Funded by the VA HSR&D (Project# SDR 10-012)

Spotlight on Women Cyberseminar Series
VA Women VA Women s’ Health

Practice-Based Research Net

An Introduction

Women s’ Health Cyberseminar Cyberseminar Series

July 12, 2011
OUTLINE

• Context for PBRN (Lipson)

• Overview of PBRN (Frayne) (Frayne)

• Divisions: How can we help you?

– Coordinating Center, Palo Alto ( ) Frayne)– Clinical Trials Division, Durham (Bastian)– Health Care Delivery Delivery Division Division, Greater Greater Los Angeles Angeles (Bean– Post‐Deployment Health Division, Iowa City (Sadler)

• Audience questions
Poll

• Do you provide clinical care to women

Veterans?

• *Yes

• *No
Poll

• Do you conduct research which focus

women Veterans?

• *Yes

• *No
Poll

• Do you conduct research which includ

women Veterans?

• *Yes

• *No
Context

Linda Lipson, MA

VA Health Services Research and Development 

Scientific Program Manager,

Women’s Health, Equity and Access
# of Women Veterans Using V

Doubled over Past Decade

Cohort: Women and men Veteran VHA users in year. Women in FY09: N=292,921; Men in FY09: N=4,846,869.

Source: WHEI analysis of ADUSH Monthly Enrollment Files, FY00–FY09.

.Sourcebook: Women Veterans in the Veterans Health Administration - Volume 1 (December 2010)
Resources

• HSR&D W ’ omen s H lth ea R h esearch

– Includes searchable women’s health literature data

searchable women’s health research portfolio

http://www.hsrd.research.va.gov/for_researchers/womens_health/

• Women s’ Health Evidence Evidence Synthesis Synthesis Reports Reports

http://www.hsrd.research.va.gov/publications/esp/women.cfmhttp://www.hsrd.research.va.gov/publications/esp/women‐vets.cfm

• Women’s Health Issues supplement

http://www.whijournal.com/content/supplements

• Cyberseminar series

http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/catalog‐

archive cfm?SeriesSortParam=y&SeriesIDz=56##Archived archive.cfm?SeriesSortParam=y&SeriesIDz=56##Archived
PBRN Overview

Susan Frayne, MD, MPH

Director, PBRN Coordinating Cent

VA Palo Alto Health Care System
Women's Health Research Publicat

Veterans and Women in the Military

60

Veterans and Women in the Military

“More articles in the past 5 years

50

s

More articles in the past

5 years

than in the previous 25 combined...”

Bean-Ma

yberry, et al. Updated Systematic Review 

(2010)

3040

lications 

y y, p y ( )

2030

# of Publ

10

0

Year of Publication
Women's Health Research Publicat

Veterans and Women in the Military

60

Veterans and Women in the Military

“More articles in the past 5 years

50

s

More articles in the past

5 years

than in the previous 25 combined...”

Bean-Ma

yberry, et al. Updated Systematic Review 

(2010)

3040

lications 

y y, p y ( ) ...but, only 5 (of 191) i tl

2030

# of Publ were experimen

t

al...

10

#

0

Year of Publication
Why are intervention/ implemen

women’s health studies challengin

• Relatively limited number of wom

any one VA f ili ac ty
Limited Number of Women Veterans at a Sing

Source: Fra

yne et al 2011, Women’s Health Evaluation Initiative 

(W
Why are intervention/ implemen

women’s health studies challengin

• Relatively limited number of wom

any one VA f ili ac ty

• Complexities Complexities of conducting conducting multi‐

research
Complexities of Multi‐Site Resea

Resea

• Identifying a site lead• Addressing local clinical logistics issues

– Cli i i Clinician engagement in recruit t men ; space 

specifics of local clinic operations; etc.

• Addressing Addressing local research research administration administration 

issues

– L l oca R&D procedures; HR issues; unions; et

• Navigating regulatory requirements

– Central IRB; multi‐site data entry; between‐

transmission; etc.
Complexities of Multi Site Rese

Women’s Healt

Complexities of Multi‐Site ^ Rese

• Special issues arising in research focusing on 

Veterans

– Clinical issues

• Preg y nanc• Menstrual cycle• Parenting• Trauma exposure/trust• Distinct patterns of illness

• Distinct patterns of health care utilization

– Health care delivery delivery issues

• Variability in systems of care for women’s primary ca

health care

• L l oca l d ea ers in women’s h lth ea (e.g., Women V t e era

Manager, Women’s Health clinical director, MST Coo

– State of the evidence base

• For some topics, relatively limited women’s health ev

to inform intervention and implementation studies
VA Women’s Health

Research Network

VA HSR&D SDR 10‐012

PI’s: Elizabeth Yano, PhD and Susan Frayne, 

• Consortium

– Train/educate, foster research‐clinical partnershi– Technical consultation consultation, mentorship mentorship, disseminatio

disseminatio

• P i ract ce B d ase R h esearch N k etwor (PBR

– Ready‐to‐use infrastructure facilitating multi‐site

interventions, implementation
Wh t a is a PBRN?

Definition (AHRQ):“...a g oup r of a bu a o y mbulatory p ac ces practices .... Typ ca 

ypicall

on the experience and insight of practicing 

identify and frame research questions who

improve ... practice .... By linking these querigorous research methods, the PBRN can presearch research findings findings that are immediately immediately rele

rele

clinician and, in theory, more easily assimila

every y da practice.”

http://pbrn.ahrq.gov/portal/server.pt/community/practice_based_research_networks_%28pbrn
Wh t a is a PBRN?

Definition (AHRQ):“...a g oup r of a bu a o y mbulatory p ac ces practices .... Typ ca 

ypicall

on the experience and insight of practicing 

identify and frame research questions who

improve ... practice .... By linking these querigorous research methods, the PBRN can presearch research findings findings that are immediately immediately rele

rele

clinician and, in theory, more easily assimila

every y da practice.”

Clinician‐centricUses Clinical Clinical Practices Practices as Laboratories Laboratories

http://pbrn.ahrq.gov/portal/server.pt/community/practice_based_research_networks_%28pbrn
Rationale for a VA Women’s Health 

• Facilitate Facilitate conduct conduct of multi‐site wome

health research

– Overcome problem of small N at any on

– Address complexities of multi‐site resea

• Foster dissemination• Encourage sense of community amon

women’s health researchers and clini

• Promote bi‐directional collaboration 

clinicians and researchers
PBRN Philosophy:

Bi‐Directional Collaboratio

Practice‐based research questio

CLINICIANS RESEA

Di i ti Dissemination of research fi di n 
Women’s Health PBRN: D

• Network of partnered VA facilities• Provides infrastructure• Accepts

– researcher‐initiated, funded research – clinician clinician‐initiated initiated quality quality improvement improvement 

• Implementation Evaluation Projects

– For early test of infrastructure
Building the Network: Network: Initia

Initia

Sadler

Frayne

Bean-M b ay erry
Infrastructure Compone

• Facilitate conduct of studies in l l oca c

– Build relationships w/ local facility leader– Identify clinic‐specific solutions to

• promote recruitment• minimize disruptions in clinic flow

• Facilitate local research administratio

– Determine site‐specific research requirem

( , R&D IRB etc.) and contacts

– Maintain generic position descriptions at 

expedite hiring
Infrastructure Componen

• S li it Solicit research using PBRN

– Outreach to investigators

• Women’s health researchers

• Other researchers wanting to increase enro

women

– Provide information about known p 

riorit

– Detect emerging practice‐based priority 
Infrastructure Component

• Support the grant application application process process

– Discuss evolving study aims

• Alignment with p y riority areas• Emphasis on intervention/implementation research• Other studies welcome, e.g., qualitative methods, observati

– Gauge it t n erest of site cli i i n c ans re parti i 

ticip

– Connect researchers with resources (CSP, 

other coll b t ) llaborators)

– Provide information relevant to grant pro

preparation

– Provide specialized methods expertise

– Review protocols to provide feedback
If t t n rastructure C 

omponen

• Promote Promote success success of funded PBRN stu

stu

– Upon notification of funding, assist PI wi

issues (e g. ., IRB, logistic logistic issues related related to 

settings, data transmission, standardizatinterviewer training, etc.)

• Note: PI will negotiate with participating site leads regardi

provided locally, budgetary needs of the sites, and whethe

will be an investigator

– Monitor progress of ongoing studies

• Note: ultimate responsibility rests with project’s PI

– Ongoing contact with sites

• local problem‐solving and team‐building• training training in relevant relevant research research methods methods (to enhance enhance standar

standar

measurement and quality of data collection across sites)
Infrastructure Componen

• P t romo e di i ti dissemination

– Women’s Health Research Consortium– PBRN Site clinicians– Women s’ Health Strategic Strategic Health Care Gr

Women Veteran Program Managers

– Steering Committee

• David Atkins MD; Joseph Francis MD; Patricia Hayes PhD; Gr

Susan McCutcheon EdD, RN; Gerry McGlynn MEd; Margaret 

Michael Parchman MD; Alina Salganicoff PhD; Paula Schnurr 

Street PhD; Robert Wallace MD; Donna Washington MD

– PBRN Advisory Committee Committee

• Rowena Dolor MD, Michael Parchman MD
Testing the Infrastructure:

Implementation Evaluation Project

• Kimerling: Kimerling: patient patient preferences preferences for gender‐sen

sen

mental health services (N = 1,000)

– Examples of infrastructure elements:

• Central IRB application; cross‐site interviewer training; 

clinic space; coordinating timing of interviews with clin

schedules; subject tracking system; Datafax data entry 

CSP; Certificate Certificate of Confidentiality; Confidentiality; Privacy Privacy Office applic

applic

SSN access

• Vogt‐Yee: gender awareness training program 

– Examples of infrastructure elements:

• Central IRB application; Expert Panel procedures; union 

identifying staff

• Klap‐Hamilton: clinician priorities for quality

improvement

– E l xamp es of if t t n rastructure el t emen s:

• Qualitative research in non‐engaged sites, with Directo
How Can We Help You?

Coordinating Center, Palo A

Team Palo Alto

Susan Fray , ne MD, MPH, Director( y@ 

susan.frayne@

Diane Carney, MA, Program Manager (diane.cCiaran Phibbs, PhD, Co‐Investigator Investigator (HERC)Julia Lin, PhD, Statistician (CSPCC)Alyssa Pomernacki, MPH, PRBN Coordinato

Andres Busette, CSP Programmer

Aileen Baylosis, CSP Clinical Data Manager

30
How Can We Help You?

Coordinating Center, Palo A

Areas of Expertise

Multi‐site research methodsData issues

Data capture and processing processingLinkage to large databasesData security

Site‐specific data

Women’s Heal ht Evaluation Initiative ( ) WHEIPBRN site characteristics

31
How Can We Help You?

Coordinating Center, Palo A

Types of issues for which investigators m

approach PBRN Coordinating Center:

I would like to submit a research grant pro

use PBRN sites

***Please contact us early!

I would like to do a multi‐site QI project projectI am interested in registering as a PBRN sit

32
Di i i v s ons

• Coordinating Center (Palo Alto)

Susan Frayne MD, MPH

• Cli i l Clinical Ti l r a s Di i i v s on (D h ) ur am

Lori Bastian MD, MPH

• Health Care Delivery Division (Greater Lo

Bevanne Bean‐Mayberry, MD, MHS

• Post‐Deployment Health Division (Iowa C

Anne Sadler, PhD, RN
Durham

Lori Bastian MD, MPH

Director, Clinical Trials Division

Durham VA Medical Center
How Can We Help You?

Clinical Trials Division, Durh

Team Durham

Lori Bastian, MD, MPH ( @ g) Lori.Bastian@va.gov)Jill Blakeney, RN, PBRN Coordinator (Jill.BlakeneJenifer Gierisch Gierisch, PhD, Co‐investigator investigatorLesley Rohrer, MPH, Intervention Coordina

35
How Can We Help You?

Clinical Trials Division, Durh

Areas of Expertise

Clinical TrialsHealth Behavior Interventions

Moving from observational observational to experimental experimental

Site‐specific data

VA E id v ence‐b d ase P i ract ce Center

Systematic Reviews

36
How Can We Help You?

Clinical Trials Division, Durh

Types of issues for which investigators 

approach PBRN Durham:

I have developed developed an intervention intervention and wou

test its efficacy in PBRN sites

I would like to conduct conduct a multi‐site random

random

of a new treatment or to test the effectiv

a women veteran veteran population population

37
Greater Los Angeles

Bevanne Bevanne Bean‐Mayberry, Mayberry, MD, MH

Director, Health Care Delivery Divisi

VA Greater Los Angeles
How Can We Help You?

Health Care Delivery Division, 

Team Greater Los Angeles

Bevanne Bean‐Mayberry, MD, MHS (bevanne.bean‐mayberCasey MacGregor, MSW, Research Associate

Ruth Klap, PhD, Program Manager, WH Research Co

39
How Can We Help You?

Health Care Delivery, Greate

Areas of Expertise• Women’s health care delivery systems (Bea

Mayberry, Yano)

• Multiple Multiple systematic systematic reviews reviews (Bean‐Mayberr

Mayberr

• Resource center for implementation studie

(Mittman)

• Women’s Health Research Consortium co‐l

GLA (Yano, Kl ) ap

40
How Can We Help You?

Health Care Delivery, Greate

Types of issues for which investigators might ap

PBRN Greater Greater Los Angeles Angeles:

• What research has been recently published on m

proposed topic area in women veterans’ health?

• Where do I fi dn if i n ormation on how VA women’s 

care is organized?

• Where do I obtain more information about imple

studies in the VA?

41
Iowa City

Anne Sadler PhD, RN

Director, Post‐Deployment Divisio

Iowa City VAMC
How Can We Help You?

Post Deployment Health, Iowa 

Team Iowa City

Anne G Sadler, PhD, RN ( @ g) Anne.Sadler@va.gov)Holly Erschens, BA, PBRN Coordinator (Holly.EMargaret Cretzmeyer Cretzmeyer, PhD: PBRN Coordina

Coordina

(Margaret.Cretzmeyer@va.gov)

43
How Can We Help You?

Post Deployment Health, Iow

Areas of Expertise• Unique Reserve/National Guard and

Department of Defense(DoD) research

considerations.

• Computer‐Assisted Telephone Intervie

methods.

• Using qualitative qualitative methods methods to facilitate facilitate

interview/measurement development

44
How Can We Help You?

Post Deployment Health, Iow

Types of issues for which investigators might approa

Iowa City:

• I have a research idea for active component and/or Res

N ti l a ona G d uar popul ti a ons, how do I access these pop

what should I consider to make this research successfu

• How could I best use PBRN sites in studying deploymen

deployment health research?

• What should I know about doing research in the VA and 

DoD funding?

45