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)

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.