» Table of Contents

Aligning Quality Improvement Efforts with VA Policy Goals

The “Foundations for Evidence-based Policymaking Act” (Evidence Act) was signed into law in 2019 and requires all cabinet-level agencies, including VA, to justify their respective budgets with evidence. To ensure that VA’s research investments are aligned with its top priorities and the Evidence Act, QUERI designed a systematic, enterprise-wide process for engaging VA leadership in prioritizing scarce implementation and evaluation resources. Guided by the Learning Health System framework and the QUERI Implementation Roadmap, QUERI—

• Engages stakeholders to nominate and rank-order priorities,
• Funds initiatives to scale-up and spread evidence-based practices using theory-based implementation strategies, and
• Evaluates the impact of these initiatives using the QUERI Impact Framework.

More specifically, from 2017-2021, QUERI identified priorities from local, regional, and national leaders, invested in implementation and evaluation initiatives aligned with top priorities after a competitive peer-review process – and assessed the impacts of these initiatives on Veterans, providers, and the healthcare system.

Partnering with VISN leaders

In 2017-2018, QUERI partnered with VISN (Veterans Integrated Service Networks) leaders and developed a VA-wide approach – the QUERI-VISN Partnered Implementation Initiative (PII) priority nomination process – to identify top healthcare priorities based on multi-level stakeholder input. Using a web-based survey, QUERI collected priority nominations from VA national (e.g., VA Program Office Directors), regional (e.g., network directors), and local (e.g., medical center directors) leaders across the country. From a list of the top 10-15 nominations, VISN Directors selected their three highest priorities during a live voting session. The three priorities identified in FY2018 included:

• Implementing effective care coordination models,
• Enhancing implementation of suicide prevention services, and
• Expanding access to effective treatments for opioid use disorder and pain.

The selected priorities were incorporated into the QUERI-VISN PII Request for Applications (RFA), which called for proposals from implementation teams co-led by a VA investigator and VISN leader (e.g., VISN Chief Medical Officer).

This process led to the funding of five QUERI-VISN PIIs. For example, led by Sara Landes, PhD, QUERI’s Implementing Caring Contacts for Suicide Prevention in Non-Mental Health Settings – an intervention that uses a brief expression of care to Veterans in order to help prevent suicide – was implemented across 11 VA sites reaching 1,550 Veterans. In addition, the Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment (CONDUIT), led by William Becker, MD, and eight other HSR&D researchers, addresses opioid use disorders across the care continuum and is expanding access to effective treatments for pain and opioid use disorders across 9 VISNs, reaching 2,191 Veterans.

Top-ranking healthcare priorities

QUERI has completed four cycles of the annual priority nomination process. The top-ranking healthcare priorities for each fiscal year have been added to subsequent QUERI Request for Applications and funding mechanisms, which currently include the QUERI Program Rapid Response Teams and Advancing Diversity in Implementation Leadership (ADIL) initiatives to foster immediate capacity-building in quality improvement (QI) and evidence-based policy.

Priorities identified for FY2021 – selected and vetted by multiple VA leadership and strategic groups – include the following:

• Improve Veterans’ experience and quality of virtual care options in VA and community care;
• Improve uptake of strategies to address health disparities and social determinants of health;
• Reduce adverse outcomes associated with delayed or suppressed care due to COVID-19;
• Reduce burnout and improve mental health among VA employees and trainees;
• Improve long-term care and home care service options for older Veterans; and
• Assess and improve quality and cost of community care.

In response, six ADILs and three PIIs were funded by QUERI including:

Advancing Diversity in Implementation Leadership (ADIL)

• Determine Disparities in Subspecialty Wait Times among Marginalized Veteran Populations is led by Kamal Henderson, MD, MSc in Denver, CO
• Evaluating Effectiveness of VA’s Digital Divide Consult in Facilitating Video-based Care Access is led by Jacqueline Ferguson, PhD in Palo Alto, CA
• Evaluating Medication Safety Risks for Dual Use Veterans is led by Alexis Barrett, PharmD in Pittsburgh, PA
• Evaluating Uptake of the Telephone Lifestyle Coaching Program (TLC) to Identify Strategies to Ensure Equitable Uptake among Women Veterans is led by Tanya Olmos-Ochoa, PhD, MPH in Los Angeles
• Evaluating VA’s Nationwide LGBT Veteran Care Coordinator Program is led by R. Sonia Singh, PhD in Little Rock, AR
• Measuring Disparities in Opioid Overdose Education and Naloxone Distribution among Homeless Veterans is led by Sarah Javier, PhD in Palo Alto, CA

QUERI-VISN Partnered Implementation Initiatives (PIIs)

• Expanded Role of Primary Care Pharmacists in the Management of Heart Failure; the principal investigator is Paul Heidenreich, MD.
• Implementing and Sustaining Critical Time Intervention in Case Management Programs for Homeless-Experienced Veterans; the principal investigators are Sonya Gabrielian, MD, Kristina Cordasco, MD, and Erin Finley, PhD.
• Improving Access to Gastrointestinal Endoscopy in the COVID-19 Recovery Phase and Beyond; the principal investigator is Megan Adams, MD.