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Director's Letter

Melissa Braganza, MPH

We are only in the spring of 2024 and so much has already happened in Health Systems Research (HSR) and QUERI this year. HSR/QUERI strategic planning is in full swing, where we have already gathered feedback from more than 200 clinical, policy, and financial leaders and researchers nationally. We are grateful for all the input and feedback from our partners, and we have begun implementing new changes and enhancing communication strategies with our operations partners and HSR/QUERI-funded investigators and staff.

In February, Network Directors voted on their top priorities for FY24, which were highlighted in our recently released QUERI Global Requests for Applications:

1. Connect Veterans to the soonest and best care: optimize Veteran access to care across in-person, virtual, and community care services.
2. Prevent Veteran suicide: prevent Veteran suicide using a public health approach (e.g., outside the clinic walls, partnerships with community service organizations).
3. Promote a culture of safety, learning, and knowledge translation: implement and evaluate programs focused on innovation, psychological safety, zero harm, and manager/leader training.

We are also excited to release our newest call for proposals: the QUERI Data Science Learning Health System Request for Applications. This QUERI News features two of the awardees from this past Fall who are focused on preventing and ending homelessness and improving geriatrics services. We are hoping to fund additional QUERI teams to deploy learning communities and develop population-based cohort datasets that can help lay the foundation for future evidence generation and evaluation activities addressing key priorities:

• Prevent opioid and related substance use disorders through programs that address the underlying environmental, social, and economic determinants (e.g., employment, education incentives, justice system and incarceration diversion programs) and/or complex, co-occurring conditions (e.g., whole health).
• Improve Veteran and provider experience and outcomes related to the EHR modernization, especially through data-driven, scalable information management clinical pathways, and artificial intelligence tools.
• Enhance VA workforce capacity, effectiveness, and retention, including policies that enhance employee and trainee recruitment and experience.
• Prevent Veteran suicide, especially through a combination of community and clinical-based interventions.
• Optimize Veteran care, access, quality, cost, and equity across in-person, virtual, and community care services with a particular focus on new technologies and processes.
• Enhance caregiver support for Veterans, particularly those who are from marginalized or at-risk populations.
• Improve Veterans’ experience and outcomes with disability claims, including policies that enhance equity in Veterans’ benefits related to health conditions screening and means testing.
• Improve the outcomes of Veterans with military and environmental exposures through enhanced health and disability benefits and access to and quality of care for exposure symptoms.
• Improve access to evidence-based treatments for Veterans with traumatic brain injury.
• Improve outcomes related to VA women’s healthcare.
• Increase access to effective programs and treatments for Veterans with cancers.
• Improve nursing workforce outcomes and nursing practice.

These learning communities and data infrastructure can help make evaluations more efficient and potentially enable evaluation teams to provide findings to clinical operations leaders and policymakers in a more timely manner. The most common question we receive from our partners is: when will we see evaluation results? And one of the biggest challenges we hear from our QUERI-funded evaluations teams is related to the delays with regulatory and data access issues. Currently, evaluation teams need to reinvent the wheel, often waiting weeks to months for regulatory approvals for every new evaluation. These new learning health systems can help to overcome these challenges by developing cohort datasets, SOPs, and other resources that can streamline these processes and enable evaluations to get started more quickly.

As we implement this new, ever evolving Learning Health System in VA, we seek to incorporate Veteran and provider perspectives to help improve the access, quality, and experience of care our nation’s Veterans receive.

Melissa Braganza, MPH
Acting Director, Quality Enhancement Research Initiative