1061 — Engaging Clinical Partners in Evidence-Based Quality Improvement: Results from the First Year of the Veterans Assessment and Improvement Laboratory
Stockdale SE, and Yano EM, VA COE Sepulveda; Altman L, Greater Los Angeles VA Healthcare System; Fickel JJ, Hamilton AB, Sapir NC, and Rubenstein LV, VA COE Sepulveda;
The VISN 22 Veterans Assessment and Improvement Laboratory for Patient Centered Care (VAIL-PCC) is one of 5 Demonstration Labs funded to identify and evaluate “best practices” for implementing Patient Aligned Care Teams (PACT). We develop a conceptual framework for VAIL-PCC’s intervention and report on the first year of implementation at demonstration sites in 3 medical centers.
VAIL-PCC is a multi-level evidence-based quality improvement (EBQI) program that engages regional, medical center, and demonstration site leadership in PACT-related problem identification, and EBQI innovation development, evaluation, and spread. The program supports the development of clinical organizational structures needed for the partnership, including a VISN Steering Committee, local demonstration site interdisciplinary Quality Councils (QCs), and expert-led across-site workgroups (WGs). We analyzed qualitative data from the first year of VAIL-PCC to understand how local QCs formed and evolved, including contextual factors shaping their development.
All three sites successfully established QCs with strong interdisciplinary participation and interaction. The development of QCs, however, differed at each site, shaped by pre-existing infrastructure and relationships among clinical leaders and research partners. In Phase I, QCs and WGs submitted 30 proposals for QI projects; the Steering Committee selected 8. QCs or WGs initiated 7 of the 8. VAIL staff undertook 2 projects in additional areas prioritized by the Steering Committee. 7 months later, at the end of Phase I, the Steering Committee approved 2 innovations for dissemination within/between sites and 6 innovations for continued development in Phase II. Contextual factors impacted EBQI innovation development at each site.
A research-clinical partnership supported by VISN and local interdisciplinary leadership structures can promote cross-disciplinary engagement in PACT and facilitate EBQI for practice transformation. The rapid and voluntary uptake of the new clinical organizational structures suggests a need for forums for interdisciplinary quality improvement management for PACT.
Empowering multilevel interdisciplinary leadership through a structured research-clinical partnership is feasible, and can promote PACT innovation.