FORUM
 translating research 

into quality health care 

for veterans

A publication of the VA Office of Research 

& Development, Health Services Research 

& Development Service, Center for 

Information Dissemination and Education 

Resources, in conjunction with AcademyHealth 

June 2005 VA Health Services Research & Development Service 

Contents 

Director’s Letter 2 

Response to Commentary 3 

Research Highlights 4 

Organizational Profile 6 

HSR&D National Meeting 7 

Veteran Health Care: Meeting Tomorrow’s Challenges 

By Jonathan B. Perlin, M.D., Ph.D., Under Secretary for Health 

Ten years ago, the VA began the process of 

reinventing itself as a model health care 

provider system characterized by patientcentered, high-quality, high-value health care. 

Today, we are widely recognized throughout 

the nation and the world for the remarkable 

transformation we have accomplished. One 

nationally prominent magazine, the 

Washington Monthly, went so far recently as to 

describe VA health care as “the best care anywhere.” 

At the heart of this magnificent transformation 

have been structural and organizational 

changes of a magnitude unprecedented in the 

long history of veterans’ health care. When we 

created 22 (now 21) Veterans Integrated 

Service Networks in 1995, we changed the way 

we allocated resources from individual facilities to geographic networks. This, in turn, 

enabled us to shift the emphasis in our care 

delivery from hospitals to outpatient clinics 

and to homes and communities. And by making every part of our system accountable for its 

performance through our comprehensive system of performance measures, we proved our 

value to Congress, the White House, and the 

American taxpayer, and our quality to the veterans we are privileged to serve. 

A decade after the opening salvos of our revolution, we are faced with the question of how 

we will continue to move forward in a time of 

increased fiscal constraints. We face challenges 

on many fronts, and our ability to meet those 

challenges will determine the legacy we will 

leave for those who will assume the mantle of 

leadership of VA for many years to come. 

For example, we must be ready to care for 

increasing numbers of Operation Iraqi 

Freedom and Operation Enduring Freedom 

veterans as they return from service and claim 

the honored title of American veteran. We 

must continue to modernize our inpatient and 

outpatient models of care, so that our health 

delivery system crosses generations, gender, 

and geography. We must create delivery models of care that account for the increasing 

number of women veterans we are seeing, a 

result of the increasing integration of women 

into all aspects of the military. And, just as we 

moved our care focus in the past 10 years from 

hospital-centric to outpatient-centric, in the 

next 10 years we must move our system to 

become fully patient-centric. 

“Just as we moved our care focus 

in the past 10 years from hospitalcentric to outpatient-centric, in the 

next 10 years we must move our 

system to become fully patientcentric.” 

How will we meet these challenges? Some of 

the answers are already being developed. The 

transformation from our VistA legacy electronic 

health record system to the new HealtheVetVistA platform is an integral part of our strateg

continued on page 
Director’s Letter 

The VA Health Services Research and 

Development Service congratulates 

Jonathan Perlin, M.D., Ph.D., on his 

appointment as VA’s Under Secretary for 

Health. Dr. Perlin has been an enthusiastic 

supporter of health services research and 

a leader in promoting the application of 

research into clinical practice. He continues to support the Quality Enhancement 

Research Initiative (QUERI) and HSR&D’s 

efforts to further develop the science of 

implementation research. We look forward 

to working with him to continue improving the health care we provide to veterans. 

Our recent HSR&D National Meeting 

demonstrated the vibrancy of our program 

and the breadth of research that we continue to undertake. More than 80 papers 

and 90 posters were presented on the 

meeting topic, Improving Care for Veterans 

with Chronic Illnesses. A highlight was the 

presentation of the Under Secretary’s 

Award for Outstanding Achievement in 

Health Services Research to Rodney 

Hayward, M.D. (see page 7 for details). 

Though we have experienced a tightening 

of the research budget this year and expect 

to again next year, our Centers, career 

development, and merit review programs 

remain strong. Our portfolio management 

structure has been strengthened and we 

continue to work with our field-based 

science advisors to fine-tune our priorities 

and processes. We expect to fund 16.4 

percent of the 152 Investigator Initiated 

Research (IIR) project proposals that were 

reviewed in March and 33.3 percent of the 

19 QUERI/Implementation projects 

reviewed. We also expect to fund six new 

Research Career Development awards and 

six Advanced Research Career Development 

awards. We expect to receive 180 IIR proposals for the June 15 round. 

With the inspiring dedication of our investigators and staff, I look forward to another 

year of outstanding achievements. 

Shirley Meehan, M.B.A., Ph.D. 

Acting Director, HSR&D 

for the future. HealtheVet-VistA will create 

a fully integrated health data repository with 

registration systems, provider systems, 

management and financial systems, and 

information and education systems. 

HealtheVet-VistA will be patient-centered, 

not facility oriented. It will have enhancements from VistA legacy that will help us 

improve the quality of the health care we 

provide, our patient safety record, and our 

performance. It will enhance our ability to 

keep our patients’ records safe and secure. 

When HealtheVet-VistA is up and running, 

our records will be interoperable with the 

systems of the Department of Defense, 

Department of Health and Human Services, 

and the Indian Health Service. We will have 

the ability to monitor trends in health care 

including outbreaks of infectious diseases 

and possible bioterrorist attacks. 

Another aspect of our health information 

architecture is My HealtheVet, which when 

fully operational will provide veterans with 

access to their personal health records, 

online health assessment tools, mechanisms for prescription refills and making 

appointments, and access to high-quality 

consumer health information. 

Care coordination is a second area where 

we are creating a platform of success for 

the future today. Through our advances in 

tele-mental health, tele-rehabilitation, teleendocrinology, and tele-retinal imaging, our 

veterans now have greater access to the 

finest specialized care the VA can offer— 

in the privacy of their homes. 

Care coordination links the special expertise 

on combat injuries that Military Treatment 

Facilities have with veterans at our 

Polytrauma centers, with our medical centers 

when the veterans’ rehabilitation has progressed significantly, and with their homes 

when they have left treatment centers. It is 

an integral part of our strategy to serve our 

nation’s newest generation of heroes. 

And care coordination enables us to provide 

care in a manner that builds in safety, effectiveness, efficiency, and compassion. By 

allowing those with frailties to succeed whil

aging in place or by managing chronic disease in their communities, we can preserv

not only community social relationships, 

but also personal relationships of many 

years. 

Care coordination and improvements to 

our electronic health record system are 

enabling us to meet our goal of extending 

our environment of care to the patient’s 

home, workplace and community. Our ulti

mate goal, however, can only be achieved 

through innovative thinking and hard 

work: to systematically and seamlessly pro

vide the right care, to the right patient, at 

the right time. VA research, and our 

researchers, must play an important role in 

helping us reach that goal. 

“Our ultimate goal can only be 

achieved through innovative 

thinking and hard work: 

to systematically and seamlessly 

provide the right care, to the righ

patient, at the right time.” 

Our research must be linked to better patien

outcomes that mean more than improved 

performance data, that make tangible 

improvements to veterans’ health, and that 

affect their daily lives. Researchers must b

part of the drive to turn the ideas and vision

of today into the practical realities and prac

tices of tomorrow. They must break down 

the barriers that have created a situation in 

which it still takes an average of 17 years to 

fully put clinical findings into practice. 

By linking today’s research innovations to 

tomorrow’s improved patient care outcomes, we can create delivery models of 

care that will enable us to meet today’s 

health care challenges—and tomorrow’s. ■ 

2 ■ Forum/June 2005 
Forum/June 2005 ■ 

Response to Commentary
 

VA Research: Responding to New Challenges 

By Stephan D. Fihn, M.D., M.P.H., Director, Seattle HSR&D Center of Excellence 


This article was written in Dr. Fihn’s recent capacity as Acting Chief Research and Development Officer.
 

Dr. Perlin eloquently summarizes the of our target population. Despite these efforts, 

transformation of an agency operating a much work remains to design innovative 

loosely organized group of inefficient, poorly approaches that maximize efficient use of the 

regarded hospitals into a well-integrated human and technical resources within our 

health care system that is now setting system to achieve the best possible outcomes. 

international standards for performance and 

outcomes. This process of change was ini­ In addition to medical informatics and 

tiated a decade ago by then Under Secretary models of care, the VA continues its strong 

for Health Dr. Kenneth Kizer, who created focus on the generation and incorporation 

a blueprint titled Prescription for Change. of reliable evidence about the efficacy of the 

Now that much of Dr. Kizer’s vision has care we deliver. Without such evidence, we 

been realized, Dr. Perlin outlines an ambi­ risk not only wasting scarce resources but 

tious vision for the next phase, moving also needlessly harming patients. VA procare out from the walls of our clinics and motes evidence-based practice through the 

hospitals and into the homes and commu­ use of clinical practice guidelines, perfornities of the veterans we serve. mance measures, and computerized 

reminders. More work will be required to 

The foundations for this continuing trans­ extend these efforts into the realms of 

formation are information technology and chronic disease management, specialty and 

new, coordinated approaches to health care. surgical care, and rehabilitation medicine. 

Our Computerized Patient Record System 

(CPRS) is so integral to the delivery of care We are fortunate to work in a system that 

that it is difficult to envision how we could respects and supports the role of health sermanage patients without it. Despite these vices research in identifying new evidence 

remarkable successes, VA is now undertak­ and synthesizing the best available evidence 

ing an even bolder reengineering of CPRS into actionable guidelines. The logical prothat ultimately will permit our patients to gression is for QUERI and HSR&D investibecome full participants in managing their gators throughout the system to take their 

own health care. bias for action into the new territories that 

VA’s journey is traversing. Some of these 

With regard to care coordination, VA has first steps are already under way: 

designed and tested innovative strategies ■ VA HSR&D investigators are working for caring for patients with complex and with the Office of Care Coordination to multiple comorbidities, including: compre­ develop evidence-based strategies for dis­ hensive geriatrics evaluation and manage­ ease management and to evaluate the effec­ ment; home-based primary care; intensive tiveness of these new systems of care. case management for the seriously mentally 

ill; collaborative care for depression; disease ■ VA HSR&D recently identified for priormanagement strategies for diabetes, heart ity funding several investigator-initiated and 

failure, and other conditions; and service-directed projects that focus on 

telemedicine to link veterans in distant improving the effectiveness of VA informatcommunities with specialized expertise. VA ics. These projects include new decisionis making further investments in training support systems that better integrate 

and equipment to extend and tailor these patient-specific clinical information with 

care coordination models to broader segments evidence-based guidelines. 

■ A new Chronic Heart Failure QUERI 

center, based in Palo Alto and San Francisco, 

focuses on care coordination as well as 

appropriate use of emerging technologies 

(e.g., implantable cardiac resynchronization 

devices). 

■ We are establishing a Polytrauma QUER

to begin the process of identifying and 

implementing evidence-based practices for 

the challenging injury clusters and sequelae 

that are the results of modern warfare prac

tices. This initiative will focus on managing 

the transition from DoD to VA, and from 

facility-based to community-based care. 

■ QUERI groups and other HSR&D inves

tigators have started to embark on a numbe

of initiatives in partnership with VA’s Offic

of Patient Care Services and the Office of 

Quality and Performance, as well as with 

the Veterans Benefit Administration. These 

activities seek to reduce inappropriate varia

tions in practice for conditions of importance to today’s returning soldier, including 

cancer care, cardiac care, and mental health

■ In partnership with the Office of 

Informatics, Patient Care Services, Operations

and the Office of Quality and Performance, 

the Ischemic Heart Disease QUERI has 

developed a new approach to employing the 

electronic health record to document and 

improve care for patients undergoing invasive cardiac procedures. 

Like most of our investigators in HSR&D, I 

was initially attracted to VA because of its 

commitment to excellence in patient care, 

research, and education. Despite budget dif

ficulties that all hope are merely temporary

we are facing a time of extraordinary oppor

tunity to participate in and influence a long 

overdue revolution in health care in which 

health care providers and their patients will 

realize all the benefits that scientific advance

have to offer. As VA prepares to embrace a 

new generation of veterans, the research 

community should eagerly embrace these 

new developments and become partners in 

this exciting venture. ■ 
4 ■ Forum/June 2005 

Research Highlights
 

How Long is the Reach of Performance 

Measurement? Lessons from a VA-Community 

Comparison 

By Mary M. Hogan, Ph.D., R.N., Ann Arbor HSR&D Center of Excellence, Steven M. Asch, 

M.D., M.P.H., Sepulveda HSR&D Center, and Eve A. Kerr, M.D., M.P.H., Ann Arbor 

HSR&D Center of Excellence 

The VA has been a leader in establishing of care. The difference between quality of 

system-wide quality measurement and, for care received by VA patients compared to 

many areas measured, performance has patients in other settings was greatest for 

improved over time. We took advantage of those specific processes measured by the 

two ongoing studies—one involving a sample VA (66 percent vs. 43 percent). In fact, 

of almost 600 VA patients and the other a the VA advantage extended to other indicanational sample of nearly 1,000 patients— tors in the same condition or area that 

to determine if care provided in the VA was were not specifically measured by the VA 

better than care received by patients in other (70 percent vs. 58 percent). For those health 

settings. We also sought to determine care areas that the VA did not measure for 

whether better care extended beyond the quality, however, the VA performance 

specific performance measures and areas advantage was greatly reduced when commonitored by the VA quality measurement pared to the national sample (55 percent vs. 

system. In both studies, reviewers abstract­ 50 percent). 

ed two years of patient medical records 

from all sources of care with the Quality This relationship between performance and 

Assessment Tools system, using 348 performance measurement suggests that 

process-of-care indicators for 26 conditions. measurement contributed to the observed 

differences in the study, though no doubt 

other factors also contributed. Moreover, 

VA Patients Received Higher Quality Care there may be a chain reaction or spillover 

effect such that measurement is associated 

We found that the VA patients were more with improved care in related areas, beyond 

likely than the patients in the national sam­ those processes specifically targeted. 

ple to receive needed care (67 percent vs. 51 

percent). This finding was also true for This finding addresses a common concern 

chronic care (72 percent vs. 59 percent) and in quality measurement—that resources 

preventive care (64 percent vs. 44 percent), will be used primarily to improve the specifbut not for acute care (53 percent vs. 55 per­ ic performance being measured at the 

cent). In particular, patients in the VA sam­ expense of other equally beneficial areas. It 

ple received significantly better care for is reassuring that, within profiled condidepression, diabetes, hyperlipidemia, and tions, performance was also better for 

hypertension. processes that were not specifically measured. This result suggests that measurement has a profound effect on quality Measurement Likely to Contribute to improvement and argues for the continued Improved Quality spread of performance measurement both 

within and outside the VA. 

These findings shed light on how performance measurement may improve quality continued on page 8 

HSR&D Priorities for 

Investigator-Initiated Research 

Fiscal Year 2006 

VA HSR&D has recently announced Fiscal 

Year 2006 funding priorities. This solicitation focuses on six priority health services 

research areas: 1) equity, 2) implementation, 

3) mental health, 4) long-term care, 

5) women’s health, and 6) research 

methodology. Each priority area has a narrowly targeted purpose that was developed 

by an HSR&D portfolio manager in consultation with field-based science advisors, 

and with input from senior VA leaders 

and other VA advisory groups. HSR&D 

envisions changing the targeting of these 

solicitations each fiscal year. 

In order to encourage investigators to 

conduct research in areas of high interest 

to HSR&D, proposals that respond to this 

solicitation will be given special consideration. As in the past, the merit review 

score, which is based on significance, 

approach, innovation, and environment, 

will continue to serve as the main criterion for identifying proposals that will be 

considered for funding. However, proposals with fundable scores that are also 

responsive to this targeted solicitation will 

be given priority consideration over other 

investigator-initiated proposals. 

Only investigators who hold a paid VA 

appointment of at least 5/8 time are eligible to apply. Proposals may request up to 

four years of funding; however, projects 

that can produce useful findings, either 

intermediate or final, in a shorter timeframe are encouraged. The initial proposal receipt date is June 15, 2005. First submission responses to this solicitation will 

receive special consideration for at least 

the next two review cycles (June 15, 2005, 

and December 15, 2005). For more information on the HSR&D Priorities 2006 

solicitation, visit the HSR&D Web site 

www.hsrd.research.va.gov/for_researchers/ 

funding/solicitations/. 
Forum/June 2005 ■ 

Measuring Intensity of Therapy in Patients 

with Diabetes 

By Dan Berlowitz, M.D., M.P.H., Bedford HSR&D Center of Excellence 

Health care payers, providers, and con­ intensification and a poor outcome; this sitsumers increasingly rely on assessments of uation is known as confounding by indicathe quality of care in making clinical, man­ tion. 

agement, or policy decisions. Yet all too 

often the quality measures on which these Our study sample consisted of 23,291 

decisions are based are flawed or do not patients with diabetes receiving regular 

capture clinically important aspects of care. medical care at 13 VA medical centers in 

Thus, a key component of health services Veterans Integrated Service Networks 1 and 

research at the VA is trying to improve the 8. Analyses were performed in three steps. 

science of quality measurement. First, we evaluated each individual visit to a 

medical clinic and developed a model to 

Quality measurement is especially impor­ predict whether treatment would be intensitant in the management of chronic medical fied at that visit, either by starting a new 

conditions that are common in the veteran antiglycemic medication or by increasing 

population, such as diabetes. Randomized the dosage of an existing medication. Next, 

clinical trials in patients with diabetes have we developed a treatment intensity score for 

convincingly demonstrated that more inten­ each patient that compares the actual numsive medication therapy results in improved ber of increases in therapy over a 16-month 

metabolic control and reduces the risk of period to that predicted by the model. 

developing microvascular disease. Yet Scores could range from -1 to +1 with posiobservational studies have consistently tive numbers indicating more intensive 

shown that many patients have poor meta­ therapy than the norm. Finally, we exambolic control and that clinicians often fail to ined the association of this treatment intenintensify therapy when indicated. This find­ sity score with two risk-adjusted outcome 

ing suggests that efforts to improve how measures: 1) whether the outcome visit glyclinicians manage medications in patients cosylated hemoglobin was greater than 8 

with diabetes may be particularly beneficial percent, and 2) change in glycosylated 

in improving health outcomes. Central to hemoglobin levels over the 16 months. 

any such effort would be a reliable and 

valid measure of the intensity of therapy. We found that treatment intensification 

occurred at 9.8 percent of medical visits. 

We recently set out to develop such a mea­ Predictors of treatment intensification 

sure. Among the properties we desired included a glycosylated hemoglobin greater 

were that: 1) this measure be based on data than 8 percent, performance of this test 

readily available in VA databases; 2) it be within the past three months, a higher 

clinically credible; and 3) it be linked to blood glucose level, and a longer interval 

patient outcomes, that is, more intensive between visits. Patients differed significanttherapy should be associated with better ly in the intensity of their therapy with 

glycemic control. This last criterion is espe­ scores ranging from -0.32 to +0.96. More 

cially difficult to show in observational intensive therapy was significantly associatstudies as elevated measures of glycemic ed with lower odds of having an outcome 

control are both a predictor of treatment glycosylated hemoglobin greater than 8 percent and a greater decrease in glycosylated 

hemoglobin over time. While the magnitude of the associations was not large, the 

fact that they were in the “right” direction 

suggests that we are successfully measurin

treatment intensity. This finding represents 

one of the few successful efforts to link dia

betes process and outcome measures. 

While additional research is required in 

evaluating this measure, it could be used in 

a variety of future applications. Quality 

improvement programs in diabetes care 

could profile providers’ practices not only 

on the basis of their glycemic control but 

also in their pharmacological management

Providers with higher intensity scores and 

better glycemic control could then be used 

for benchmarking. Important subgroups of 

patients with poor glycemic control, such a

ethnic minorities and individuals with 

mental health illnesses, could also be evalu

ated to determine whether differences in 

glycemic control reflect differences in med

ication management or other factors. 

“This finding represents one of 

the few successful efforts to link 

diabetes process and outcome 

measures.” 

Current quality measures for diabetes 

capture many important aspects of care. 

However, randomized trials clearly demonstrate that intensity of therapy is important 

in achieving glycemic control. Through 

advances in health services research, we 

will be better able to measure and improve 

this critical aspect of care. ■ 

For further information, please contact the 

author at the Center for Health Quality, 

Outcomes and Economic Research at 

dberlow@bu.edu. 
Organizational Profile
 

The VA/DoD Evidence-Based Practice Work 

Group 

By Carla L. Cassidy, A.N.P., M.S.N., and Lynnette Nilan, R.N., M.S.N., Ed.D., both 

from VA Office of Quality and Performance, and Leonard Pogach, M.D., M.B.A., 

National Program Director for Diabetes and HSR&D Center for Healthcare Knowledge 

Management Research 

The VA National Clinical Practice 

Guideline (CPG) Council has a new look 

and a new name. In November 2004, the 

VA/DoD Health Executive Council (HEC) 

chartered the new VA/DoD Evidence-Based 

Practice Work Group. This work group 

replaces the VA National Clinical Practice 

Guideline Council and will advise the 

VA/DoD HEC on the use of clinical and 

epidemiological evidence to improve health 

care across populations served by the VA 

and the Military Health Care System. 

Since 1998, the VA and DoD have enjoyed 

a meaningful partnership in developing and 

implementing clinical practice guidelines. 

Together they have developed 27 clinical 

practice guidelines, which are available on 

the VA and DoD Web sites and also the 

National Guideline Clearinghouse. 

The new Evidence-Based Practice Work 

Group’s membership includes 10 representatives each from the DoD and VA. The 

work group’s vision is to improve the overall health of VA and DoD beneficiaries by 

using evidence-based practices, reducing 

variations in care, and optimizing patient 

outcomes. The work group tasked four subgroups with accomplishing this mission: 

1) Clinical Guideline Portfolio Management 

and Development, 2) Evaluation and 

Analysis, 3) Decision Support for EvidenceBased Practice, and 4) Evidence-Based 

Knowledge Management and Transfer. 

Various Quality Enhancement Research 

Initiative (QUERI) groups are involved in 

both the subgroups and guideline development work groups. 

This year the Evidence-Based Practice Work 

Group will assemble expert teams to develop 

a new clinical practice guideline for obesity 

and update four other guidelines including 

dyslipidemia, post-deployment with a module 

on traumatic amputation, chronic obstructive pulmonary disease, and psychosis with 

a module on bi-polar conditions. The work 

group also plans to update the asthma 

guideline. With the help of the Technology 

Assessment Program, an acute stroke module is being developed as an addition to the 

stroke rehabilitation guideline. 

“For the VA, performance 

measurement translates into 

accountability, with the ultimate 

goal of improved practice and 

decreased variability across the 

system.” 

Evidence-based guidelines form the backbone of any strong performance management system. At the VA, these guidelines 

are developed by VA/DoD clinical leaders 

working with multidisciplinary work groups 

and the Evidence-Based Practice Work Group. 

These guidelines provide the basis for what 

will be measured and targeted for improvement across the VA system. For the VA, 

performance measurement translates into 

accountability, with the ultimate goal of 

improved practice and decreased variability 

across the system. Improvement efforts 

focus on education, guidance, and assistance 

in the form of shared experiences, and dissemination of tools that enable providers and 

facilities to reach their performance goals. 

Resources 

A complete listing of available guidelines, 

summaries, pocket and key point cards, an

VA-related performance measures can be 

found on vaww.oqp.med.va.gov. and 

www.qmo.amedd.army.mil. Pharmacotherapeutic guidelines developed by the 

Medical Advisory Panel to the Pharmacy 

Benefits Program can also be accessed 

online at www.vapbm.org/pbm/ 

treatment.htm. ■ 

Coming Soon: Implementation 

Science, A New Online Journal 

VA’s HSR&D Service is supporting the 

launch of a new e-journal in the field of 

health care quality improvement and 

implementation research. Tentatively titled 

Implementation Science, the new journal 

will complement existing journals in this 

field by focusing on core research problems and issues. The journal will cover the 

full range of perspectives comprising 

implementation research by attracting 

authors and readers from disciplines as 

diverse as evidence-based medicine, 

knowledge utilization, the social sciences, 

and others. 

The journal’s planning group includes 

researchers and representatives from VA, 

the Agency for Healthcare Research and 

Quality, and other research institutions in 

the United States, United Kingdom, Canada, 

Norway, and the Netherlands. Members of 

the editorial board will represent a broad 

range of disciplines, institutions, and 

countries. The journal will be published as 

an online, open-access journal through 

BioMed Central (www.biomedcentral.com). 

For additional information about the journal 

and to access a brief survey designed to 

gather input into key decisions regarding 

the journal title, scope, and mission, visit the 

journal’s Web site at www.hsrd.research.va.gov/ 

for_researchers/journal-information.cfm. 

6 ■ Forum/June 2005 
Forum/June 2005 ■ 

A Recap of the HSR&D National Meeting
 

More than 500 researchers, clinicians, and from VA’s Quality Enhancement Research 

policymakers participated in VA’s Health Initiative (QUERI). Doubling flu vaccination 

Services Research & Development Service among veterans with spinal cord injury, dou­

(HSR&D) 23rd National Meeting held bling adherence to antidepressants among 

February 16–18, 2005, in Baltimore. patients with depressive disorders, and increas

“Improving Care for Veterans with Chronic ing provider adherence to guidelines for HIV 

Illness” was the meeting theme, which focused treatment were offered as examples. 

on how to provide the best and most costeffective health care for veterans living with In the coming year, QUERI plans to expand 

chronic illnesses. coordination and integration with other parts 

of VA in applying evidence-based approaches 

Hosted by HSR&D’s Houston Center for to a broader spectrum of conditions and chalQuality of Care and Utilization Studies, the lenges that affect the health of veterans. Specia

conference addressed numerous health care focus will be on new veterans who may be 

issues relating to quality improvement for dealing with traumatic amputations, PTSD, or 

chronic illnesses, such as chronic care models, other health issues related to military deploypatient-centered care, performance measure­ ment. 

ment systems, physician-patient communication, and translating research findings into Guest speaker Kenneth Dexter provided a vetpractice. Researchers also addressed many eran patient’s perspective when he spoke abou

chronic diseases and conditions that affect vet­ living with chronic illness, his recuperation 

erans, including HIV, post-traumatic stress dis­ from stroke, and the excellent care he has 

order (PTSD), diabetes, chronic viral hepatitis, received over the years from the VA. He 

and heart disease. stressed the need to improve communication 

between patients and providers, and emphasized the importance of research, particularly 

Highlights his involvement in several clinical trials that 

improved the quality of his health and life. 

In his opening remarks, Stephan Fihn, M.D., 

M.P.H., Acting Chief Research and Edward Wagner, M.D., M.P.H., Director of the 

Development Officer, noted a few recent and MacColl Institute for Healthcare Innovation in 

significant contributions made by HSR&D Seattle, served as this year’s keynote speaker. 

investigators: improving the cost-effectiveness In his remarks, Dr. Wagner emphasized the 

of routine HIV screening; increasing access to need for collaboration across the health care 

specialty care in nursing homes via interactive continuum, including primary care providers 

video; and assessing a VA bar-code medication and specialists, and communities to best serve 

administration system that reduces medication those with chronic illnesses. 

errors, the most common cause of adverse 

events in hospitals. To learn more about research presented at this 

year’s meeting, visit www.hsrd.research.va.gov

Dr. Fihn also discussed VA research priority about/ national_meeting/. ■ 

areas including interventions to reduce health 

disparities related to ethnicity or gender, 

improving the continuum of care for new veterans and active duty military personnel seek­ The 2006 HSR&D National Meeting is tentaing VA care, and improving the quality of care tively scheduled for February 15–17 in 

for women veterans and veterans who need Washington, D.C. Watch the Web for details at 

long-term care. He also highlighted several www.hsrd.research.va.gov. 

patient care improvements that have resulted 

Hayward Receives Under 

Secretary’s Award for 

Outstanding Achievement 

Rodney A. Hayward, M.D., has 

received this year’s prestigious 

Under Secretary’s Award for 

Outstanding Achievement in 

Health Services Research. Dr. 

Hayward was acknowledged as an 

exceptional health services 

researcher, excellent mentor, and 

respected VA leader. Jonathan R. 

Perlin, M.D., Ph.D., Under 

Secretary for Health, presented the 

award via video at the HSR&D 

National Meeting. 

As Director of HSR&D’s Center for 

Practice Management and 

Outcomes Research in Ann Arbor, 

Mich., Dr. Hayward has been 

instrumental in developing the 

Center as one of the elite health 

services research centers in the 

country. Further, his work in quality 

measurement and improvement, 

especially with regard to patient 

safety and in diabetes health care 

delivery, has been innovative and 

influential. 

Dr. Hayward has a long and 

accomplished academic career at 

the University of Michigan, where 

he is currently a professor in the 

Division of General Medicine. 
Hogan continued from page 4 

Challenges for the Future gate measures into composite scores; and 

incorporating appropriate assessments of 

Our study also provides lessons regarding measurement error when reporting 

selection of measures for performance provider profiles (Hofer, 1999). ■ 

monitoring systems. Because the act of 

measuring and reporting appears to be a References 

Asch SM, McGlynn EA, Hogan MM, et al. critical motivator for health care administraComparison of Quality of Care for Patients tors, managers, and providers to improve in the Veterans Health Administration and 

quality of care, performance measures Patients in a National Sample. Annals of should focus on those conditions and care Internal Medicine 21 December 2004; 

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(Kerr, 2001); understanding how to aggre­ Medicine 2003; 348:2635-2645. 

FORUM 

Geraldine McGlynn, Editor-in-Chief 

Margaret Trinity, Editor 

Editorial Board 

Martin P. Charns, D.B.A., Director, VA HSR&D 

Center of Excellence, Boston, MA 

Phil Crewson, Ph.D., Assistant Director, 

VA HSR&D, Central Office 

Joseph Francis, M.D., M.P.H., Director, HSR&D 

QUERI, Central Office 

Rodney A. Hayward, M.D., Director, VA HSR&D 

Center of Excellence, Ann Arbor, MI 

Shirley Meehan, M.B.A., Ph.D., Acting Director, 

VA HSR&D, Central Office 

Laura Miller, Deputy Under Secretary for Health 

for Operations and Management, Washington, DC 

Michael J. Miller, M.D., Ph.D., Chief Medical 

Officer, VA Network #1, Bedford, MA 

Eugene Z. Oddone, M.D., M.H.Sc., Director, 

VA HSR&D Center of Excellence, Durham, NC 

Alan S. Perry, M.H.A., FACHE, Director, 

VA Medical Center, Fresno, CA