Article Title

Peer-to-Peer Toolkits Enhance Sharing of Best Practices Across an Integrated Delivery System

Publication Date



quality, toolkit


Background/Aims: A peer-to-peer approach to develop and disseminate online packages (“toolkits”) of locally developed system improvement resources (“tools”) at Veterans Affairs (VA) medical centers across the country. Toolkits were launched between 2010 and 2015. Tools consisted of medical record-based templates, decision support resources, patient-tracking databases and service agreements intended to improve the quality and timeliness of care.

Methods: Series of online questionnaires and semi-structured telephone interviews about tool use, targeting clinicians, quality managers and others involved in veteran care or quality improvement (QI).

Results: We evaluated uptake and use of the cancer/palliative care, primary care, specialty care and emergency services for women toolkits. Since first toolkit launch in 2010, more than 30,000 unique individuals have visited with nearly 19,000 visitors to the primary care toolkit alone. We identified facilitators of toolkit awareness and use across all four titles, including: 1) presence of facility/workgroup-level champions, 2) participation in learning collaboratives and the presence of other social networks, 3) engagement in QI initiatives, and 4) awareness of the facility’s performance on quality metrics/reports. Among respondents to the cancer care toolkit questionnaire, those who were aware of their facility’s performance on a VA-sponsored lung cancer study were significantly more likely to have visited the toolkit (odds ratio: 3.10, 95% confidence interval: 1.91–5.01). Respondents to the emergency services for women toolkit questionnaire who were involved in other QI activities were more likely to report toolkit use (odds ratio: 0.312 for uninvolved in QI, 95% confidence interval: 0.14–0.69). Barriers to uptake included strained personnel and financial resources as well as complicated approval processes to support tool implementation.

Conclusion: User-driven online toolkits have broad appeal to providers and staff. They are a low-cost complement to other QI approaches, including gold standard toolkits whereby organizations rigorously design, test and disseminate tools. Additional work is needed identifying “less engaged” facilities and promoting toolkit use to them and others less closely tied to existing social networks. Increased opportunities for participation in learning/QI collaboratives and local support for the use of new tools may enhance uptake. Additional research is needed to increase our understanding of the link between toolkit use and clinical outcomes.




June 29th, 2016


August 12th, 2016