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

With more than 200 investigators, 50 centers, and 70 VA leadership partners across the country, VA HSR&D’s Quality Enhancement Research Initiative (QUERI) works to implement and evaluate effective practices that address cross-cutting key strategic areas in healthcare, including: population health, care coordination, safety and quality, virtual care, personalized care, behavioral health, access and equity.

Each year, QUERI engages national, regional, and local leaders across VA in helping to prioritize scarce implementation and evaluation resources using a systematic, enterprise-wide process grounded in the Learning Health System framework and the QUERI Implementation Roadmap and featured in the FY2022-2028 VA Strategic Plan.

Current QUERI FY22 priorities:

• Improve workforce development, retention, & wellbeing of VA employees & trainees, especially in rural areas;
• Enhance community care and virtual care coordination to improve Veteran care;
• Improve clinical care efficiency (e.g., administrative, technology, supply chains);
• Optimize integration of care for primary, mental health, specialty, and urgent care services;
• Improve long-term care, aging in place, geriatric care, and home care service options;
• Evaluate strategies to mitigate the long-term impact of COVID-19 (e.g., preventive care);
• Evaluate the impact of strategies to optimize electronic health record modernization;
• Assess the impact of Market Area Health System Optimization (AIR Commission) on access to care;
• Assess MISSION Act standards of care and impacts on policy changes; and
• Implement effective strategies for patient empowerment and treatment engagement.

On May 19, QUERI held its Annual Strategic Meeting to capture emerging VA priorities and Veteran needs. QUERI Director, Amy Kilbourne, PhD, posed the following question to VA clinical, strategic, and financial operations leaders, “What are your short-, medium-, and long-term goals and what is keeping you awake at night?”

Telehealth and virtual care provide unlimited opportunities, but there’s a lot we need to learn. For example, what do Veterans expect and/or want during a virtual appointment? How do you evaluate virtual care from both a patient and provider perspective? How much will virtual care change training for healthcare professionals? —Carolyn Clancy, MD, Assistant Under Secretary for Discovery, Education, and Affiliate Networks

I’m concerned about the effects of the pandemic; not just the potential long-term effects of COVID but the effects on mental health, supply chain issues, and staff burnout. —Julianne Flynn, MD, Chief of Staff, South Texas VA Healthcare System

A key priority for me is the balance of virtual care, in-person VA care, and community care to ensure Veterans are getting timely, effective care. For example, is virtual care efficient? How is virtual care being measured, and are we getting too far ahead of the evidence on virtual care and training?  —Paul B. Greenberg, MD, MPH, Deputy Chief Academic Affiliations Officer

Health system research and innovation are crucial to transforming Veteran care, and we need to decrease the length of time between discovery to practice. How do we close the gap? It is also important that we evaluate our efforts – including recruitment and efficiency measures. What should we not be doing anymore for example?  Are performance measures effective? —Wendell Jones, MD, MBA, Network Director VISN 17, Arlington, TX.

QUERI is deeply involved in evaluation of our programs, but I am concerned about QUERI’s capacity across the board. How can QUERI satisfy everyone’s demand for assessing programs and policies? My second concern is workforce training, acquisition, and management. My third concern is the evaluation of interagency programs that reach beyond VA (i.e., standing up Rural Partners Network – linking rural communities with government agencies, including VA). How do we leverage the terrific job QUERI does in evaluating these programs?  —Tom Klobucar, PhD, Executive Director, VA Office of Rural Health