QUERI stands for Quality Enhancement Research Initiative. Begun in 1998, QUERI today encompasses a national network of programs designed to translate research findings into everyday care at VA medical centers and clinics. Integral to the effort are close partnerships among researchers, clinicians, and program offices in VA headquarters in Washington, D.C.

Kirchner's team, as one of 15 QUERI programs, is probing a number of areas related to team–based mental health care. One is tele–mentalhealth – delivering psychotherapy to Veterans with behavioral health problems in their homes and in VA community–based outpatient clinics. Among other tools, the group developed and field–tested a planning checklist that is now being used by VA to expand telehealth to Veterans in rural and other underserved areas.

The main focus now for Kirchner's QUERI is exploring how care teams communicate with each other, with an eye toward avoiding redundancy and streamlining processes. The team wants to map out best practices that can be deployed in freestanding VA mental health clinics, as well as those clinics that combine primary and mental health care.

"When you move toward team–based care, you work together and communicate together about the patient, and you pull information from multiple sources," explains Kirchner. "That benefits the patient in at least two ways. First, they don't have to tell their story again and again and again. Second, I as the psychiatrist may not be the specialist on what that person needs, but the social worker on our team may be that specialist. And they will do a lot better job of ascertaining where we need to focus the team's energy."

The measurement piece complements that research, as part of the larger QUERI. The idea might seem simple – have the patient complete some type of quantitative assessment at each and every visit, to provide a score that can be tracked over time. But it is far from the norm in mental health clinics.

The government may be ahead of the curve on this one."I would say that outside of VA and DoD [the Department of Defense], measurement–based mental health care is rare," notes Kirchner. The exception, she says, might be at baseline, or a first visit, when the patient is assessed to determine what disorders are present. But even then, many practitioners in the private sector will do an assessment without any type of validated instrument, or survey.She says DoD and VA are leading the country in assessing the use of measurement–based care in mental health care, and then working to implement it on a wide scale.

"Traditionally, mental health care in general has not been grounded in comprehensive measurement of outcomes," she says. "But there is a national initiative, with the VA Office of Mental Health Operations and Mental Health Services, as well as one of our QUERI projects that is complementary to that initiative, to incorporate measured outcomes across time, and to use them to inform care decisions with the provider and the patient."

Kirchner explains how the process works in mental health clinics that don't emphasize measurement, for a typical patient complaining of feeling sad: "Quite possibly you would go through a process to determine the degree to which you meet the criteria for a depression disorder, and the provider would determine yes or no, you meet or don't meet the criteria for depression. Let's say you do, and I prescribe a medication, and I say I want to see you back in two weeks and see how you're doing. And I would tell you to call me if you have problems or side effects, or concerns about wanting to hurt yourself.

"You come back in, and I would probably ask you a few questions like, How's your energy level? How's your attention and concentration? How are you sleeping? Have you been able to feel joy or happiness?"