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QUERI’s relationship to HSR&D and Operations

QUERI’s relationship to HSR&D and Operations. SD Fihn MD MPH July 11, 2010. Brief History. Perceived block to implementation (T1 vs. T2) Long delays to integrate evidence into routine practice

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QUERI’s relationship to HSR&D and Operations

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  1. QUERI’s relationship to HSR&D and Operations SD Fihn MD MPH July 11, 2010

  2. Brief History • Perceived block to implementation (T1 vs. T2) • Long delays to integrate evidence into routine practice • Traditional scientific communication did not foster dialogue between researchers & clinical/operational leaders • QuERI devised as a link between research and operations to address block • VA is almost unique as an health care organization with a mature intramural research program.

  3. QUERI • Disease orientation – high prevalence/high importance • Stepwise approach to implementation • Identify the evidence • Identify practice variation • Implement changes • Monitor impact • Multidisciplinary investigative teams • Executive Committees comprised of internal and external stakeholders

  4. Initial Challenges • Developing linkages with leadership and program offices • Building data resources • Securing resources to support collaborative efforts

  5. QUERI – examples of notable successes • Mental Health • Programs that double adherence to antidepressant RX • National screening standards for problem drinking • ’ed use of opioid agonist RX by 20% in VA SUD clinics • Diabetes • Demonstrated quality of diabetes care in VA • New approaches to retinal screening, glycemic control • CHF - National network of care providers • SCI -3X  in flu & pneumococcal vaccination • IHD • National cath lab database and quality/safety program • Development of CPGs and performance measures

  6. New and Ongoing Challenges • Many new opportunities for involvement – “which to choose?” • Necessity to cultivate long-term relationships (as opposed to one-off projects) • Increasing administrative overhead, e.g., IRBs, data access/security/privacy • Programs sponsored directly by VISNs and program offices, i.e., bypassing HSR&D Svc. • Increasingly demanding projects and greater sophistication of leadership

  7. Blurring Boundaries System Redesign HSR&D HSR&D QuERI QuERI Operations Operations Quality/ Safety

  8. Looking Forward • Research must actively engage health system • Energy and resources focused on transformational initiatives for present and foreseeable future • New models of “integrated” research • Evaluation “platforms” • Opportunities for “structural” evaluation

  9. Looking Forward • Establishing durable partnerships • Understanding organizational relationships (formal and informal) • Understanding operational mechanisms • Maintaining proper balance between: • Service & science • Prosaic & productive • Risk & reward

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