Table 3.
QUERI Program Center Impacts
| Domain and degrees of impact | QUERI metrics | QUERI program center reported impacts |
|---|---|---|
| Alignment with Multi-Level Priorities: How is the initiative directly linked to health system operations and research priorities? |
1a. Research priorities Office of Research & Development (ORD) priority being addressed Number of evidence-based practices (EBPs) implemented Number of EBPs derived from ORD research implemented 1b. Health system operations priorities National VA priority being addressed Metrics derived from VA performance plan goalsNumber of distinct partners across geographical areas and service lines Role and involvement level of specific individuals in the initiative |
1a. Research priorities All QUERI Program initiatives aligned with ORD priority to move more research into real-world practice 49 EBPs 37 (76%) EBPs derived in part from ORD research 1b. Health system operations priorities All QUERI Program initiatives linked to one or more national priorities Patient engagement (e.g., awareness of diagnosed conditions) Utilization (e.g., appointment completion, screening and diagnosis of specific conditions) Caretaker and patient experiences (e.g., access, decision-making process, pain score) Provider engagement (e.g., overall satisfaction with process) Quality (e.g., error rates, rate of adverse events, hospitalization rates) Health outcomes (e.g., specific disease outcomes, weight loss, reduction in inappropriate prescriptions)Cost (e.g., cost of intervention)62 national partners representing 37 unique organizational and/or patient care service areas9 regional partners representing 7 VISNs |
| Commitment: How effective is the research-operations partnership? |
2. Administrative research and operations resources Operations partner funding commitment Tangible operations resources provided 3. Investigator-developed tools and strategies Type of strategy used Innovations and/or adaptations to implementation strategy, particularly for facilities experiencing quality gaps Evaluation design for examining implementation strategy effectiveness Description of learning collaborative or other methods used to share learnings and enhance implementation efforts Number and type of products developed by QUERI investigators |
2. Administrative research and operations resources $5,420,074 Nearly all national operations partners provided non-monetary support 3. Investigator-developed tools and strategies Facilitation* (n = 22; 45%) most commonly used, followed by audit and feedback† (n = 14; 29%) Adaptations included more intensive support and feedback, increased facilitation, recruitment of a local champion, integration of clinical reminders 31% (n = 15) of initiatives have an evaluation plan to examine effectiveness of implementation strategy versus usual care/standard implementation or comparing two implementation strategies 11 of the 15 QUERI Programs have a Learning Collaborative or other methods used to share learnings and enhance implementation efforts across projects 71 tools, toolkits, and manuals |
| Tailoring to local context: To what extent were specific strategies and tools adopted into routine practice? |
4. Direct proximate impacts Number and type of facilities implementing EBP/tool/strategy Number and type of facilities with quality gaps implementing EBP/tool/strategy Number of VA staff trained in EBP/tool/strategy or number of VA staff no longer using low-value approach (for de-implementation) Number of Veterans served by EBP/tool/strategy Special populations served by EBP/tool/strategy |
4. Direct proximate impacts 465 facilities across 18 VISNs 15 facilities with quality gaps 5147 VA staff trained 250,159 Veterans served 1 QUERI Program focuses on rural Veterans 1 QUERI Program tailors EBPs to women Veterans 2 QUERI Programs focus on vulnerable populations (e.g., homeless Veterans, Veterans at risk of functional decline) |
| Informing the field: How are the project results being communicated to key stakeholders and organizations? |
5a. Extent to which results were disseminated to health system leadership and other operations stakeholders Description of briefings held in which goals or results were directly presented to operations partners, Veterans Service Organizations, Veterans advisory councils, or other organizations with decision-making or financial authority 5b. Extent to which results were disseminated to research stakeholdersNumber of published journal articles directly stemming from QUERI-funded initiativesDescription of conference presentations directly stemming from QUERI-funded initiatives List of citations directly stemming from QUERI-funded initiatives5c. Extent to which results were disseminated externally to the public Number of articles published on national media outlets6. Extent to which there was additional scale up and spread beyond original participating facilitiesWhether EBP was submitted to Diffusion MarketplaceNumber of additional sites implementing EBP/tool/strategy (beyond the original sites that were directly part of the initial implementation effort) |
5a–c. Extent to which results were disseminated to health system leadership and other operations stakeholders, research stakeholders, and externally to the public All initiatives presented multiple times to health system leadership271 published journal articles 320 presentations at non-VA conferences/meetings 6. Extent to which there was additional scale up and spread beyond original participating facilities 15 submissions to Diffusion of Excellence (DEI) Shark Tank or Diffusion Marketplace 2 EBPs selected as semifinalists in DEI Shark Tank 1 EBP designated as gold status practice for national diffusion across VA |
| Observing healthcare changes and generating New questions/projects: What improvements in quality of care and health outcomes, policy, and/or culture were observed? Were new analyses/projects launched as a result of the effort? |
7. Sustainability Development of a business case analysis, including a data-driven evaluation plan estimating costs of implementing EBPs and ongoing maintenance of EBP 8. Quality of care and health outcomes Observed changes based on relevant quality measures or data from the patients touched by implementation effort 9. Policy Degree in which findings directly lead to the creation or improvement of policy or clinical practice guidelines and/or were used to inform US government testimony or panel meetings of national organizations 10. Culture Observed changes on employee and specifically provider engagement Number of products (e.g., toolkit, demonstration project) developed by mentees Number and depth of new quality enhancement projects or evaluation analyses launched or expanded in direct response to a specific, policy, or clinical question from VA local, regional, or national leadership |
7–10. Sustainability, quality of care and health outcomes, policy, culture 9 QUERI Programs conducting an economic analysis Most QUERI Programs reported it was too early for observed long-term changes in relevant quality and provider engagement measures and policy 30 initiatives report new quality enhancement projects or evaluation analyses |
*Often utilized for facilities with complex needs, facilitation is a multi-faceted interpersonal approach for overcoming barriers to implement an intervention14
†Audit and feedback involves changing provider behavior and improving clinical guideline adherence through delivery and feedback of quality performance data15