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Durham Center of Innovation to ADAPT

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Dynamic Diffusion Network (DDN) QUERI Program


The Dynamic Diffusion Network (DDN) QUERI Program was launched in 2021. The overarching goal of the DDN QUERI Program is to expand utilization of evidence-based practices among later adopter sites, with a specific focus on innovations in diabetes and moral injury for affected Veterans.  DDN QUERI leverages the use of practical implementation strategies and frameworks to successfully spread complex clinical evidence-based practices beyond early adopters of innovation.

Project Components

DDN QUERI involves the implementation and evaluation of two distinct evidence-based practices:

  1. Integrated Mental Health & Chaplaincy Moral Injury Groups – A mental health provider and a chaplain co-facilitate therapy groups for Veterans experiencing moral injury. Therapy groups share  core components (e.g., utilizing Yalom-style therapeutic processes, enhancing cognitive flexibility and perspective-taking, targeting difficulties with forgiveness) while allowing for adaptations based on local context, clinical experience, and patient preferences.
  2. Advanced Comprehensive Diabetes Care (ACDC) - A nurse-administered telehealth program for Veterans with persistently poor diabetes control despite use of existing VA services. The program uses existing telehealth staffing and equipment to deliver diabetes telemonitoring, self-management support, and clinician-guided medication management.


Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, the DDN QUERI will carry out hybrid type 3 randomized trials of Moral Injury Groups and ACDC.  Each trial will compare the implementation strategy of “dynamic diffusion” for operationalizing EPIS to technical assistance among a group of later adopter sites.

Primary outcomes consist of the difference in percentage of patients receiving appropriate dose/adherence to group attendance for Moral Injury Groups (attending ≥ 80% of group sessions) and difference in the percentage of patients receiving appropriate dose/adherence to ACDC encounters (having ≥ 80% of patient phone encounters) as indicators of fidelity.

The DDN QUERI will also carry out a mixed-methods evaluation using the Consolidated Framework for Implementation Research (CFIR) to examine factors influencing trial outcomes at each EPIS stage; and a budget impact analysis to establish the business case for the practices.

The practices will be implemented and evaluated across a total of 20 VA Medical Centers (10 sites per practice).


DDN QUERI Program Fall/Winter 2021 Newsletter
DDN QUERI Program Summer 2022 Newsletter
DDN QUERI Program Fall/Winter 2022 Newsletter


  • VHA Innovation Ecosystem
  • VA Rocky Mountain Network (VISN 19)
  • VHA Office of Rural Health
  • VHA Office of Mental Health & Suicide Prevention
  • VHA Integrative Mental Health
  • VHA National Chaplain Service
  • VHA Office of Connected Care
  • Center for Healthcare Organization and Implementation Research (CHOIR)
  • Center for Clinical Management Research (CCMR)
  • Center for Innovation to Implementation

For More Information:

George Jackson, Ph.D., MHA (Corresponding PI)


Brandolyn White, MPH (Lead Coordinator)