QUERI – Quality Enhancement Research Initiative

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PrOVE: PeRsonalizing Options through Veteran Engagement

Ann Arbor, MI

Principal Investigators: Julie Lowery, PhD (Corresponding PI, VA Ann Arbor); Angela Fagerlin, PhD (VA Ann Arbor); Ann-Marie Rosland, MD, MS (VA Ann Arbor)

Principal Operational Partners: National Center for Health Promotion and Disease Prevention (NCP), Primary Care Services, and the Office of Analytics and Business Intelligence.

Executive Summary:

"One size does not fit all" in healthcare. No two Veterans are alike, nor are any two VA medical centers or community-based outpatient clinics (CBOCs). Decisions in healthcare delivery too often are based on "average" effects. Current guidelines and performance measures frequently recommend prescribing the same treatments to many different types of patients based on the average result of a clinical trial without considering important differences between patients. This QUERI will build on an extensive body of work by the VA HSR&D's Center for Clinical Management Research (CCMR) and the Quality Enhancement Research Initiative (QUERI) on individualizing prevention strategies and treatments to optimize care delivered to Veterans.

Program Objectives:

Improve the prevention and management of chronic conditions by supporting Veterans and providers in making personalized healthcare decisions that take into account individual patient risk and preferences. Investigators will work to improve the appropriateness of care (e.g., decrease overuse and underuse), increase Veteran engagement in their healthcare, and enhance Veterans' experiences. Specific aims include implementing:

  • Patient-centered performance management systems that enhance appropriateness of care and incorporate shared decision-making; and
  • Personalized self-management programs that promote health and prevent disease.

MyVA Goals: Improve Veterans' experience with VA healthcare through shared decision-making and 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.

Program Methods:

Use the Consolidated Framework for Implementation Research (CFIR) to collect and analyze data on context across studies, both for this QUERI and in collaboration with other QUERI programs, to determine the association between context and implementation success. Implementation strategies for all projects will incorporate systems redesign techniques (in collaboration with the VA Center for Applied Systems Engineering) with use of a tailoring tool ("Barrier Busters") that will help local teams chose appropriate implementation strategies based on features of local context.

Project Summaries:

Project 1: Investigators will implement and evaluate a shared-decision making tool for lung cancer screening in collaboration with VA's National Center for Health Promotion and Disease Prevention (NCP) and the Office of Primary Care. An evidence-based tool has been developed and pilot tested, and will be disseminated to the eight VAMCs that are currently participating as pilot sites in NCP's national Lung Cancer Screening Demonstration project.

Project 2: Investigators will work with NCP and VA's Office of Analytics and Business Intelligence to improve dissemination of the new MOVE! Weight Management Program guidelines, with the goal of reducing wide local variation in the effectiveness of MOVE!, and maximizing personalized weight management support for Veterans in a group setting.

Project 3 (Quality Improvement): Investigators will implement and evaluate a performance management tool for improving statin use that is personalized to individual patient risk factors.