QUERI – Quality Enhancement Research Initiative

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Spinal Cord Injury (SCI) QUERI
» Hines, IL / Seattle, WA

Background

VA cares for over 18,000 Veterans with Spinal Cord Injuries and Disorders (SCI/D) and 3,000 Veterans through SCI Specialty Care each year and is one of the largest providers of healthcare for individuals with SCI/D. SCI/D is a life-long condition that impacts all aspects of functioning, abilities, participation, and health. Individuals with SCI/D are at high risk for developing complications and secondary conditions as a result of their SCI/D.

Mission

The SCI QUERI works closely with the Office of SCI/D Services and the SCI/D System of Care to improve the lives of Veterans with SCI/D. The central mission of SCI QUERI is to promote health, independence, functioning, quality of life, and productivity of Veterans with SCI/D, through the evaluation and implementation of evidence-based findings.

Priority Areas

SCI QUERI has identified four primary areas of focus for research and implementation based on stakeholder input, research expertise, evidence based practice, and burden and impact on Veteran outcomes and the healthcare system.

These areas include:

  • Pressure Ulcer Prevention and Treatment
  • Infection Prevention and Management
  • Virtual Health
  • Optimization of Function, Activities and Participation

Goals

Goal #1: Reduce the number and severity of pressure ulcers in Veterans with SCI/D

  1. Standardize monitoring of wound healing, using the SCI Pressure Ulcer Monitoring Tool (PUMT) for Veterans with SCI/D and pressure ulcers within the SCI/D system of care.
  2. Standardize patient assessment and prevention interventions based on Clinical Practice Guideline (CPG) recommendations within the SCI system of care.

Importance: Veterans with SCI/D are at high risk for developing pressure ulcers. Treatment and management of pressure ulcers is very costly and pressure ulcers have a negative impact on patient outcomes such as quality of life.

Goal #2: Prevent and improve management of infections and healthcare outcomes in Veterans with SCI/D

  1. Enhance prevention and management of infections.
  2. Improve antimicrobial stewardship in the SCI care setting.
  3. Improve uptake of influenza vaccination by health care workers.

Importance: Veterans with SCI/D are at high risk for infection. Impairment of respiratory muscles increases risk for development of respiratory infections and use of invasive devices and frequent healthcare contact increase risk for other types of infection.

Goal #3: Enhance implementation of virtual health to increase access to care and improve outcomes for Veterans with SCI/D

  1. Enhance implementation of Clinical Video Telehealth to increase access to care for Veterans with SCI/D.
  2. Enhance implementation of secure messaging.
  3. Develop a virtual health program to promote smoking cessation to Veterans with SCI/D.

Importance: Veterans with SCI/D have significant mobility limitations that create challenges for accessing health care; additionally, many must travel long distances to access care and often experience transportation barriers. By increasing the ability of Veterans with SCI/D to communicate with their healthcare team, virtual health technologies (e.g., telehealth, secure messaging) have the potential to increase access, engagement in care, and coordination.

Goal #4: Optimize function, activities and participation in Veterans with SCI/D

  1. Examine the needs of Veterans with SCI/D related to issues of function.
  2. Implementation of evidence-based supported employment initiatives.
  3. Enhance implementation of inpatient environmental control units.

Importance: As people with SCI/D are surviving longer, a better understanding of the factors that serve as barriers and facilitators to optimal functioning is needed. As a first step, a needs assessment with Veterans with SCI/D to identify what problems with functioning they encounter, how these functional challenges affect their participation opportunities, life satisfaction, and QOL, and what factors are addressable to facilitate optimal function will provide direction for next steps. Supporting and optimizing function and participation of Veterans with SCI/D is essential to enhancing and improving patient outcomes.

For more details please refer to our Strategic Plan (link above).

Workgroups

SCI QUERI has three standing workgroups. The standing workgroups and their goals are included below:

Pressure Ulcers Workgroup: This workgroup group is led by Dr. Barbara Bates-Jensen, Associate Director for Research & Implementation for Pressure Ulcers in SCI, and Dr. Marylou Guihan and is comprised of researchers and and clinicians working toward the goal of prevention and improving management of pressure ulcers. Activities include providing guidance and consultation to investigators on existing projects and the development of new projects /investigators with an interest in the area of pressure ulcers

Contacts: Barbara Bates-Jensen, PhD (batesjen@sonnet.ucla.edu) or Marylou Guihan, PhD (Marylou.Guihan@va.gov)

Infection Prevention Workgroup: This workgroup led by Dr. Charlesnika Evans is comprised of investigators and clinicians working toward the goal of prevention and improving management of infections. Activities include developing and maintaining collaborations with VA Multidrug Resistant Organism (MDRO) Program office and researchers and clinicians in SCI/D and infectious disease.

Contact: Charlesnika T. Evans, PhD, MPH (Charlesnika.Evans@va.gov)

Implementation Workgroup: The implementation workgroup is comprised of the Implementation Research Coordinator (Dr. Henry Anaya) and the Associate Implementation Research Coordinator (Jennifer N. Hill, MA) along with other investigators in the group with implementation experience. The goals of this group are to:

  • Develop, organize, and disseminate information resources about implementation to SCI QUERI investigators and new investigators interested in VA SCI research
  • Provide guidance and consultation to investigators on existing projects and the development of new projects that involve implementation
  • Lead or assist with the development of implementation products from projects with implementation components

Contacts: Henry Anaya, PhD (Henry.Anaya@va.gov) or Jennifer N. Hill, MA (Jennifer.Hill3@va.gov)