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Amy Kilbourne, PhD, MPH, Director of QUERI

Director's Letter

With bipartisan support, Congress recently passed the Foundations for Evidence-based Policymaking Act of 2018. Known as the Evidence Act, this law impacts all executive branch Cabinet agencies including VA, and requires that all programs within these agencies use data and evidence to justify their budgets – and submit yearly evaluation plans reflecting unmet needs for evidence for their programs. Moreover, the Law improves secure access to data (“open data”) and strengthens privacy protections. Federal agencies are just realizing the enormous potential of the Evidence Act in its ability to promote evidence-based policy, such as ensuring that new programs or policies have scientific support before making budgetary decisions.

QUERI has been a vital part of VA’s quality improvement efforts to implement evidence-based research into routine care for more than 20 years. Our collective expertise can now be used to help facilitate the Evidence Act, particularly through QUERI’s National Partnered Evaluations (NPE) initiative and, more recently, by providing technical support to VA national program offices on developing their evidence-building activities (referred to as “learning agendas” in the Law). Examples of evidence-building activities include:

• Reviews of the strength of evidence for programs;
• High-level policy summaries of how program offices use rigorous practices to make decisions about programs (e.g., through policy briefs coordinated by QUERI’s Partnered Evidence-based Policy Resource Center [PEPReC)]); and
• Processes for selecting and executing high-level program evaluations (e.g., requiring randomized or stepped-wedge implementation designs through the NPE Initiative mechanism).

To this end, QUERI is fulfilling its strategic goal of implementing partner-focused rigorous evaluations informing policy (see QUERI Strategic Plan, 2016-2020), and serving as VA’s trusted third party when it comes to identifying and evaluating the evidence behind the programs so that VA can make sound budgetary decisions over time.

The three articles below showcase QUERI’s deep knowledge of evidence and evaluation to inform VA’s implementation of the Evidence Act across the national network of QUERI programs and centers. For example, through its Center for Evaluation and Implementation Resources (CEIR), QUERI has operationalized a standard implementation process via the QUERI Implementation Roadmap. The Measurement Science QUERI Program has worked on data standardization protocols to enhance the quality of cancer care. Finally, QUERI’s new Implementation Strategy Training Hubs help VA promote a learning agenda through the training of frontline providers in pragmatic implementation science skills. Future activities are likely to involve ongoing evaluation of national programs and policies related to top clinical priorities, through the QUERI-VISN Partnered Implementation Initiatives (PIIs), MISSION Act, and VA’s transition to Cerner [health information and electronic health records (EHR) technologies] under the VA EHR Modernization initiative, which will leverage an existing commercial solution (Cerner Millennium®) to achieve interoperability within VA, with DoD, and with community care providers.

QUERI has a front seat in VA’s deployment of the Evidence Act, which if fully implemented, may lead to a substantial cultural shift in how the Federal Government conducts its business (Hahn R. Science, 2019). Ultimately, QUERI can provide the pathway for investigators to work with operations and community stakeholders to ensure that their programs benefit Veterans—and are fully implemented and sustained over time. In this way, QUERI serves as a trusted third party in helping national programs make important decisions on which programs and policies to invest in to improve Veterans’ healthcare.

Amy Kilbourne, PhD, MPH
Director, Quality Enhancement Research Initiative