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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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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

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


Queri s relationship to hsr d and operations

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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