QUERI – Quality Enhancement Research Initiative

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Substance Use Disorder QUERI
» Palo Alto, CA


Substance use disorders (SUDs) have substantial negative consequences on Veterans' mental and physical health, work performance, housing status, and social functioning. The population of Veterans with SUDs, other than nicotine dependence, is increasing in both absolute terms and as a percentage of the overall VHA patient population - from 270,991 (6.1% of VHA patients) in FY02 to 461,927 (8.3% of VHA patients) in FY10. These figures do not include Veterans who use alcohol or other substances in ways that are risky in terms of acute or chronic effects. In addition, approximately 20% of VHA enrollees are current smokers. The rate is considerably higher among Veterans with other SUDs. For example, approximately two-thirds of the 15,320 Veterans in SUD residential programs in FY10 were nicotine-dependent.


The mission of the Substance Use Disorder (SUD) QUERI is to improve the detection and treatment of Veterans with hazardous substance use. SUD-QUERI works in partnership with the VA Office of Mental Health Services (OMHS), VA Office of Mental Health Operations (OMHO), VA Office of Public Health, National Center for Post-traumatic Stress Disorder (NCPTSD), HSR&D's Pain Research, Informatics, Medical Comorbidities, and Education Center (PRIME), and VA/HSR&D's Mental Health and Human Immunodeficiency Virus/Hepatitis C Virus (HIV/HCV) QUERI Centers.


Goal 1: Improve the Accessibility, Quality, Effectiveness, and Efficiency of SUD Specialty Treatment

  • Improve symptom monitoring and measurement-based care
  • Improve care transitions and quality of intensive SUD treatment
  • Implement integrated smoking treatment in Mental Health specialty care
  • Increase implementation of pharmacotherapy for alcohol dependence

Goal 2: Improve the Accessibility, Quality and Efficiency of Treatment of Hazardous Substance Use within VA Medical Settings, Particularly Primary Care

  • Enhance access and quality of screening, brief interventions, and referral to treatment (SBIRT)
  • Enhance integration of treatment for unhealthy substance use into Patient-Aligned Care Teams (PACTs)
  • Increase implementation of addiction pharmacotherapy

Goal 3: Improve the Integrated and/or Co-located Treatment of SUD and Common Co-morbidities (i.e., infectious diseases, PTSD, and pain)

Infectious Disease Workgroup

  • Promote implementation of the nurse-based rapid oral HIV testing strategy within multiple VISNs with high HIV infection rates
  • Assess sustainability of hepatitis-related services implemented by programs that have previously attended Liver Health Initiative programs
  • Develop an implementation strategy to engage "implementation resistant" programs
  • Evaluate new services models for SUD screening and intervention in hepatitis clinics

SUD-PTSD Workgroup

  • Define existing practice patterns of PTSD specialty programs in providing integrated, parallel, or sequenced care for co-occurring SUD and PTSD
  • Determine whether Veterans who have co-occurring substance use disorders face specific barriers to accessing PTSD specialty treatment

Pain Workgroup

  • Increase utilization of non-pharmacological, evidence-based pain management for pain in specialty SUD treatment settings
  • De-implement "worst practices" in pain medication prescribing to decrease the likelihood of adverse events (e.g., avoidable hospitalizations, overdoses) among Veterans in SUD treatment who also receive treatment for pain
  • Improve the understanding and measurement of opioid misuse in SUD specialty care, and develop, test and implement effective interventions to reduce misuse
  • Identify and test strategies to improve communication about pain management between primary care and SUD specialty care

Quality Improvement in SUD Treatment

View: Alex Sox-Harris, PhD, talks about his work focusing on quality improvement in treating substance use disorders.