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Table 1 The VA Quality Enhancement Research Initiative (QUERI)

From: The role of economics in the QUERI program: QUERI Series

The U.S. Department of Veterans Affairs' (VA) Quality Enhancement Research Initiative (QUERI) was launched in 1998. QUERI was designed to harness VA's health services research expertise and resources in an ongoing system-wide effort to improve the performance of the VA healthcare system and, thus, quality of care for veterans.

QUERI researchers collaborate with VA policy and practice leaders, clinicians, and operations staff to implement appropriate evidence-based practices into routine clinical care. They work within distinct disease- or condition-specific QUERI Centers and utilize a standard six-step process:

   1) Identify high-risk/high-volume diseases or problems.

   2) Identify best practices.

   3) Define existing practice patterns and outcomes across the VA and current variation from best practices.

   4) Identify and implement interventions to promote best practices.

   5) Document that best practices improve outcomes.

   6) Document that outcomes are associated with improved health-related quality of life.

Within Step 4, QUERI implementation efforts generally follow a sequence of four phases to enable the refinement and spread of effective and sustainable implementation programs across multiple VA medical centers and clinics. The phases include:

   1) Single site pilot,

   2) Small scale, multi-site implementation trial,

   3) Large scale, multi-region implementation trial, and

   4) System-wide rollout.

Researchers employ additional QUERI frameworks and tools, as highlighted in this Series, to enhance achievement of each project's quality improvement and implementation science goals.