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

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 (Ql) initiatives using a standardized form created in the VA Research Electronic Data Capture (REDCap). Principal Findings: QUERI launched five Ql 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. KEYWORDS evidence-based policy, evidence-based practice, implementation science, knowledge translation, Learning Health System, quality improvement, veterans What is known on this topic * Research evidence needs to be used more effectively to solve health care challenges and benefit end-users. * Little guidance exists on how to prioritize scientific investments that address health care challenges and inform policy in resource-constrained federal agencies. What this study adds * A novel, enterprise-wide approach to match scientific investments with emerging health system needs and national policy (e.g., Evidence Act) goals. * Prioritization of scientific investments, informed by the Learning Health System framework and based on a multilevel stakeholder approach and rigorous peer review and implementation processes, to ensure that Veterans benefit from research discoveries.
1 | INTRODUCTION Implementation, evaluation, and quality improvement (Ql) initiatives rooted in scientific evidence and methods are crucial for addressing complex health care challenges and enhancing quality, efficiency, equity, experience, [...]