213989 Developing a Plan to Reduce Health Disparities within a Large, Integrated Healthcare System: The Department of Veterans Affairs (VA) Quality Enhancement Research Initiative's (QUERI), Inter-QUERI Equity Workgroup (I-QEW)

Tuesday, November 9, 2010

S. Randal Henry, DrPH, MPH , Quality Enhancement Research Initiative for HIV/AIDS and Hepatitis, Veterans Affairs of Greater Los Angeles Healthcare System, Los Angeles, CA
Keri L. Rodriguez, PhD , Center for Health Equity Research and Promotion; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
Susan Zickmund, PhD , Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Hildi Hagedorn, PhD , Quality enhancement Research Initiative for Substance Use Disorders, VA Minneapolis Health Care System, Minneapolis, MN
Erin Conners, MPH , Quality Enhancement Research Initiative for HIV and Hepatitis (QUERI-HIV/HEP), US Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, CA
Brian Mittman, PhD , VA Greater Los Angeles Healthcare System, VA Center for Implementation Practice and Research Support, Sepulveda, CA
Jeff Smith, MPH, PhDc , Quality Enhancement Research Initiative - Mental Health, Department of Veterans Affairs, North Little Rock, AR
In the United States (US), inequities in healthcare access, utilization and outcomes have been documented across a range of healthcare settings, including the US Department of Veterans Affairs healthcare delivery system (VA). The VA provides healthcare for veterans of the US armed services and is the largest integrated healthcare delivery system in the US. Within the VA, health inequities disproportionately affect women, elderly, homeless, people with mental health conditions, and racial and ethnic minorities. In 1998, the VA established the Quality Enhancement Research Initiative (QUERI) to improve the quality of healthcare through the use of research-derived best practices. Key elements of the QUERI Program include: 1) nine QUERI Centers (i.e. Diabetes; Chronic Heart Failure; HIV/Hepatitis; Ischemic Heart Disease; Mental Health; Polytrauma/Blast-Related Injuries; Spinal Cord Injury; Stroke; and Substance Use Disorders); 2) a core set of goals; 3) a network of affiliated researchers, 4) contacts with local/national clinical and policy leaders, and 5) a focus on system-wide quality improvement. Over the past decade, QUERI has promoted evidence-based care management practices and improved performance as the central tenets of its approach to patient treatment. In the coming decade, QUERI is poised to make the reduction of health disparities a parallel quality improvement goal, focusing efforts towards veterans at highest risk of inequity in access to healthcare and poor treatment outcomes. However, equity improvement is complex, and singular approaches have failed to adequately address its multifaceted, complex nature. Addressing inequity within the VA is a problem that, by its very nature, is beyond the scope, resources, and organizational capacity of any single QUERI center. The QUERI Program's Inter-QUERI Equity Improvement Workgroup (I-QEW) was developed to strengthen and support QUERI's equity improvement activities. In this session, we will introduce the I-QEW project and discuss the cross-cutting nature of health inequities within the VA. We will also discuss the following key issues: 1) advancing from disparity identification to systemic interventions to reduce disparities; 2) identifying dissemination and implementation methods that can be utilized to improve equity; 3) developing valid and reliable measures of equity improvement; 4) developing collaborative projects to expand equity improvement activity.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
In this session, we will introduce the I-QEW project and discuss the cross-cutting nature of health inequities within VHA-QUERI, as well as address the following key issues: 1) describe the need to move from disparity identification to systemic interventions to improve equity; 2) identify dissemination and implementation science methods that can be utilized to improve equity; 3) discuss the development of valid and reliable measures of equity activities; 4) list suggestions to facilitate the development of collaborative, implementation-science projects for equity improvement; and 5) formulate innovative methods to coordinate and expand dissemination and implementation of equity improvement activities.

Keywords: Health Disparities, Veterans' Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract author because I concieved the project, wrote the grant, and serve as project PI.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.