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Partnering with VISN leaders

QUERI partners with VISN (Veterans Integrated Service Networks) leaders on the QUERI-VISN Partnered Implementation Initiative (PII) in order to target top VA healthcare priorities. Currently, there are five PIIs that focus on delayed/suppressed care due to COVID-19, primary care efficiency, health disparities and care coordination, opioid use disorder, suicide prevention.

The Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment (CONDUIT) PII partners with VISNs 1, 5, 7, 15, 16, 19, 20, 22, and 23 to support providers at VA sites in facilitating Veterans’ access to effective treatments for opioid use disorder (OUD) and chronic pain across diverse settings through the use of telehealth technology and referral to specialty services. CONDUIT’s implementation teams work with staff at local VA sites in a process called “Implementation Facilitation (IF),” which is a set of strategies and tools to enhance the adoption of evidence-based practices. Further, CONDUIT works to assess several outcomes including:

• Number of Veterans using and retained on medications for OUD,
• Number of VA providers licensed to prescribe buprenorphine, and
• Opioid prescription dose for Veterans on long-term opioid therapy.

CONDUIT’s VA operational partners include VA’s Academic Detailing Service, Pharmacy Benefits Management (PBM), Center for Medication Safety (VA MedSAFE), Pain Management, and Office of Mental Health and Suicide Prevention. CONDUIT also has a Veteran Engagement Core comprised of 13 Veterans who provide feedback to ensure that efforts always take Veterans’ needs and perspectives into account.

The Expanded Role of Primary Care Pharmacists in the Management of Heart Failure PII partners with VISN 21 to implement pharmacy-targeted evidence-based practice (EBP) at frontline VA Primary Care through Patient Care Aligned Teams (PACTs) focusing on Veterans with chronic heart failure (CHF). QUERI investigators will work with their partners to implement pharmacy-targeted EBP for CHF at one primary care clinic in a large VA medical center and in one smaller VA community-based outpatient clinic. They will train 10 VA providers in EBP for chronic heart failure for 200 Veterans. They also plan to develop and disseminate a PACT Pharmacist-led clinics manual, a Cyberseminar, and a toolkit. Operational partners include VA’s Office of Specialty Care, the Office of Pharmacy Benefits Management (PBM), and the VA National Cardiology Field Advisory Committee.

The Implementing Caring Contacts for Suicide Prevention in Non-Mental Health Settings PII works with VISNs 5, 6, 10, 12, 16, 17, 19, 22, and 23 to implement and evaluate Caring Contacts in emergency department and urgent care settings in order to reach Veterans who may not engage with mental health services. Caring Contacts is an evidence-based suicide prevention intervention that consists of sending brief, non-demanding expressions of care and concern to Veterans. External facilitators will work with site champions at 29 VA medical centers across the nine participating VISNs toward the following goals.

• Spread Caring Contacts across 29 sites in the nine participating
• Evaluate clinical and implementation outcomes associated with Caring Contacts spread (e.g., service utilization, suicide related behavior, and number of Veterans reached).
• Conduct a budget impact analysis that documents cost of implementation and cost outcomes of Caring Contacts in the emergency department.
• Evaluate the role of geographic context in clinical and implementation outcome patterns.

The Implementing and Sustaining Critical Time Intervention (CTI) in Case Management Programs for Homeless-experienced Veterans QUERI PII is partnering with VISNs 1, 10, 12, 19, 20, 21, and 22 and the National Center on Homelessness among Veterans (NCHAV) to support housing transitions for Veterans who have experienced homelessness. The VA Grant and Per Diem Case Management (GPD-CM) Program provides six months of case management for homeless Veterans undergoing housing transitions. However, at present, no specific case management paradigm is required in the GPD-CM program, resulting in significant practice variation across sites. This QUERI PII will identify effective practices to spread and sustain CTI and to evaluate its associated costs. QUERI investigators will support 32 GPD-CM sites with a stakeholder-informed training and technical assistance implementation strategy called “Replicating Effective Programs (REP).” Half of the sites will also receive additional tailored support (“external facilitation”) to adopt and incorporate CTI into their routine care process. Investigators will then compare the impacts of REP versus REP enhanced with external facilitation (“enhanced REP”) to understand which strategy works better.

The Improving Access to Gastrointestinal Endoscopy in the COVID-19 Recovery Phrase and Beyond PII works with VISN 10 to replace colonoscopy with stool-based fecal immunochemical testing (FIT) for Veterans with average risk for colorectal cancer (CRC) screening – and to address and prevent any adverse outcomes associated with delayed CRC care due to the COVID-19 pandemic. Replacing colonoscopy for FIT testing for Veterans at average risk for CRC has the greatest potential to significantly increase access to an endoscopy. QUERI investigators will work with their operational partner – the National Gastroenterology and Hepatology Program – to accomplish the following.

• Optimize facility-level uptake and sustain FIT-based CRC screening using theory-based implementation methods.
• Develop an implementation “playbook” to help VA facilities optimize and sustain FIT-based CRC screening.
• Partner with two facilities in VISN 10 to develop, deploy, and refine the implementation playbook.
• Scale-up and evaluate the use of the FIT-based CRC screening.

This is expected to lead to decreased demand for screening colonoscopy, which will result in overall improvements in Veterans’ access to an endoscopy.