QUERI – Quality Enhancement Research Initiative

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Denver-Seattle Specialty Care Evaluation Initiative

Denver, CO and Seattle, WA

Overview:

Over half of the more than 8 million Veterans in VA care are seen by at least one medical specialty care clinician. While primary care initiatives actively promote providing care to Veterans in their communities, specialty care services are limited and typically concentrated at urban medical centers, making access difficult for many Veterans. The VA Office of Specialty Care Services/Office of Specialty Care Transformation (SCS/OSCT) implemented a number of transformational initiatives designed to improve access and delivery of specialty care incorporating the essential elements of being Veteran-centered, team-based, efficient, and evidence-based. The main goals of the Denver-Seattle Specialty Care Evaluation Initiative are to partner with SCS/OSCT to evaluate the impact of the specialty care transformation initiatives, as well as to inform decisions about maintaining, modifying, and/or expanding the programs. This evaluation also will assess the implementation of the initiatives, and variations in success across sites to inform QUERI about successful implementation for future initiatives.

Objectives:

Specific aims include:

  • Evaluate the impact of the specialty care transformational initiatives by applying the RE-AIM framework comprised of reach, effectiveness, adoption, implementation, and maintenance.
    • Reach: Assessed by describing the number of patients, providers, and representativeness of each participating in the initiatives.
    • Effectiveness: Evaluated based on domains of access, care coordination, and care delivery at the patient, provider, and healthcare system levels.
    • Adoption: Evaluated based on the number of sites engaged in the initiative.
    • Implementation and maintenance: Evaluated using mixed methods based on key-informants' assessments and structured surveys of program fidelity, including consistency of delivery as intended, and the time and cost of the intervention.
  • Assess barriers and facilitators of effective adoption, implementation and maintenance at early adopting sites through formative evaluation, and incorporate findings to inform later adopting sites. The Consolidated Framework for Implementation Research (CFIR) will be used to guide data collection and organize findings

Methodology:

The Specialty Care Evaluation Center (SCEC) includes five VHA sites, Denver, Cleveland, Seattle, Ann Arbor, and East Orange. A formative evaluation, including administrator/provider cross-sectional interviews and surveys will be combined with a summative evaluation using quantitative data on patterns of use of each initiative will be I guided by two frameworks: RE-AIM (reach, effectiveness, adoption, implementation, maintenance) and CIFR. The formative evaluation will identify barriers and facilitators to implementation of the initiatives using the CFIR as a guide, and summarize these at regular intervals to identify what is or is not working at sites, and to facilitate transferring knowledge gained from early-adopter sites to those who are in the process of implementation or future sites. Investigators also will measure important domains of interest (i.e., access, care coordination and care delivery) for the summative evaluation for each initiative so that SCS/OSCT can assess not only the effectiveness of the initiatives, but also their reach. Reports of findings will be provided to the SCS/OSCT every 6 months. At the conclusion of the 2-year period, investigators will evaluate how each initiative site has performed, and compare performance across all initiative sites so that SCS/OSCT has a broad view of the impact of the specialty care transformational initiatives.

Operations Partner:

The mission of the Office of Specialty Care Transformation Initiatives Program (OSC) is to serve as subject matter expert to the Under Secretary for Health and VA healthcare facilities. The OSC is an advocate for the field and represents their needs related to resources, clinical guidance, and any other issues that might arise, and develops policies and procedures intent on improving processes and care provided to Veterans.

Principal Investigator: Michael Ho, MD; contact at Michael.Ho@va.gov .