Article Discusses Importance of VA's Quality Enhancement Research Initiative in the Choice Act Era
One of VA's biggest challenges is rapidly adapting new research findings into clinical practice across its healthcare system, which has become more challenging with the passage of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act) and the establishment of community provider networks. The Choice Act allows Veterans enrolled in VA healthcare who have waited longer than 30 days to see a provider – or who live more than 40 miles from a VA clinic – the option of seeking care from non-VA providers. The Choice Act also mandated an independent assessment of VA business and healthcare practices. Released in 2015, this assessment included several recommendations, such as reducing variation in care by providing a clear path to implementing existing best practices. VA HSR&D's Quality Enhancement Research Initiative (QUERI) was created in 1998 to help address the challenge of translating research into practice more quickly and consistently across the VA healthcare system. This article describes how QUERI is responding to the Choice Act, particularly through the implementation strategies that facilitate more rapid uptake of effective practices across different settings, and the rigorous evaluation of new VA programs and policies.
As VA becomes more of a healthcare payer as well as provider though the Choice Act, QUERI reorganized to become more responsive to VA's changing priorities, such as access, timeliness, and coordination of patient care. This reorganization includes a national network of 15 QUERI programs, each led by investigators in partnership with clinical operations leaders and providers that focus on achieving a VA national priority goal. For example, Triple Aim QUERI works to improve the quality, safety, and efficiency of care transitions, while Virtual Specialty Care QUERI enhances access to specialty services with a focus on telehealth innovations. In addition, QUERI Partnered Evaluation Initiatives (PEIs) rigorously assess the impact, spread, and sustainability of VA national clinical programs or policies. In 2016, VA leaders significantly increased their investment in the PEIs in response to the U.S. Office of Management and Budget's recommendations that government agencies advance evidence-based policy, particularly through the use of randomized program evaluation designs. QUERI's national network of implementation scientists also promotes best practices on a national scale by working with local providers and national leaders. Identification and deployment of scientifically-supported implementation strategies represent important future directions of the implementation science field, and have been acknowledged as a key component of a Learning Health Care System.
- QUERI is an example of how to operationalize core components of a Learning Healthcare System, by which scientists can contribute to the deployment and evaluation of best practices in real-world healthcare settings to provide optimal care for Veterans.
Dr. Kilbourne is Director of QUERI. Dr. Elwy is part of HSR&D's Center for Healthcare Organization and Implementation Research (CHOIR) and Dr. Sales is part of HSR&D's Center for Clinical Management Research (CCMR). Dr. Atkins is Director of HSR&D.
Kilbourne AM, Elwy AR, Sales AE, and Atkins D. Accelerating Research Impact in a Learning Health Care System. Medical Care. December 16, 2016; Epub ahead of print.