QUERI – Quality Enhancement Research Initiative

Using Data-Driven Implementation Strategies to Improve the Quality of Cirrhosis Care

Pittsburgh, PA

Overview

Nearly 120,000 Veterans in VA care have cirrhosis, or advanced liver disease, and this number is rapidly rising. Millions of Veterans are at risk for cirrhosis due to alcohol use, hepatitis C, fatty liver disease, and other causes. While there are life-saving measures that can slow the progression of cirrhosis, many Veterans do not receive care aligned with these evidence-based practices (EBPs). Thus, there is an urgent need to improve the delivery of high-quality cirrhosis care for Veterans. To address the needs of Veterans with liver disease, HIV, Hepatitis, and Related Conditions Programs (HHRC) and the National Hepatic Consortium for Redesigning Care (HCRC) created a quality improvement learning collaborative called the Hepatic Innovation Team (HIT) Collaborative. The HIT supports VA regional teams of providers with the goal of promoting the uptake of evidence-based liver disease care. .

The Using Data-Driven Implementation Strategies to Improve the Quality of Cirrhosis Care QUERI National Partnered Evaluation is working to improve the delivery of evidence-based care for Veterans with cirrhosis. Our specific evaluation aims are to:

• Determine which combinations of implementation strategies ('data-driven strategies') are associated with the successful implementation of EBPs for Veterans with cirrhosis;
• Develop an intervention to increase the quality of cirrhosis care; and
• Evaluate whether this implementation intervention increases the use of EBPs for cirrhosis, using a hybrid type III, stepped wedge, cluster randomized trial.

Anticipated Impacts

The knowledge gained from this evaluation is expected to help improve the quality of cirrhosis care in VA. This evaluation also will expand our understanding of novel strategies to support the development and implementation of interventions to improve the delivery of evidence-based healthcare. By doing so, investigators will address VA’s priorities to focus resources more efficiently, increase access to care, and improve the quality and timeliness of services.

Corresponding Principal Investigator: Shari Rogal, MD, MPH, also is part of HSR&D’s Center for Health Equity Research and Promotion (CHERP) in Pittsburgh.

Operations Partners: VA’s HIV, Hepatitis, and Related Conditions Programs (HHRC) within the Office of Specialty Care Services, and the National Hepatic Consortium for Redesigning Care (HCRC).