# MIDAS: Maintaining Implementation through Dynamic Adaptations

> **NIH VA I50** · VETERANS HEALTH ADMINISTRATION · 2021 · —

## Abstract

MIDAS QUERI’s overarching goal is to reduce the variability in implementation of evidence-based practices
(EBPs) by targeting late adopters. A center is considered a late adopter if data indicate gaps in care even after
national implementation efforts have been made to increase use of an EBP. We will help achieve VHA’s
Modernization Plan goal to become a High Reliability Organization (HRO), committed to zero harms. All three
of our EBPs focus on reducing potentially harmful medication practices and substituting them with more
appropriate therapy. Our proposed MIDAS QUERI will focus on Maintaining (aka sustaining) changes
designed to improve care, specifically practices that have had targeted Implementation efforts rolled out
nationally. Our implementation approaches are designed to engage clinicians and teams at the frontline in a
Dynamic process of identifying and implementing incremental changes that are feasible within busy clinical
settings. Our approach will lead to Adaptations of clinical processes and the three EBPs.
 The MIDAS QUERI’s Implementation Core will augment our partners’ prior national implementation efforts
with two additional strategies for promoting sustained use of the EBPs: the Learn. Engage. Act. Process.
(LEAP) quality improvement (QI) training program and enhanced Academic Detailing (eAD). LEAP, which was
recently funded as part of an “Implementation Hub,” is already recognized as a valuable strategy for practice
change and is included in VHA’s Online Marketplace. We will conduct cluster randomized controlled trials
(cRCTs) to rigorously compare these strategies delivered alone and in combination. We will focus our
sustainment efforts across three EBPs, all of which are priorities of our operational partners:
Project 1: Optimizing use of proton pump inhibitors to minimize iatrogenic injury, including upper GI bleeding.
This includes two sub-projects: 1a) addressing underuse of PPIs; and 1b) addressing overuse of PPIs. Our
operations partners in these projects are VISN 10 and Pharmacy Benefits Management (PBM), respectively.
Project 2: Safer Use of Direct Oral Anticoagulants (DOACs) to reduce preventable emergency room visits. Our
national operations partner is PBM and our VISN partner is VISN 15.
Project 3: Increasing use of Cognitive Behavioral Therapy for Insomnia (CBTI) rather than pharmacologic
sleep aids as a first-line treatment of insomnia disorder. Our operations partner is the Office of Mental Health
and Suicide Prevention (OMHSP).
 We will recruit 12 late adopter sites per project based on metrics demonstrating inadequate implementation
of the EBP following participation in a national implementation program. Our specific aims are:
Specific Aim 1: To improve clinical care by increasing adoption of three EBPs in late-adopting VHA facilities.
Impact on care will be measured by the percentage of eligible patients receiving guideline-concordant
medications and dosages (Projects 1 and 2), and percentage of eligible p...

## Key facts

- **NIH application ID:** 10062256
- **Project number:** 1I50HX003251-01
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** JACOB ELI KURLANDER
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-10-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10062256

## Citation

> US National Institutes of Health, RePORTER application 10062256, MIDAS: Maintaining Implementation through Dynamic Adaptations (1I50HX003251-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10062256. Licensed CC0.

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