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Announcing Three New Advancing Diversity in Implementation Leadership Awardees!

Jessica Faiz, MD, MSHPM, of HSR’s Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), is working on the ADIL project “Assessing Practices and Equity in Care Recommendations and Receipt in VA’s Tele-Emergency Care Program.” VA’s Tele-Emergency Care (TEC) service provides Veterans with on-demand virtual access, via a nurse triage line, to emergency medicine physicians or advanced practitioners. Preliminary data has shown TEC’s potential value for decreasing Veteran hospitalizations and community care spending. However, TEC recommendations (e.g., orders, referrals, medications), their completion, and the potential impact of social drivers of health (SDOH) on recommendation completion, have not been examined. This ADIL, to be conducted with mentorship and support from QUERI’s LEARN Evidence Based Policy Evaluation Center, will:

• Characterize TEC recommendations and determine Veterans’ receipt of recommended care for chronic ambulatory care-sensitive conditions (ACSCs): asthma, chronic obstructive pulmonary disease, heart failure, diabetes, and hypertension.
• Assess potential variations in TEC recommendations for ACSCs, and care receipt, by Veteran demographic and neighborhood SDOH.
• Explore how Veteran knowledge and perceptions of TEC recommendations and SDOH may influence Veteran care receipt.

This work was designed and will be conducted in partnership with the VA National Emergency Medicine Office and VISNs 2 and 22 TEC leaders. It aligns with VA priorities to connect Veterans to the soonest and best care, and reduce health disparities for underserved, marginalized, and at-risk Veterans. Dr. Faiz’s primary mentor for the project is Dr. Kristina Cordasco of QUERI’s LEARN Center.

Agatha Palma, PhD, of HSR’s Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), is working on the ADIL project “Improving Community Integration for Veterans Engaged in Time-Limited Case Management Services.” VA’s “Aftercare” program provides six months of case management for homeless-experienced Veterans (HEVs) as they transition from institutions to community-based independent living. In response to the high rates of returns to homelessness during these transitions, the Housing Transitions QUERI (HT QUERI) is implementing Critical Time Intervention (CTI), a six-month case management practice that links HEVs to community-based resources specific to their housing needs and recovery goals, at 32 Aftercare sites. Though CTI effectively decreases days spent homeless, little is known about CTI’s impact on HEVs’ community integration or social support after case management ends — both of which are critical to HEVs’ well-being.

This ADIL seeks to augment HT QUERI by examining and advancing CTI implementation in Aftercare to improve community integration for HEVs. Among its aims are to:

• Characterize physical, social, and psychological integration of HEVs at Aftercare sites that implemented CTI.
• Identify factors relevant to HEVs’ community integration outcomes, which will impact HEVs’ health and well-being.
• Identify ways to enhance CTI that may improve community integration in Aftercare, and augment HT QUERI’s implementation playbook to reflect these adaptations.
• Ensure that case managers have the tools to help HEVs build enduring links to formal (e.g., providers) and informal (e.g., family, friends) sources of emotional support.

This project aligns with VA’s priority to reduce Veteran homelessness and ensure that more at-risk Veterans receive early interventions, partnerships, and supportive services to avoid homelessness. Dr. Palma is being mentored by Drs. Sonya Gabrielian and Erin Finley, who are with CSHIIP and are primary investigators and co-investigators on HT QUERI.

Camilla Cummings, PhD, of HSR’s Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), is working on the ADIL project “Enhancing Health Outcomes Among Homeless-Experienced Veterans in Permanent Supportive Housing on the West Los Angeles VA Campus.” Homelessness is associated with poor health, chronic and complex health conditions, and high healthcare costs due to a reliance on acute care. Permanent supportive housing (PSH; subsidized permanent and independent housing with field-based supportive services) improves housing outcomes among persons experiencing homelessness. However, evidence is mixed on how PSH affects health service use and health outcomes. Additionally, fragmentation of health and housing services has resulted in few tested and scalable models to enhance health in the PSH context. Although VA has implemented a plan to address Veteran homelessness in Los Angeles by developing PSH on its West LA (WLA) campus, efforts to assess these homeless-experienced Veterans’ (HEVs) health service utilization, access to care, and health outcomes have not been initiated.

This ADIL project — an adjunct to QUERI’s Leading Evaluations to Advance VA’s Response to National Priorities (LEARN) Evidence-Based Policy Evaluation Center — seeks to conduct a mixed methods health-focused needs assessment of Veteran participants in PSH located at VA’s West LA campus, aiming to:

• Characterize acute care (Emergency Department visits and hospitalizations) and outpatient (primary care, mental health, and substance use disorder) service utilization among HEVs housed in PSH on the West LA campus.
• Identify unmet care coordination and health service needs among HEVs housed in PSH on the West LA campus, and Veterans’ preferences to address these needs.

This ADIL project aligns with VA’s priorities to ensure equity and access for underserved, marginalized, and at-risk Veterans, and reduce Veteran homelessness. Dr. Cummings is being mentored by Dr. Sonya Gabrielian of CSHIIP.