This is a proposal to establish a Measurement Science QUERI Program with the following Impact Goal: To Integrate Measurement Science into Healthcare for Veterans. This goal supports strategic priorities at all levels of the Department of Veterans Affairs and directly aligs with Strategy 3 of the Veterans Health Administration (VHA)'s Blueprint for Excellence: Leverage information technologies, analytics, and models of health care delivery to optimize individual and population health outcomes. Measurement Science (defined as the theory, practice and application of suitable metrics) is at the core of VHA's Learning Healthcare System and a critical component at every stage of the quality improvement and implementation process. Using system- wide data to promote performance measurement, improvement efforts, and electronic tools such as reminders and decision support depends entirely on the uniformity of those metrics, the efficiency with which they can be obtained, and the accuracy with which they have been measured. Whenever a healthcare decision is made, be it for an individual patient encounter or in the Office of the Undersecretary for Health, we must ensure that this decision is based on valid and reliable data that are linked with all relevant information. Without meaningful metrics, quality improvement and implementation of evidence-based therapies cannot be accomplished. The Measurement Science QUERI Program will work with VHA operational partners to:
(Aim 1) promote standardization of VHA data through use of a Common Data Model;
(Aim 2) conduct two high-priority quality improvement and three implementation science projects;
and (Aim 3) speed dissemination of research into practice through training programs for healthcare providers. The five projects in Aim 2 will: (1) improve quality assessment of colonoscopy; (2) expand integrated pain management programs; (3) evaluate implementation strategies for home-based cardiac rehabilitation; (4) expand use of telephone cognitive-behavioral therapy for insomnia; and (5) improve measurement of functional status. These projects are united by a need to identify and clearly define standardized metrics that will facilitate tracking of future benefits (or harms). The Measurement Science QUERI will also include a unique training component (Aim 3) that will accelerate the dissemination of evidence-based therapies into practice by integrating an implementation science curriculum into training programs and involving health professional trainees in quality improvement projects. This will not only increase motivation to engage in continuous quality improvement but will accelerate the implementation of evidence-based practices by providing trainees with the skills to become future leaders in these areas. The Measurement Science QUERI Program is broadly supported by partners in the Office of Informatics and Analytics (see letters from Jonathan Nebeker MD MS, Stephan Fihn MD MPH, and John Quinn), the VA Informatics and Computing Infrastructure (see VINCI letter from Scott Duvall PhD and Michael Matheny MD MS MPH), Patient Care Services (see letters from Jason Dominitz MD and John Rumsfeld MD PhD), Geriatrics and Extended Care (see letter from Kenneth Shay DDS MS), Mental Health Services (see letters from Andrew Pomerantz MD and others), and Academic Affiliations (see letter from Stuart Gilman MD MPH) as well as VISN 21 (see letter from Mary Anne Johnson MD) and the University of California Clinical and Translational Sciences Institute (see CTSI letter from Jennifer Grandis MD and Deborah Grady MD MPH). The purpose of this work is to demonstrate how QUERI can assist operational partners promote more rapid translation of evidence-based therapies into practice.
This is a proposal to improve and streamline the measurement of health care quality. How do you know whether your doctor has done a thorough colonoscopy? Can you be sure that your doctor did not miss a small tumor? How would you measure this anyway? These are the kinds of questions that can be answered using Measurement Science (the application of suitable metrics). The VA Healthcare Modernization Study (released by the Office of Management and Budget in 2014) provided 4 recommendations: (1) Improve quality of care; (2) Improve access to care; (3) Improve the Veteran experience; and (4) Increase efficiency. Measurement Science can achieve all of these goals. First, it can improve quality of care by tracking quality measures and providing feedback to providers. Second, it can improve access to care by accurately assessing wait times and appointment availability. Third, it can improve the Veteran experience by providing information about health care options. Fourth, it can increase efficiency by eliminating tedious and repetitive work for providers.