Accelerating Research Impact in a Learning Health Care System: VA's Quality Enhancement Research Initiative in the Choice Act Era

Amy M Kilbourne, A Rani Elwy, Anne E Sales, David Atkins, Amy M Kilbourne, A Rani Elwy, Anne E Sales, David Atkins

Abstract

Background: Since 1998, the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) has supported more rapid implementation of research into clinical practice.

Objectives: With the passage of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act), QUERI further evolved to support VHA's transformation into a Learning Health Care System by aligning science with clinical priority goals based on a strategic planning process and alignment of funding priorities with updated VHA priority goals in response to the Choice Act.

Design: QUERI updated its strategic goals in response to independent assessments mandated by the Choice Act that recommended VHA reduce variation in care by providing a clear path to implement best practices. Specifically, QUERI updated its application process to ensure its centers (Programs) focus on cross-cutting VHA priorities and specify roadmaps for implementation of research-informed practices across different settings. QUERI also increased funding for scientific evaluations of the Choice Act and other policies in response to Commission on Care recommendations.

Results: QUERI's national network of Programs deploys effective practices using implementation strategies across different settings. QUERI Choice Act evaluations informed the law's further implementation, setting the stage for additional rigorous national evaluations of other VHA programs and policies including community provider networks.

Conclusions: Grounded in implementation science and evidence-based policy, QUERI serves as an example of how to operationalize core components of a Learning Health Care System, notably through rigorous evaluation and scientific testing of implementation strategies to ultimately reduce variation in quality and improve overall population health.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
QUERI national strategic goals: accelerating research impact in a Learning Health Care System. QUERI indicates Quality Enhancement Research Initiative; VHA, Veterans Health Administration.
FIGURE 2
FIGURE 2
QUERI program: general architecture. QUERI indicates Quality Enhancement Research Initiative; QI, Quality Improvement; VHA, Veterans Health Administration.

References

    1. Giroir BP, Wilensky GR. Reforming the Veterans Health Administration—beyond palliation of symptoms. N Engl J Med. 2015;373:1693–1695.
    1. Kizer KW, Jha AK. Restoring trust in VA health care. N Engl J Med. 2014;371:295–297.
    1. Asch SM, McGlynn EA, Hogan MM, et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med. 2004;141:938–945.
    1. Cooper AL, Jiang L, Yoon J, et al. Dual-system use and intermediate health outcomes among Veterans enrolled in Medicare Advantage Plans. Health Serv Res. 2015;50:1868–1890.
    1. Veterans Access, Choice and Accountability Act of 2014 (“Choice Act” US Public Law 113–146). 2014. Available at: . Accessed December 7, 2016.
    1. US Department of Veterans Affairs. Healthcare Inspection Access to Urology Service Phoenix VA Health Care System, Phoenix, Arizona. Washington, DC: Office of Inspector General; 2015. Report No. 14-00875-03. Available at: . Accessed October 24, 2016.
    1. The MITRE Corporation. Independent Assessment of the Health Care Delivery Systems and Management Processes of the Department of Veterans Affairs Volume I: Integrated Report. McLean, VA: The MITRE Corporation; 2015. Available at: .
    1. Commission on Care. Commission on Care Final Report. Washington, DC: Commission on Care; 2016. Available at: .
    1. Demakis JG, McQueen L, Kizer KW, et al. Quality Enhancement Research Initiative (QUERI): a collaboration between research and clinical practice. Med Care. 2000;38(suppl 1):I17–I25.
    1. Stetler CB, McQueen L, Demakis J, et al. An organizational framework and strategic implementation for system-level change to enhance research-based practice: QUERI Series. Implement Sci. 2008;3:30.
    1. Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10:21.
    1. Institute of Medicine of the National Academies. Best care at lower cost: the path to continuously learning health care in America. Recommendations. 2012. Available at: . Accessed November 15, 2015.
    1. Feussner JR, Kizer KW, Demakis JG. The Quality Enhancement Research Initiative (QUERI): from evidence to action. Med Care. 2000;38(suppl 1):I1–I6.
    1. Rubenstein LV, Mittman BS, Yano EM, et al. From understanding health care provider behavior to improving health care: the QUERI framework for quality improvement. Quality Enhancement Research Initiative. Med Care. 2000;38(suppl 1):I129–I141.
    1. Institute of Medicine of the National Academies. Annual report. 2014. Available at: . Accessed November 15, 2015.
    1. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104:510–520.
    1. Bridgeland J, Orszag P. Can government play moneyball? How a new era of fiscal scarcity could make Washington work better. 2013. Available at: . Accessed November 17, 2015.
    1. Finkelstein A, Taubman S. Health care policy. Randomize evaluations to improve health care delivery. Science. 2015;347:720–722.
    1. Allen H, Baicker K, Taubman S, et al. The Oregon health insurance experiment: when limited policy resources provide research opportunities. J Health Polit Policy Law. 2013;38:1183–1192.
    1. Chambers DA, Feero WG, Khoury MJ. Convergence of Implementation Science, Precision Medicine, and the Learning Health Care System: a new model for biomedical research. JAMA. 2016;315:1941–1942.
    1. Woolf SH. The meaning of translational research and why it matters. JAMA. 2008;299:211–213.
    1. Kilbourne AM, Neumann MS, Pincus HA, et al. Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implement Sci. 2007;2:42.
    1. Wells KB, Jones L, Chung B, et al. Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities. J Gen Intern Med. 2013;28:1268–1278.
    1. Kirchner JE, Ritchie MJ, Pitcock JA, et al. Outcomes of a partnered facilitation strategy to implement primary care-mental health. J Gen Intern Med. 2014;29(suppl 4):904–912.
    1. Aarons GA, Ehrhart MG, Farahnak LR, et al. Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation. Implement Sci. 2015;10:11.
    1. Nadeem E, Olin SS, Hill LC, et al. Understanding the components of quality improvement collaboratives: a systematic literature review. Milbank Q. 2013;91:354–394.
    1. Nicolay CR, Purkayastha S, Greenhalgh A, et al. Systematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare. Br J Surg. 2012;99:324–335.
    1. Kilbourne AM, Almirall D, Eisenberg D, et al. Adaptive Implementation of Effective Programs Trial (ADEPT): cluster randomized SMART trial comparing a standard versus enhanced implementation strategy to improve outcomes of a mood disorders program. Implement Sci. 2014;9:132.
    1. US Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Evidence-based Synthesis Program website. 2015. Available at: . Accessed November 15, 2015.
    1. US Department of Veterans Affairs, Veterans Health Administration, Office of Research Oversight. VHA handbook 1058.05 transmittal sheet: VHA operations activities that may constitute research. 2011. Available at: . Accessed November 15, 2015.
    1. Shulkin DJ. Beyond the VA crisis—becoming a high-performance network. N Engl J Med. 2016;374:1003–1005.
    1. US House of Representatives. Evidence-based Policymaking Commission Act, Public Law No: 114-140. 2016. Available at: . Accessed December 7, 2016.

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