One size does not fit all in health care. No two Veterans are alike, nor are any two VA medical centers or community-based outpatient clinics (CBOCs). Decisions in healthcare delivery too often are based on average effects. Current guidelines and performance measures often recommend prescribing the same treatments to many different types of patients based on the average result of a clinical trial without considering important differences between patients. This proposed QUERI builds on an extensive body of work by the VA Center for Clinical Management Research (CCMR, a VA HSR&D COIN) and the Diabetes QUERI on individualizing prevention strategies and treatments to improve the effectiveness of care delivered to Veterans. The overall Impact Goal of our proposed QUERI is to improve prevention and management of chronic conditions by supporting Veterans and providers in making personalized healthcare decisions that take into account individual patient risk and preferences. Through this goal we aim to improve appropriateness of care (decrease overuse and underuse), increase Veteran engagement in their health care, and enhance Veteran experiences. This goal aligns directly with the Blueprint for Excellence Strategy Six: Advance healthcare that is personalized, proactive, and patient-driven, and engages and inspires Veterans to their highest possible level of health and well-being.
The specific aims for our QUERI program include the following: 1. Implement patient-centered performance management systems that enhance appropriateness of care and incorporate shared decision-making. 2. Implement personalized self-management programs for promoting health and preventing disease. Our QUERI program will include the following projects beginning in year 1: Project #1: This project will include the implementation and evaluation of a shared-decision making tool for lung cancer screening in collaboration with VA's National Center for Health Promotion and Disease Prevention (NCP) and the Office of Primary Care. The evidence-based tool has been developed and pilot tested at the Ann Arbor VAMC and will be disseminated to the eight VAMCs that are currently participating as pilot sites in NCP's national Lung Cancer Screening Demonstration project. Project #2: In this project we will work with NCP and VA's Office of Analytics and Business Intelligence (OABI) to improve dissemination of the new MOVE! guidelines, with the goal of reducing wide local variation in the effectiveness of MOVE! and maximizing personalized weight management support for patients in a group setting. Local QI Initiative: This project will implement and evaluate a performance management tool for improving statin use in the Ann Arbor VAMC that is personalized to individual patient risk factors. Implementation Core: This core will focus on using the Consolidated Framework for Implementation Research (CFIR) to collect and analyze data on context across studies, both for this QUERI and in collaboration with at least five other QUERI programs (if they are funded) to determine the association between context and implementation success. Our implementation strategies for all projects will incorporate systems redesign techniques (in collaboration with VA's Center for Applied Systems Engineering) with use of a tailoring tool (the Barrier Busters Tool) that will help local teams chose appropriate implementation strategies based on features of local context.
Through our proposed QUERI, we envision more effective, targeted approaches to healthcare delivery that incorporate individual patient data and preferences. Anticipated impacts include improved quality of care; more efficient use of scarce clinical resources; increased patient satisfaction with care; and increased patient engagement in care.
