Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Quality Enhancement Research Initiative

QUERI E-news
October 2022

» Table of Contents

Director's Letter

The symbiotic relationship between research and quality improvement: QUERI’s implementation of a Learning Health System

Amy Kilbourne, Ph.D., M.P.H., Director of QUERI

Amy Kilbourne, PhD, MPH, Director of QUERI

Researchers need implementation experts to take their effective innovations to scale and evaluate the impacts to further inform program quality improvement and, ultimately, policies that improve Veteran health. For more than 20 years, QUERI’s organizational home has been in VHA’s Office of Research and Development (ORD) for good reason—to ensure scientifically supported innovations get into the hands of Veterans who need them, and to support frontline providers using strong quality improvement methods to facilitate this process. QUERI’s funding source (clinical services) also enables QUERI to serve as a bridge that strengthens partnerships between research and operational partners.

This symbiotic relationship between researchers and practitioners is essential to not only close the persistent gaps between research and real-world practice, but to enable new discoveries that happen when implementation occurs. Providing effective innovations can often confront unintended consequences, such as barriers to uptake or new operating challenges, but it can also lead to new opportunities such as innovations in practice redesign or new treatment discoveries. As a result, QUERI adopted a continuous learning cycle to replace the former pipeline it once used to move research into practice (Friedman 2022; Kilbourne 2019).  

Research knowledge, infrastructure, and governance, in turn, ensures continuous improvement and support of innovations and discoveries through QUERI activities. For example, QUERI relies on scientific review processes used by the National Institutes of Health (NIH) to ensure the highest quality implementation and evaluation initiatives, and once executed, the data ascertainment curation and validation from informatics and qualitative methods developed through HSR&D. Researchers training in strong implementation and evaluation methods also originate from HSR&D and ORD’s extensive cohort of professional development opportunities recently described in a paper on How the VA is training the Next-Generation workforce for learning health systems (

The latest evolution of QUERI is to take the cycle to the next level, informing changes to national policy. In this issue we describe QUERI’s national role as supporting VA’s effort to fulfill the Evidence Act, which requires federal agencies to justify budgets using evidence.

Notably, QUERI is leading the VHA Evidence-based Policy Subcommittee (EBPS), which has a direct reporting line to VHA National Leadership and the Under Secretary’s Office – and represents the first ORD committee to have an official role within the VHA leadership governance. EBPS’s role is to serve as a principal forum for advancing evidence-based policymaking in VA through national evaluations that address the health priorities of Veterans, thereby informing programmatic improvements.

The evolution of QUERI’s role in VHA governance could not have happened without the long-term investments from ORD in health services research, as well as the impacts QUERI investigators have made since its inception in 1998. A key example of this evolution and symbiotic relationship is the research and QUERI work informing implementation and evaluation of effective programs and policies affecting Veterans with opioid use disorder. The Stepped Care for Opioid Use Disorder, Train the Trainer (SCOUTT) initiative was born out of a strong partnership based on the Substance Use Disorder QUERI Center (2000-2015) and subsequent Research and QUERI national centers focused on opioid and pain treatment implementation (e.g., Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment, CONDUIT) with the Office of Mental Health and Suicide Prevention (OMHSP) and the Pain Management, Opioid Safety, and PDMP (PMOP) programs. Other Research-QUERI-Operations partnerships ensued from this symbiotic relationship, notably the HSR&D Pain and Opioid Consortium of Research (CORE), Stratification Tool for Opioid Risk Mitigation (STORM) medication safety dashboard (with investigators from PEPReC and HSR&D CHERP), virtual cognitive behavioral therapy for pain management (COPES: Cooperative Pain Education and Self-management) and TelePain Evaluation Metrics and Pain Outcomes (TEMP). OMHSP and PMOP are continuing implementation of these programs in partnership with QUERI and ORD, informing improved policies to ensure Veterans get access to effective care more quickly.

Ultimately, Research and QUERI work symbiotically to solve complex healthcare problems facing Veterans, tackling different issues while discovering new opportunities for improvement. The future success of this relationship depends on the cultivation of a scientifically savvy workforce, curation of meaningful data that can be harnessed to inform Veteran-centric care improvements, and governance that ensures effective translation of findings into the hands of Veterans and their providers in an ethical manner to improve their overall health.

Amy Kilbourne, PhD, MPH
QUERI Director

Melissa Braganza, MPH
QUERI Deputy Director

» Next