# Presentation: 511480

##  Health Services Research and Development 

*** ***
**John G. Demakis, MD - Director**
**Shirley Meehan, MBA, PhD - Deputy Director**
**Presentation to**
**Administrative Officers for Research**
**February 25, 2004**

** ****Health Services Research and Development**** **

## HSR&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

**52**

**50**

**45**

**41.4**

**42**

**56**

**54**

**49 **

**45**

**47**

**$0**

**$20**

**$40**

**$60**

**$80**

**$100**

**$120**

**1999**

**2000**

**2001**

**2002**

**2003**

**Budgeted HSR $**

**Medical Care Research $**

**88.4**

**($ in millions)**

**87**

**94**

**104**

**108**

**%      13.1           13.1             12.9            13.6             13.3****ORD**

## HSR&D Funding DistributionFY03

_**Capacity Building**_**Career Development**
**Research Career Scientist**
**Associate Investigator**
**OAA Training Supplements**
**MREP**
**REAPS**
**TREPs**
**Research Experience Awards**

_**Service Specific Projects**_
**Regular SDR**
**QUERI SDR**
**VISN Collaboration Projects**
**Undersecretary’s Awards**

_**Investigator Initiated**_
**Basic IIR****	****	**
**Nursing Research**
**Special Solicitations****	**
**QUERI IIRs****	**

_**Centers**_
**Centers of Excellence**
**Joint RR&D Center**

_**Administration**_
**Durham****	****Review Costs**
**Travel****	**

**35%**

**26%**

**6%**

**20%**

**5%**

***Based upon $52M Budget**** **

_**Other Centers**_
**Resource Centers**

**6%**

## VA HSR&D Goals link to ORD, 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 ORD, VHA and VA Goals (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 PROBLEMS

- 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 Research Initiative (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 Savings

- 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 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 Management 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 Consultation

**Aim: **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 Populations 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 Effectiveness 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 Portfolio

**Aim: Improve HSR Methodology**
**Research 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 ServiceCapacity Program

**Aim: Ensure excellent infrastructure**
**Centers of Excellence**
**Resource Centers**
**Research Enhancement Award Program (REAP)**
**Targeted-Research Enhancement Program (TREP)**

**Aim: Ensure excellent personnel**
**Career Development Awards**
**Research Career Scientist Awards**
**Associate Investigator Awards**
**Research Experience Program**
**Merit Review Entry  Program**
**Training Programs**
**Nursing Initiative**

**HSR&D Service**
**Capacity Program**

## HSR&D Organizational Structure

**HSR&D Director**
**John D. Demakis, M.D.**

**Deputy Director**
**Shirley Meehan, MBA, Ph.D.**

**QUERI**
**Brian Mittman, **
**Acting***
**Linda McIvor**

**Capacity Bldg.**
**Phil Crewson**
**Susan Schiffner**
**Rob Small**

** ****Management **
**Consultation**
**Neil Thakur***

**Implementation **
**& Management**
**Caryn Cohen***

**Equity & **
**Special Pop.**
**Martha Bryan **
**Serena Chu**

**Quality **
**Measurement**
** ****& Effectiveness**
**Pauline Sieverding**

**Research  **
**Methodology**
**Christine Elnitsky**

***ORD-Wide Programs**

## HSR&D Future Directions

**Implementation Research**
**Quality Improvement **
**Patient Safety**
**Management Research**
**HSR Research Methods**

## New 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 http://www.hsrd.research.va.gov/about/national_meeting/2004/

## HSR&D Issues for Administrative Officers

- Final Reports
- Publication Notifications
-       E-mail: _[VHACOHSRD@mail.va.gov](mailto:VHACOHSRD@mail.va.gov)_
- Citation database:
-       www.hsrd.research.va.gov/publications/citations
- Budget Sheets
- Modifications

## Visit HSR&D on the Webhttp://www.hsrd.research.va.gov