QUERI – Quality Enhancement Research Initiative

Go to the HSRD website

Bridging the Care Continuum QUERI

Bedford and Boston, MA, and Palo Alto, CA

View program fact sheet

The goal of the Bridging the Care Continuum (Bridge-QUERI) program is to improve the health of vulnerable Veterans by improving diagnosis, outreach, linkage, and engagement with specialty care. BRIDGE-QUERI investigators test and implement models of care to help vulnerable Veterans negotiate the care continuum, striving to improve choice and timely access to specialty care while ensuring consistency of best practices. Bridge-QUERI focuses on vulnerable Veterans living with hepatitis or liver disease, as well as those who are homeless or involved with the justice system and have comorbid substance use and mental illness – not because they address all health vulnerabilities, but because they are important opportunities to improve the lives of the many Veterans. Moreover, vulnerable Veterans often require complex, specialized services both within and outside VA.

Findings and Expected Impacts

The Hepatitis C Testing , Linkage, and Treatment project employed quality improvement and Lean Management strategies to improve local practices and expand hepatitis C (HCV) testing and linkage to specialty care in order to prevent cirrhosis among Veterans. The HCV Testing, Linkage, and Treatment project also led to projects of interest to operational partners. One project examined provider and patient experiences with the Hepatitis C Choice program. A second project is evaluating a VA text messaging system—both in terms of understanding implementation issues and assessing effectiveness at improving patient self-management for Veterans undergoing treatment for HCV.

The Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION) project will integrate mental health and substance treatment, engaging homeless Veterans in healthcare. This study is being implemented in the Greater Los Angeles Homeless-PACT clinics to understand facilitation in implementing a complex intervention.

The Post-Incarceration Engagement peer support program aims to link and engage Veterans with VA and community healthcare and other supportive services after release from incarceration. This is a two-state comparative implementation that will be initiated in one state and then adapted for a second.

Principal Investigators: Allen Gifford, MD (Corresponding PI, Bedford VA); Keith McInnes (Bedford VA), ScD, MPH, Amanda Midboe, PhD (VA Palo Alto), David Smelson (Bedford VA), PsyD.

Principal Operational Partners: VA's Clinical Public Health Group, VA National Center on Homelessness among Veterans, Health Care for Re-entry Veterans (HCRV) Program, and the Office of Health Equity