Colorado PROFILES, The Colorado Clinical and Translational Sciences Institute (CCTSI)
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Triple Aim QUERI Program

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? DESCRIPTION (provided by applicant): PROJECT SUMMARY The goals of our Triple Aim QUERI Program are to leverage healthcare data to identify actionable care gaps, and to implement innovative healthcare delivery interventions to improve the Triple Aims of VA health care. Our QUERI Program and projects address one or more Triple Aim dimensions including: improving the patient care experience; improving the health of populations; and reducing per capita costs of care. Our QUERI program addresses Blueprint for Excellence strategies: #2a (VHA will aspire to the Triple Aim), #3 (leverage information technologies, analytics, and models of health care delivery to optimize individual and population health outcomes) and #7h (rapidly translate research findings and evidence-based treatments into practice). The Practical, Robust Implementation and Sustainability Model (PRISM) framework will serve as an overarching implementation model for our QUERI program to create consistency, translatability, and evaluability across our projects. To improve the Triple Aim dimensions, we will utilize an implementation strategy that leverages data to identify actionable health care gaps and tests the impact of audit and feedback only versus audit and feedback plus facilitation to improve these gaps. We have defined a range of analytic tools comprised of quantitative, qualitative and quality improvement methods to identify gaps in care. Then, we will test an increasing intensity of implementation strategies comprised of audit and feedback (small to moderate effects for health care improvement) versus audit and feedback plus facilitation (moderate sized effects for health care improvement) to improve care. Our program aims include: Aim 1: Leverage data to identify actionable care gaps and test an implementation strategy informed by PRISM domains of audit and feedback only versus audit and feedback plus facilitation to improve healthcare gaps. Aim 2: Evaluate the impact of the implementation strategies across projects and identify overarching learnings using the RE-AIM (reach, adoption, effectiveness, implementation, maintenance) measures. Aim 3: Create an interactive implementation toolkit and dissemination strategies that provides guidance on audit and feedback and facilitation strategies and implementation resources for broader dissemination. We are proposing projects that address clinical issues or scenarios that are prevalent (e.g., chronic pain and medication non-adherence) or high cost (percutaneous coronary intervention (PCI) and Veterans with hospitalizations outside of VA) to VHA. For example, chronic pain affects ~50% of Veterans and ~50% of patients are non-adherent to their chronic medications; and VHA spends ~170 million dollars on over 10,000 PCIs per year nationally and the VA Eastern Colorado Health Care System spent~33 million in FY14 for hospitalizations outside of VA for 2,341 Veterans. Across our projects, we apply the same methodology of leveraging data to identify actionable care gaps and will work with our operational partners to implement interventions to address the care gap. These projects represent test cases and the resulting approaches can be applied to other clinical conditions/scenarios. Our operational partners include: Office of Specialty Care, National Pain Management Program, National Cardiology Program, CART Program, Office of Analytics and Business Informatics, Office of Quality, Safety and Value, VA Eastern Colorado Health Care System, Office of Rural Health, National Pharmacy Benefits Management, and VISN 19 Chief Pharmacy Officer.
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