QUERI – Quality Enhancement Research Initiative

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Measurement Science QUERI

San Francisco, CA

Principal Investigators: Mary Whooley, MD (corresponding PI), Rebecca Brown, MD MPH, Tonya Kaltenbach, MD MAS, and Karen Seal, MD MPH

Principal Operational Partners: Office of Analytics and Business Intelligence, Primary Care Services, Patient Care Services (PCS), VINCI (VA Informatics and Computing Infrastructure), Specialty Care (SCS)/Gastroenterology, Cardiology, Mental Health, Integrated Healthcare, and Geriatrics and Extended Care.

Overview:

The primary goal is to integrate measurement science into healthcare for Veterans. Measurement Science (defined as the theory, practice, and application of suitable metrics) is at the core of VA's Learning Healthcare System and is a critical component at every stage of the quality improvement (QI) and implementation process. Using system-wide data to promote performance measurement, improvement efforts, and electronic tools (i.e., clinical reminders) depends on the uniformity of those metrics, the efficiency with which they can be obtained, and the accuracy with which they are measured. Whenever a healthcare decision is made, it must be based on valid and reliable data that are linked with all relevant information. Without meaningful metrics, QI and implementation of effective therapies cannot be accomplished.

Objectives:

Workwith VA operational partners to:

  • Promote standardization of VA data through use of a Common Data Model, and
  • Conduct four high-priority quality improvement and implementation projects to:

    1) Improve quality assessment of colonoscopy,

    2) Expand integrated pain management programs,

    3) Evaluate implementation strategies for home-based cardiac rehabilitation, and

    4) Improve measurement of functional status.

These projects are united by the need to identify and clearly define standardized metrics that will facilitate tracking of future benefits (or harms). The Measurement Science QUERI also will include a unique training component that will accelerate the dissemination of evidence-based therapies into practice by integrating an implementation science curriculum into training programs - and involving health professional trainees in quality improvement projects. This will not only increase the motivation to engage in continuous quality improvement, but also will accelerate the implementation of evidence-based practices by providing trainees with the skills to become future leaders in these areas.

Responsiveness to MyVA Goals: Improve Veterans' experience with healthcare through more personalized measures that establish a culture of continuous performance improvement. [The MyVA initiative will reorient VA around Veterans' needs and empower employees to assist them in delivering excellent customer service to improve their experience with VA healthcare.]

Methodology:

The Measurement Science QUERI Programwill promote standardization of VHA data through use of a common data model, complete four separate projects to implement evidence-based practices that are of high priority to its operational partners, and disseminate evidence-based therapies by incorporating quality improvement and implementation science into training programs for healthcare providers. The purpose of this work is to promote more rapid translation of research into practice.

Project Summaries:

Project 1: Improve colonoscopy care quality through a standardized assessment of colonoscopy quality metrics and the extraction of relevant electronic data, test the assessment's validity, and create a colonoscopy quality report card for physicians to ensure accountability to Veterans and the communities in which they live.

Project 2 (Quality Improvement): Implement an Integrated Pain Team into the San Francisco VA healthcare system to reduce opioid use in Veterans with chronic pain.

Project 3: Improve implementation of guideline-recommended cardiac rehabilitation (CR) by comparing rates of participation with vs. without a bedside visit from the CR team during the index hospitalization. Project 4: Develop and promote standardized measurement of functional status of elderly patients, and utilize data effectively so that hospitals can better understand how to treat Veterans with reduced functional status.