QUERI – Quality Enhancement Research Initiative

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Triple Aim QUERI Program

Denver, CO

Principal Investigators: Catherine Battaglia, PhD (Corresponding PI, VA Denver), Steven Bradley, MD, MSPH (VA Denver), Anne Lambert-Kerzner, PhD (VA Denver)

Principal Operational Partners: Office of Specialty Care Services (SCS), VHA Pain Management, National Cardiology Program and CART, Office of Analytics and Business Intelligence, Quality, Safety and Value, Office of Rural Health (ORH), Pharmacy Benefits Management Services (PBM).

View program fact sheet

Executive Summary:

The Triple Aim QUERI Program will leverage healthcare data to identify actionable care gaps, and to implement innovative healthcare delivery interventions to improve the Triple Aims of VA healthcare. This Program will work to enhance the patient care experience, improve the health of populations, and reduce per capita costs of care. The Practical, Robust Implementation and Sustainability Model (PRISM) framework will serve as an overarching implementation model across projects. Projects will address clinical issues or scenarios that are prevalent (e.g., chronic pain and medication non-adherence) or high cost (e.g., percutaneous coronary intervention, and Veterans with hospitalizations outside of VA) to VA. Across projects in this QUERI program, investigators will apply the same methodology of leveraging data to identify actionable care gaps - and will work with their operational partners to implement interventions to address the care gap.

Program MyVA Goals: Establishing 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 Objectives:

  • Leverage data to identify actionable care gaps and test an implementation strategy informed by PRISM domains of audit and feedback only versus audit and feedback plus facilitation to improve healthcare gaps.
  • Evaluate the impact of the implementation strategies across projects and identify overarching learnings using the RE-AIM (reach, adoption, effectiveness, implementation, maintenance) measures.
  • Create an interactive implementation toolkit and dissemination strategies that provides guidance on audit and feedback and facilitation strategies and implementation resources for broader dissemination.

Program Methods:

To improve the Triple Aim dimensions, an implementation strategy will be used that leverages data to identify actionable healthcare gaps - and tests the impact of audit and feedback only versus audit and feedback plus facilitation to improve these gaps. A range of analytic tools have been identified that are comprised of quantitative, qualitative, and quality improvement methods that will identify gaps in care. Investigators will then test implementation strategies comprised of audit and feedback versus audit and feedback plus facilitation.

Project Summaries:

Project 1: Use data to define multi-modal pain care and identify gaps in care at VA community-based outpatient clinics and medical centers; then implement provider audit and feedback (of the quality of multi-modal pain care) versus provider audit and feedback plus provider enrollment in Pain SCAN ECHO [Specialty Care Access Network - Extension for Community Healthcare Outcomes] program to improve chronic pain care.

Project 2:Use longitudinal disease-specific health status measures to identify VA patients with significant interval declines in health status following elective percutaneous coronary intervention (PCI), and implement provider audit and feedback (of declines in health status) versus provider audit and feedback plus cardiology facilitation via E-Consults of further evaluation (e.g., increasing medications) to improve patient health status.

Project 3 (Quality Improvement):Use value stream mapping (Lean Six Sigma) to identify gaps in the transition of patients back to VA primary care following hospitalization outside of the VA; then implement audit and feedback (of the gaps in transition of care) versus audit and feedback plus nurse facilitation to improve continuity of care for Veterans in VISN 19.