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VHA's Priorities for Strategic Action

Spotlight on High-Performance Healthcare Network: Studies/Resources

November 2015

A number of HSR&D Centers of Innovation and QUERI Programs and Initiatives are working on studies related to high-performing healthcare; below are links to more information on these studies. Please note that these lists are not intended to be comprehensive. For more information, please visit the Center's website and/or the study/citation search pages on the HSR&D website.

HSR&D Centers of Innovation


Quality Enhancement Research Initiative (QUERI) Programs

QUERI Partnered Evaluation Initiatives

Ann Arbor

Promoting Veteran-Centered Colorectal Cancer Screening

This project will test the impact of a personalized decision aid for Veterans and a revised screening reminder for clinicians and will lead to an implementation study of Veteran-centered screening on a broader scale. Furthermore, it will lead to the development of Veteran-centered performance measures that can be tested and potentially extended to other screening and preventive services. Lessons learned from this work may ultimately provide a model for delivering preventive care in a more Veteran-centered way.

Identifying and Reducing Catheter-Related Complications

This study will provide critical information about the complications associated with urinary catheters and peripherally inserted central catheters (PICCs) and help to identify and test strategies to prevent or reduce the occurrence of these complications. Given the frequency of use of these devices, investigators expect that this work will have a direct impact on the safety and well-being of hospitalized Veteran and non-Veteran patients.

VA Ann Arbor Patient Safety Center of Inquiry (PSCI)

The goal of the VA Ann Arbor PSCI is to enhance the safety of patients by promoting the safe and appropriate use of urinary catheters to prevent catheter-associated urinary tract infection, which builds off of a significant area of work by Ann Arbor HSR&D investigators. The specific aims of the Center are: (1) to develop a comprehensive list of appropriate indications for the initial placement and continued use of indwelling urinary devices; and (2) to develop effective strategies for implementing an evidence-based Catheter-Associated Urinary Tract Infection Prevention Program within VA.

VA Diabetes Prevention: Enhanced Implementation Evaluation

VA's National Center for Disease Prevention and Health Promotion turned to Ann Arbor HSR&D investigators to help design and implement a demonstration project of the Diabetes Prevention Program (DPP) in three VA sites. To determine the benefit of the DPP, Veterans with pre-diabetes were assigned to either the VA DPP program or to MOVE!. Findings from the program have already been used to inform the re-tooling of the current VA MOVE! Program.

Patient-Centered Performance Management

The goal of patient-centered performance management is to decrease over-treatment by discouraging use of very low or negative-benefit services and to decrease under-treatment by encouraging use of high-benefit services while respecting patient preferences for care that has low or moderate benefit. Policy-making, health care delivery, research, and quality-improvement communities should dedicate themselves to making patient-centered performance management a reality in the foreseeable future.

Partnership with Office of Clinical Analytics and Reporting

This study sought to determine the prevalence of cardiac stress testing before low-risk surgeries prior to Choosing Wisely (CW) recommendations against this procedure, to estimate the potential effect of recommendations on future use of resources. Findings showed that stress testing before low risk surgery was rarely performed among either VA or Medicare patients, indicating that most physicians had already incorporated guidelines about appropriate preoperative stress testing into their practices before the CW recommendations became available. Investigators suggest specialty societies should focus future CW recommendations on services that have high baseline rates of inappropriate care to call attention to areas where interventions can best improve quality.

Antidepressant Prescribing for New Episodes of Depression and Implications for Health System Quality Measures

The object of this study was to assess the extent to which 90-day initial antidepressant prescriptions for patients with new episodes of depression have contributed to health system performance on the HEDIS antidepressant measure from fiscal years 2001 to 2008. Findings indicate that although increases in initial 90-day supplies contribute to improved performance on the HEDIS measure, actual adherence during the acute treatment phase may not be changed by this practice. Quality measures based on pharmacy fills may need modification in the setting of large initial prescriptions.

Developing Electronic Measures of Overuse of CRC Screening

Overuse measures developed by this study can be utilized by VHA to examine overuse and improve the appropriateness of colorectal cancer screening in VA.

Quality Measurement in Inappropriate Use of Screening for Colorectal Cancer

This study examined whether the age-based quality measure for screening for colorectal cancer was associated with overuse of screening in patients aged 70-75 in poor health and underuse in those over age 75 in good health. Findings showed that screening decreased markedly after the age of 75; however a Veteran aged 75 who was unhealthy was significantly more likely to undergo screening than a Veteran who was healthy but over 75. Investigators concluded that future patient-centered quality measures should focus on clinical benefit rather than chronological age to ensure that patients who are likely to benefit from screening receive it (regardless of age), and that those who are likely to incur harm are spared unnecessary and costly care.

Diabetes Treatment Guidelines vs. Treatment Burden

This paper examines how treatment burden affects the benefits of glycemic control in patients with type 2 diabetes. Findings suggest the current approach of broadly advocating intensive glycemic control for millions of patients with diabetes should be reconsidered; instead, treating A1cs of less than 9% should be individualized based on estimates of benefit weighed against the patient's view of treatment burden.

Using Benefit-based Tailored Treatment to Improve the Use of Antihypertensive Medications

This paper examines the use of benefit-based tailored treatment (BTT), rather than treating to specific blood pressure targets (treat-to-target, or TTT), as an approach to the management of hypertension. Findings strongly suggest that current TTT approaches to hypertension management are not optimal, and that BTT leads to better outcomes at a lower cost.

Implementing Tightly-Linked Clinical Action Measures for Diabetes

"Tightly-linked" measures give credit for appropriate clinical action even when a target threshold is not achieved. This study indicated that use of the tightly-linked clinical action measures has the potential to reduce overtreatment and the potential harms associated with it.

Change in VHA Lipid Management Performance Measures

On October 1, 2011, the VA national performance measure for lipid control for Veterans with diabetes and with ischemic heart disease ceased to be "LDL < 100," and became "LDL < 100 or on a statin." This change was informed by seminal work conducted by Ann Arbor HSR&D investigators that demonstrated a more effective and efficient approach to lipid measurement, which incorporates appropriate treatment rather than a solely "treat-to-target" based approach.

New Guidelines for Lipid Management

New guidelines for lipid management released by the American College of Cardiology and the American Heart Association in November 2013 are a direct result of the work of Ann Arbor HSR&D investigators started over a decade ago. The major change was that clinicians now are directed to initiate either moderate-intensity or high-intensity statin therapy for patients who fall into four specific categories, without titration to a specific LDL cholesterol target. Measuring lipids during follow-up of drug-treated patients should be done to assess adherence to treatment and not to see whether a specific LDL cholesterol target has been achieved.

Putting Patient Safety Research into Practice in VISN 11 and Nationwide

Ann Arbor HSR&D investigators are working to reduce catheter-associated urinary tract infections (CAUTI) in VISN 11 (as part of the "No Preventable Harms" campaign), as well as nationally (as part of a 50-state effort by AHRQ to reduce CAUTI). Results from this work are being widely disseminated through a website, Educational tools created by the team include a CAUTI cost calculator, as well as a CAUTI prevention Guide to Patient Safety (GPS) to help individual hospitals identify potential challenges and strategies for improvement in the area of CAUTI prevention.


Racial Variations in Communication, Decision-Making, and Diabetes Outcomes

This project investigated racial variations in communication and decision making for patients with diabetes in order to improve the quality and outcomes of care and reduce disparities for Black and White veterans with Type 2 diabetes.

Identifying Rural-Urban Disparities in Chronic Disease Burden and Care

This project will inform VA's Office of Rural Health about rural-urban disparities in chronic disease burden and care by creating a 10-year cohort to provide information at the national level on chronic disease burden and care in relationship to rural, highly rural, and urban residence.

Efforts to Lower A1c <8.0% in Ralph H. Johnson Veterans with Diabetes

This project utilizes a multi-pronged approach to identifying and solving barriers to ensuring Veterans lower their mean A1c and as a result improve their outcomes. The project will focus on effective intervention delivery and feasibility of roll out at other sites.


Tailored, eHealth-based Management for Persistent Poorly-Controlled Diabetes

This project will create a patient-centered treatment option for Veterans with persistent poorly-controlled diabetes mellitus, a group that comprises the most poorly-controlled, highest-risk diabetes patients in the VA system.

Simulation-Guided Systems Redesign in GI Endoscopy

This project will result in a simulation-based intervention to expand the colorectal cancer screening capacity of VHA through improved endoscopy unit efficiency.

Organization and Outcomes of Dialysis for Veterans with End Stage Renal Disease

The objective of this study is to examine the extent of Veterans' dialysis utilization in VA and non-VA settings, to identify patient characteristics associated with Veterans' dialysis setting, and to compare the effectiveness of Veterans' chronic dialysis care settings. Findings will inform VA efforts to improve the quality and efficiency of dialysis care for a growing population of Veterans with end-stage renal disease, by identifying which Veterans are best served by receiving dialysis in VAMC clinics, VA Fee Basis, or the Medicare ESRD program.

Colorectal Cancer Survivorship Care in the Veterans Affairs Healthcare System

The goal of this project is to improve quality of care for VA colorectal cancer (CRC) survivors through a self-management intervention bridging cancer surveillance and chronic disease management. Developing a better understanding of the CRC survivor community served by the VA healthcare system, as well as their specific perceptions of and experiences with self-management care, will facilitate development of an intervention to motivate long-term self-management.


Use of Declination Forms to Improve Influenza Vaccination in Health Care Workers

The overall goal of this study was to implement an evidence-based strategy, the declination form program (DFP), in a practice setting to improve influenza vaccination in health care workers (HCW) in spinal cord injuries and disorders care settings. Findings showed a significant increase in HCW influenza vaccination post-implementation, suggesting that DFPs are a valuable influenza vaccination promotion strategy (used alone or with existing promotion campaigns).


Understanding Veterans' Experiences in PE and CPT

In this project, investigators interviewed Veterans who had completed evidence-based posttraumatic stress disorder (PTSD) treatments to examine the barriers and facilitators to entering care and to discuss with them what might have helped them start treatment, including their thoughts on how peer support for PTSD may have helped engage them in care.

Integration of Peer Support across the PTSD Continuum of Care

In this project, investigators are conducting a formative evaluation of peer support for PTSD, creating a peer program that will support uptake of evidence-based PTSD treatments and conducting a pilot trial of that program.

Partners in Dementia Care

Partners in Dementia Care (PDC) is a telephone-based care-coordination program integrating healthcare and community services to support Veterans with dementia and their caregivers. Delivered via partnerships between Veterans Administration Medical Centers (VAMCs) and Alzheimer's Association chapters, PDC targets both patients and caregivers and highlights the benefits of combining the strengths and resources of two complementary organizations.

What Patients Value in their Doctors and Implications for Enhanced Engagement: A Longitudinal Qualitative Study

Understanding what Veterans value with respect to their health care and well-being is a large missing element of most clinician encounters, and yet it is critical to fostering patient-centered approaches to improving care experiences and outcomes. The purpose of this research is to identify what traits patients value in their provider, and which ones are most salient to engagement in their own HIV care.

Clarifying Anxiety Diagnosis in Primary Care

Unspecified anxiety disorder is the most commonly diagnosed anxiety disorder among primary care patients, but is often an inaccurate diagnosis and serves as a barrier to accessing appropriate mental health services. The goal of this project is to evaluate the accuracy of unspecified anxiety diagnoses for Veterans in primary care using a gold-standard diagnostic interview. Data from this project will be used as part of a formative evaluation to understand current practices with the goal of improving diagnostic specificity to ultimately increase Veterans' access to evidence-based treatments for anxiety.

Kicking CAUTI: The No Knee Jerk Antibiotics Campaign – Guidelines Implementation to Decrease Inappropriate Bacteriuria Treatment

The purpose of the Kicking CAUTI Campaign was to implement best practices around management of suspected catheter-associated urinary tract infection (CAUTI). This project led to a 71% reduction in urine cultures and over a 50% reduction in unnecessary antibiotics used to treat the urinary infections at the Houston VA. The intervention has now become the foundation of the VA Choosing Wisely for UTI Campaign, a national antibiotic stewardship project supported by the Office of Specialty Care Services and the Veterans Evaluation Resource Center.

Point-of-Care Health Literacy and Activation Information to Improve Diabetes Care

This study aims to evaluate the process of implementing a collaborative goal-setting intervention personalized to patient activation and health literacy levels (Empowering Patients in Chronic Care [EPIC]) and to evaluate the effectiveness of this intervention relative to usual care. Integration of patient-reported measures into routine care should aid providers in personalizing goals and action plans for Veterans with treated but uncontrolled diabetes.

Improving Communication of Test Results to Patients and Providers

In this award-winning portfolio of research, investigators sought to understand and reduce breakdowns in communication of test results to patients. They then developed and disseminated two best practices toolkits nationally: 1) "Ten Strategies Providers Can Use to Improve Management of "View Alert" Notifications in CPRS", which is used for provider training by most VA sites; and 2) "Communication of Test Results Toolkit" that informs the field of readily actionable strategies to improve test result follow-up. Subsequently, this work informed the revision of national policy on test results communication (Directive 2009-019) and led to creation of best practices on how providers are notified of test results and then in turn notify patients of these results.


Comprehensive vs. Assisted Management of Mood and Pain Symptoms (CAMMPS) Trial

This study is a randomized comparative effectiveness trial designed to test the relative effectiveness of a lower-resource vs. a higher-resource enhancement of usual primary care in the management of Veterans with a combination of pain and anxiety or depression. CAMMPS provides an integrated approach to PAD symptom comorbidity rather than fragmented care of single symptoms; coordinated symptom management in partnership with both primary care clinicians and psychologists embedded in primary care; the efficient use of health information technology; attention to physical and psychological symptom comorbidity; and the coupling of self-management with optimized medication management and facilitated mental health care.

Quality of Care for Veterans with TIA and Minor Stroke

Care for Veterans with transient ischemic attack and minor stroke varies among medical facilities. This study aims to identify gaps in care quality received by patients with one of these conditions, and to identify facilitators and barriers to providing excellent quality of care for these patients.

Intervention for Stroke Improvement Using Redesign Engineering

This project identified important strategies to improve feedback of quality data to VA clinical staff, and also identified key barriers and facilitators to providing high quality stroke care in VA.

A Formative Evaluation of a Trial for OEF/OIF Veterans with Chronic Pain

Findings from this qualitative study indicate that a multi-component, stepped-care intervention customized to each patient and involving intensive, one-on-one contact, is perceived as helpful by patients and appears to produce positive results with respect to pain management. The challenge is now to determine how such a model (or a similar model) can feasibly be implemented into VA primary care clinics.

VISN Implementation of VA Acute Stroke Care Centers: Formative Evaluation

This study aimed to identify VISN and VA facility administrative and clinical perceived barriers and facilitators to implementing VA's emergency department acute ischemic stroke directive and modifying its acute stroke care services, and to identify the organizational factors and external resources and patterns of acute stroke care associated with a VISN and VA facility's designation of level of stroke emergency services. Findings suggest that strategies to identify and develop effective clinical champions would be fruitful for the implementation of coordinated care processes within healthcare organizations.

Comparison of Fidelity Assessment Methods

Fidelity concerns the consistency and adherence to detail in delivering a program of care. Assessing fidelity is an important step towards long-term improvement of care. This study examined the effectiveness of innovative and potentially cost-effective methods to assess the quality of mental health services for disabled Veterans with mental illness. This project addresses a critical need in the VA system to effectively and efficiently monitor mental health program adherence to model standards for quality.

Care Management for the Effective Use of Opioids (CAMEO)

This study is a randomized clinical trial to compare the effectiveness of pharmacological vs. behavioral approaches to treating chronic lower back pain. Findings will provide information vital to begin filling an evidence vacuum regarding comparative effectiveness of treatments for chronic pain, especially in the primary care setting. CAMEO will extend our current understanding of pharmacological and behavioral approaches and which approach may prove more beneficial and effective.

Iowa City

Building an Optimal Hand Hygiene Bundle: A Mixed Methods Approach

This study has the potential to significantly impact the science of hand hygiene and improve patient safety both in and outside VHA by reducing the number of hospital-associated infections, while also improving the existing VHA Methicillin-resistant Staphylococcus aureus (MRSA) prevention bundle.

Checklist to Prevent MRSA Surgical Site Infections

The goals of this project are 1) to assess the effectiveness and cost-effectiveness of a checklist to prevent Methicillin-resistant Staphylococcus aureus (MRSA) surgical site infections (SSIs) among Veterans undergoing total joint arthroplasty (TJA) or cardiac surgery, and 2) to assess barriers and facilitators to checklist implementation. The long-term goal is to develop an effective and easy-to-implement checklist, with an accompanying implementation toolkit, that can be incorporated into the current VA MRSA Prevention Initiative to prevent MRSA SSIs in the entire VHA system.

Little Rock

Blended Facilitation to Enhance PCMH Program Implementation

This project has cemented partnerships with operational leaders, continues to have significant impacts on VA's efforts to implement the Uniform Mental Health Services Handbook to ensure that all Veterans have access to needed mental health services, has informed national policy and planning task forces and other research studies and has contributed to implementation of two primary care-mental health integration "best practices."

Training SUD Counselors in CBT for Depression

Among the organizational hurdles to be crossed in use of evidence-based psychotherapies (EBP) are convincing administrators and other key stakeholders of the advantages of EBP adoption (e.g., improved client outcomes, consistency of care) and addressing concerns about how training and implementation can fit within existing organizational practices. This project developed and tested a web-based training program for addiction therapists to be trained in cognitive behavioral therapy for depression, as well as a distance supervision plan to accompany the web training. The three training products developed in this study are now available on TMS and providers from around the country are using them.

Monitoring and Management for Metabolic Effects of Antipsychotics

This study will test an implementation intervention to enhance uptake of evidence-based tools and strategies to improve monitoring and management of metabolic side effects of antipsychotics, within the context of the planned national implementation effort.

HIV Translating Initiatives for Depression into Effective Solutions

HIV Implementation of Translating Initiatives for Depression into Effective Solutions (HI-TIDES) used evidence-based quality improvement for depression methods to adapt and implement a depression collaborative care model for the HIV clinic setting. The HI-TIDES intervention improved depression and HIV outcomes relative to usual care and may serve as a model for collaborative care interventions in other specialty physical health care settings where patients find their medical home.

Los Angeles

Impacts of Delivery of Comprehensive Women's Health Care in the VA

This study will provide a better understanding of area/facility characteristics and organizational factors associated with achievement of key elements of comprehensive care for women and will inform VA practice improvement and policy development to support adaptation of existing initiatives (e.g., PACT, SCAN-ECHO, Patient Centered Care) to women Veterans' needs.

PACT to Improve Health Care in People with Serious Mental Illness (SMI-PACT)

This project will partner with leadership at two medical centers to implement SMI-PACT, with the goal of improving healthcare and outcomes among people with SMI, while reducing unnecessary use of emergency and hospital services. Evidence-based quality improvement strategies will be used to reorganize processes of care.

Evaluating a Collaborative Care Model for the Treatment of Schizophrenia (EQUIP)

EQUIP partnered with medical centers to implement evidence-based, patient-centered care for schizophrenia in 4 VISNs. It used patient-facing kiosks to support care improvement, and improved treatment and outcomes for employment and weight.

Cognitive Support Informatics for Antimicrobial Stewardship

In this project, investigators will correlate antimicrobial stewardship activities at individual VA medical centers nationwide with quality indicators of antimicrobial usage in an effort to develop decision support tools that promote appropriate antimicrobial utilization. This thorough assessment of the impact of specific existing VA stewardship activities as well as a prospective analysis of enhanced stewardship interventions will be relevant not only to VA but also to other large healthcare systems using informatics to improve care.

The Cost Effectiveness of Complementary and Alternative Treatments to Reduce Pain

The results of this cost-effectiveness study will help VA determine the extent to which types of complementary and integrative health treatments can be a cost-effective way to reduce musculoskeletal disorder pain and address its co-morbid conditions given limited resources.


Trial of Nurse-delivered Alcohol Brief Intervention for Hospitalized Veterans

Additional evidence for the efficacy of brief interventions (BI) to identify alcohol misuse in hospitalized patients could improve the quality of VA inpatient care by providing additional justification and guidance for the mandatory implementation of BI-related hospital accreditation measures from the Joint Commission.

Improving Detection and Management of Alcohol Misuse among VA Inpatients

Study aims support clinical care guidelines for improving substance use screening and the provision of motivational counseling for alcohol misuse contained in the VA/DoD SUD Clinical Practice Guidelines and the VA Uniform Mental Health Services Handbook. Results of this study will directly support brief alcohol intervention implementation efforts in VA and inform potential nursing practice change for general hospitalized patients and those seen in PACT.

Safety of Opioid Use among Veterans Receiving Care in Multiple Health Systems

VA cannot fully understand the safety of opioid prescribing to Veterans or develop successful interventions to improve opioid safety without understanding use of opioids from non-VA sources. By examining the extent of dual opioid use, the influences on dual use, and the effects of dual use on safety, VA can design more effective policies and interventions to ensure safe use of opioids for pain management in Veterans.

Costs and Outcomes of Chronic Heart Disease Care in the VHA

This project will identify the key institutional, programmatic, and leadership factors that characterize the nation's top-performing VA Medical Centers (VAMCs) in high-value ischemic heart disease and chronic heart failure care, providing a critical blueprint to VA clinical and operations leaders seeking to improve cardiovascular care throughout the VA's health system.

Determinants of Diabetes Control in Veterans with Serious Mental Illness

Investigators found that in a population of Veterans with co-morbid serious mental illness and diabetes, patients on average had good medication adherence and glucose control regardless of where they received primary care (usual primary care vs. co-located mental health and primary care). While there was a trend toward better outcomes in those receiving integrated collocated care it was not statistically significant, mostly because there was not much to be achieved over what was already being achieved in usual care.

Identifying and Measuring Risk for Homelessness among Veterans

The primary contribution of this study will be the examination and refinement of the current set of policies and practices to identify, refer, and intervene with Veterans who are experiencing homelessness or are at risk. This study will have an immediate impact on the system of care by informing and guiding more efficient and effective use of homelessness prevention resources.

Veterans' and Families' Priorities for Palliative Home Care Services

Identified preferences in this study for palliative home care services can guide policy-level decisions about the appropriate roles for hospice and palliative care. Findings regarding patients' and families' priorities for services can help palliative care programs select services that are most important to Veterans and their families, even when they may not be eligible for traditional hospice services. Findings can also be used to tailor service offerings that incorporate the preferences of older Veterans and those facing financial constraints.

Dual Use of VA-Medicare Drug Benefits and Unsafe Prescribing in Dementia Patients

Study aims are expected to have a positive impact by providing VA with information needed for better understanding patterns, risk factors, and outcomes associated with dual use in Veterans with dementia, filling a crucial gap in evidence needed for appropriate policy and clinical interventions.

Interventions to Improve Fatigue Management among Physician Trainees

The question about how to optimally manage fatigue for physicians in training is particularly important for the care Veterans receive within the VA health care system because 70% of VA hospitals are teaching hospitals. This study demonstrated that protected sleep periods are feasible and do increase the amount slept by residents on call, reduce the amount of prolonged wakefulness, and increase cognitive performance.

Understanding Women's Disparities in Satisfaction with VA Health Care

Given VA's commitment to providing high quality care to all patients, it is critical to understand the reasons underlying racial and ethnic disparities in satisfaction. This study will use an innovative approach to pinpoint key modifiable areas of dissatisfaction for African American and Hispanic female Veterans, as well as patient-identified potential solutions to improve care for women in general. This will be the first step toward the development of targeted interventions designed to improve satisfaction with VA health care among the growing proportion of diverse female Veterans.


Training and Coaching to Promote High Performance in VA Community Living Centers

This study aims to bolster workplace learning systems in VA CLCs by targeting factors that affect transfer of learning to practice, are expected to identify ways to enhance the human capital of CLC staff thereby improving their caregiving capabilities. This will improve quality of care and quality of life for Veterans currently receiving care in CLCs and of those who will receive care in CLCs in the future.

Salt Lake City

Measuring Patient-Centeredness in Patient-Provider Interactions in VHA

Results from this project will lay the foundation for a program of research into patient-centered care (PCC) that integrates PCC strategies and information components using sociotechnical approaches, such as decision support interventions, educational programs and new metrics for measurement in the domain of patient-centered care.

Automating Heart Failure Data for Patient Treatment Goals at the Point of Care

The primary goal of this project is to improve beta blocker titration according to guideline-recommended care in our national VA network of hospitals, thereby reducing Veteran readmissions and improving Veteran outcomes.

Current Evidence and Early Warning Indicators of Homelessness Risk among Veterans

The objectives of this project are to: 1) develop robust electronic algorithms to identify Veterans who are currently homeless or those who are at risk of homelessness using predictive modeling; and 2) review the extent to which Veterans are accessing and receiving appropriate services.

Using Economics and Epidemiology to Evaluate MRSA Decolonization in the VA

The goal of this research is to apply cutting edge empirical methods of estimating the costs and benefits of prevention efforts for infectious disease transmission to the specific case of decolonization of Methicillin-resistant Staphylococcus aureus (MRSA) within VA.

Preventing MRSA Infections: A Virtual Comparative Effectiveness Model

The goal of this study is to build a VISN-wide agent-based simulation model of Methicillin-resistant Staphylococcus aureus (MRSA) transmission and control to compare the effectiveness and cost-effectiveness of various MRSA control strategies. Investigators expect the results of this "virtual" comparative effectiveness model to have great impact in improving VA quality of care, both for identifying targets for leveraging the investments of the current MRSA initiative and for informing future modifications.

Antimicrobial Use and Control of Clostridium difficile Transmission and Infection

By examining the associations between facility-level antibiotic prescribing and Clostridium difficile infection (CDI) rates, and the impact and costs of various control strategies for CDI, investigators may gain a better understanding of the dynamics of C. difficile transmission in ways that will contribute to the implementation of VA-wide initiatives aimed at controlling CDI, such as antibiotic stewardship. The findings from this project have the potential to impact infection control practice throughout the VA healthcare system.

Veterans Like Mine Cognitive Support for Therapeutic Decision Making

The goal of this project is to develop an informatics tool that will retrieve and present information about other patients similar to the individual patient at hand, to facilitate the management of diagnostic uncertainty, the assessment and access of treatment options, and the prediction of clinical outcomes.

Cognitive Support Informatics for Nurse Medication Stewardship

This study will significantly improve the care of patients with delirium by improving team coordination, and enhancing early detection to enable greater access and more effective tailored response. The result will be fewer days of stay in the hospital, fewer falls and increased probability of discharge to home.

Cognitive Support for Shared Decision Making Using Veterans Like Me

The goal of this project is to enhance shared decision-making (SDM) between Veterans and healthcare providers. Investigators will empower patients to participate in SDM by providing graphical information regarding outcomes of interest, along with concrete stories about individuals like themselves.


Smart Phone Application for Postconcussion Symptom Reduction

The primary goal of this study is to evaluate the efficacy of Concussion Coach, an interactive, self-management smartphone application, for improving clinical outcomes in those with a history of mild traumatic brain injury and to determine what aspects of Concussion Coach are most useful to Veterans.

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National Surveillance of Acute Kidney Injury Following Cardiac Catheterization

The overall objective of this project is to develop and evaluate the informatics infrastructure and tools to perform national VA near real-time automated adverse event surveillance after cardiac catheterization, and to demonstrate the utility of the tools within the use case of post-procedural acute kidney injury (AKI). The informatics infrastructure and natural language processing development used in this study has the potential to be applied in a wide variety of exposures and outcomes beyond AKI for cardiac catheterization surveillance.

San Diego

Optimizing Colorectal Cancer and Polyp Surveillance after Colorectal Polypectomy

The sensitivity and specificity of current guidelines for predicting occurrence of colorectal cancer (CRC) or a polyp with features considered high risk for developing into CRC after initial colonoscopy are limited, resulting in surveillance colonoscopy under-use among individuals incorrectly labeled low risk, and over-use among those incorrectly labeled high risk. Findings from this study have the potential to improve prevention and early detection of CRC, as well as reduce under- and over-use of colonoscopy for Veterans.

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QUERI Programs

PrOVE: PeRsonalizing Options through Veteran Engagement - Ann Arbor, MI

This QUERI Program will work to improve the prevention and management of chronic conditions by supporting Veterans and providers in making personalized healthcare decisions that take into account individual patient risk and preferences. Investigators will work to improve the appropriateness of care (e.g., decrease overuse and underuse), increase Veteran engagement in their healthcare, and enhance Veterans' experiences.

QUERI for Team-Based Behavioral Health - Little Rock, AR

Team-based behavioral healthcare improves outcomes and satisfaction for individuals with mental health conditions. However, healthcare teams do not develop naturally and require targeted support to form and be sustained. Using common facilitation techniques and common measures, this QUERI Program will enhance and inform team-based care for Veterans with behavioral health conditions.

Bridging the Care Continuum QUERI - Bedford, MA

The goal of BridgeQUERI is to improve vulnerable Veterans' use of services across the care continuum, "bridging" the continuum by improving outreach and diagnosis, as well as linkage and engagement with specialty care, which will lead to better health outcomes.

Improving Pain-Related Outcomes for Veterans (IMPROVE) - VA Connecticut Healthcare System and VA Palo Alto Health Care System

The primary goal of this Program is to improve safe and effective pain management through partnered implementation of personalized, proactive, patient-centered interventions that optimize access to care.

Implementing Goals of Care Conversations with Veterans in VA Long-Term Care (LTC) Settings - Ann Arbor, MI

This QUERI program focuses on improving the provision of Veteran-centered care in VA Community Living Centers (CLCs) and Home-Based Primary Care Programs (HBPCs), and is designed to support a process that incorporates Veterans' preferences for care, particularly services and interventions that are typically used in the event of a life-threatening emergency.

Measurement Science QUERI - San Francisco, CA

Measurement Science (defined as the theory, practice, and application of suitable metrics) is at the core of VA's Learning Healthcare System and is a critical component at every stage of quality improvement (QI) and implementation processes. The primary goal of this QUERI Program is to integrate measurement science into healthcare for Veterans.

The Care Coordination QUERI - Los Angeles, CA

The Care Coordination QUERI aims to learn how to improve coordination between the Veteran, his or her primary care team, and the specialty care, emergency department, hospital, and home community resources the Veteran may need.

Precision Monitoring to Transform Care (PRISM) - Indianapolis, IN

Despite growing accessibility, data are most commonly used to retrospectively evaluate quality of care rather than to provide the right data at the right time to the right person in a way that increases patient and staff satisfaction - and improves healthcare. This QUERI Program will establish a culture of continuous performance improvement, with projects leading directly to the implementation and evaluation of tools that will be useful across all VA facilities and multiple clinical settings.

Improving Safety and Quality through Evidence-Based De-Implementation of Ineffective Diagnostics and Therapeutics - Seattle, WA

The Choosing Wisely initiative is a program to de-implement low-value practices that can provide an effective message to simultaneously improve quality and value. This QUERI Program will conduct a series of quality-improvement projects to compare the effectiveness of alternative de-implementation strategies that are based on changing clinician information and knowledge, as well as strategies based on providing clinicians with tools and substitutes for the low-value practices.

Triple Aim QUERI Program - Denver, CO

This QUERI Program will leverage healthcare data to identify actionable care gaps, and to implement innovative healthcare delivery interventions that will enhance the patient care experience, improve the health of populations, and reduce per capita costs of care.

Virtual Specialty Care QUERI Program - Seattle, WA

While community-based outpatient clinics have dramatically improved access to first-class primary care services, it has been more challenging to deliver specialty care to rural Veterans. This QUERI Program will work to implement and evaluate technology-facilitated clinical interventions designed to improve outcomes for rural Veterans.

The Enhancing Mental and Physical health of Women through Engagement and Retention (EMPOWER) QUERI - Los Angeles, CA

EMPOWER QUERI is designed to improve women Veterans' engagement and retention in evidence-based care for three high-priority health conditions: diabetes, cardiovascular disease, and anxiety/depression.

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QUERI Partnered Evaluation Initiatives

Disseminating a Dashboard for VA Purchased Community Nursing Homes - Providence, RI

This project seeks to improve the quality of care that Veterans receive in Community-based Nursing Home (CNH) facilities, by understanding the process of CNH selection, evaluating the systematic dissemination of the CNH Dashboard on VA-purchased CNH quality, and evaluating Veteran-specific measures of CNH quality. Successful completion of the objectives will provide the tools for VA to manage CNH program quality more effectively.

VA Caregiver Support Evaluation Center (VA CARES) - Durham, NC

The Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law:111-163) enacted legislation to enhance access to training, services, and assistance for Veteran caregivers in need through two landmark programs: Comprehensive Assistance for Family Caregivers, and Caregiver Support Services. This project will evaluate the impacts of these programs on Veterans and caregivers, to include how the Comprehensive Program has affected Veteran health care utilization.

eHealth Partnered Evaluation Initiative - Bedford, MA and Birmingham, AL

eHealth is a model for the delivery and receipt of healthcare services with an expanding evidence base that suggests great potential to increase access and support the transition from episodic to continuous care. This eHealth Partnered Evaluation Initiative will support the further implementation of eHealth technologies across the VA healthcare system and measure impacts on dimensions of access and other outcomes.

Evidence-Based Policy Resource Center - Boston, MA

The Partnered Evidence-Based Policy Resource Center is designed to provide timely, rigorous data analysis to support the development of high-priority policy, planning, and management initiatives and quantitative program evaluations with strong potential to improve the quality and efficiency of VA healthcare.

Advancing Healthcare Innovation: A Partnered-Evaluation of Geriatric Patient-Aligned Care Team (GeriPACT) Implementation - Boston, MA and Iowa City, IA

The Geriatric Patient Aligned Care Team (GeriPACT) model offers an alternative to standard PACTs by providing frail, elderly Veterans and their caregivers with access to the most appropriate care for their healthcare needs with a single point of contact for multidisciplinary geriatric care. This initiative will help understand how GeriPACTs are structured, how variations in programs across VAMCs influence the care that Veterans receive, or whether GeriPACTs improve the patient and provider experience.

Office of Health Equity-QUERI Partnered Evaluation Initiative - Los Angeles, CA

Among other activities within this initiative, investigators will evaluate whether characteristics of the healthcare delivery setting (e.g., geography, treatment setting) and the types of care that individuals use, including new models of care such as telehealth, influence the quality of care that Veterans receive.

Building Implementation Science for VA Healthcare-Associated Infection Prevention - Madison, WI

This initiative will implement and evaluate an evidence-based intervention for prevention of healthcare associated infection (HAI) and will use the VA Healthcare-Associated Infection Prevention Network (VHIN) to assess current practices and needs related to HAI prevention in collaboration with VHIN partners across the VA healthcare system.

Action-Oriented Evaluation of Inter-Professional Learning Efforts in the CoEPCE and IAPACT Environments - Portland, OR

As team-based care becomes a cornerstone of emerging norms in primary care delivery, health care professionals from diverse fields need clinical training that prepares them to work in collaborative, interdisciplinary teams. The goal of this evaluation is to provide rapid insights into the characteristics of tools and configurations of clinic dynamics that best promote sustained and widespread use of effective learning techniques. Investigators also will examine the effectiveness of developed strategies and tools for promoting core values of inter-professional education, as well as budget and quality impacts associated with their use.

Lean Enterprise Transformation Evaluation Initiative - Boston, MA and Palo Alto, CA

This QUERI initiative is evaluating Lean Enterprise Transformation implementation to assess improvement initiatives, measure organization-level transformation, and identify factors that both facilitate and hinder program success.

Cleveland Evaluation of OSC Specialist Knowledge Management Initiatives - Cleveland, OH

A series of Office of Specialty Care Transformation Initiatives Program (OSC) initiatives is designed to contribute to improving healthcare for the millions of Veterans with chronic diseases by improving the efficiency and effectiveness of specialist care. This QUERI initiative will evaluate the extent to which each of the four OSC initiatives meet the clinical and organizational goals of each program (i.e. improving clinical outcomes, access to care, and patient/provider satisfaction).

VA Nursing: Effectiveness and Entry - Ann Arbor, MI

This QUERI initiative will support the work of VA's Office of Nursing Services by evaluating Staffing Methodology and RN Transition-to-Practice initiatives, both of which focus on supporting effective nurse staffing and retaining new graduate nurses in practice. The evaluation team will look at both the way the initiatives are being put into place and the effect they are having on patients, staff, and the VA healthcare system.

VA Nursing Innovations Collaborative for Evaluation - Tampa, FL

The mission of the VHA Nursing Innovations Collaborative for Evaluation is to provide VA's Office of Nursing Service with services for evaluating structures and processes of implementation and outcomes of VHA nursing strategic initiatives, such as preventing pressure ulcers and identifying ways to best support nurse attainment of doctoral degrees to advance practice, nursing research, and evidence-based practice, and improve quality, safety, and patient outcomes.

Evaluating VA Patient-Centered Care: Patient, Provider, and Organizational Views - Bedford and Boston, MA and Los Angeles, CA

This initiative evaluates the experience and practice of patient-centered care at VA hospitals throughout the US to help ensure that patients are fully integrated into medical consultation, treatment, and follow-up.

Capitalizing on Quantitative Metrics to Advance the Implementation and Evaluation of the Clinic Management Training Program - Boston, MA

A key initiative of the Veterans' Access Choice and Accountability Act is the implementation of the clinic management training program, which will revamp the organization and delivery of VA outpatient care by providing standardized education on healthcare practice management and scheduling, and by implementing a group practice manager model (GPM) at each facility. This QUERI evaluation initiative will rigorously evaluate the implementation of GPM to identify the effect of this intervention on VA patient outcomes.

Partnered Evaluation of the Social Determinants of Health and Healthcare Resource Needs of Rural Veterans - Little Rock, AR and Seattle, WA

The goal of this initiative is to provide VA's Office of Rural Health with data, including recommendations from Veterans and community stakeholders, to inform strategic planning for policies and programs that will improve the health of Veterans living in rural areas.

Denver-Seattle Specialty Care Evaluation Initiative - Denver, CO and Seattle, WA

VA's Office of Specialty Care Services/Office of Specialty Care Transformation (SCS/OSCT) implemented a number of transformational initiatives designed to improve access and delivery of specialty care. This QUERI Evaluation Initiative aims to partner with SCS/OSCT to evaluate the impact of the specialty care transformation initiatives, as well as to inform decisions about maintaining, modifying, and/or expanding the programs.

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