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Evidence-based quality improvement is deploying learning healthcare system principles through data-driven priority settings, local training, leadership and employee engagement, structured use of evidence, systematic planning/tracking of progress, and external practice facilitation.
Gaps in the delivery of gender-sensitive comprehensive care have resulted in disparities in quality and patient experience among women Veterans who use VA healthcare. Traditional policy implementation – even when leveraged by multilevel women’s health champions – has not been uniformly successful in achieving the delivery of comprehensive care by designated providers in gender-sensitive care environments that ensure women’s privacy, dignity, and safety.
Building on prior partnered research demonstrating marked quality gains among VAs using evidence-based quality improvement (EBQI), VA Women’s Health Services (WHS) adopted EBQI to see if it would work with low-performing VA healthcare facilities with persistent gaps in delivering comprehensive services – and meeting VA policy and practice goals for women’s healthcare. WHS quickly sought an external contractor to implement EBQI, and then needed a partner to evaluate whether the implementation has been successful.
The QUERI Partnered Evaluation initiative Evaluating Evidence-based Quality Improvement of Comprehensive Women’s Health Care in Low-Performing VA Facilities (Women’s Health Care QUERI) partnered with WHS, providing QUERI investigators with access to VA facilities that are rarely studied. This allowed for a unique window into the management dynamics and implementation challenges in facilities that may be more at risk of quality problems. In partnership with WHS, the Women’s Health Care QUERI is evaluating:
- Barriers and facilitators to achieving delivery of comprehensive women’s healthcare in these low-performing VAs;
- Effectiveness of EBQI in supporting and strengthening local capacity in these facilities; and
- Contextual factors, local implementation processes, and organizational changes in the participating facilities over time.
As noted by Dr. David Atkins, HSR&D Director, spreading best practices will “require joining people in different roles—including researchers, clinicians, mid-level managers, and executives—who share a commitment to solve a particular problem.”1
Evidence-based quality improvement strategies are enhanced by inter-organizational communication aided by WHS leaders at VA Central Office, VISNs, and VAMCs. For example, an EBQI champion at one site noted that stakeholder meetings were helpful “because we had everyone at the same table and we could speak about issues and what we wanted to work on.” Empowerment of frontline providers and staff toward a culture of quality improvement enables sustained capacity to arrive at innovative solutions to VA challenges, and thereby supports transformation to a learning healthcare system. EBQI is seen by users as providing a platform for communication and dialogue, engaging employees (and potentially patients) in planning, processes, and tools that support implementation of evidence-based practices, programs, and innovations.
The partnership between Women’s Health Care QUERI and WHS reflects a commitment to ensuring that women Veterans have access to high-quality comprehensive care in settings that are continually learning and evolving in response to—and in anticipation of—women Veterans’ needs and preferences.
EBQI is also one of the QUERI-supported implementation strategies that was selected to support Diffusion of Excellence Gold Status practice scale-up and spread. For more information on the QUERI implementation training hub programs such as EBQI, please visit the QUERI Center for Evaluation and Implementation Resources (CEIR).
For more information about Women’s Health Care QUERI, please contact Elizabeth Yano, PhD, MSPH at Elizabeth.Yano@va.gov or Alison Hamilton, PhD, MPH at Alison.Hamilton@va.gov .
- Atkins D. Are we growing the right health services research workforce of the future? Thoughts from a national delivery system. Health Services Research. October 2018;53 Suppl 2:4034-4040.