Implementing Logic Models for Quadruple Aim QUERI Evolution

This paper from Glasgow et al. (2025) delves into the conceptualization and evolution of implementation logic models (ILMs) within the context of the Quadruple Aim Quality Enhancement Research Initiative (QUERI). The authors highlight how ILMs serve as a valuable tool for understanding the role and selection of implementation strategies, planning the evaluation of their intended impacts on implementation and effectiveness outcomes, and communicating key aspects of a project.

The methodology involved applying ILMs in the Quadruple Aim QUERI, a large multi-study program funded by the Veterans Health Administration (VA), starting with two primary implementation strategies: Iterative RE-AIM and Relational Facilitation. A key finding was that implementation strategies are often not discrete, and their delivery and adaptation are dynamic, necessitating guidance by emerging data and evolving context. The paper emphasizes that ILMs are helpful for clarifying key objectives and issues for both study teams and implementation partners, even though challenges exist in their construction and presentation, especially when multiple strategies are employed or when strategies change over time. The authors recommend presenting both original and periodically updated project models and provide insights for their future use. They also illustrate how ILMs can be used to clarify similarities and differences across projects, demonstrate how context and implementation strategies change and adapt over time, and discuss the nuances and challenges in using ILMs to summarize complex, interrelated issues.

The overarching Implementation Science (IS) model guiding the Quadruple Aim QUERI is the Practical, Robust Implementation and Sustainability Model (PRISM), which is a contextually expanded version of the RE-AIM framework. PRISM focuses on multilevel contextual factors (e.g., patients, staff, systems, policies) that are conceptualized to impact the RE-AIM implementation outcomes of Reach, Effectiveness, Adoption, Implementation, and Maintenance.

Reference for the article:

Glasgow, R. E., McCreight, M. S., Morgan, B., Sjoberg, H., Hale, A., Ujano‑De Motta, L., McKown, L., Kenney, R., Gilmartin, H., Jones, C. D., Frank, J., Rabin, B. A., & Battaglia, C. (2025). Use of implementation logic models in the Quadruple Aim QUERI: conceptualization and evolution. Implementation Science Communications, 6(10). https://doi.org/10.1186/s43058-024-00678-6