Evidence-Based Quality Improvement Learning Network Hub Site

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Healthcare systems that deliver high-quality care are characterized by systematic approaches to capacity- building for improvement. Learning healthcare systems use quality improvement (QI) and implementation science methods to identify, assess, and improve quality issues, and to support system-wide spread of successful innovations. Evidence-based quality improvement (EBQI) is a form of continuous quality improvement that is directed at supporting learning healthcare system goals. The strategy aims to improve implementation of programs and practices in delivery systems by ensuring that QI initiatives benefit from the best scientific evidence as well as from clinical operations leadership, data, and expertise. EBQI promotes ongoing alignment of QI innovation design across the research-clinical-patient partnership; across regional-, facility-, and clinic-level leaders; and across disciplinary and programmatic boundaries. EBQI initiatives have resulted in improved uptake of evidence-based clinical practices such as collaborative care, supported employment, and the patient-centered medical home, and have supported national, regional, and local clinical policy development. The objective of the proposed EBQI Implementation Strategy Learning Network Hub Site (“EBQI Hub”) is to equip stakeholders in various VA roles (policymakers, operations managers, frontline providers and staff, and researchers) with the training and resources needed to apply EBQI. In doing so, the EBQI Hub will support increased implementation, scale-up, spread, and sustainability of effective practices, with the goal of strengthening VA as a Learning Healthcare System. The Specific Aims are to (1) provide two cycles of virtual EBQI training per year to at least 100 VA leaders, providers, and staff (~50/cycle), and at least four researchers (~2/cycle); (2) provide EBQI tools, resources, and guidance on a SharePoint site and via a virtual help desk; (3) Provide six months of intensive guided mentorship to at least four trainees/trainee teams annually; and (4) Using mixed methods, evaluate the: (a) utilization, usefulness, and feasibility of Hub components; (b) Hub’s impacts on participants’ QI confidence, knowledge, and skills; (c) effectiveness of the EBQI Hub in fostering QI projects that reflect both scientific evidence and delivery system priorities; and (d) impacts of the mentored QI projects. The EBQI Hub focuses on didactic and applied hands-on training in EBQI theory and practice. Using the curriculum developed with VA QUERI start-up funds in FY18 and guided conceptually by a theory of QI spread, the EBQI Hub will provide virtual EBQI training nationally using distance-learning technology. The training is comprised of four 90-minute live webinar modules; an EBQI SharePoint site with recorded webinars, training materials, and QI tools; and a virtual help desk staffed by EBQI Hub expert faculty. The EBQI Hub will also provide six months of guided mentorship to at least four trainees and/or teams (especially Diffusion of Excellence Initiative Gold Status Fellows) annually who have clearly specified innovations. Demand for EBQI Hub training is already high, especially because the EBQI Hub faculty has a strong track record of successful EBQI training and implementation experiences. Currently there are four initiatives (VISN-level and national) that stand ready to call upon the EBQI Hub resources to advance their objectives. All eight of the healthcare systems within VISN 22 (serving 1.5 million Veterans in Arizona, New Mexico, and Southern California) have confirmed interest in engagement in EBQI Hub training, including at least 20 sites of care; additionally, 10 sites outside of VISN 22 have confirmed interest. The EBQI Hub supports modernizing systems and focusing resources more efficiently by training, supporting, and motivating leaders, providers, and staff to identify, address, and solve local prioritized problems, using an evidence- based, multilevel, stakeholder-driven approach to implement needed improvements and innovations.