The Leading Evaluations to Advance VA's Response to National Priorities (LEARN) Evidence-Based Policy Evaluation Center

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Background and Priority Topics: Rigorous evaluation is foundational for evidence-based policymaking, which optimizes value and operational efficiencies. We propose to establish the Leading Evaluations to Advance VA’s Response to National Priorities (LEARN) Evidence-Based Policy Evaluation Center, which will partner with VA leaders to design and conduct rigorous and responsive evaluations, and disseminate evaluation findings, to influence continual improvements in VA policies and programs. LEARN will conduct and build VA’s capacity to perform evaluations aligned with six VA priorities: women’s health initiatives; effectiveness and implementation of programs to eliminate homelessness among Veterans; strategies to address Veteran health disparities and social determinants of health; reducing burnout and improving experience and outcomes among VA employees and trainees; Veteran experience and quality of virtual care options; and electronic health record modernization. Specific Aims: LEARN will: (1) design evaluation plans that respond to priorities of senior VA leadership and other United States executive and legislative leaders, in partnership with VA program offices and the VA Partnered Evidence-based Policy Resource Center; (2) conduct timely and rigorous evaluations of VA policies and programs, in partnership with program partners and policymakers, to fulfill core requirements of the Foundations for Evidence-based Policymaking Act of 2018; (3) support continual improvements in VA policies and programs through dissemination of evaluation results and evidence-based recommendations to internal and external stakeholders; and (4) expand capacity and expertise among VA investigators, staff, and academic collaborators to design and conduct evaluations of VA policies and programs, with attention to supporting early career investigators and expanding investigator diversity, equity, and inclusion. Methods: To conduct high-impact evaluations, LEARN will draw upon a broad network of 59 investigators who are topic and methods experts within VA and LEARN’s academic affiliates. LEARN will also build on over 30 years of partnered evaluation expertise, with over 20 national program offices, in its home at the Center for Healthcare Innovation, Implementation, and Policy (CSHIIP). Guided by the Learning Healthcare System framework and the QUERI Roadmap, LEARN will conduct partnered, theory-based evaluations, using VA’s robust health data infrastructure, rapid qualitative analyses, and mixed-method approaches, that assess the implementation, effectiveness, efficiency, and overall impacts (e.g., magnitude and scope of intended and unintended consequences) of VA policies and programs. Consistent with VA’s Strategic Plan, LEARN will assess the extent to which policies or programs advance VA’s goals of improving Veteran access, choice, customer service, trust, outcomes, and health equity, while optimizing care quality, operational efficiencies and promoting provider well-being and workforce stability. LEARN evaluations will also study variations in implementation and impacts across groups and settings (e.g., Veteran and facility characteristics), contextual factors that may influence these variations, and strategies for promoting policy or program implementation. LEARN will also communicate with, and receive feedback from, stakeholders throughout the evaluation process. LEARN will concurrently mentor a diverse group of post-doctoral fellows and early-career investigators, aiming to foster a VA investigator pipeline for conducting rigorous and responsive evaluations. Impact: LEARN evaluations will position VA and external leaders to proactively engage legislative and executive branch stakeholders in rich policy discussions to ensure the best use of VA resources to meet the needs of Veterans. With knowledge from such evaluations integrated into VA policy and program decision- making, the VA learning healthcare system can engage in evidence-based continual improvement and innovation that optimizes VA care.