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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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brief history
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.
queri
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
initial challenges
Initial Challenges
  • Developing linkages with leadership and program offices
  • Building data resources
  • Securing resources to support collaborative efforts
queri examples of notable successes
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
new and ongoing challenges
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
slide7

Blurring Boundaries

System

Redesign

HSR&D

HSR&D

QuERI

QuERI

Operations

Operations

Quality/

Safety

looking forward
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
looking forward1
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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