John G. Demakis, MD - DirectorShirley Meehan, MBA, PhD - Deputy Director

Presentation toAdministrative Officers for Research

February 25, 2004

Health Services Research and Development

HSR&D MissionHSR&D Mission

To advance knowledge, develop VA health services researchers and leaders, and promote innovations that translate into advances in health care for veterans and the nation

HSR&D Funding FY 1999-2003

52504541.4 42

565449

4547

$0

$20

$40

$60

$80

$100

$120

1999 2000 2001 2002 2003

Budgeted HSR $

Medical Care Research $

88.4

($ in millions)

8794

104 108

% 13.1 13.1 12.9 13.6 13.3ORD

HSR&D Funding DistributionFY03

Capacity BuildingCareer DevelopmentResearch Career ScientistAssociate InvestigatorOAA Training SupplementsMREPREAPSTREPsResearch Experience Awards

Service Specific ProjectsRegular SDRQUERI SDRVISN Collaboration ProjectsUndersecretary’s Awards

Investigator InitiatedBasic IIRNursing ResearchSpecial SolicitationsQUERI IIRs

CentersCenters of ExcellenceJoint RR&D Center

AdministrationDurham Review CostsTravel

35%

26%

6%

20%5%

*Based upon $52M Budget

Other CentersResource Centers

6%

VA HSR&D Goals link to VA HSR&D Goals link to ORD, VHA and VA GoalsORD, VHA and VA Goals

VA Goal 3: Honor and serve veterans in life and memorialize them in death for their sacrifices on behalf of the nation.

Objective 3.1: Improve the overall health of enrolled veterans

including specialpopulations of veterans through a health care system characterized by convenient access, high quality, satisfied patients and cost efficiency.

VA HSR&D Goals link to VA HSR&D Goals link to ORD, VHA and VA Goals ORD, VHA and VA Goals (cont’d.)(cont’d.)

VA Enabling Goal 4: Contribute to the public health, socioeconomic well being, and history of the nation.

Objective 4.1: Advance VA medical research and development

programs to better address the needs of the veteran population and to contribute to the Nation's knowledge of disease and disability.

Restructuring to Emphasize Priority Restructuring to Emphasize Priority PROBLEMSPROBLEMS

Problem Dimensions include- continuum of care- staying healthy (prevention)- getting better (treatments)- living with illness or disability- end-of-life care- components of care (structure, process, outcomes)- care factors (access, cost, quality)- care system level (patient, provider, micro-system(s), macro-

system) [and interactions]- preferred methodological/discipline area for addressing

problem/issue- perceived best process/ state-of-the-art for addressing

problem/issue (e.g., pilot, IIR, SDR, qualitative research, RCT)

Quality Enhancement Quality Enhancement Research Initiative Research Initiative (QUERI)Program(QUERI)Program

Aim: Identify and address quality care gaps in priority veteran areas

– Recruiting new leader– Enhancing Guidance, Implementation links– Collaborating with OQP, others to select needed

implementation projects (national advisory committee)

– Continuing peer review and management of Coordinating Centers

– Adding amputation QUERI – Reporting results, impacts, opportunities and budget

(medical care) documentation

QUERI Potential Cost QUERI Potential Cost SavingsSavings

If all effective QUERI interventions were implemented throughout VHA:– Potential cost savings ~ $880 million annually– Potential 35,000 lives saved over a 10-year period

Includes $255 million in avoided CHF readmission $12.6 million in lower antipsychotic costs $484 million in lower costs for diabetes care and

admissions $117 million in avoided admissions for major cardiac

events

QUERI Lessons LearnedQUERI Lessons Learned Importance of senior leadership support and buy-

in Importance of the strength of evidence Formative or process evaluation is critical to

successful generalization of knowledge from one study to another

Timing of implementation– Rapid response to barriers is essential to

successful implementation– Keeping up momentum is critical

Implementation and Implementation and Management ProgramManagement Program

Aim: Systematize what works and encourage management research.

Research topics include: Integrating evidence-based practices into

routine clinical and administrative operations Organizational change Service-Directed projects on implementing

research into practice

Management ConsultationManagement ConsultationAim: Help managers clarify and address issues through

existing evidence or consultation

Helping managers clarify and address operational issues and develop consultation projects

Identifying VA investigators to conduct consultation projects

Serving as a liaison between consultation project investigators and managers

Growing with demand and requestors' continued budgetary support

Equity and Special Equity and Special Populations PortfolioPopulations Portfolio

Aim: Enhance equity and address specific population needs.

Research topics include: Racial/ethnic and gender equities. Health care needs of special populations,

including those with mental illness and substance abuse disorders, disabilities, homeless, and those from rural areas.

Nursing research

Quality Measurement and Quality Measurement and Effectiveness PortfolioEffectiveness Portfolio

Aim: Improve Health Care Quality (IOM areas and chronic, complex and other foci not in QUERI)

Research topics include: Quality measurement and effectiveness of health

care, including clinical outcomes studies. Studies to develop/test quality measures, methods,

tools and indicators. Patient-centered care, long-term care,

access/timeliness, efficiency of care, and chronic disease areas.

Research Methodology PortfolioResearch Methodology PortfolioAim: Improve HSR MethodologyResearch topics include: Econometric modeling, innovative economic approaches Evidence syntheses techniques Innovative approaches to multi-site trials Qualitative and mixed research approaches Decision analysis techniques Utility assessments Enhanced technological communications, use of in

databases

HSR&D ServiceCapacity Program

Aim: Ensure excellent infrastructure Centers of Excellence Resource Centers Research Enhancement Award

Program (REAP) Targeted-Research Enhancement

Program (TREP)

Aim: Ensure excellent personnelCareer Development AwardsResearch Career Scientist AwardsAssociate Investigator AwardsResearch Experience ProgramMerit Review Entry ProgramTraining ProgramsNursing Initiative

HSR&D ServiceCapacity Program

HSR&D Organizational StructureHSR&D Director

John D. Demakis, M.D.

Deputy DirectorShirley Meehan, MBA, Ph.D.

QUERIBrian Mittman,

Acting*Linda McIvor

Capacity Bldg.Phil CrewsonSusan SchiffnerRob Small

Management ConsultationNeil Thakur*

Implementation & ManagementCaryn Cohen*

Equity & Special Pop.

Martha Bryan Serena Chu

Quality Measurement

& EffectivenessPauline Sieverding

Research Methodology

Christine Elnitsky

*ORD-Wide Programs

HSR&D Future Directions

Implementation Research Quality Improvement Patient Safety Management Research HSR Research Methods

New InitiativesNew Initiatives

HSR&D/VISN Implementation Collaborative: Innovations to Implement Evidence-Based Clinical Practice

Supplements to Support Collaboration between VA and Academic Experts in Implementation Research

Ethnic/Racial/Gender Issues

HSR&D Active Solicitations HSR&D Priorities for Investigator Initiated

Research Access VA Managed Care Implementation of Clinical Practice Guidelines Telemedicine Pain Management Ethnicity and Culture Patient-Centered Care Women’s Health

HSR&D Active Solicitations (cont.)

Nursing Research Initiative Prevention of Errors and Injuries in Clinical Care HSR&D/VISN Collaborative Health Services

Research Projects Costs, Cost-Effectiveness and Health Economics

Terrorism

Sensory Disorders and Loss

HSR&D Service Cooperation with Other Federal Agencies

Agency for Healthcare Research and Quality National Cancer Institute Centers for Disease Control Centers for Medicare & Medicaid Services (CMS) National Institutes of Health

HSR&D National Meeting HSR&D National Meeting http://www.hsrd.research.va.gov/about/national_meeting/2004/

HSR&D Issues for HSR&D Issues for Administrative OfficersAdministrative Officers

Final ReportsPublication Notifications E-mail: VHACOHSRD@mail.va.govCitation database: www.hsrd.research.va.gov/publications/citationsBudget SheetsModifications

Visit HSR&D on the Webhttp://www.hsrd.research.va.gov