VA Office of Research and Development, Health Services Research and Development Service 1

HSR&D National Meeting 2006

HSR&D’s 24th National Meeting is scheduled for February 15–17,

2006, at the Hyatt Regency Crystal City in Arlington, VA. 

The meeting will be hosted by HSR&D’s Center for Health Equity

Research and Promotion (CHERP), based at the VA Pittsburgh

Healthcare System and the Philadelphia VA Medical Center, and is

centered around the theme “Implementing Equity: Making Research

Work for Diverse Veteran Populations.” It will feature over 180

impressive oral, poster, and workshop presentations of

competitively selected HSR&D research as well as talks by invited

guest speakers. Dr. Jonathan Perlin, VA’s Under Secretary for

Health, has been invited to present the Under Secretary’s Award for

Outstanding Achievement in Health Services Research and Timothy

G. Evans, PhD, MD, Assistant Director-General for Evidence and

Information for Policy with the World Health Organization will

provide a keynote talk. 

As in past years, a proposal development workshop will be offered

on February 15. It is intended to benefit any new investigators who

need guidance on creating a proposal that invites serious

consideration for funding by public and private granting agencies. It

will also be helpful to more seasoned investigators who want to

hone their skills. There will also be a number of special topic

breakfast sessions and ample opportunity for networking and

collaboration. 

An invitation-only meeting for VA clinician and non-clinician career

development awardees will be held on February 15 as well. This

year’s career development meeting theme is “Making the Most of

Your Career Development Award: Turning Research into Policy and

Practice.” Events will include feature presentations by several

awardees, a panel discussion focusing on opportunities for translating

research into policy and practice, and an introduction to selected key

negotiation skills that can help investigators gain the most from their

award support. Second-year awardees will also be on hand to

highlight their research progress in a poster session that day.

For the HSR&D National Meeting agenda as well as registration

details, please visit www.hsrd.research.va.gov/about/national_

meeting/2006. 

In This Issue

HSR&D National Page 1

Meeting 2006

New QUERI Addresses Polytrauma 

and Blast-Related Injuries Page 2

HERC to Support QUERI 

Economics Research Page 2

Tampa VHA Patient Safety 

Director Honored Page 3

Cyber Seminars Forge Ahead Page 3

Getting Published? Page 4

Patient Treatment 

Adherence Book Published Page 4

Online Journal Available in 

Early 2006 Page 4

Research Highlights Page 5

Google’s Open Access Option Page 6

New Career 

Development Awardees Page 6

Newly Funded 

Research Projects Page 6

T ranslating

R esearch

into Practice

Vol. 4, No. 1 January 2006
2 VA Office of Research and Development, Health Services Research and Development Service

HSR&D Research Briefs JANUARY

New QUERI Addresses

Polytrauma and 

Blast-Related Injuries

HSR&D and the Rehabilitation Research &

Development Service (RR&D) are co-sponsoring a

new Quality Enhancement Research Initiative

(QUERI) Coordinating Center for the

Implementation of Practices in Polytrauma and

Blast-Related Injuries (PT/BRI). Officially launched

on October 1, the new PT/BRI-QUERI is a

collaborative endeavor involving four VA

Polytrauma Lead Centers located in Minneapolis,

MN, Tampa, FL, Palo Alto, CA, and Richmond, VA.

The nature of modern warfare has changed. There

are new causes of injury, improvements in body

armor and surgical stabilization at the front-line of

combat, and more war-wounded are returning with

complex, multiple injuries such as amputations,

brain injuries, and psychological adjustment

problems. Moreover, improvised explosive devices,

blasts (high pressure waves), landmines, and

explosive fragments now account for the majority

of combat injuries. Blast-related injuries are often

“polytraumatic,” meaning they result in injury

and/or impairment to more than one body system

or organ, and often require complex rehabilitation.

The new PT/BRI-QUERI will help identify and

implement evidence-based practices for these new

challenges to the health and health care of veterans.

This initiative also will focus on managing the

transition of health care for veterans from the

Department of Defense (DoD) to VA, and from

facility-based to community-based care. 

The Research Coordinator for PT/BRI-QUERI is

Nina Sayer, PhD (Minneapolis), and the Co-Clinical

Coordinators are Barbara Sigford, MD, PhD

(Minneapolis), and Steven Scott, DO (Tampa). For

more information about this new QUERI, please

visit www.hsrd.research.va.gov/research/queri. 

HERC to Support QUERI

Economics Research

HSR&D has funded a three-year project through 

the Health Economics Resource Center (HERC) to

enhance the scope and quality of Quality Enhancement Research Initiative (QUERI) economic research.

The project will teach economic methods, give

support and guidance to researchers, and sharpen

methods for building managerial support for

implementation.

The principal objective of QUERI is to identify and

implement interventions that will improve the

quality of healthcare for veterans. To move from a

local project to regional or national implementation

requires approval from managers at several levels.

Clinical effectiveness is paramount in their decisionmaking, but budget constraints force managers to

weigh clinical benefits against increased costs. 

As the QUERI program expands and multi-site

implementation projects become more common,

there is a greater need for sound research on the

costs of new interventions. Managers need to know

whether the increase in the quality of care provided

by new interventions is significant enough to justify

the increased cost needed to carry them out. As a

national HSR&D resource center, HERC already

provides a Help Desk, guidebooks and technical

reports, and more than two dozen seminars each

year. The new project will enable HERC to provide

additional services to QUERI investigators. 

Training will be a key element. HERC will survey

QUERI researchers to determine their needs and

VA HSR&D Research Briefs is a biannual publication

of the Office of Research and Development’s Health

Services Research and Development Service. Each

issue will provide summary information about recently

completed research projects and publications, as well

as descriptions of new initiatives, solicitations, newly

funded studies and other items of interest to a broad

VA audience. For more information or to provide us

with your questions or suggestions, please contact:

Geraldine McGlynn, Director

Center for Information Dissemination and 

Education Resources

Boston VA Healthcare System (152C)

150 South Huntington Ave

Boston, MA 02130-4893

FAX: (857) 364-4511

E-mail: geraldine.mcglynn@va.gov 

VA HSR&D Research Briefs is available on the Internet

at www.hsrd.research.va.gov or Intranet at

vaww.hsrd.research.va.gov
VA Office of Research and Development, Health Services Research and Development Service 3

2006 HSR&D Research Briefs

interests and results will guide the adaptation or

development of cyberseminars, technical reports,

and guidebooks.

HERC has already developed guidelines for

proposing economic analysis within implementation

research that are different from traditional guidelines

in several ways. For example, while a standard costeffectiveness analysis has a very long time horizon,

VA managers must make annual budget decisions.

An intervention with front-loaded costs may look

attractive over a 20-year timeframe but too costly

over one to two years. And while standard analyses

value costs paid by all sources, VA managers are

concerned primarily with VA costs. Therefore, the

guidelines emphasize the need to perform analyses

from the VA manager’s perspective. HERC will also

develop guidance on how to present cost analyses in

a manner persuasive to VA leaders. 

To learn more about HERC and this project, visit the

HERC website at www.herc.research.med.va.gov or

contact Mark Smith at mark.smith9@va.gov.

Tampa VHA Patient Safety

Director Honored 

Audrey Nelson, PhD, RN, FAAN, director of the

Veterans Health Administration’s (VHA) Patient Safety

Center of Inquiry in Tampa, FL, has been awarded 

the prestigious John M. Eisenberg Patient Safety and

Quality Award for 2005 in the category of individual

achievement. Established in

memory of John M. Eisenberg,

MD, former Director of the

Agency for Healthcare

Research and Quality, this

award recognizes the

achievements of individuals

and organizations that have

made important contributions

to patient safety and

healthcare quality.

Dr. Nelson received the award in recognition of her

research dedicated to improving the quality of care

delivered to people with disabilities. In addition to

her role as director of the Patient Safety Center, Dr.

Nelson serves as the associate director for research

for nursing at the University of South Florida, and

is an accomplished health services researcher. As a

Health Services Research & Development Service

(HSR&D) investigator, Dr. Nelson’s research has

focused on safe patient mobility for the disabled.

The Eisenberg Award was presented to Dr. Nelson

during the National Quality Forum’s Annual

Membership Meeting on October 6th, in Washington, D.C. The December 2005 issue of the Joint

Commission Journal on Quality and Safety also

features the achievements of this year’s Eisenberg

award recipients.

Cyber Seminars Forge Ahead

In 2005, HSR&D launched its cyber seminar

program and began bringing key HSR&D

information right to the user’s computer. Facilitated

by the Center for Information Dissemination &

Education Resources (CIDER), HSR&D cyber

seminars use state-of-the-art web conferencing

technologies, enabling geographically dispersed

participants to share information and benefit from

interactive demonstration of tools, techniques,

products, and solutions to some of the critical

challenges facing HSR&D researchers. 

Recent seminar topics included demonstrating a

software application for modeling medical decisionmaking, conducting cost-effectiveness analysis, and

using VA-Medicare datasets. The popular 15 session

course “An Introduction to Health Economics”

presented by the Health Economics Resource Center

(HERC) is being updated and will be offered again in

2006. Other upcoming presentations will include

information-rich sessions on accessing and using

VA’s data resources, presented by the VA Information

Resource Center (VIREC), and tutorials in

measurement theory and instruments developed by

the Measurement Excellence and Training Resource

Information Center (METRIC).

Email alerts

To receive email alerts as new offerings are added to

the 2006 calendar send an email to CIDER.boston

@va.gov or visit www.hsrd.research.va.gov/

for_researchers/cyber_seminars/ to view the course

schedule, register for an upcoming seminar, or

access on-demand seminar archives. 

Audrey Nelson, PhD, RN, FAAN
4 VA Office of Research and Development, Health Services Research and Development Service

HSR&D Research Briefs JANUARY

Getting Published? 

When you have an article accepted for publication, please let us know. An HSR&D funding

requirement, early notification allows us to prepare

briefing materials for VA leadership and plan for

other dissemination of your research findings. 

Send an email to vhacohsrd@va.gov and research.

publications@va.gov and include the following

information:

• Name of the journal publishing the article

• Anticipated publication date

• Funding source (if the research was HSR&D

funded, include the project number)

• Attach a copy of the accepted manuscript

• Details of any anticipated press or publicity about

the article and include press releases, if any

• Information regarding embargoes put in place by

the journal(s), if any

Once your article is published, we’ll include its

citation in HSR&D’s online citation database, and

highlight important findings in a variety of print and

electronic publications. Visit the HSR&D web site at

www.hsrd.research.va.gov/publications/citations to

view HSR&D citations. 

Patient Treatment Adherence

Book Published

HSR&D investigators, Drs. Hayden Bosworth,

Eugene Oddone, and Morris Weinberger are editors

of a new book titled, Patient Treatment Adherence. 

The book is a comprehensive source on the conceptualization, interventions, and measurement of

adherence to medical treatment, and provides a

synthesis of the research across chronic diseases. 

The book also presents models that have been 

used to improve adherence with specific behaviors,

such as exercise, diet, rehabilitation, medication,

and psychological therapies for mental illness,

including depression.

Drs. Bosworth, Oddone, and Weinberger are part 

of HSR&D’s Center for Health Services Research 

in Primary Care in Durham, NC, which works to

enhance the delivery, quality, and efficiency of

primary care for veterans. Research topics studied 

by center investigators include ambulatory care,

women’s health, geriatrics, and the epidemiology 

of chronic disease. 

For additional information about Patient Treatment

Adherence and how to order, visit the publisher’s

website at www.erlbaum.com/shop/tek9.asp?pg=

products&specific=0-8058-4833-9.

Online Journal 

Available In Early 2006

Implementation Science is a new online, open-access

journal published through BioMed Central. It will

complement existing journals serving the healthcare

quality improvement (QI) and implementation fields

by focusing on research examining methods to

accelerate the implementation of evidence-based

clinical practices in routine healthcare settings. The

publication aims to become an important

communication tool for implementation researchers,

while also providing content useful to QI

practitioners, healthcare managers, and others. As an

online journal, Implementation Science will offer a

rapid publication schedule while maintaining a

rigorous peer review process. 

The need for a journal focusing on the science of

implementation became clear as implementation

researchers, including those from VA’s Quality

Enhancement Research Initiative (QUERI), recognized

that communication challenges and a lack of

dedicated conferences and journals in their field

made it difficult to exchange scientific information

about implementation research. The journal is

expected to bridge the full range of perspectives

comprising implementation research by attracting

authors and readers from various disciplines,

including evidence-based medicine, knowledge

utilization, social science, and management

perspectives on QI and healthcare practice change. 

The journal’s planning group included

representatives from VA, the Agency for Healthcare

Research and Quality, and other research institutions
VA Office of Research and Development, Health Services Research and Development Service 5

2006 HSR&D Research Briefs

in the United States, United Kingdom, Canada,

Norway, and the Netherlands. 

Implementation Science will begin publication in

early 2006. To read more or to submit articles, please

visit www.implementationscience.com. QUERI and

other HSR&D investigators interested in contributing

to the editorial process should contact Dr. Brian

Mittman at brian.mittman@va.gov.

Research Highlights

Individuals Who Participate in Alcoholics

Anonymous Along With Treatment Are More

Likely to Achieve Remission

Several studies have shown that participation in

Alcoholics Anonymous (AA) is associated with better

alcohol-related and psychosocial outcomes among

individuals with alcohol use disorders. However, most

of these studies focused on individuals who

participated in AA during or immediately after

treatment, so little is known about those who initially

choose to participate only in AA, or of how timing of

entry into AA and treatment affects alcohol-related

outcomes. A recent study found that individuals who

enter treatment for alcohol use disorders in the first

year after seeking help, in addition to participating in

AA, were more likely to achieve remission than those

who entered AA later or not at all. 

Participants were surveyed at baseline, one year, three

years, eight years, and 16 years, and were divided into

three groups based on their first-year treatment

selection: AA only, treatment along with AA, or

treatment only. At each contact point, individuals

described their participation in AA and treatment, as

well as their current alcohol-related functioning. They

also described their reasons for entering AA and/or

treatment and the perceived benefits of these sources of

help. Findings show that early entry into AA and treatment achieved the best outcomes. Also, over the 16-

year follow-up, a longer duration of participation in AA

was associated with a higher likelihood of remission.

Moos RH, Moos BS. Paths of Entry into Alcoholics

Anonymous: Consequences for Participation and

Remission. Alcoholism: Clinical & Experimental

Research 2005 October; 29(10):1858-68.

Implantable Cardioverter-Defibrillators

Prove Cost-Effective in Preventing Sudden

Death Among High-Risk Patients

The implantable cardioverter-defibrillator (ICD)

can correct episodes of serious heartbeat

irregularities, thus preventing death. Several trials

have shown that ICDs significantly reduce overall

mortality, but given their substantial cost, the

economic effect must be evaluated. This study

assessed the cost-effectiveness of ICDs in patients

who participated in eight randomized trials on the

prophylactic use of ICDs. Investigators used a

decision model to estimate costs, survival, and

quality of life among patients who received either

an ICD for the primary prevention of sudden death

from cardiac causes or control therapy. For

patients in six of eight trials analyzed, the use of

an ICD reduced the risk of sudden death and was

projected to add between 1.01 and 2.99 qualityadjusted life years (QALY) and between $68,300

and $101,500 in cost.

Sanders G, Hlatky M, Owens D. Cost-Effectiveness

of Implantable Cardioverter-Defibrillators in

Preventing Sudden Death. New England Journal of

Medicine 2005 October 6;353(14):1471-80.

VHA RNs Express More Satisfaction with

Their Jobs and Work Environment

Compared to Non-VA Nursing Personnel

This cross-sectional, observational study assessed

the characteristics and perceptions of nurses

working in the VHA, comparing various nursing

personnel, including registered nurses (RNs),

practical or vocational nurses (LPNs), and a broad

group of nursing personnel such as nurse aides or

unlicensed assistive personnel (UAP). Study

investigators administered a mailed survey to all

nursing personnel in 125 VA medical centers

between February and June 2003. Focusing on

questions related to practice environment and job

satisfaction, investigators compared RN responses

among different types of nursing personnel within

VHA, and also compared RN responses from the

International Hospital Outcomes Consortium

(IHOC) survey with RN responses from the VHA

survey. Among the three types of nursing
6 VA Office of Research and Development, Health Services Research and Development Service

HSR&D Research Briefs JANUARY

personnel within VHA, RNs appear to be the least

satisfied and may have a less positive perception of

their practice environment. However, VHA RNs are

more satisfied, overall, than non-VHA RNs who

participated in the IHOC survey. Within VHA, UAPs

appear to be the most satisfied.

Sales A, Sharp N, Li Y, et al. Nurse Staffing and

Patient Outcomes in Veterans Affairs Hospitals.

Journal of Nursing Administration 2005 October;

35(10):459-56.

Google’s Open Access 

Option Now Available

Google.com now allows users to limit search results to

only Creative Commons-licensed material. All articles

published by BioMed Central, and several other open

access publishers, are distributed under the terms of

the Creative Commons Attribution License, which

permits unrestricted use, distribution, and reproduction

in any medium, with the proper citation. 

This new feature will enable researchers or students to

immediately find material they can freely reproduce

without needing special permission from the

publisher. The option to restrict a search to Creative

Commons licensed material is available on Google’s

advanced search page under “Usage Rights.”

New Career 

Development Awardees

HSR&D Career Development Awards provide VA

clinician researchers with full salary support to

enable them to pursue health services research

training and experience, with minimal clinical

responsibilities, and under the guidance of an

experienced mentor. Congratulations to the most

recent awardees, listed below along with their

locations and areas of research interest to be pursued

through their award. (Only awardees with funding

start dates that have been confirmed since the last

issue of Research Briefs are listed here). For more

information about this program and for awardee

biosketches, visit the HSR&D web site at

www.hsrd.research.va.gov/

for_researchers/professional_development.

Matthew J. Bair, MD

Indianapolis VAMC

Improving Pain Management in Primary Care

Deborah Fisher, MD

Durham VAMC

Multilevel Barriers Influencing Colorectal 

Cancer Prevention and Detection

Henry K. Yaggi, MD, MPH

VA Connecticut Health Care System

Race, Sleep Apnea, and Risk of 

Cardiovascular Outcomes

Newly Funded 

Research Projects 

HSR&D continues to have a strong merit review

program. This strength is reflected in the number and

diversity of newly funded HSR&D research projects

listed below. (Only projects with funding start

dates that have been confirmed since the last

issue of Research Briefs are listed here. For all

other HSR&D funded projects, see the web study

section at www.hsrd.research.va.gov/research).

INVESTIGATOR-INITIATED RESEARCH

Amputation Related Trends, Health Care Use and

Outcomes in Veterans

Chin-Lin Tseng, DrPH

VA New Jersey Health Care System

Funding Period: July 2005 – December 2007

Antibiotic Use, Resistance and Clostridium 

Difficile-Associated Diarrhea

Jorge P. Parada, MD, MPH

Hines VAMC

Funding Period: September 2005 – August 2007
VA Office of Research and Development, Health Services Research and Development Service 7

2006 HSR&D Research Briefs

Assessing and Addressing Patient Colorectal

Cancer Screening Barriers

Melissa Partin, PhD

Minneapolis VAMC

Funding Period: July 2005 – December 2008

Behavioral/Pharmacological Telemedicine

Intervention for BP Control

Hayden Bosworth, PhD

Durham VAMC

Funding Period: August 2005 – September 2008

Effect of Self-Management on Improving Sleep

Apnea Outcomes

Carl J. Stepnowsky, PhD

VA San Diego Health Care System

Funding Period: October 2005 – September 2009

Effectiveness of Anti-Epileptic Drugs for Older

Veterans: Old and New Drugs

Mary Jo Pugh, PhD

VA South Texas Health Care System

Funding Period: July 2005 – June 2008

Evaluation of a Cardiac Nurse Practitioner Palliative

Care Program

Faith Hopp, PhD

VA Ann Arbor Health Care System

Funding Period: September 2005 – February 2010

Implementing Symptoms Assessment into Clinical

HIV Care

Joseph M. Mrus, MD, MSc

Cincinnati VAMC

Funding Period: October 2005 – December 2006

Improving Safety Culture and Outcomes in VA

Hospitals

David M. Gaba, MD

VA Palo Alto Health Care System

Funding Period: July 2005 – June 2008

Improving the Treatment of Chronic Pain in

Primary Care

Steven K. Dobscha, MD

Portland VAMC

Funding Period: September 2005 – November 2009

Insulin Treatment Variation in Southwestern

Diabetics: Therapeutic Decision-Making

M. Jane Mohler, MPH, PhD

Southern Arizona VA Health Care System

Funding Period: May 2005 – April 2008

Intervention to Improve Care at Life’s End in VA

Medical Centers

Kathryn L. Burgio, PhD

Birmingham VAMC

Funding Period: July 2005 – June 2010

Joint Replacement Disparity: Communication and

Decision-Making Factors

Said A. Ibrahim, MD, MPH

VA Pittsburgh Health Care System

Funding Period: September 2005 – August 2008

Manifestations, Causes and Consequences of PECU

in Elderly TCU Residents

Dennis H. Sullivan, MD

Central Arkansas Veterans Health Care System

Funding Period: September 2005 – October 2010

Quality of Care and Outcomes in Veterans with

Pre-End Stage Renal Disease

Leonard Pogach, MD, MBA

VA New Jersey Health Care System

Funding Period: July 2005 – June 2008

Reducing Avoidable Deaths by Directing Veterans’

Surgical Care in the Private Sector

William B. Weeks, MD, MBA

White River Junction VAMC

Funding Period: July 2005 – June 2007

Suicide Among Veterans: Using the VA Depression

Registry to Inform Care

Marcia Valenstein, MD

VA Ann Arbor Health Care System

Funding Period: July 2005 – June 2008

Tele-Mental Health Intervention to Improve

Depression Outcomes in CBOCs

David Mohr, PhD

San Francisco VAMC

Funding Period: July 2005 – June 2009
8 VA Office of Research and Development, Health Services Research and Development Service

HSR&D Research Briefs JANUARY

Validation of Pain as a Vital Sign Among Veterans

with Advanced Illness

Karl Lorenz, MD

VA Greater Los Angeles Health Care System

Funding Period: July 2005 – June 2007

Variability in Surgical Blood Transfusion Practices

and Cardiovascular Outcome

Wen-Chin Wu, MD

Providence VAMC

Funding Period: July 2005 – June 2007

MANAGEMENT CONSULTATION

Quality Improvement for Timely Initiation of

Antibiotic Therapy in Pneumonia 

Michael J. Fine, MD, MSc

VA Pittsburgh Health Care System

Funding Period: June 2005 – December 2005

Timing of Pre-Operative Administration of

Prophylactic Antibiotics

Thomas Houston, MD, MPH

Birmingham VAMC

Funding Period: July 2005 – December 2005

NURSING RESEARCH INITIATIVE

Efficacy of Mantram Repetition on Symptoms of

PTSD in Veterans

Jill E. Bormann, PhD

VA San Diego Health Care System

Funding Period: July 2005 – June 2009

SERVICE-DIRECTED PROJECTS

Decision Support for the Management of Opioid

Therapy in Chronic Pain

Denise Daniels, PhD

VA Palo Alto Health Care System

Funding Period: July 2005 – June 2008

Dissemination and Implementation of Supported

Employment in VHA 

Sandra G. Resnick, PhD

VA Connecticut Health Care System

Funding Period: December 2005 – November 2007

CIDER

VA Boston Healthcare System (152C)

150 South Huntington Avenue

Boston, MA 02130-4893