QUERI – Quality Enhancement Research Initiative

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Precision Monitoring to Transform Care (PRISM)

Indianapolis, IN

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The overall goal of the Precision Monitoring to Transform Care (PRIS-M) QUERI national program is to use existing data from VA’s electronic health records to implement actionable, personalized, and timely monitoring in order to transform the quality and outcomes of care for Veterans across multiple healthcare settings – and to promote a learning healthcare organization. The PRIS-M QUERI National Program includes the following projects:

National Evaluation of the VHA TeleStroke Program. The VHA “vritual” TeleStroke program has enormous potential for increasing access to stroke specialists and to thrombolysis for Veterans with acute stroke.  Dr. Glenn Graham, Deputy Director of Neurology in VA Specialty Care Services, and his TeleStroke Program implementation team will serve as external facilitators to support the implementation of TeleStroke within the VA. PRIS-M QUERI investigators will evaluate the implementation strategy and impact of TeleStroke on patients, providers, and the VA healthcare systems.

Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT). The objective of this PRIS-M QUERI project is to develop and evaluate an intervention program to improve the quality of care for Veterans with transient ischemic attack (TIA) and minor stroke that includes a set of validated electronic clinical quality measures (eCQMs) to provide teams with actionable information about the quality of care for Veterans; staff education program; and virtual learning collaborative. Six clinical teams from VA medical centers across the VA healthcare system are participating in PREVENT through a monthly virtual learning collaborative – and have access to their local quality performance data through an electronic data HUB. In addition, they receive external facilitation.

De-Implementation of Low Value Carotid Artery Exam Ordering at the Point of Care. PRIS-M QUERI investigators are working with vascular surgeons to understand messaging preferences for practice guidelines on carotid artery exam ordering at point-of-care. In addition, investigators plan to develop a report card as an audit and feedback strategy directed at local facility leadership that provides an assessment of the quality of ordering indications for Veterans with carotid ultrasounds (e.g., appropriate, uncertain and inappropriate).

Evaluation of VA Tele-Stroke Robotic Rehabilitation Program Implementation. The VA Tele-Stroke Robotic Rehabilitation program provides rural Veterans who have had a stroke with an innovative, proven solution for physical rehabilitation that improves functional independence and access to care in a new way that mitigates transportation barriers for Veterans who live in rural areas far from VA medical centers. This project is funded by the VA Office of Rural Health.


The PREVENT hub is the platform that supports the PREVENT learning collaborative and is the forum for sharing process and outcome data, a library of quality improvement tools, and professional education materials. In addition, in collaboration with the Indianapolis VAMC Medical Media [SCOPE], PRIS-M QUERI has developed a video that demonstrates how an experienced, multidisciplinary stroke team functions to anticipate and respond to continuous audit and feedback. This video has been used in kick-off meetings, as well as learning collaborative meetings.

In addition, PRIS-M QUERI implemented a local quality improvement program at the Richard L. Roudebush VA Medical Center in Indianapolis, Indiana that focused on remote positive airway pressure (PAP) monitoring to improve outcomes for Veterans with obstructive sleep apnea. The project used a set of validated electronic clinical quality measures to provide sleep medicine and telehealth services with information about the quality of care for Veterans specifically on PAP therapy. This successful program was officially adopted by the local facility and was sustained.

Corresponding PI: Teresa Damush, PhD (Teresa.Damush@va.gov)

Operations Partners: The Office of Analytics and Business Intelligence, Inpatient Evaluation Center, Office of Specialty Care Services, National Center for Health Promotion and Disease Prevention, VA Telehealth Services, and the Veterans Engineering Resource Center.