“…13,16,18,22 For example, the results of survey questionnaire pilot projects or projects evaluating patient interventions may simultaneously provide generalizable "research" knowledge to other settings at the same time they provide insights into potential individual healthcare settings (i.e., more QI) improvements. 6,22,28,29 Although SA projects that utilize pre-existing or secondary data (e.g., already collected electronic health record data) can first appear to be relatively straightforward, the methodological and analytic complexities involved in examining multi-faceted healthcare phenomena can still be considerable. 18,27,35 In fact, just as with studies collecting "new" (i.e., prospective) data, a well-developed PDS for a project using retrospective data will just as likely include additional project measures (i.e., "exposures" and "outcomes" of interest) to study complex medical topics.…”