Aligning quality improvement efforts and policy goals in a national integrated health system

Abstract

Objective To describe the design and impact of a systematic, enterprise‐wide process for engaging US Department of Veterans Affairs (VA) leadership in prioritizing scarce implementation and evaluation resources. Data Sources From 2017 to 2021, the VA Quality Enhancement Research Initiative (QUERI) identified priorities from local, regional, and national leaders through qualitative discussions and a national survey and tracked impacts via reports generated from competitively funded initiatives addressing these priorities. Study Design Guided by the Learning Health System framework and QUERI Implementation Roadmap, QUERI engaged stakeholders to nominate and rank‐order priorities, peer‐reviewed and funded initiatives to scale up and spread evidence‐based practices (EBPs) using theory‐based implementation strategies, and evaluated the impact of these initiatives using the QUERI Impact Framework. Data Collection/Extraction Methods QUERI collected priority nominations through qualitative discussions and a web‐based survey, and live voting was used to rank‐order priorities. QUERI‐funded teams regularly submitted progress reports describing the key activities, findings, and impacts of the quality improvement (QI) initiatives using a standardized form created in the VA Research Electronic Data Capture (REDCap). Principal Findings QUERI launched five QI initiatives to address priorities selected by VA leadership. In partnership with 28 health system leaders, these initiatives are implementing 10 EBPs across 53 sites, supporting 1055 VA employees in delivering evidence‐based care. The success of these initiatives led to an expansion of QUERI's process to address 2021 VA leadership priorities: virtual care, health disparities, delayed or suppressed care due to COVID‐19, employee burnout, long‐term and home care options, and quality and cost of community care. Conclusions QUERI, a unique program embedded in a national integrated health system, deployed a novel approach to inform policy making and enhance the real‐world impact of research through prioritization of limited resources, rigorous peer‐review, and assessment of impacts on the health system, employees, and Veterans.

How the VA is training the Next‐Generation workforce for learning health systems

“…The goal of AMPs is to align the LHS infrastructure, including data curation, and the learning community, to promote areas of research that can also enhance outcomes for Veterans. They also build upon similar initiatives such as the University of Michigan‐Blue Cross Blue Shield Clinical Quality Collaboratives 48 , 49 and QUERI‐partnered initiatives 50 by also building the LHS infrastructure and learning communities to sustain ongoing discovery, testing, and improvement in the research area over time. One example of an ORD AMP involves developing data and partnerships to increase Veterans' access to validated precision oncology‐focused treatments.…”

“…Third, the development of multiple learning communities and interest groups will necessitate prioritization of research and quality improvement topics and ensure active engagement across interested parties. For example, the VA has recently adopted a process developed by QUERI 50 based on the VA Strategic Plan 51 to prioritize scientific funding using multi‐level input from consumers, providers, and leaders of VA health care.…”

Hurdles of innovation—insights from a new healthcare delivery innovation program

“…12 Identifying and providing metrics-patient, employer, and health system impacts-that demonstrate the real-world value of investments and new initiatives across multiple stakeholders encourages ongoing support. 11,36 Developing effective tools and techniques that will enable successful innovation will bring about positive change for years to come.…”

Translating research into policy and action

“…Finally, Braganza et al, 20 as well as Daumit et al 21 (all in this issue), present novel funding mechanisms from the VA Quality Enhancement Research Initiative (QUERI) and NIH Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) programs that focus on using community input and the lived experiences of individuals to inform priorities for evidence generation and development of implementation methods to promote health equity and policy impact.…”

“…in this issue actively involved interested communities and partners to inform policies that improve Veteran access to care and long-term care outcomes. Ngo and Colleagues18 and Stadnick et al19 in this issue also present novel research directions that focus on community-informed evidencebased policy making and health equity research.Finally, Braganza et al,20 as well as Daumit et al…”