Talk to the Veterans Crisis Line now

QUERI – Quality Enhancement Research Initiative

QUERI Enhances Partnered Research Efforts

Q-News Header

» Back to Table of Contents

QUERI Enhances Partnered Research Efforts

VA's Office of Specialty Care Services/Office of Specialty Care Transformation (SCS/OSCT) has launched four initiatives to improve access to and delivery of specialty care, including: 1) E-Consults - consultations requested and completed via VA's electronic health record; 2) Specialty Care Access Network-Extension for Community Health Outcomes - "real time" tele-video consultations between specialists and primary care providers across outlying clinics; 3) Specialty Care Neighborhood - team-based specialty care targeted toward Veterans with the greatest specialty care needs; and 4) Mini-Residency Program - training primary care providers for a given condition or specialty. OSCT and QUERI have collaborated to fund Partnered Evaluation Centers that will assess the implementation and impacts of these four initiatives. The following articles discuss two of these newly funded Centers.


VA's national Office of Patient-Centered Care and Cultural Transformation (OPCC&CT) is charged with transforming the current medical model of healthcare delivery in VHA - from "find it, fix it" disease care to a personalized, proactive approach that is driven by the individual needs of the Veteran. But exactly how the patient-centered care (PCC) model is best implemented - or how innovations are reflected in patient outcomes, has been unclear. Thus, the Center for Evaluating Patient-Centered Care in VA (EPCC-VA), under the directorship of Barbara Bokhour, Ph.D., has been funded by OPCC&CT and QUERI to evaluate the impact of a wide range of patient-centered care innovations and to evaluate the process of PCC cultural transformation.

Now in its third year, EPCC-VA seeks to improve our understanding of exactly what pathways the transformation to patient-centered care takes, given the wide range of initiatives already underway in the VA healthcare system. In 2013 and 2014, Dr. Bokhour and her team visited VA Centers of Innovation (COIs) in Texas and New Jersey to talk with providers and patients about their experiences with patient-centered care, how it is implemented, and how it has impacted patient health outcomes. The team also administered patient surveys at several COIs, assessing the intersection of patient-centered care and eHealth initiatives, such as secure messaging, and investigating the role of organizational factors in implementing patient-centered care.

Lessons learned have been brought to other VA medical centers to help facilitate the transformation to patient-centered care nationally. White paper deliverables to OPCC&CT include results that are "actionable," including specific tools such as a guide to patient-centered secure messaging. In addition to presenting findings at COI meetings, EPCC-VA works with OPCC&CT to develop toolkits that address barriers and facilitators to implementing PCC approaches, which are disseminated to patient-centered care coordinators and providers. EPCC-VA also joins working groups and committees, such as the Personal Health Inventory Workgroup, ensuring that data informs the iterative planning process, and that the OPCC&CT/EPCC-VA partnership continues at each stage of the process.

Work for FY2015 is already underway. Highlights include a study of the implementation of the Personal Health Inventory; a national study of barriers and facilitators to implementing PCC; an analysis of the PCC-related questions on the All Employee Survey; and a study examining the implementation of complementary integrative medicine. EPCC-VA also is working to develop an evaluation toolkit for facilities to assess the impact of PCC practices, and is leading a pilot project to establish a registry to examine the impact of integrative medicine therapies on patient-reported outcomes.

For more information about EPCC-VA, contact Barbara Bokhour (, Senior Health Research Scientist at HSR&D's Center for Healthcare Organization and Implementation Research (CHOIR).


The VA Office of Patient-Centered Care and Cultural Transformation (OPCC&CT) was charged with transforming the VA healthcare system from a provider-centric model to one that focuses on the patient, and provides personalized, proactive, patient-driven healthcare to meet the needs and preferences of Veterans and their families. To catalyze this shift in VA culture, OPCC&CT designated several VA hospitals as "Centers of Innovation" (COIs), which would roll out innovations in line with the principles of patient-centered care (PCC), such as environment of care changes, personalized health planning, and integrative medicine.

The Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), directed by Sherri LaVela, Ph.D., M.P.H., M.B.A., was funded by OPCC&CT and QUERI to understand if and how PCC innovations impacted Centers of Innovation. CEPEP aims included evaluating the implementation and sustainability of patient-centered care at the COIs, and measuring the impact of innovations on patient, family, provider/employee, and facility/organizational outcomes. Key domains that can be used to promote the spread of patient-centered care and cultural transformation throughout the VA healthcare system were identified as:

  • Role of leadership,
  • Enculturating staff,
  • Engaging Veterans and families,
  • Fostering innovations,
  • Staff roles and priorities,
  • Organizational structures and processes, and
  • Environment of care.

The CEPEP evaluation generated valuable data on participant (patient, employee) perspectives, and may be incorporated into future quality improvement initiatives and care design strategies to ensure that future efforts consider and reflect what is most important to Veterans. One of these methods was Photovoice - a novel participatory data collection method used for the CEPEP evaluation, in which Veterans were given cameras and asked to tell stories of their experiences with patient-centered care during their VA healthcare via photographs and follow-up interviews. Through Photovoice, investigators found several key factors that influenced Veterans' views of PCC, including communication and relationships with providers and staff, accessibility of care, and physical and social environments of care. Moreover, using Photovoice with employees, investigators found that most generally reported being satisfied with VA and their work environment, but wanted additional training and professional growth opportunities, as well as employee health and wellness initiatives to enhance their employee experience.

Several extension projects developed from this work, including a project to asses impacts related to Integrative Health Coaching (IHC) on Veterans who are homeless. Medical chart review data indicated that a lesser proportion of Veterans had an episode of homelessness (6% vs. 25%), and a greater proportion were in school (students) (19% vs. 3%) after receiving IHC than before. These findings suggest that using IHC with homeless Veterans may result in improved outcomes, including decreased episodes of homelessness, and may help engage this cohort in accomplishing important life goals (e.g., further education).

For another extension project, Dr. LaVela drew from her years of experience as a Spinal Cord Injury (SCI)-QUERI investigator and built upon CEPEP work to understand PCC delivery, in the form of empathy and therapeutic relationships with providers, from the perspective of Veterans with SCI. Less than half (47%) had Consultation and Relational Empathy (CARE) scores that were above the normative values. These findings suggest that there is room for improvement in one or more facets in the healthcare delivered to Veterans with SCI, such as consultation content/quality, and better communication in the patient-provider relationship.

For more information, please contact Dr. LaVela at Dr. LaVela is a Senior Research Health Scientist for SCI-QUERI and HSR&D's Center of Innovation for Complex Chronic Healthcare (CINCCH).


This Journal of General Internal Medicine (JGIM) Supplement focuses on partnered research, which has been defined as "activities where researchers and practitioners work together, with different roles, to use research both to solve practical problems and to contribute to science." HSR&D and VA's Quality Enhancement Research Initiative (QUERI) have made major efforts to enhance partnered research in order to produce relevant research that is more likely to have an impact on the health and care of Veterans. In this Supplement, 12 articles describe partnered research at various stages-and cover a wide range of topics highly relevant to VA policy and practice, including impact of performance measure implementation on provider motivation, opioid management, suicide prevention, homelessness, medical home models, and communication of adverse events. The majority of the papers in the Supplement describe partnerships with program offices within VA, while others focus on more field-based partnerships; for example, with one or more of the 21 Veterans Integrated Service Networks (VISNs) and/or local VA medical centers, closer to the point of patient care.

CITATION: Journal of General Internal Medicine (JGIM) Supplement. December 2014;29(4 Suppl):1525-1497.

*(Full text is available from within the VA network or via VPN connection. Non-VA readers will only have access to the full text if they are SGIM members or subscribers to JGIM.)


The goal of the QUERI Rapid Implementation Supplements for Operations & Methodological Enhancements (RISOMEs) RFA is to promote promising initiatives involving VA and non-VA partners that ultimately inform implementation and quality improvement strategies that will improve healthcare for Veterans. An initial call for RISOME applications was sent out in the fall in response to recommendations from the QUERI National Evaluation, conducted by HSR&D's Center for Implementation Practice and Research Support (CIPRS). RISOMEs were designed to specifically address the need for cross-cutting implementation initiatives, and to speed up the research-into-clinical practice cycle.

QUERI reviewed 52 RISOMEs applications in October, 2014. Priority was given to proposals that were most aligned with priority goals from the updated QUERI National Strategic Plan, with a focus on speeding the research cycle, increasing impact, and promoting implementation science. Priority also was given to proposals that would forge time-sensitive partnerships across VA or non-VA organizations/national programs in response to VHA priorities (e.g., Blueprint for Excellence), and that had the potential for further spread and promotion of national implementation studies. The following RISOMEs have been approved for funding:

  • Cross-QUERI Resource Center for Improving Prescribing Practices
    Principal Investigator: Alex Sox-Harris, Ph.D., Substance Use Disorders-QUERI Principal Partners: Cross-QUERI Partnership
  • Develop a Tool for Tailoring Implementation Strategies
    Principal Investigator: Laura Damschroder, Ph.D., Diabetes-QUERI
    Principal Partners: Cross-QUERI Partnership
  • Evaluation and Implementation-Collaborative Group Focused on Sustained Improvement in the Cost and Quality of Cancer Care in VHA
    Principal Investigator: Jeff Whittle; M.D., Ischemic Heart Disease-QUERI
    Principal Partners: VA Oncology and The American Legion
  • Identifying Specific Non-VHA Healthcare with the Mental Health Research Network
    Principal Investigator: Laurel Copeland, Ph.D., Central Texas VA Health Care System
    Principal Partner: HMO Research Network
  • Infrastructure for Improvement in Community Living Centers
    Principal Investigator: Anne Sales, Ph.D., HSR&D's Center for Implementation Practice and Research Support (CIPRS)
    Principal Partners: Inpatient Evaluation Centers and VISNs (Veterans Integrated Service Networks)
  • Methodological Enhancement for the Construction of Business Case Analyses
    Principal Investigator: Dawn Bravata, M.D., Stroke-QUERI
    Principal Partners: Veterans Engineering Resource Center (VERC) and HSR&D's Health Economics Resource Center (HERC)
  • Predicting VHA Reliance of High-Risk Patients in PACTs for Intensive Management
    Principal Investigator: Julia Prentice, Ph.D., VA Health Care Financing & Economics (HCFE)
    Principal Partner: VA Patient-Aligned Care Team (PACT)
  • VA ACHIEVE to Improve Care Transitions and Reduce Readmissions
    Principal Investigator: Paul Heidenreich, M.D., M.S., Chronic Heart Failure-QUERI
    Principal Partner: Patient-Centered Outcomes Research Institute (PCORI)
  • VA Quality Scholars National Practicum to Bring Veterans' Voices to Choosing Wisely Conversations
    Principal Investigator: Aanand Naik, M.D., HSR&D's Center for Innovations in Quality, Effectiveness and Safety (IQuEST) Principal Partners: VA Quality Scholars Fellowship Program (NQSFP), and the Office of Specialty Care Services (SCS)

Approved RISOME projects transcend a number of topics critical to improving the health and care of Veterans, including care transitions, aging, population health, and chronic illness, as well as methods such as implementation strategy operationalization, business case analysis, practice-based implementation networks, and/or intramural research opportunities.