Evidence-based Policy Impact Center (EPIC) QUERI

Va Boston Health Care System, Boston MA

Investigators

Abstract

The Evidence-based Policy Impact Center (EPIC) QUERI, consisting of experienced QUERI Program, Partnered Implementation Initiative, Partnered Evaluation Initiative, Rapid Response Team, and HSR&D COIN and CORE leaders, is poised to address a number of wide-ranging VA policy and evaluation priorities in response to the Foundations for Evidence-based Policymaking Act of 2018 (Evidence Act). Our proposal identifies four priority subject matter areas and two evaluation priorities for immediate attention: 1) suicide prevention initiatives for Veterans and transitioning servicemembers, and 2) effectiveness and implementation of programs to eliminate homelessness among Veterans. Since 2019, VA has taken numerous steps to become a High Reliability Organization (HRO). However, it is not yet clear whether the programs implemented across the VA to address suicide prevention and homelessness, among other priority areas, include HRO principles, such as sensitivity to operations, appreciating the complexity of healthcare, looking for opportunities for improvement, valuing insights from experts, and practicing resilience. Building on Learning Health System competencies of scientific evidence standards, methods, informatics, improvement and implementation science, and engagement with leadership, EPIC QUERI has developed robust evaluation plans to immediately examine national suicide prevention and homelessness initiatives. In addition to strengths in operations, methods, and knowledge translation, EPIC QUERI brings a unique perspective to the Evidence Act by creating 1) a workforce development core building on Office of Personnel Management evaluation competencies, and 2) a diversity, equity, and inclusion initiative with local universities to create a workforce development pipeline. Our workforce development core will design, deliver, and evaluate a professional workforce development program that focuses on providing mentored VA, QUERI, QI, and evaluation experience to master’s level research staff; and recruit, retain, and mentor a range of diverse, master’s-level staff with on the job evaluation experience with incoming projects for the EPIC QUERI. Guided by the QUERI Implementation Roadmap and engaging closely with the Office of Mental Health and Suicide Prevention (OMHSP) and the Homeless Programs Office (HPO)/National Center on Homelessness among Veterans (NCHAV), our proposed evaluations will examine the data to knowledge (pre-implementation), knowledge to performance (implementation), and performance to data (sustainment) capacity of Public Law 116-171, Section 201 Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program and the HPO iPad and iPhone outreach to homeless Veterans during COVID-19. Each evaluation’s specific learning agenda and evaluation question will be unique; however, our overall specific aims are as follows: Aim 1: Identify pre- implementation barriers to adopting evidence-based practices (EBPs), policies, and implementation strategies across VA; Aim 2: Evaluate the implementation of EBPs, policies, and implementation strategies; and Aim 3: Ensure sustainment of our EBPs and policies through ongoing program planning and stakeholder engagement with operational partners. Each evaluation begins with a logic model, incorporating RE-AIM and Proctor’s Implementation Outcomes Framework. Our Methods Core consists of SMEs in health system engineering, quality improvement, implementation science, policy analysis, demography, health economics, psychometrics and survey design, and rapid ethnographic and qualitative analysis. Primary outcomes will focus on pre- implementation (acceptability, appropriateness, feasibility), implementation (reach, effectiveness, adoption, and implementation metrics, such as number of facilities where implementation occurred, number of staff trained and Veterans served, and implementation strategies used, as identified in the QUERI ACTION Framework), and sustainment (maintenance metrics). These outcomes will assist VA leadership in understanding the value of implementation and quality improvement investments to inform program and policy decisions.