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Special 25th QUERI Anniversary Issue!
Amy Kilbourne, PhD, MPH, Director of QUERI
For 25 years, QUERI has sought to accelerate the implementation of research evidence into practice to improve the health and care of Veterans. By funding more than 200 VA scientists and staff, QUERI supports peer-reviewed, rigorous national quality improvement initiatives across the U.S., and supports thousands of VA employees in implementation and evaluation best practices so these initiatives can be sustained over time.
Along that journey, QUERI has been a key player in the growth of implementation science—or the study of methods that improve the uptake of science into real-world practice, in addition to promoting greater interest in “embedded” or patient-, provider- and community-engaged science. Implementation science is finally getting its due through recent publications in JAMA (Rubin, 2023) and Science (Proctor, 2021). Funding agencies, such as the National Institutes of Health (NIH) and the Patient-Centered Outcomes Research Institute (PCORI), are also following VA’s lead and requiring implementation science components within research, to ensure effective treatments ultimately get into the hands of patients and the providers who care for them more quickly and effectively.
Not surprisingly, QUERI investigators are increasingly in high demand, driven in part by new VA research priorities that require implementation plans for clinical trials, as well as the expansion of implementation science across other funding agencies. In the federal government, new laws (i.e., Evidence Act) require Cabinet-level agencies, including VA, to justify programs and policies using evidence and evaluation. This new focus on evidence-based policy also requires strong implementation science methods to ensure feasibility, fidelity, and sustainment of programs and policies in the real world. Not surprisingly, QUERI has a prominent role in supporting VA’s fulfillment of this legislative mandate.
The 17-year gap between evidence and practice has been quoted widely as a key reason for implementation science. But why the focus on implementation ”science” when we can simply implement medical treatments? Rigorous study of the implementation of an effective treatment, program, or policy is needed because changing people’s behavior, especially given “unfunded mandates,” can be complex, multi-level, and sometimes counterintuitive. An effective treatment, program, or policy is only as good as a clinic’s capacity to adopt it, a provider’s willingness to use it, and a patient’s acceptance of it. Hence, funding organizations, such as VA’s Health Services Research and Development (HSR&D) service, lead the empirical research to determine the optimal timing, intensity, and levels of behavior change (i.e., implementation) strategies that promote effective treatment uptake (or help de-implement low-value care). QUERI then applies this knowledge to improve the uptake and sustainment of new treatments so that they reach patients more efficiently on a national scale.
This work is not easy and requires coalition-building across multi-level interested parties – and among leaders, frontline providers, and Veterans and their communities to build trust and motivate and inspire change. Moreover, new and effective innovations are often in competition with an idealized version of what the innovation is replacing.
Nonetheless, despite challenges faced with implementation, QUERI investigators have made substantial impacts on improving Veteran care. This includes disseminating 100+ effective healthcare practices to over 5.3 million Veterans, reaching more than 27,000 VA providers and staff, in partnership with 100+ national program office and VISN partners.
The future for QUERI will be exciting, with the growth of new technologies, partnerships, and policies that can enhance implementation science. The increased demand for implementation science training and learning opportunities will also be challenging for our scientists, especially with increased interest from VA and the NIH to build implementation science capacity across the translational spectrum. Having one foot in research and one in practice has been QUERI’s secret sauce over the years, as it ensures rigorous but rapid practice change. To this end, we want to extend a special thanks to our QUERI scientists and staff, as well as to our VA local, regional, and national leaders, managers, frontline providers, and Veterans and community partners who have made our work possible over the last quarter century. We look forward to the next few decades of QUERI innovation!
Amy Kilbourne, PhD, MPH
Melissa Braganza, MPH
QUERI Deputy Director