ࡱ>  dbjbjWW 655clP P 80,,,,>EX///////$25 0III 0,,02U#U#U#IX,,/U#I/U#U#-|., J p-/0<0-~+7 +7$.+7.IIU#IIIII 0 0!III0IIII+7IIIIIIIIIP p: VA Medical Center Differentiating Research from Other Projects Research is defined as a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge and to produce information to expand the knowledge base of a scientific discipline or other scholarly field of study. Operations Activities are certain administrative, financial, legal, quality assurance, quality improvement, and public health endeavors that are necessary to support VHAs missions of delivery health care to the Nations Veterans, conducting research and development, performing medical education, and contributing to national emergency response. Operations activities may or may not constitute research. Quality Improvement is defined as a data-driven, systematic approach to improving care locally and focuses on tracking quality of care. Evidence Based Practice (formerly Research Utilization) is defined as a clinical decision-making approach that integrates best available research evidence into practice with the practice change in one area or unit prior to institutional implementation. Responsible Individual:  FORMTEXT       Department/Service:  FORMTEXT       Phone:  FORMTEXT       E-mail:  FORMTEXT       Project Title:  FORMTEXT       Please submit this completed checklist and a brief (1 page) description of the proposed project, clearly stating the purpose of the activity, how the work will be conducted, and what will be done with the resulting information, to the Research Office. CONDITIONS FOR DETERMINATION OF STATUSYesNoIs this project or activity designed to be implemented and used solely for internal VA purposes? (ie, findings are intended to be used by and within VA or by entities responsible for overseeing VA, such as Congress or the Office of Management and Budget). FORMCHECKBOX  FORMCHECKBOX Does the project aim to produce information that expands the knowledge of a scientific discipline or scholarly field? FORMCHECKBOX  FORMCHECKBOX Does the project consist of operations activities? (see footnote for examples) FORMCHECKBOX  FORMCHECKBOX  Do you have any plans in the future with this project to do either of the following: Supplement/modify your project or analyze the data collected in a different way to produce information generalizable outside the VA? FORMCHECKBOX  FORMCHECKBOX Supplement/modify your project or analyze the data collected in a different way to produce information that expands the knowledge base of a scientific discipline? FORMCHECKBOX  FORMCHECKBOX Will the proposed project meet requirements set forth by a university level degree program that requires research be conducted? FORMCHECKBOX  FORMCHECKBOX Does the project involve prospective assignment of patients to receive different or additional procedures or therapies? FORMCHECKBOX  FORMCHECKBOX Does the project involve a control group (patients or employees) for whom an intervention is intentionally withheld or process not done to allow an assessment of its efficacy? FORMCHECKBOX  FORMCHECKBOX Will individuals be exposed to additional physical, psychological, social or economic risks or burdens? FORMCHECKBOX  FORMCHECKBOX Will the project collect and record identifiers and/or personal health information (PHI) for purposes other than treatment, payment or operations?  FORMCHECKBOX  FORMCHECKBOX OTHER RELEVANT INFORMATIONYesNoWho will participate?  FORMTEXT      Is participation voluntary? FORMCHECKBOX  FORMCHECKBOX Please indicate below all of the following that will be measured with this project:  FORMCHECKBOX Variation from standard of practice FORMCHECKBOX Rate of adoption FORMCHECKBOX Improved adherence with standard of practice FORMCHECKBOX Ease of implementation FORMCHECKBOX Satisfaction with standard of practice FORMCHECKBOX Cost reduction FORMCHECKBOX Feasibility FORMCHECKBOX Other:  FORMTEXT      Do you plan to publish or present the findings from this project?  FORMTEXT       FORMCHECKBOX  FORMCHECKBOX Who or what VA organizational body (if any) authorized or sanctioned the project?  FORMTEXT      Is this project funded? If yes, by whom?  FORMTEXT       FORMCHECKBOX  FORMCHECKBOX Please include any comments, clarifications, and/or questions regarding the project:  FORMTEXT       ____________________________________________ _____________________ Signature of Responsible Individual Date *Please note that it is the responsibility of this individual and/or each VA author and coauthor (in cases of publications) to retain a copy of this form signed by the ACOS/Research for a minimum of 5 years after publication and in accordance with any applicable records retention schedules. A copy will also be retained by the Research Service. Office Use only  FORMCHECKBOX  Determined NOT to be research- no research approvals required  FORMCHECKBOX Research - requires IRB approval _______________________________________ ______ ACOS/R&D VA Medical Center Date  FORMCHECKBOX  See attached comments. Form is based on VHA Handbook 1058.05, VHA Operations Activities that May Constitute Research (October 28, 2011). Per paragraph 7.c. Other Peer-Reviewed Publications, the ACOS-R is designated by the Facility Director to acknowledge the non-research status of an activity, as specified on this form for facility operations activities. Any network operations activities must be reviewed by the Network Director or their designee.  Examples of operations activities include activities designed for internal VA purposes, including routine data collection and analysis for operational monitoring, evaluation and program improvement purposes, VHA system redesign activities, patient satisfaction surveys, case management and care coordination, policy and guidance development, benchmarking activities, Joint Commission visits and related activities, medical use evaluations, business planning and development such as cost-management analyses, underwriting, and similar activities.  PHI (Protected Health Information) = Health information + identifiers. 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W ՜.+,D՜.+,\ hp  PVAMC( X -QA-QI Checklist (Portland VA Medical Center) Titlel@+;O[Creator DateCreated DateReviewed LanguageTypeDepartment of Veterans Affairs, Veterans Health Administration, Portland VA Medical Center, Research and Development Service2004 20100506enForm  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHJKLMNOPQRSTUVWXYZ\]^_`abcdefghijklmnopqrstuvxyz{|}~Root Entry F J Data IP"1Table[O7WordDocument 6SummaryInformation(wDocumentSummaryInformation8MsoDataStorePJ  J BE1MUK2E==2PJ  J Item  PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q