretical
study design Project title involved condition framework TRIP intervention Outcomes
..............................................................................................................................................................................................................................................................................................................
1. Balas Point of care Family Patients of family physicians Adult learning Computer decision support % of patients (who are)
University of Missouri, delivery of physicians (diabetes, acute myocardial theory system with interactive treated in accordance
Columbia University, research infarction, heart failure, Organizational electronic guidelines with with evidence and
Duke University evidence pneumonia, stroke/transient theory feedback, including resources guidelines
Randomized controlled trial ischemic attack/atrial and education
fibrillation, breast cancer)
2. Chin Improving Health care Indigent vulnerable patients Adult learning Breakthrough series of Quality of care
University of Chicago, diabetes care providers at with diabetes who attend Organizational communication/behavior standards
Bayer Institute collaboratively community community health centers theory interventions: extended training
Randomized controlled trial in the health in quality management and
community centers chronic disease model,
brainstorming and problem
solving, patient–provider
communication
3. Davis Pediatric Pediatricians Children with otitis media, Organizational Evidenced-based decision Changes in provider
University of Washington evidence- and family acute sinusitis, allergic theory support system behavior
Randomized controlled trial based phyisicians rhinitis, bronchiolitis Marketing theory
medicine
4. Feldman Evidence- Home Patients with cardiac heart Behavioral theory Electronic ‘just in time’ Process measures
Visiting nurse service of based visiting failure and cancer Organizational reminders, follow-up with Patient health status
New York/Johns Hopkins reminders in nurses Two-thirds of the patients theory experts, clinical practice Use and cost of health
University home health are female Medicare guidelines, and patient care services
Randomized controlled trial care recipients education
continued
235
Translating research into practice

4. 236
Table 1 continued
C. M. Farquhar et al.
TRIP I
..............................................................................................................................................................................................................................................................................................................
Principal investigator/ Health care Conceptual/
organization/collaborators/ providers Patient population/ theoretical
study design Project title involved condition framework TRIP intervention Outcomes
..............................................................................................................................................................................................................................................................................................................
5. Gurwitz Reducing Health care Long-term care residents Organizational Computer-based clinical Reduction in adverse
Universty of Massachusetts adverse drug providers at theory decision support systems drug events
Randomized controlled trial events in long stay
nursing resident care
homes units
6. Holmes-Rovner Patient Mixed: Patients following a Social influence Decision support and coaching Physician prescribing,
Michigan State University decision physicians, myocardial infarction theory health behaviors,
Comparative study support and nurses Adult learning functional status,
counselling theory cholesterol
measurements, utility,
patients perception
7. Horbar Evidence- Pediatricians Neonates at risk of Social influence Multifaceted approach to Patient outcomes of
University of Vermont/ based respiratory disease syndrome theory education by training mortality, treatment
University of Alabama/ surfactant Adult learning workshops, reviewing evidence, given, time to first
Vermont Oxford Network treatment for theory feedback and audit, and peer dose, chronic lung
Randomized controlled trial pre-term comparisons disease, infection
infants
8. Katz Improving the Emergency Patients with unstable Cognitive Linking adherence to guidelines Patient outcomes
University of Wisconsin evidence for department angina feedback/ to patient outcome related to unstable
Randomized controlled trial unstable physicians knowledge angina
angina
guidelines
continued

5. Table 1 continued
TRIP I
..............................................................................................................................................................................................................................................................................................................
Principal investigator/ Health care Conceptual/
organization/collaborators/ providers Patient population/ theoretical
study design Project title involved condition framework TRIP intervention Outcomes
..............................................................................................................................................................................................................................................................................................................
9. Manfredi Smoking Health care Women in maternal and Organizational Academic detailing for Provider compliance
University of Illinois control in providers in child health clinics theory providers, train the trainer with AHRQ guidelines
Randomized controlled trial maternal and maternal and (pregnant, post-partum, Adult learning workshop Reduction in patients’
child health child health well-child, family planning theory Patients’ access to centralized smoking
clinics clinics services) telephone counseling
10. Morrison Interventions Inpatient Surgical and medical Adult learning Education of nurses and Change in pain intensity
Mt Sinai School of Medicine to improve units inpatients theory physicians Pain relief
Comparative study pain outcomes Behavioral theory Patient education Analgesic prescribing
Marketing theory Audit and feedback practices
Computer decision support
system
11. Shafer Do urine tests Nurses in Sexually active teens Adult learning Educational: targeting and % urine testing for
University of California San increase outpatient theory training clinic nurses, 5 hour Chlamydia testing in
Francisco/Kaiser Chlamydia pediatric workshop sexually active
Randomized controlled trial screening in clinics adolescents (part of
teens? (HMO) HEDIS reporting)
12. Swartz Practice Physicians Cigarette smokers Adult learning Personalized data feedback and % of patients with
Maine Medical Assessment profiling to theory educational office visits tobacco status
Foundation increase (profiling) ascertained by providers
Randomized controlled trial tobacco and practice
cessation Patients and provider
survey
continued
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Translating research into practice

6. 238
C. M. Farquhar et al.
Table 1 continued
TRIP I
..............................................................................................................................................................................................................................................................................................................
Principal investigator/ Health care Conceptual/
organization/collaborators/ providers Patient population/ theoretical
study design Project title involved condition framework TRIP intervention Outcomes
..............................................................................................................................................................................................................................................................................................................
13. Thompson Translating Primary care Adolescents aged 14–20 Adult learning Opinion leaders, measurement Adherence to guidelines
Group Health Puget Sound Chlamydia physicians of years theory and feedback, prompts, and for chlamydia measured
Randomized controlled trial guidelines into an HMO Behavioral theory chart prompts by the % of females
practice Social influence tested for Chlamydia
theory
14. Titler Evidence- Nurses and Elderly patients with hip Organizational Guideline development Rate and extent of
University of Iowa, based practice: physicians in fracture theory: Rogers’ Acute pain management in the innovation adoption by
partnership with 12 acute pain hospitals (1995) model for elderly nurses and physicians
hospitals in the Midwest management diffusion of Quick reference guides Nurse and physician
Randomized controlled trial in the elderly innovation Incorporation into existing perceived barriers to
policies and procedures use of evidence-based
Focus groups guidelines
Education and use of nurse Cost of delivering an
and physician leaders intervention that
Web-based, video, and written promotes adoption of
resources evidence-based
Use of change champions and guidelines
core group approach
continued

7. Table 1 continued
TRIP II
..............................................................................................................................................................................................................................................................................................................
Principal investigator/ Health care Conceptual/
organization/collaborators/ providers Patient population/ theoretical
study design Project title involved condition framework TRIP intervention Outcomes
..............................................................................................................................................................................................................................................................................................................
15. Allison An internet Primary care Women at risk of Chlamydia Adult learning Internet-based learning % of women at risk
University of Alabama/US intervention providers trachomatis aged between Audit and feedback screened for Chlamydia
Quality Algorithms to increase 16 and 26 years old Case-based medical education trachomatis (HEDIS)
Randomized controlled trial Chlamydia
screening
16. Bates Improving Primary care Patients (not specified) Organizational Electronic reminders, electronic Guideline compliance,
Partners Health Care System quality with physicians theory links to evidence-based utilization, quality of
Randomized controlled trial outpatient Behavioral theory information care
decision
support
continued
239
Translating research into practice

8. 240
Table 1 continued
C. M. Farquhar et al.
TRIP II
..............................................................................................................................................................................................................................................................................................................
Principal investigator/ Health care Conceptual/
organization/collaborators/ providers Patient population/ theoretical
study design Project title involved condition framework TRIP intervention Outcomes
..............................................................................................................................................................................................................................................................................................................
17. Borbas Improved Hospitals Ischemic stroke patients Social marketing Use of formal hospital Guideline adherence:
Minneapolis Medical utilization of Behavior theory leadership teamed with the appropriate use of
Research Foundation, ischemic informal medical opinion thrombolytic and aspirin
Hospital consortium stroke research leaders and the feedback of therapy, avoidance of
Randomized controlled trial organizational data as well as excessive blood pressure
clinical data at the intervention reduction, early
sites mobilization, anti-
embolism efforts,
patient and family
education, therapy
assessment within 48
hours, long-term anti-
thrombotic therapy and
planning for anti-
hypertensive
management at
discharge
18. Cloutier Use of a Primary care Children with asthma Organizational Asthma management program Guideline adherence,
University of Connecticut/ pediatric providers theory (Easy Breathing) utility rates, prescription
ConnectiCare (IPA, MCO) asthma Marketing/social rates, hospital and
Randomized controlled trial management marketing emergency room rates,
program by patient, family, and
providers provider satisfaction,
through a quality of life, cost
MCO
continued

9. Table 1 continued
TRIP II
..............................................................................................................................................................................................................................................................................................................
Principal investigator/ Health care Conceptual/
organization/collaborators/ providers Patient population/ theoretical
study design Project title involved condition framework TRIP intervention Outcomes
..............................................................................................................................................................................................................................................................................................................
19. Fifield Better Primary care Children with asthma Organizational Guideline prompts at point of Process data: asthma
University of Connecticut pediatric providers theory care action plans
Health Center/Community outcomes Adult learning Family education Patient data: symptom
Health Network of through control
Connecticut, Inc, Medicaid chronic care Health-related quality of
MCO life
Comparative study Pharmaceutical use
Emergency room visits
and hospitalization
Cost
20. Gerber Multimedia Primary care Patients with diabetics Adult learning Computer-based education for Patient knowledge, self-
University of Illinois, Cook diabetes providers patients with diabetes efficacy and self-care,
County Hospital education glycosylated
Ambulatory Network hemoglobin, patient and
Randomized controlled trial staff satisfaction
21. Irwin Implementing Primary care Adolescents Organizational Training and use of evidence- Rates of delivery of
University of California, San adolescent providers theory based medicine tools preventive services and
Francisco/Kaiser preventive adolescents
Permanente guidelines
Randomized controlled trial
continued
241
Translating research into practice

10. 242
Table 1 continued
C. M. Farquhar et al.
TRIP II
..............................................................................................................................................................................................................................................................................................................
Principal investigator/ Health care Conceptual/
organization/collaborators/ providers Patient population/ theoretical
study design Project title involved condition framework TRIP intervention Outcomes
..............................................................................................................................................................................................................................................................................................................
22. Jones Improving Nursing Nursing home residents Organizational Translation of multiple clinical Process measures:
University of Colorado, pain home staff theory—diffusion practice guidelines for pain into Identification of
Area Health Education management of innovations training residents in pain
Centers in nursing Videos for staff and Medication
Comparative study homes educational videos for residents appropriateness
and their families Staff survey of
Also use of chart review and knowledge and attitudes
feedback to physicians Outcomes measures:
Creation of an internal pain Assessment of pain
team Improved staff
knowledge and attitudes
about pain management
Improved organizational
policies related to pain
Cost
23. Levine Translating Nurses and Low income patients who Organizational Nurse-mediated prevention Proportion of
Meharry Medical College/ prevention physicians require preventive services theory reminders preventive services
Meharry Medical Practice research into delivered for infant
Plan practice mortality, cardiovascular
Randomized controlled trial disease, cancer
screening, HIV/AIDs,
and adult and child
immunization
continued

11. Table 1 continued
TRIP II
..............................................................................................................................................................................................................................................................................................................
Principal investigator/ Health care Conceptual/
organization/collaborators/ providers Patient population/ theoretical
study design Project title involved condition framework TRIP intervention Outcomes
..............................................................................................................................................................................................................................................................................................................
24. Loeb Optimizing Nursing staff Residents of nursing homes Organizational Implement evidence-based Reduction of antibiotic
McMaster University, antibiotic use in nursing theory clinical algorithm by use
Hospital Network in long-term homes Marketing theory teleconferencing, site visits,
Randomized controlled trial care distribution of printed material,
workshops
25. Ornstein Prevention of Primary care Patients who receive Adult learning Academic detailing and Guideline
Medical University of South coronary heart physicians preventive services Social influence electronic medical record adherence—15 process
Carolina/Practice Partners disease and theory through practice site visits, measures
Research Network cerebrovascular Organizational sharing of quality improvement
Randomized controlled trial disease theory techniques by investigator
Marketing theory meetings, ongoing support by
project investigators
26. Vargas Developing Head Start Pre-school children with Organizational Multifaceted asthma case Process outcomes:
Arkansas Children’s Hosp an asthma personnel asthma theory management model Attendance
Research Institution/Head management Marketing theory
Start sites model for
Head Start
children
continued
243
Translating research into practice

12. 244
C. M. Farquhar et al.
Table 1 continued
TRIP II
..............................................................................................................................................................................................................................................................................................................
Principal investigator/ Health care Conceptual/
organization/collaborators/ providers Patient population/ theoretical
study design Project title involved condition framework TRIP intervention Outcomes
..............................................................................................................................................................................................................................................................................................................
Randomized controlled trial Adult learning Patient outcomes:
Asthma-related school
absences
Asthma symptoms
Quality of life for
parents and children
Medication use
Cost
27. Watson A model of Nursing staff Residents of nursing homes Organizational Identify, evaluate and follow up Guideline adherence
University of Rochester/ use of urinary in nursing theory cases of urinary incontinence (eight parameters)
Nursing home network incontinence homes Adult learning
Comparative study guidelines in
nursing homes
MCO, managed care organization.

13. Translating research into practice
Table 2 Key dimensions of translating research into practice projects
Focus on
disparities/
Health care Grantee Patient vulnerable
provider institution Collaborators1 population1 populations1 Condition focus Setting Location
.............................................................................................................................................................................................................................
Primary care University University Nursing Ethnic/ Asthma (3) [18, Home/ Urban (7)
providers (10) (22) [1–3, networks (10) home racial (13) 19,26] community [7,8,10,11,
[1–3,12,16,19,20, 5–11,14–16, [1–3,5,10,12,16, residents (4) [2,4,9,14,16, (18) [1–4,6, 16,18,21]
21,23,25] 18–25,27] 17,23,24] [5,22,24,27] 19–23,25,26] 9,11–13,15,
16,18–21,
23,25,26]
Hospital staff Research MCO (6) Children/ Children/ Pain Inpatient Rural (only)
(4) [7,8,14,17] Foundation/ [11–13,18,19, adolescents adolescents management (4) (5) [7,8,10, (0)
institute (3) 21] (8) [3,7,11, (7) [3,7,11, [4,10,14,22] 14,17]
[12,17,26] 13,18,19,21, 13,19,21,26]
26]
Nursing staff (5) MCO (1) Commercial (1) Elderly (3) Elderly (9) Urinary Nursing Mixed (20)
[3,4,11,22,27] [13] [15] [4,14,17] [4–6,10,14, incontinence (1) home (4) [1–5,9,
17,22,24,25, [27] [5,22,24,27] 12–15,17,
27] 19,20,
22–27]
Multidisciplinary Nursing Provider Medicaid/ Medicaid/ Infections/
group (10) [5,6, service (1) network (5) indigent (4) indigent (4) antibiotic use
9–11,13,15,18, [4] [2,9,17,20,25] [2,9,12,23] [2,9,12,23] (2) [3,24]
24,26]
Nursing home Population Diabetes (2)
networks (2) based (4) [2,20]
[5,27] [1,10,15,16]
Hospital Disease Cardiovascular
networks (4) specific (5) disease (5) [4,6,
[6–8,14] [6,8,17,20, 8,17,25]
25]
Other (2) [22, Prevention
26] services (8) [7,9,
11–13,15,21,23]
MCO, managed care organization.
1
More than one category possible.
Total number of projects in the named category is given in parentheses, and reference number of project is in square brackets, listed
below by principal investigator (see Table 1).
1. Balas; 2. Chin; 3. Davis; 4. Feldman; 5. Gurwitz; 6. Holmes-Rovner; 7. Horbar; 8. Katz; 9. Manfredi; 10. Morrison; 11. Shafer; 12.
Shwartz; 13. Thompson; 14. Titler; 15. Allison; 16. Bates; 17. Borbas; 18. Cloutier; 19. Fifield; 20. Gerber; 21. Irwin; 22. Jones; 23. Levine;
24. Loeb; 25. Ornstein; 26. Vargas; 27. Watson.
benefit by promoting formal venues for discussion among The coordinating committee incorporated the findings from
the investigators. In addition, all of the TRIP projects were the TRIP I meeting into planning for the TRIP II initiative.
limited to 3 years, so it was important that study problems After the TRIP II grants were awarded, the coordinating
be addressed early and effectively. committee held a meeting of the principal investigator and
After the awarding of the TRIP I grants, AHRQ formed partner from each TRIP II project. This meeting had the
an internal coordinating committee to plan and support the same purpose as the previous meeting of TRIP I investigators,
TRIP II initiative, and convened a meeting of the TRIP I in addition to the goal of establishing a TRIP II steering
investigators. Grantees were asked to give a brief overview committee made up of representatives of TRIP II in-
of their methods, problems anticipated or experienced, and vestigators and partners and the AHRQ. The major goals
the importance of their research. The discussion confirmed for the steering committee are to continue to develop the
the AHRQ’s belief that some of the impediments to per- science base for implementation, provide leadership to the
forming this type of research are not isolated or insignificant. field, advance methods for the study of TRIP, lead the
245

14. C. M. Farquhar et al.
Table 3 Features of study methodology
Focus on guidelines
or performance Unit of Framework for
Study design measures randomization Unit of analysis1 change1 Project evaluation1
.............................................................................................................................................................................................................................
Randomized National (14) Hospitals (3) Hospital (3) Adult learning/ Process outcomes
controlled trial [4,8–10,12,14,15, [7,14,17] [7,14,17] health education (5) [10,21,22,25]
(22) [1–5,7–9, 19–23,25–27] theory (16) [1–3,6,7,
11–18,20,21, 9–13,15,19,20,25–27]
23–26]
Comparative (5) Professional Provider (5) Provider (5) Social influence Provider outcomes
[6,10,19,22,27] organization (5) [1,3,4,16,21,23] [3,12,13,18,21] theory (4) [6,7,13,25] (6) [3,6,12,18,20,22]
[2,3,7,17,18]
Local/adapted (4) Practices/clinics Practice/clinic Marketing/Social Hospital/nursing
[1,6,16,24] (6) [11–13,15,18, (2) [18,25] marketing theories home/practice
25] (7) [3,10,17,18, outcomes (13) [5,6,
24–26] 7,11,13,14,17,18,21,
23–25,27]
HMO/HEDIS Community Community Organizational Patient outcomes
measure (2) [13,15] health centers/ health centers/ theory (17) [1,2,4,5,9, (17) [1,2,4,6,8,9,10,
maternal and maternal and 11,14,15,18–27] 12,14–16,18–22,26]
child health child health
clinics (3) [2,26] clinics (1) [11]
Nursing homes Nursing homes Behavioral theory/ Cost (12) [2–4,6,10,
(2) [5,24] (4) [5,22,24,27] cognitive feedback 13,14,16,18,20,22,
(6) [4,5,8,13,15,17] 25]
Patient (3) [8,20] Patients (15) Preceed/proceed Qualitative (4)
[1,2,4,6,8–10,12, model (10) [4,7,10, [2,22,24,25]
14–16,19,20,25, 11,13,15,16,21,22]
26]
Not randomized Roger’s diffusion of
controlled trials innovation model (1)
(5) [6,10,19,22,27] [14]
MCO, managed care organization.
1
More than one category possible.
Total number of projects in the named category is given in parentheses, and reference number of project is in square brackets, listed
below by principal investigator (see Table 1).
1. Balas; 2. Chin; 3. Davis; 4. Feldman; 5. Gurwitz; 6. Holmes-Rovner; 7. Horbar; 8. Katz; 9. Manfredi; 10. Morrison; 11. Shafer; 12.
Shwartz; 13. Thompson; 14. Titler; 15. Allison; 16. Bates; 17. Borbas; 18. Cloutier; 19. Fifield; 20. Gerber; 21. Irwin; 22. Jones; 23. Levine;
24. Loeb; 25. Ornstein; 26. Vargas; 27. Watson.
dissemination of TRIP II results, advise the AHRQ on future The key dimensions of the projects are presented in Table
TRIP initiatives and on development of an agency toolbox 2. The grants focused on a wide variety of health care
of implementation tools and research aids, and conduct providers and patients. Primary care providers (10) and
external evaluation. The steering committee is chaired by a multidisciplinary teams (10) were the most frequent health
TRIP II investigator and has established several working care providers. Collaborators were most often provider or
subcommittees. The steering committee meets at least twice university networks (21) and only six were managed care
a year with ongoing communication via conference call, organizations. Children were the most common patient popu-
E-mail, and ad hoc meetings of subcommittees. lation (eight) followed by nursing home residents (four) and
Medicaid beneficiaries (four). Nearly half of the studies
included substantial numbers of patients from different ethnic
Results and racial groups. Prevention services were a common focus
(eight), as was cardiovascular disease (five). Eighteen of the
A total of 27 grants were awarded, 14 TRIP I grants in 1999 studies were community-based and the remainder hospital-
and 2000, and 13 TRIP II grants in 2000. A description of (five) or nursing home-based (four).
each of the grants is given in Table 1. The study methodologies are presented in Table 3. The
246