Go to QUERI online at www.hsrd.research.va.gov/QUERI/

January 2008

In This Issue:

Cross-Cutting QUERI Group Collaborations

Depression

Mental Health QUERI (MH-QUERI) is collaborating with Substance Use Disorders QUERI (SUD-QUERI) on a recently approved project to address the under-use of cognitive behavioral therapy for depression in SUD treatment programs by developing and testing a web-based training module and supervision plan for SUD counselors, along with a companion web-based workbook for veterans using the MyHealtheVet platform. For more information contact Jeff Smith, PhD Candidate, MH-QUERI Implementation Research Coordinator, at Jeffrey.smith6@va.gov.

Mental Health QUERI developed the Translating Initiatives for Depression into Effective Solutions (TIDES) project - a collaborative care model for the treatment of depression in the primary care setting. HI-TIDES is an HIV/Hepatitis-QUERI project conducted in collaboration with MH-QUERI, which aims to adapt and test a collaborative care model for coordinated depression care in HIV treatment settings. For more information contact Jeffrey Pyne, MD, HI-TIDES Principal Investigator, at jeffrey.pyne@med.va.gov.

Spinal Cord Injury QUERI (SCI-QUERI) has projects underway to examine patterns of care for depression after spinal cord injury. SCI-QUERI also is developing methods, such as telehealth interventions, for coordinating depression care between SCI centers and more remote care locations. For more information contact Phil Ullrich, PhD, SCI-QUERI Implementation Research Coordinator, at phillip.ullrich@med.va.gov.

Stroke QUERI is partnering with VA clinicians and managers involved in the outpatient care of veterans with recent stroke to improve the detection and treatment of post-stroke depression. This project aims to reduce the physical, emotional, and social burden for veterans with post-stroke depression. For more information contact Teresa Damush, PhD, Stroke-QUERI Implementation Research Coordinator, at tdamush@iupui.edu.

Substance Use Disorder QUERI is working with MH-QUERI to improve treatment and outcomes of comorbid substance use disorders and depression. For more information contact Hildi Hagedorn, PhD, SUD-QUERI Implementation Research Coordinator, at hildi.hagedorn@va.gov.

Smoking Cessation

HIV/Hepatitis-QUERI is increasing smoking quit rates in HIV-infected veterans and is initiating an extension of a multi-VISN smoking cessation project (HIV Smoking Roll-out) that will include veterans receiving care in HIV specialty clinics. For more information contact Randal Henry, DrPH, HIV/Hepatitis-QUERI Implementation Research Coordinator, at stephen.henry@va.gov.

SCI-QUERI is developing an evidence-based smoking cessation project that includes pharmacological and psychological interventions designed to increase the number of veterans with SCI who choose to quit smoking. For more information contact Phil Ullrich, PhD, SCI-QUERI Implementation Research Coordinator, at phillip.ullrich@med.va.gov.

Stroke QUERI's new project "STARS: Stop Tobacco Attributable Risk after Stroke" aims to determine current VA procedures for the management of tobacco cessation in veterans admitted with stroke, and to obtain the necessary data for creating an effective tobacco cessation intervention for veterans admitted with stroke. For more information contact Teresa Damush, PhD, Stroke-QUERI Implementation Research Coordinator, at tdamush@iupui.edu.

SUD-QUERI is working with the Public Health Strategic Health Care Group to assess the quality of smoking cessation care for hospitalized VA patients and to create a clinical reminder about tobacco use, among other efforts. For more about smoking cessation efforts throughout the VA, visit the Public Health Strategic Health Care Group at vaww.vhaco.va.gov/phshcg/smoking (VA intranet site).

Chronic Pain

HIV/Hepatitis-QUERI is increasing smoking quit rates in HIV-infected veterans and is initiating an extension of a multi-VISN smoking cessation project (HIV Smoking Roll-out) that will include veterans receiving care in HIV specialty clinics. For more information contact Randal Henry, DrPH, HIV/Hepatitis-QUERI Implementation Research Coordinator, at stephen.henry@va.gov.

More than 60% of VA primary care patients report having chronic non-cancer pain. Diabetes Mellitus QUERI (DM-QUERI) researchers surveyed primary care physicians concerning challenges they face in treating patients with chronic non-cancer pain. For more information, visit their website at www.va.gov/annarbor-hsrd/queriindex.htm.

Polytrauma and Blast-Related Injuries QUERI (PT/BRI-QUERI) is working to ensure that blast-exposed veterans receive screenings for high-frequency "invisible" problems, including pain, traumatic brain injury, hearing loss, vision loss, and mental health problems. PT/BRI collaborates with the VHA National Pain Research Working group that focuses on identifying best practices for pain assessment and management in polytrauma and research priorities in this area. For more information, visit their website at www.hsrd.minneapolis.med.va.gov/PTqueri/.

More than half of patients with spinal cord injury and disease (SCI&D) experience chronic pain, with one-third of all pain problems being described as "severe." SCI-QUERI is examining current pain management practices for veterans with SCI&D in the VA healthcare system. Interdisciplinary and psychological treatments for pain are being examined for future implementation projects. For more information, contact Phil Ullrich, PhD, SCI-QUERI Implementation Research Coordinator, at phillip.ullrich@med.va.gov.

Solicitations/Funding

Special Solicitation: Implementing Research into Practice to Improve Care Delivery
VHA seeks to increase collaboration between Research and Operations with a particular emphasis on using the QUERI model to improve care delivery. Proposals responsive to this solicitation will include efforts that: 1) Implement research findings and guidelines into routine practice; 2) Evaluate specific programs and strategies to improve VHA health care quality; 3) Develop evidence and insights about effective implementation and quality improvement approaches; 4) Create? through partnerships and collaborations with VHA leaders, managers, and policymakers at local, network, and national levels? sustainable tools, processes, and infrastructure that support improved quality. For more information, go to: www.research.va.gov/funding/solicitations/docs/SDP-1005-final.pdf.

QUERI Center Updates

Chronic Heart Failure QUERI has initiated the Heart Failure Provider Network - a network of providers interested in improving heart failure care throughout the VA healthcare system. This Network is an important mechanism for the implementation of interventions that will improve the health and healthcare for veterans with heart failure. For more information about joining the Heart Failure Provider Network, contact Anju Sahay, PhD at anju.sahay@va.gov.

Diabetes Mellitus QUERI investigators are implementing and evaluating an intervention that uses a low-cost interactive voice response (IVR) exchange system to promote peer-to-peer communication among veterans with diabetes, who are initiating or increasing insulin therapy under medical guidance. This will allow veterans to talk by phone with a peer who is facing the same self-management challenges. For more information about this project, contact Amy Butchart, MPH at amy.butchart@va.gov.

HIV/Hepatitis QUERI is working to increase screening for veterans at risk of HIV through several strategies that include using clinical reminders to alert providers when seeing at-risk veterans that need to be tested, and reducing test result wait times by using rapid-testing techniques. Better screening can lead to early treatment and improved patient outcomes. Viral hepatitis initiatives include improving self-management skills for Hepatitis C patients, and assessing the impact of integrated care on hepatitis treatment. For more information, contact Randal Henry, DrPH at stephen.henry@va.gov, or visit their website at www.va.gov/queri-hiv/.

Ischemic Heart Disease QUERI is working with VA's Patient Care Services, the Office of Quality and Performance, and the Office of Information on a national VA reporting system for procedures performed in VA cardiac catheterization clinics. The Cardiovascular Assessment, Reporting and Tracking System for Cardiac Catheterization Laboratories (CART-CL) tracks coronary procedures such as percutaneous coronary interventions, which serve as the primary therapy for ischemic heart disease. CART-CL is installed or in the process of installation at all 75 VA cath labs. For more information, contact the CART-CL Clinical Director, John Rumsfeld, MD, PhD at john.rumsfeld@va.gov.

Mental Health QUERI developed Translating Initiatives for Depression into Effective Solutions (TIDES) - a depression collaborative care model. A key feature of TIDES is collaboration between primary care providers and mental health specialists supported by a depression care manager. TIDES implementation at seven demonstration clinics enabled 8 out of 10 depressed patients to be treated effectively in primary care. TIDES collaborative care is currently being spread to new clinics across VA through Primary Care/Mental Health integration initiative funding from the Office of Mental Health Services. For more information about the TIDES program or other MH-QUERI research, contact Jeff Smith (PhD candidate) at Jeffrey.smith6@va.gov.

Comprehensive TIDES materials can be found at vha22web6/sites/Research/HSRD/ClinicalPart/default.aspx (VA access only).

Polytruama/Blast-Related Injuries QUERI is partnering with four VA Polytrauma Rehabilitation Centers (PRCs) to provide specialized rehabilitation treatment and to expand clinical expertise in polytraumatic injuries throughout VA. (Polytraumatic injuries result in impairments to more than one body system or organ.) PT/BRI-QUERI investigators also are working on a project focused on the usefulness of an innovative discharge planning and coordination system called "Integrated Care Coordination Pathway for Use in the Four PRCs." For more information about this project, contact Henry Lew, MD, PhD at henry.lew@va.gov.

Spinal Cord Injury QUERI has projects underway to examine current patterns for the management of respiratory conditions including COPD, pneumonia, and sleep apnea, as well as developing a disease management protocol for the treatment of pressure ulcers. SCI-QUERI also is developing methods for coordinating depression care between SCI centers and more remote care locations, and is working to address the issue of obesity among veterans with SCI. For more information about SCI-QUERI, contact Phil Ullrich, PhD at philip.ullrich@va.gov.

Stroke QUERI is performing a needs assessment on stroke patients and their family members' perception of home-telehealth services that enable a clinician and/or their caregiver to maintain direct communication. The VA is a recognized leader in the development and implementation of home-telehealth services, and this project will help create in-home messaging devices specifically designed for veterans who have survived a stroke. For more information about this project, contact Neale Chumbler, PhD at neale.chumbler@med.va.gov.

Substance Use Disorders QUERI is working with clinical partners in VA to implement evidence-based management of alcohol misuse nationwide. SUD-QUERI is involved in multiple efforts to implement routine brief alcohol counseling and specialty care referral, when indicated for veterans who screen positive for alcohol misuse. For more information about this project, contact Katharine Bradley, MD at Katharine.bradley@va.gov.

Recent QUERI Publications

Don't see your citation? Space constraints prevent us from being able to list all current citations, but please check the HSR&D citation database to be sure your publication is included there. If your citation doesn't appear in the citation database, please contact your center AO, who is responsible for entering citations into ART, which is used to populate the online citation database.

  1. Aron D and Pogach L. One size does not fill all: A continuous measure for glycemic control in diabetes - The need for a new approach to assessing glycemic control. Joint Commission Journal of Quality Improvement 2007;33:636-643.
  2. Chinman M, Hassell J, Magnabosco J, et al. The feasibility of computerized patient self-assessment at mental health clinics. Administration and Policy in Mental Health 2007; 34(4):401-409.
  3. Clark M, Bair M, Buckenmaier C, et al. Pain and combat injuries in soldiers returning from Operation Enduring Freedom and Iraqi Freedom: Implications for research and practice. Journal of Rehabilitation Research and Development 2007; 44(2): 179-194.
  4. Fickel J, Parker L, Yano E, and Kirchner J. Primary care-mental health collaboration: An example of assessing usual practice and potential barriers. Journal of Inter-Professional Care 2007; 21(2):207-216.
  5. Fortney J, Pyne J, Edlund M, et al. A randomized trial of telemedicine-based collaborative care for depression. Journal of General Internal Medicine 2007; 22:1086-1093.
  6. Hagedorn H, Dieperink E, Dingmann D, et al. Integrating hepatitis prevention services into a substance use disorders clinic. Journal of Substance Use Treatment 2007;32(4):391-398.
  7. Hayward R. Performance measurement in search of a path. The New England Journal of Medicine 2007;356(9):951-953.
  8. Ho M, Luther S, Masoudi F, et al. Inpatient and follow-up cardiology care and mortality for acute coronary syndrome patients in the Veterans Health Administration. American Heart Journal September 2007;154(3):489-94.
  9. Guihan M, Garber S, Bombardier C, et al. Lessons learned while conducting research on prevention of pressure ulcers in veterans with spinal cord injury. Archives of Physical Medicine and Rehabilitation July 2007;88(7):858-861.
  10. Krein S, Heisler M, Piette J, Butchart A, and Kerr E. Overcoming the influence of chronic pain on older patients' difficulty with recommended self-management activities. The Gerontologist 2007;47(1):61-68.
  11. Kupersmith J, Francis J, Kerr E, et al. Advancing evidence-based care for diabetes: Lessons from the Veterans Health Administration. Health Affairs 2007;26(2):w156-168.
  12. Niv N, Cohen AN, Mintz J, Ventura J, and Young AS. The validity of using patient self-report to assess psychotic symptoms in schizophrenia. Schizophrenia Research 2007; 90(1-3):245-250.
  13. Sherman SE, Fotiades J, Rubenstein LV, et al. Teaching systems-based practice to primary care physicians to foster routine implementation of evidence-based depression care. Academic Medicine 2007; 82(2):168-175.
  14. Stecker T, Fortney J, Hamilton F, and Ajzen I. An assessment of beliefs about mental health care among veterans who served in Iraq. Psychiatric Services 2007; 58 (10):1358-61.
  15. Weiner B, Helfich C, et al. Adoption and implementation of strategies for diabetes management in primary care practices. American Journal of Preventive Medicine (Suppl). July 2007;33(1 Suppl)S35-44.
  16. Williams JW, Gerrity MS, Holsinger T, et al. Systematic review of multifaceted interventions to improve depression care. General Hospital Psychiatry 2007; 29(2):91-116.
  17. Yano E, Soban L, Parkerton P, and Etzioni D. Primary care practice organization influences colorectal cancer screening performance. Health Services Research June 2007;42(3 Pt 1):1130-49.
  18. Ullrich P. Pain following spinal cord injury. Physical Medicine and Rehabilitation Clinics of North America May 2007;18(2):217-233.
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