The Program Impact Goal of the Measurement Science QUERI Program is “To Integrate Measurement Science into Healthcare for Veterans.” Measurement Science (defined as the theory, practice, and application of suitable metrics) is at the core of the Veterans Health Administration (VHA) Learning Healthcare System and a critical component of High Reliability Organizations (HROs). Measurement Science supports strategic priorities at all levels of the Department of Veterans Affairs (VA), aligns with VA’s ICARE values (Integrity, Commitment, Advocacy, Respect, and Excellence) and directly addresses five of the ten VHA modernization priorities (committing to zero harm, reducing unwarranted variation, engaging Veterans in lifelong health, modernizing Electronic Health Records, and improving access to care). The Measurement Science QUERI has a track record of successfully working with national VA program offices to identify and integrate informative metrics that speed the translation of evidence-based therapies into healthcare practice. During the next five years, we propose to scale-up and spread three, high-priority, evidence-based practices (EBPs) that are united by the need to clearly define and continuously monitor standardized metrics to improve the safety of care. In collaboration with the National Office of Gastroenterology, Dr. Kaltenbach and team will use video-based training to improve the quality of colonoscopy for cancer screening. In partnership with the National Rheumatology Field Advisory Committee and Center for Medication Safety, Dr. Schmajuk and team will use national dashboards to prevent fatal infections in patients treated with immunotherapy. Working with the National Office of Cardiology, Dr. Whooley and team will expand remote monitoring of life-saving implantable cardiac devices. For implementation, we will utilize Audit and Feedback along with 5 key implementation strategies (developing leadership, supporting a culture of safety, building & using data systems, implementing quality improvement interventions to address patient safety, and providing training opportunities for providers and staff) that have been identified as the most rigorously-developed for promoting the 5 principles of HROs (reluctance to simplify, deference to experts, sensitivity to operations, preoccupation with failure, and commitment to resilience). A 2019 VA Evidence Synthesis Program report concluded that spreading innovations to improve quality of care must focus on low performers. Thus, to foster scale-up and spread, we will disseminate the above EBPs to 18 VA sites, including eight facilities with colonoscopy quality metrics in the lowest quintile, four facilities with low rates of screening for infection prior to immunotherapy, and six facilities that have poor patient engagement in remote monitoring of cardiac devices. While these EBPs are being disseminated, the Measurement Science QUERI’s Rapid Response Team will be available to support more time-sensit...