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What Keeps You Up at Night? QUERI Stakeholders Share their Priorities

HSR&D’s Quality Enhancement Research Initiative (QUERI) recently held its Annual Strategic Meeting to discuss how to align its priorities with the needs of Veterans and the VA healthcare system. With more than 200 investigators, 50 centers, and 70 VA leadership partners across the country, QUERI works to implement and evaluate programs at the clinic level that address VA national priorities. Therefore, a significant part of this meeting with stakeholders – including VA senior leadership, VISN directors, chief medical officers, and chiefs of staff – focused on answering the question posed by QUERI Director Amy Kilbourne, PhD, “What keeps you up at night?”

We need to examine the impacts of the pandemic on this health system as we move forward, including Long (or Post) COVID-19. For example, how did deferred or delayed care impact Veterans? How do we ensure that our Veterans have access to the care they need? Also, when we think about the effects of the pandemic, we need to consider the effects on our workforce. Not just the clinical workforce, but VA support staff at all levels. —Mark Upton, MD, VA Acting Deputy Under Secretary for Health

As Integrated Veteran Care (IVC) rolls out, we will need to evaluate the variations among VA facilities and community care. This will be a critical need in the future. In the near term, we need an evidence checklist and a framework to evaluate whether an innovation actually makes a difference for our patients and the VA healthcare system. —Carolyn Clancy, MD, Assistant Under Secretary for Health for Discovery, Education, and Affiliate Networks

We need to look at efficiencies in our workforce – workload, burnout, and expansion issues that may affect capacity to meet the needs of the increase in Veterans that are forecasted. Assess inefficiencies in how we deliver care and identify how to address them. We need to become more efficient across the board so we can increase our capacity —Kameron Matthews, MD, JD, FAAFP, Assistant Under Secretary for Health, Clinical Services

How do we empower patients to be stewards of their own health? How can the systems we have in place be treatment engagement vehicles? Patient empowerment and treatment engagement will help Veterans better navigate both VA and community care. —Thomas O’Toole, MD, Deputy Assistant Under Secretary for Health, Clinical Services

I’m concerned about getting a handle on preventative care, which lagged during the pandemic. The private sector is dealing with the same. It’s also difficult to access care in the private sector for our Veterans, including limited resources for mental healthcare and rehab services. —Skye McDougall, MD, VISN 16 Network Director

What keeps me awake at night is the rural workforce problem. It’s not about technology, it’s about keeping healthcare workers in rural areas. The rural workforce is getting older. In the next few years, there will be a 25% reduction in physicians based only on aging out. Some of our workforce has also left rural areas due to the pandemic. And it’s not just VA losing rural workforce, private hospitals and clinics in rural areas are closing and their staff are leaving rural areas and choosing to work in hospitals in the cities. —Thomas Klobucar, PhD, Director, Office of Rural Health

QUERI continues to gather information from VA stakeholders and will release the list of top FY22 priorities in early 2022.