QUERI Highlights Implementation and Evaluation Science
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This issue highlights state-of-the art implementation and evaluation science led by QUERI investigators, which informs VA and national efforts to promote evidence-based policymaking and practice.
Evidence-based policy, where programs or policies are informed by rigorously established evidence and evaluation, is a core component of QUERI’s overall mission. A key measure of QUERI’s success is whether the work of our 50+ Centers shapes or leads to new programs or policies that improve the health and care of Veterans. Evidence-based policy is also foundational to the learning health system, where knowledge is translated to performance improvements, and is mandated in the recent White House Memorandum on Restoring Trust in Government Through Scientific Integrity and Evidence-Based Policymaking. This emphasizes the need to make policy and programmatic decisions that are “guided by the best available science and data.” The memorandum and subsequent Executive Order 14007 follow the implementation of the Foundations for Evidence-Based Policymaking Act (Evidence Act, U.S. Public Law 115-435), which requires all cabinet-level agencies in the United States government to support policy and budget decisions with rigorous evidence. QUERI is leading the Veterans Health Administration’s (VHA) response to the Evidence Act and fosters partnerships among researchers, clinicians, and system managers and leaders to maximize the policy impact of research and, ultimately, to improve health outcomes and equity for Veterans.
QUERI is helping VA promote evidence-based policy by promoting rigorous implementation and evaluation science to improve Veteran health.
More fundamentally, the Evidence Act requires that government agencies adopt a rigorous process for generating and using evidence to inform programs and policies. With nationally recognized research and clinician training programs embedded within a health system, VHA is a national leader in what has been referred to as a continuous learning organization. To this end, QUERI has led implementation of the Evidence Act by routinely soliciting health priorities from VHA stakeholders via national surveys, focus groups, and live voting to inform its funding mechanisms, and utilizes rigorous scientific peer review to support state-of-the-art implementation and evaluation initiatives that inform programs and policies for the ultimate benefit to Veterans. This process is described in the VA Learning Agenda, which is a required component of the Evidence Act, and also informs national evaluation plans to inform policies.
In 2021, VHA national leadership identified the following five priorities as the most crucial for improving Veteran health, which will inform QUERI’s RFAs as well as future VA Evidence Act evaluation plans:
- Improve Veterans’ experience and quality of virtual care options;
- Reduce adverse outcomes due to delayed/suppressed care from COVID-19;
- Assess and improve quality and cost of community care;
- Improve uptake of strategies to address health disparities and Veteran social determinants of health; and
- Reduce burnout and improve mental health for VA employees and trainees.
Current Evidence Act evaluation plans include suicide prevention, in close coordination with VA’s Office of Research & Development (ORD) and HSR&D researchers, including the Suicide Prevention Research Impact Network (SPRINT) initiative. QUERI recently launched national evaluations addressing suicide prevention among transitioning service members. Ongoing evaluations also include best practice for opioid and pain treatment, based in part on the extensive work by HSR&D and QUERI investigators in the Pain Consortium of Research and the Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment (CONDUIT) initiatives.
QUERI’s Partnered Evidence-based Policy Resource Center and Center for Evaluation and Implementation Resources are also working with ORD and HSR&D to evaluate COVID-19 long-term impacts, and in coordination with VA’s Office of Academic Affiliations (OAA), are leading national evaluation efforts to understand impacts of COVID-19 and virtual care on workforce and trainee productivity. These evaluations were also informed by QUERI investigator successes such as the Whole Health initiative, featured below. Ultimately, these implementation evaluations serve to put VA on the map as a national leader in evidence-based policy, as well as to inform quality improvement and best practices for the Veterans we serve.
Amy Kilbourne, PhD, MPH
Melissa Braganza, MPH
QUERI Program Manager