# The Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) QUERI Program

> **NIH VA I50** · DURHAM VA MEDICAL CENTER · 2021 · —

## Abstract

Background: Healthcare systems face the challenge of delivering care of the highest possible quality while
simultaneously ensuring broad access to services and prudent use of resources. Without thoughtfully
designed implementation strategies, the impact of evidence-based practices (EBPs) cannot be fully realized
because it is difficult to spread the EBP beyond early adopting facilities. The Spreading Healthcare Access,
Activities, Research and Knowledge (SHAARK) QUERI will compare implementation strategies for EBPs in two
areas of high relevance to VA: addressing the needs of veterans suffering from moral pain (e.g., guilt, shame,
betrayal) as a result of actions taken or not taken during their service (aka, moral injury) and veterans who face
the substantial health risks of persistently poor diabetes control. While these groups are important in-and-of
themselves, the synergy that comes from studying implementation of distinct EBPs aimed at different complex
health conditions will lead to a greater understanding of how to address the overarching implementation
challenge of moving clinical EBPs across health systems.
Significance/Impact: In alignment with VA facility and VISN Director Performance Plan metrics to identify and
spread innovations, the SHAARK QUERI will provide evidence for how VA and other healthcare systems can
use strategies for spreading complex clinical EBPs beyond successful earlier adopters across the healthcare
system. This evidence will be obtained by conducting clinical trials of an implementation strategy aligning with
the Exploration, Preparation, Implementation, Sustainment (EPIS) implementation framework, while specifically
seeking to improve care for moral injury and persistently uncontrolled diabetes.
Specific Aims: Using two EBPs, Advanced Comprehensive Diabetes Care (ACDC) and Moral Injury Groups,
we will conduct two hybrid type 3 implementation trials that align with the EPIS framework for the
establishment of strategies to implement EBPs. The specific aims are as follows: Aim 1a: Measure difference
in the percentage of patients receiving appropriate dose/adherence to group attendance (attending ≥ 80% of
group sessions) as an indication of fidelity; Aim 1b: Measure differences in the percentage of core components
implemented and number of adaptations to EBP processes; Aim 1c: Examine differences in the number and
intensity of quality improvement efforts/plan-do-study-act cycles undertaken by sites; Aim 2: Examine
differences in change in PTSD symptoms, suicidal behavior, & perceived life significance (for Moral Injury
Groups trial) and difference in change in hemoglobin A1c (for ACDC trial); Aim 3: Conduct evaluation of
implementation process; and Aim 4: Build a business case including budget impact (for both EBP trials).
Methods: We will test the implementation strategy, Dynamic Diffusion Network (DDN), for operationalizing
EPIS (1 separate DDN per trial) for later adopters of EBPs. The DDN will be compared to tech...

## Key facts

- **NIH application ID:** 10188846
- **Project number:** 1I50HX003198-01A1
- **Recipient organization:** DURHAM VA MEDICAL CENTER
- **Principal Investigator:** Matthew J. Crowley
- **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/10188846

## Citation

> US National Institutes of Health, RePORTER application 10188846, The Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) QUERI Program (1I50HX003198-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10188846. Licensed CC0.

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