Implementation of New Clinical Programs in the VHA Healthcare System: The Importance of Early Collaboration Between Clinical Leadership and Research

Abstract

Collaboration between policy, research, and clinical partners is crucial to achieving proven quality care. The Veterans Health Administration has expended great efforts towards fostering such collaborations. Through this, we have learned that an ideal collaboration involves partnership from the very beginning of a new clinical program, so that the program is designed in a way that ensures quality, validity, and puts into place the infrastructure necessary for a reliable evaluation. This paper will give an example of one such project, the Lung Cancer Screening Demonstration Project (LCSDP). We will outline the ways that clinical, policy, and research partners collaborated in design, planning, and implementation in order to create a sustainable model that could be rigorously evaluated for efficacy and fidelity. We will describe the use of the Donabedian quality matrix to determine the necessary characteristics of a quality program and the importance of the linkage with engineering, information technology, and clinical paradigms to connect the development of an on-the-ground clinical program with the evaluation goal of a learning healthcare organization. While the LCSDP is the example given here, these partnerships and suggestions are salient to any healthcare organization seeking to implement new scientifically proven care in a useful and reliable way.

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

“…Our results suggest that screening implementation within the VA may require the investment of both time and money to ensure that facilities are supported adequately. The VA ORIGINAL RESEARCH has embarked on a carefully designed, multifacility demonstration project of lung cancer screening in the real world (17,40); the lessons learned from this pilot project will no doubt inform large-scale implementation of lung cancer screening both within and outside the VA. n…”

“…Indeed, there are several reasons to believe that the VA may be better prepared for lung cancer screening implementation than are many hospitals in the private sector. First, the VA, the nation's largest integrated health system, has a proven track record in providing high-quality preventive care and care for chronic illnesses (37)(38)(39) and is undertaking implementation of lung cancer screening in a deliberate fashion (17,40). Second, VA facilities are more likely than are many academic and community hospitals to have processes of care in place to facilitate pulmonary nodule evaluation (41).…”

Research and Operations: Joining Forces to Improve Care for Veterans

“…This has led to many new studies developed jointly with input from stakeholders in clinical and policy roles, with various levels of engagement from partners [3]. There are also notable recent examples of operations tapping researchers to evaluate new clinical programs or initiatives, such as the implementation of the patient-centered medical home and the lung cancer screening program [4,5].…”

“…This has led to many new studies developed jointly with input from stakeholders in clinical and policy roles, with various levels of engagement from partners [3]. There are also notable recent examples of operations tapping researchers to evaluate new clinical programs or initiatives, such as the implementation of the patient-centered medical home and the lung cancer screening program [4,5].VHA's move to adopt a joint operations-research perspective in promoting clinical innovation in the health care system is also evident in the increasing number of researchers, clinicians, and policy leaders collaborating on quality improvement (QI) activities. As part of its Transformation to the 21st Century Non-institutional Long Term Care (T21 NILTC) initiative, the VHA Office of Geriatrics and Extended Care (GEC) has funded more than 167 clinical demonstration projects since 2010 to support innovative programs intended to reduce the need for institutional care among older veterans.…”

Lessons from Initiating the First Veterans Health Administration (VA) Women's Health Practice-based Research Network (WH-PBRN) Study

“…While this complexity introduces challenges for a VA-based PBRN and necessitates extra effort to ensure multilevel stakeholder engagement, it also introduces opportunities to partner with frontline providers and with leaders poised to translate research findings into local practice and national policy. 18,[25][26][27][28] Future VA-based PBRNs can profit from this context and from the experience of the WH-PBRN 3 and other VA-based networks (such as the VA Office of Dentistry's VADER-PBRN, VA Mental Health PBRN, 29 Heart Failure Provider Network, 30 and the National Center for Posttraumatic Stress Disorder's Practice-Based Implementation Network 31 ).…”