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Amy Kilbourne, PhD, MPH, Director of QUERI

Director's Letter

Improving Veteran Mental Health: Implementation and Knowledge Translation of Effective Innovations

Mental disorders are among the top causes of disability and years of potential life lost world-wide. VA is one of the largest single providers of mental health services in the U.S., and one of the largest employers of mental health professionals nationally. Not surprisingly, VA has been a model for optimizing the use of effective innovations to improve mental health services through implementation science. Often referred to as “knowledge translation,” implementation science is the study and deployment of strategies to support providers in promoting the uptake of effective practices.

This issue features key success stories from QUERI-funded implementation and evaluation initiatives that are focused on improving Veterans’ mental health:

• Sustaining STAR VA (Staff Training in Assisted Living Residences for VA) evaluated the impact of a national program to train VA employees to help Veterans in community living centers manage behavioral symptoms of dementia. STAR-VA was associated with reduced use of inappropriate antipsychotic medications and fewer staff injuries.
• VA’s Behavioral Health Interdisciplinary Program (BHIP) provides Veterans with continuous care driven by interdisciplinary teams using practice guidelines, proactive use of data tools to assess clinical progress, patient self-management support, and linkages to community resources. BHIP was associated with a significant decrease in mental health hospitalizations for Veterans, and the program has been spread to more than 20 additional VA healthcare facilities.
• EMPOWER, VA’s Enhancing Mental and Physical health of Women through Engagement and Retention, is a national QUERI-funded Program that promotes strategies that encourage women Veterans to engage in care for depression, anxiety, or PTSD, notably by using innovations such as computerized cognitive-based therapy. EMPOWER also offers coordinated care for the “unwanted co-travelers” of mental illness, especially chronic physical health problems such as heart disease or diabetes which are associated with premature mortality if not treated.

QUERI Investigators as Trusted Purveyor of Implementation and Knowledge Translation

The overall success of these three initiatives to help Veterans with mental disorders could not have happened without QUERI implementation strategies, many of which were featured in a comprehensive review of implementation best practices conducted by QUERI in partnership with the Innovation Ecosystem and VA’s RAPID (Reporting, Analytics, Performance, Improvement, and Deployment) program. Implementation strategies such as cultivating local and national interdisciplinary provider teams, deployment of routine data analytics to monitor and provide feedback on quality and outcomes of care, enabling local adaptations, and facilitation (e.g., provider empowerment through strategic thinking and coalition-building skills development) were vital to their implementation and sustainment.

STAR-VA, BHIP, and EMPOWER also embody VA’s strive towards a Learning Health System, which involves understanding and alignment of the complex interactions of people, processes, technologies, and infrastructures to enhance the quality and outcomes of care for Veterans. In the near future, QUERI’s Center for Evaluation and Implementation Resources (CEIR) will be deploying additional opportunities including the QUERI Implementation Roadmap Guide and Implementation Learning Hubs to enable more providers to garner implementation skills that are essential to promote the uptake of effective innovations and foster a Learning Health System.

Amy Kilbourne, PhD, MPH
Director, Quality Enhancement Research Initiative