Center for Innovations in Quality, Effectiveness, and Safety (IQuESt)

Student summary

Why This Research Matters

The Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) has been a cornerstone of healthcare research within the Veterans Affairs system since its establishment in 1990. This significant center operates with an extensive team comprising 81 faculty members and over 200 employees, supported by ten coordinating centers, national program cores, various training programs, and collaborations with 32 VA operational partners across the United States. IQuESt's scale is notable; it stands as the largest Health Services Research (HSR) center in the southwestern region of the country.

In its fiscal year 2023 alone, IQuESt demonstrated remarkable productivity and impact. The center successfully mentored a cohort of 14 research fellows, contributing to the next generation of healthcare innovators. It also achieved an impressive output with 307 peer-reviewed articles published, reflecting robust scientific inquiry and dissemination. Furthermore, IQuESt conducted substantial research valued at $29 million in total funding for that year, including a significant portion—$5.7 million—in projects directly supported by its VA operational partners.

A key strength of IQuESt is its ability to leverage COIN (Center for Innovations) funding strategically. This financial support facilitates the cultivation and maintenance of strong relationships with its affiliated quaternary-care Veterans Affairs Medical Center (VAMC), other affiliate institutions, and numerous operational partners within the VA network. These collaborations are instrumental in fostering a highly productive, collaborative research environment that mirrors the principles of a learning health care system, where knowledge is continuously generated, shared, and applied to improve patient outcomes.

The mission of IQuESt is clearly defined: "Improving health and well-being through innovations in health care delivery." This mission is actively pursued and achieved through substantial VA operational partnerships. Several notable examples illustrate this commitment: 1) The center has significantly increased access to practice-ready, evidence-based psychotherapies for Veterans receiving care in both primary care settings and specialty medical clinics. Through these efforts, over 100 healthcare providers across ten Veterans Integrated Service Networks (VISNs) and more than 90 VAMCs have been trained. 2) The Personalized Implementation of Virtual Treatments for Rural Veterans (PIVOT-R) team has played a crucial role in facilitating the implementation of Veteran Video Connect. This initiative involved training over 315 providers at 22 different VAMCs and 150 affiliated clinics, thereby accelerating access to essential virtual mental health care services for rural Veterans. 3) Dr. Singh and his research team have made foundational contributions to policy and science related to patient safety and informatics that span nearly two decades. Their impactful work was recognized with the prestigious 2021 John M. Eisenberg Patient Safety and Quality Award. This achievement underscores their influence on national standards, as evidenced by Dr. Singh co-chairing the revision of VHA Directive 1088 ("Communicating Test Results to Providers and Patients") and his research forming a critical basis for the Centers for Medicare & Medicaid Services (CMS) mandated SAFER Guides. 4) Research conducted under HSR funding at IQuESt has led to significant advancements in antibiotic stewardship. Specifically, studies focused on appropriate diagnosis and treatment of catheter-associated urinary tract infections have expanded from initial implementation at a single VAMC to successful rollout across more than 41 sites within 15 different VISNs. 5) Enhanced use of data derived from the VA/DoD Airborne Hazards and Open Burn Pit Registry (AHOBPR), coupled with strong partnerships, has led to improved monitoring and implementation of AHOBPR initial examinations. This initiative resulted in a substantial increase in examination rates for Veterans exposed to airborne hazards, rising from 13% in 2020 to an impressive 76% by the end of 2023 across more than 40 VAMCs located within ten VISNs.

Looking ahead, IQuESt has established clear strategic impact goals for the next five years. These priorities are designed to drive further innovation and improvement in Veteran healthcare: 1) Implementing innovative approaches aimed at improving equitable access to behavioral health care services across all VA facilities. 2) Utilizing clinical informatics as a powerful tool to enhance the safety of overall health care delivery processes within the VA system. 3) Accelerating the development, integration, and application of toxic exposure knowledge into routine clinical practice for Veterans who have been exposed to hazardous environments during their service.

These strategic goals are directly aligned with several overarching priorities set by the Department of Veterans Affairs (VA), including increasing the real-world impact of VA research initiatives, effectively leveraging VA data resources for the benefit of Veterans, promoting diversity, equity, and inclusion within all aspects of healthcare delivery, serving the unique needs of Veterans who have experienced military exposures, improving overall access to quality care, and striving towards becoming a high-reliability organization.

In addition to these core research areas, IQuESt also contributes significantly in other important domains. For instance, it engages in research-informed approaches for monitoring nurse staffing levels, workload distribution, and turnover rates on an enterprise-wide basis within the VA system. Furthermore, the center is actively involved in assessing and improving existing VA policies through innovative research methodologies to ultimately enhance Veteran outcomes.

IQuESt's success is also deeply rooted in its extensive network of partnerships and its strong support for the broader research enterprise within the VA. The center is fully integrated into VISN 16, which includes the Michael E. DeBakey VAMC in Houston, Texas, and collaborates closely with Baylor College of Medicine. IQuESt maintains seven major VA partners that are crucial to its mission: the Office of Mental Health and Suicide Prevention, the Office of Rural Health, the National Center for Patient Safety, the Health Outcomes Military Exposures/Airborne Hazards Burn Pits Center of Excellence, the Office of Nursing Services, the Office of Human Capital Management, and the Office of Academic Affiliations. Through these partnerships, IQuESt supports a wide array of research initiatives that are vital to advancing Veteran healthcare.

Moreover, IQuESt plays an essential role in supporting numerous key VA research programs and resources. These include the Million Veteran Program (MVP), which is a large-scale initiative aimed at understanding how genes affect health; the Military Exposure Research Program, focused on investigating the long-term effects of military exposures; Centralized Interactive Phenomics Resources (CIPHER), designed to facilitate access to complex phenotypic data for research purposes; Coordinating Hub to Promote Research Optimizing Veteran-centric EHR Networks (PROVEN), which aims to enhance the use of electronic health records in VA research; the Cooperative Studies Program Network of Dedicated Enrollment Sites (CSP NODES), a network dedicated to conducting clinical trials and observational studies; and the Lung Cancer Precision Oncology Program (LPOP), focused on advancing personalized treatment approaches for lung cancer. These programs, along with many other individual service examples, highlight IQuESt's comprehensive commitment to fostering a vibrant and impactful research enterprise within the VA system.

Faculty notes

Educational Relevance

Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) can be used for source-grounded discussion. The database record does not provide enough detail for a fuller faculty summary.