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New QUERI Partnered Evaluation Initiatives

QUERI Partnered Evaluation Initiatives (PEIs), co-funded by operations partners, evaluate programs or policies that align with national VA priorities and have the potential to significantly impact Veteran healthcare. Working with VA partner offices, QUERI recently co-funded two new PEIs that address high-priority topics in VA:

• Integrating Comprehensive Tobacco Treatment to Enhance Lung Cancer Screening (ICARE-LCS). Lung cancer is the leading cause of cancer-related death among Veterans. Lung cancer screening (LCS) with annual CT scans decreases deaths in high-risk current and former smokers through early detection. As up to 58% of LCS participants are smokers, integrating tobacco dependence treatment (TDT) in LCS significantly increases the benefits of the screening itself. However, integrating TDT in LCS is complex, and VA data shows poor use of TDT at the time of LCS initiation, with only 16% of smokers receiving cessation-related medications and even fewer receiving the recommended combination of behavioral and pharmacologic treatment (“combined TDT”).
  
  In partnership with VA’s Oncology and Precision Medicine (OPM), the Tobacco Use Treatment National Program office (TUT), and the National Center for Lung Cancer Screening, Anne Melzer, MD, is leading a QUERI Partnered Evaluation Initiative (PEI) to inform efforts to improve TDT in LCS programs. The evaluation will build on the results of a current TUT “Cancer Moonshot” pilot that demonstrated the feasibility of combining TDT and LCS. This evaluation aims to identify key components of effective tobacco treatment programs in LCS and success factors for providing combined TDT; test multicomponent facilitation to improve integration of TDT and LCS; and evaluate the feasibility, acceptability, fidelity, appropriateness, and cost of implementing TDT integrated with LCS. This project will feature a multi-phased evaluation using implementation science to support OPM’s goals of increasing high-quality LCS and leveraging VA’s Lung Precision Oncology Program as a learning health system. It addresses VA’s goals of providing Veterans with the soonest and best care and serving Veterans with deployment-related exposures, and addresses tobacco treatment — a key priority identified by several Veteran engagement groups. Its goal is to support rapid uptake of the highest impact TDT processes, making best use of the considerable investment VA has made in LCS programs and tobacco treatment.

• Implementation and Cost-Effectiveness of VA Clinical Pharmacy Practitioners: Extending Headache Care Access (EXTEND). The Implementation and Cost-Effectiveness of VA Clinical Pharmacy Practitioners: Extending Headache Care Access QUERI Partnered Evaluation Initiative (PEI) targets Veterans’ limited access to timely, high quality, headache-specific neurology care by focusing on the implementation and cost-effectiveness of headache care delivery via VA clinical pharmacy practitioners (CPPs). CPP-delivered headache care may extend access to headache-specific neurology services and specialty care while decreasing neurology wait times and increasing cohesion in care across clinicians and services.
  
  The evaluation team, led by Senior Research Career Scientist Awardee Teresa Damush, PhD, is collaborating with VA’s National Headache Centers of Excellence (HCoE), an initiative that establishes and supports VA clinical infrastructure and programs to deliver and improve headache care access and quality. EXTEND aims to conduct a formative evaluation of the implementation of CPPs as extenders of VHA headache care in five VA medical centers (VAMCs) with HCoEs and five VAMCs without HCoEs. The EXTEND team will examine Veterans’ experiences with CPP-delivered headache care, including barriers and facilitators to access, acceptability, and impact on health-related quality of life as well as provider perceptions of appropriateness, acceptability, and feasibility of CPP-delivered headache care. The team will also evaluate the cost-effectiveness and budget impact, from a VHA perspective, of CPP-delivered headache care compared to neurologist-delivered headache care.
  
  Identifying implementation facilitators and challenges across the clinical service contexts of primary and specialty care services will inform HCoE quality improvement and the future spread of CPP-delivered headache care. This work aligns with VA priorities to provide the soonest and best care, and examines new delivery models at organizational, team, and provider levels for headache diseases.