Veterans Affairs Responsive Innovation Evidence Review (RIER) - - PowerPoint PPT Presentation

Lessons from the Department of Veterans Affairs’ Responsive Innovation Evidence Review (RIER) Program

Susanne Hempel, Margie Danz, Yee-Wei Lim, Paul Shekelle, & Lisa Rubenstein

Context

• VISN 22 - VAIL/PACT Site

– Desert Pacific Healthcare Network (VISN 22) – Veterans Assessment and Improvement Laboratory (VAIL) – Patient Aligned Care Teams (PACT)

• Funded by the VA Office of Patient Care Services
• Innovation teams

– Evidence-Based Quality Improvement initiative – Redesign of primary care

• Evidence review team

– Evidence-based Practice Center (EPC) staff

• Located at RAND
• Systematic reviewers, librarian, project assistance

Rationale

• Large number of tested approaches to improve quality
• f care

– Knowledge translation

• Innovation teams

– Committed to Evidence-Based Quality Improvement – Research volume and access increases steadily – Need for valid summary of the evidence

• Evidence review team

– Expertise in comprehensive literature searches – Used to synthesize large bodies of evidence – EPC staff objective, no preference or bias – Transparent documentation techniques

Service

• Responsive Innovation Evidence Review (RIER)

– Responsive to innovators’ needs

• Specific audience target

– Process started with initial review request

• Engaging practitioners to identify evidence needs

– Questions beyond general effectiveness

• Evidence requests included effectiveness, but also

implementation tools, costs, locally important aspects – Rapid review

• Completed between 2-6 weeks
• Cost-effective methods
• Highly structured, 6-15 pages long

Responsive Evidence Review Topics

– Advanced Access – Homelessness – PCMH Evaluation Measures – Patient Registries – PCMH and Mental Health – Pharmacists – Primary Care Team Functioning – Readmissions – Relational Coordination – Secure Messaging – Self-Management – Motivational Interviewing – Interactive Communication – Role of Nursing – Clinician Burnout – Guided Imagery – Resident Training – Medication Renewal – Measuring Homelessness – Provider Continuity

Methods

• Stakeholder engagement

– Request form developed to clarify innovator needs – Review questions established together with innovators

• Search methods

– Filters (PCMH search filter, PubMed Clinical Query) – Sources (SR databases, grey literature resources) – Strategy (e.g., PubMed Similar Article function)

• Valid overview

– Use of systematic reviews – Meaningful literature sampling – Emphasis on most relevant evidence

Dissemination

• Transparent, structured reporting

– Background, key messages, further reading – Methods section – Evidence table

• Dissemination

– Short reports, handouts for meetings, slide decks – Intranet site, conference brochure – Handout “Quick guide to the literature”

• Where to look, how to search, what to look for, what to consider,

how to summarize a body of evidence

Evaluation

• Interim evaluation

– Satisfaction with service – Need for process improvement

• DOI: 10.13140/RG.2.2.17346.38086
• Final project evaluation

– Feasibility, usability, process, format

• Incorporating evidence review into innovation
• Evidence-Based Quality Improvement

– http://dx.doi.org/10.1136/bmjqs-2012-001722

• Remaining open question

– Impact evaluation