IN THIS ISSUE

Commentary . . . . . . . . . . . . . . . . . . . . . . . 1

Response . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Methodology. . . . . . . . . . . . . . . . . . . . . . . . 4

Research Highlights . . . . . . . . . . . . . . . . . 5

Young Investigators. . . . . . . . . . . . . . . . . .6

A Publication of the VA Office of Research & Development, Health Services Research & Development Service,

Management Decision and Research Center, in conjunction with the Association for Health Services Research

continued on page 2

Tools for Research: Information

Management at VA

By John Higgins, M.D., VISN 16 Director; Laura Miller, VISN 10 Director;

and Anita Weeks, VISN 16 Associate Chief Information Officer

FORUM

VA HEALTH SERVICES RESEARCH & DEVELOPMENT NOVEMBER 1999

Because research is about the

expansion and refinement of scientific knowledge, information management is a critical tool for

research. At VA, a highly sophisticated and mostly homegrown computer system, with an integrated

clinical database and electronic

patient record, not only supports

the management and delivery of

health care services but serves as

an important resource for research.

In particular, it supports the activities of the Health Services 

Research and Development Service

(HSR&D) in improving the quality

of patient care and increasing the

efficiency of health care delivery.

The Veterans Health Administration Information Systems and

Technology Architecture (VISTA)

is used in the day-to-day operations

of all VA Medical Centers

(VAMCs). VISTA encompasses the

complete information environment

at these medical facilities, including workstations and software

locally developed by VA employees,

as well as commercial, off-the-shelf

software and products. In developing software applications, VA

applies standards that permit

export to all VA medical facilities,

technical integration through use

of a common database, programming standards and conventions,

data administration functions, and

specifications that are not vendorspecific platforms. VISTA is a wellintegrated clinical system that

incorporates all patient-specific

information at each VAMC in one

easily accessible database.

In addition to the integrated

clinical database at each VAMC,

VISTA includes several quality

management and monitoring modules, an engineering module that

provides for equipment management, space and facility management, construction project

planning and submission, project

tracking, and accident analysis.

C OMMENTARY

A t VA, a highly sophisticated and mostly homegrown computer system,

with an integrated clinical

database and electronic

patient record, not only

supports the management

and delivery of health care

services but serves as an

important resource for

research. 

DIRECTOR’S LETTER

The Veterans Health Administration, with its large databases, is a

unique laboratory for research. In

this issue of FORUM, which

focuses on tools for research, some

of the key players describe some of

the efforts underway to improve

VHA’s valuable database

resources, provide guidance on

accessing the databases, and illustrate an application involving the

National Center for Cost

Containment.

Our Commentary Article is coauthored by two Network

Directors who are the outgoing

and the incoming chairs of the

Information Technology Advisory

Committee (ITAC). They give a

broad overview of VHA databases

and the role of the ITAC in setting

priorities for new databases. The

co-directors of HSR&D’s new VA

Information Resource Center

(VIReC) then explain the research

uses of VHA databases. The

Director of HSR&D’s new Health

Economics Resource Center then

describes the tools for estimating

VA health care costs. We also are

pleased to offer some reflections on

our capacity-building program for

clinicians (career development), by

the program’s initiator.

VA health services researchers

are some of the most skilled in the

nation and hold key leadership

positions in major professional

societies within and outside of the

field of health services research.

Only through the continued development of these health services

research leaders – who know how

to apply research tools – can we

capitalize on VHA’s potential as a

research laboratory, and continue

to improve the quality and efficiency of our veterans health care

system.

John Demakis, M.D.

Director, VA HSR&D Service
2

There is also a financial module that

handles accounting and procurement activities, as well as a prosthetics module that can provide a

quick history of prosthetic services

and care for each patient and cut

down on the time required to repair

or replace new or existing devices.

Various environmental, security,

and other computer systems

required for proper management of

a complex health care delivery system are included in VISTA.

VA has developed and is implementing an electronic patient

record accessed with personal computers through a graphical user

interface (GUI). The Computerized

Patient Record System (CPRS)

allows clinicians instant, online

access to patient data. Data elements are captured and stored in

local databases as events take place. 

As data elements are captured,

selected fields are transmitted to

the National Patient Care Database

(NPCD). The NPCD is housed at

VA’s Austin Automation Center in

Texas, along with many other VA

databases. The NPCD comprises

inpatient and outpatient data from

all VAMCs and includes fee basis

data from the Fee-for-Service program. The NPCD data are accessible to all VA programs for

statistical and research purposes.

HSR&D is an important part of the

user community for this database. 

This database can be accessed

through time-sharing, remote job

entry, or through the VA Intranet,

as some data elements are available

there. A researcher sitting at a

computer in any location within the

system can make a decision, based

on predetermined criteria, to look

at a specific group of patients. 

Databases Are Resources 

for Researchers

Most HSR&D staff have intimate

knowledge of the data elements

Commentary

continued from page 1

C OMMENTARY

that make up the national databases. They can develop and initiate

programs that will go to the database, retrieve specified data elements — such as lab results or

pharmacy data — and produce

reports that can either be printed

out or incorporated in an electronic

format for further analysis. For

example, in one multi-site study of

patients with chronic lung disease,

researchers are using local VISTA

Health Summary options to extract

lab and diagnostic radiology results

and transfer them electronically to

build a central, analytic database.

VA network and medical center

staff frequently work with HSR&D

on independent studies of specific

patient populations. Studies of this

type are underway among the

VISNs now.

As noted, VA employees historically have developed most of VA’s

software programs, and there is

enormous demand for software

development and support from all

VA departments, including

HSR&D. And like most large organizations, there are never enough

available resources on hand to

accommodate demand. As the VA

Chief Information Officer (CIO)

and staff continuously struggled to

meet users’ needs, it became clear

that some method for prioritizing

software requests and determining

whether to build or buy must be

developed. This type of systematic

approach would allow staff to meet

users’ demands in a more timely

and systematic fashion. 

The Information Technology

Advisory Committee (ITAC) was

formed to develop this strategy.

Among the committee’s members

are physicians, nurses, network

directors, VAMC directors, network

clinical services managers, network

CIOs, the VA CIO, VA associate

CIOs or ACIOs, and several VA

Headquarters program managers. 

A Screening Committee composed of network CIOs, ACIOs, and

technical staff was designated to

review all Information Technology

requests, and assess their feasibility, and then forward them to the

ITAC with a recommendation

based on their feasibility within

existing resources. For each

request, the Screening Committee

does the research, gathers the

background information required

to make the best possible assessment, and presents its findings to

the ITAC for decision and prioritization. This is no small task. At

last count, there were some 160

items on the VA CIO’s project

request list. 

In summation, VA has a rich

information technology infrastructure that supports VA’s goal of providing the best care to our patients

that resources — both financial

and human — allow. This system

enhances not only the management

and delivery of care, but also the

myriad activities by VA researchers

to maximize the quality, efficiency,

and impact of that care. To do this,

we employ a complex information

management system and very dedicated medical, administrative, and

research staff. Most of our medical

centers are teaching hospitals that

are affiliated with medical schools,

and our research and development

program is second to none. Finally,

we have in place a process for

assessing and prioritizing requests

to keep pace with new information

needs and advances in information

technology. As HSR&D continues

to grapple with the challenges of

operating in an ever-changing

health care system, VA’s information technology architecture will be

right there to support it.

V A has a rich information technology infrastructure that supports VA’s

goal of providing the best

care to our patients that

resources — both financial

and human — allow. 
3

R ESPONSE

VA’s research and development

program conducts an array of activities that grapple with some of the

most difficult challenges in health

care research. VA is a world leader

in research on aging, women veterans’ health concerns, spinal cord

injury, post-traumatic stress disorder, and other mental health

issues. It has improved medical

care not only for veterans but also

for the general population at large.

At the VA Information Resource

Center (VIReC), we know firsthand

the challenges researchers face in

understanding and using VA information systems. We believe that

many of these challenges can be

minimized and mutual benefits

derived by including researchers in

the earliest stages of information

system design. 

The Office of the Chief

Information Officer (OCIO) is the

information management arm of

VA responsible for information

resources planning, policy, software development, customer support, investigations, and

acquisitions that support VA

health care. In 1998, OCIO hosted

a Data Summit to address data

quality problems in VA’s information systems. Four major areas

were examined: gaps in current

information systems, sources of

data and problems associated with

data input, data management, and

data use. Participants represented

most key stakeholders in VA health

care. The inclusion of HSR&D in

both the planning and conduct of

the Data Summit program facilitated broad-based discussions of the

utility of current and planned

information systems to support

specific priorities. 

Research teams will have to

work closely with information technology experts to continually refine

their data needs. Initial activities

that focus on identifying data gaps

and creating databases will give

way to efforts to enhance data collection, improve data standardization, develop new multipurpose

databases, re-engineer the current

data flow architecture, and develop

approaches for profiling and feedback.

HSR&D’s role continues to be

critical in providing support to

technology and information system

resources. HSR&D-funded projects

have resulted in valuable references on VA databases for VA

researchers. The Database

Resource Guides and the Long

Term Care Guides, for example,

filled an important information

gap. In addition, these projects

forged relationships with the various information services within

VA, making information about new

databases more accessible to

researchers. Other HSR&D supported efforts, such as the State of

the Art (SOTA) Conferences, serve

to build relationships and open

communication between the various information stakeholders about

existing data resources and future

information needs. 

Most recently, VA HSR&D

established the VIReC, a new field

unit created to serve as an information resource and referral center

for researchers, clinicians, and

managers. We also feel it is imperative to develop a systematic plan

for feedback, linkages, and ongoing

discussions with the larger VA

information infrastructure. We

view the VIReC as a leader in this

effort.

Much work remains to be accomplished regarding data quality.

Additional research needs to be

conducted on the integrity of VA

data and databases to further build

upon VA’s firm informatics foundation. The new VIReC will focus

more of its efforts on these issues

as we enter the next millennium.

However, we should also challenge

our own researchers to assist in

identifying, pinpointing, publicizing, advocating, and correcting

data flaws that may exist across

the myriad of databases maintained by VA. 

To meet VA’s goal of becoming

the nation’s state-of-the-art health

care system, we must continue to

improve our information systems

for better assessment of patient

outcomes, quality of care, and customer service. VA’s information

systems must serve multiple purposes and be easily accessible to

many potential users: policymakers, managers, clinicians, and

researchers.

Solid Data, Solid Research: 

A Response From the VA Information Resource Center 

By Diane C. Cowper, M.A., and Denise M. Hynes, Ph.D.

Co-Directors, VA Information Resource Center

I nitial activities that

focus on identifying data

gaps and creating databases will give way to

efforts to enhance data

collection, improve data

standardization, develop

new multipurpose databases, re-engineer the 

current data flow architecture, and develop

approaches for profiling

and feedback.
4

To conduct high-quality health economics research, VA must be able

to determine its health care costs.

Cost-effectiveness analysis requires

accurate information on the costs

of health care. In addition, VA

needs this information to assess

program efficiency and to decide

whether to make or buy specialized

medical care. 

Because VA does not routinely

prepare patient bills, VA researchers and analysts must rely

on other sources to calculate the

cost of health care encounters.

Three alternatives are available:

micro-cost methods; average costing; and the Decision Support

System (DSS), a state-of-the-art,

computerized cost-allocation system that VA is implementing.

Methods have benefits 

and limits

The choice of method depends 

on the level of accuracy required

(see table on this page). Microcosting methods are very accurate,

but expensive to employ. Average

cost methods are easier to undertake, but the cost estimate may not

fully reflect all factors that affect

the resources used in providing

care.

There are three types of microcost methods:

■ The psuedo-bill requires

detailed utilization data, much like

the lines in an itemized hospital

bill. The cost of each item is estimated using Medicare reimbursement rates, the charge rates of an

affiliated university medical center,

or some other non-VA sector

source. 

■ The cost function method

requires detailed cost and utilization data for a specific, non-VA service to simulate the cost of a comparable VA service. However, the

appropriate data may not always be

available. 

■ Direct measurement is used to

determine the cost of new interventions and programs unique to VA.

Staff time and supply costs are

measured directly to develop a precise cost estimate, while labor costs

are estimated from payroll records.

The total cost is then divided by

the volume of workload to find the

cost per unit of service provided.

Relative value units may be needed

to estimate the costs of departments that produce a diverse workload.

Because these micro-cost methods are very expensive, they are

best used to estimate costs associated with the specific intervention

or treatment under study. In a

study of methods for treating heart

attack, micro-cost methods should

be used to accurately gauge the

costs of cardiac angioplasty and

bypass surgery. Average costing,

on the other hand, can determine

costs not directly associated with

treatment, such as the cost of longterm care for a patient who subsequently has a stroke.

The average cost method uses

only information from the centralized VA utilization databases. As a

result, it is simpler to apply than

micro-costing. 

Unit costs are based on relative

values derived from non-VA cost

data sets and the department-level

cost estimates contained in the VA

Cost Distribution Report. The estimate assumes that the average cost

of a given encounter is the same as

that of all other encounters with the

same characteristics. Using this

method, the same cost is assigned to

all hospital stays in a particular

DRG with the same length of stay. 

Cost Analysis Presents Challenges and Opportunities 

for VA Researchers

By Paul G. Barnett, Ph.D., Director; and Sally S. Hui, Technical Writer; 

HSR&D Health Economics Resource Center

METHODOLOGY

continued on page 8

Methods for Estimating VA Health Care Costs

Method Description Benefits and limitations

Micro-cost

Average cost

Decision

Support System

Pseudo bill, costfunction, or direct

measurement

Combines cost and

utilization data with

non-VA relative

value unit

Detailed VA product

cost-allocation 

system

Precise but expensive

method

Data are easily obtained,

but method may not be

sensitive to all factors

affecting cost

Very detailed, but must be

validated; so far is difficult to access
5

R ESEARCH HIGHLIGHTS

Although VA facilities do an excellent job of managing blood-sugar

levels among veterans with diabetes,

per-patient costs related to glycemic

control are increasing, according to

the Diabetes Cost and Outcomes

Reports produced by the VA

National Center for Cost Containment (NCCC).1 Given NCCC’s estimate that 12 percent of all VA’s

veteran patients have pharmacologically treated diabetes, the challenge

for researchers is clear: how to

develop diabetes management programs that rein in costs without

compromising quality of care. 

The NCCC reports are unique in

their integration of data on both

health outcomes and drug acquisition costs. They were designed to

assess the prevalence of diabetes in

the VA, identify patterns of pharmacy utilization and costs, determine rates of admissions and

procedures for people with diabetes,

and, for FY96 and FY98, to link

system-level evaluation of laboratory outcomes with pharmaceutical

utilization. 

The NCCC VA Diabetes Cohort

consists of patients identified

through facility-level pharmacy data

as receiving prescriptions for

insulin, sulfonylurea, oral

antiglycemic agents (metformin,

acarbose, and troglitazone), or blood

glucose monitoring supplies. The

data extraction program is nearly

100 percent accurate in identifying

those patients — and only those

patients — with the specified prescriptions. Although the FY98

prevalence and utilization analysis

has been expanded to include

patients identified by a combination

of diabetes-specific prescriptions and

ICD9-CM codes, the pharmacy cost

data reflect patients identified

through the pharmacy file using

acquisition costs. 

Pharmacy expenditures related to

glycemic control in veterans treated

with insulin and/or oral agents

increased significantly from 1994 to

1998 in all groups. Overall, perpatient costs related to glycemic

control were 22 percent ($168), 21

percent ($195), and 27 percent

($232) of total pharmacy expenditures for 1994, 1996, and 1998

respectively. In 1998, total

glycemic control pharmacy costs

were $160 for patients taking oral

agents, $279 for veterans using

insulin alone, and $501 for patients

who received both insulin and oral

agents. Drug acquisition costs

remained stable during this time.

Pharmacy costs include the costs

of glucose monitoring supplies as

well as medications. The graph below

shows the increasing mean costs of

annual blood glucose monitoring

supplies among VA patients with

diabetes treated with insulin and/or

oral agents from 1994 to 1998.

During this period, the unit cost for

monitoring supplies remained relatively stable. In FY 1994, mean

annual expenditures for these supplies were $67; these costs

increased to $149 and $170 in FY

1996 and 1998, respectively. The

costs of glucose monitoring supplies

were 11 percent, 20 percent, and 19

percent of total pharmacy costs for

these veterans in 1994, 1996, and

1998, respectively. 

The highest costs were observed

in patients using insulin with or

without oral agents ($215 and $213,

respectively, in 1998). In 1998, for

patients self-administering insulin,

taking oral agents, or using both,

costs of glucose monitoring were 76

percent, 80 percent, and 43 percent,

respectively, of all glycemic control

expenditures. Overall, in 1998, 

self-monitoring expenditures represented 73 percent of total annual

glycemic control pharmacy costs.

Since the unit cost of monitoring 

strips did not significantly increase,

these higher expenditures reflect an

increase in the quantity of supplies

dispensed. 

During the same study periods,

glycemic control, as measured by

overall HbA1c values, improved sigDiabetes Cost and Outcome Reports 

from the National Center for Cost Containment

By Leonard Pogach, M.D., National Director, VA National Diabetes Program; Ruth Weinstock, M.D., Ph.D., 

Syracuse VAMC; Gerald Hawley, R.N., M.S.N., NCCC; and Denis Repke, Ph.D., NCCC

continued on page 7

Insulin Oral Both Neither Overall

Changes in Overall Mean Total Blood Glucose Monitoring

Expenditures Among VA Patients With Diabetes

FY94 FY96 FY98

$250

$200

$150

$100

$50

0
6

Y OUNG INVESTIGATORS

Reflections on the HSR&D Career Development Program

By Daniel Deykin, M.D.

Professor of Public Health, Boston University School of Public Health

There is an old saying: “Be careful

what you wish for — you may get

it.” When I became Director of the

HSR&D Service, I wished that we

could start a Career Development

program. I envisioned it as similar

to the Medical Research Service’s

program and to the Career Development Awards of the National Institutes of Health, one of which launched

my own research independence.

But our budget was too constrained.

In 1990, our HSR&D budget

received its first major adjustment,

an increase of $5 million that effectively doubled it. Shirley Meehan

and I were then able to launch the

program. Our goal was to invest

approximately 10 percent of our

budget in Career Development awards.

Our initial strategy was to recognize rising health services research

stars within the VA, and to advance

their careers by affording them relatively unfettered time for research.

We recognized that they needed to

stay relevant to their home Medical

Centers, so we required that they

give 25 percent of their time (but

no more) to clinical activities at

their home base. Soon, we were

able to extend the program to nonclinical research scientists, and

then, to to a second tier of investigators. These researchers were

more junior than the “stars,” but

still luminaries who had demonstrated their interest and capacity

for health services research by completing rigorous training in a related discipline, and by completing

and publishing papers in critically

edited journals. 

Our not-so-subtle intent was not

only to advance VA’s capacity for

health services research, but also to

retain those bright individuals who

might be tempted to leave the system for putatively greener pastures

elsewhere. (I have always believed

our pastures were the best for nourishing health services research, but

we always seem to have to justify

our excellence.) By creating a cadre

of health services researchers within

the VA, we hoped they would demonstrate the value of research in informing VA policy and decision-making.

Fortunately, we got what we

wished for. The initial class of

investigators proved to be as stellar

as we had hoped. Over the years,

HSR&D’s budget has increased

steadily to its present level of over

$40 million, and the Career

Development program has grown

proportionately. It has been my

pleasure to have attended, first as

director, and then as a willing

recruit, virtually all the meetings of

the review committee we set up to

select the successful candidates, to

monitor their progress, and to

make recommendations on how the

program should be shaped. We

have had extraordinary applicants,

and they have met and exceeded

our most ambitious expectations. 

As you know, the old saying has

a down side as well. In another

iteration, it is expressed as a curse:

“May you get what you wish for.”

It would be ludicrous to see anything but good outcomes from the

program to date, but, characteristically, I want to raise some caveats

as the program continues to expand.

I hope these will be taken in the

spirit in which they are given — as

expressions of support, not criticism.

1. We must be careful not to make

the Career Development program a

training program. If it is to meet

its goals, and to serve as a medium

to recognize excellence, we must

adhere to strict requirements for

the award. If there are sufficient

funds to start or enhance training

programs, that should be the path

for junior investigators. There will

always be pressure to use Career

Development for junior staffing,

but eroding the base of entry

requirements will inevitably weaken the entire structure.

2. We must be careful to protect

the independence of the awardees.

As the excellence of their work

receives increasing recognition, they

can be co-opted by the system itself

— locally, at the VISN level, or at

headquarters. They should be useful

to high-level administrators, but

always independent if they are to

provide the dispassionate analysis

that makes them and their work 

relevant. I know that this argument

is annoying to some people, but,

Cassandra-like, I continue to preach it.

3. We need to find new ways to

enhance the program. For starters,

I would like to see more sabbatical

opportunities for intellectual

enrichment made available to the

awardees. I would also like them to

have more opportunities to participate in Congressional activities,

both to expand their horizons, and

to inform (and impress) members of

Congress and their staffs about the

excellence of the HSR&D Service

and, more importantly, how the VA

can serve as a model for understanding complex health systems.

The Career Development program is a gem. Like any other valuable asset, its worth is clear, but it

needs to be protected.

T he Career Development

program is a gem. Like

any other valuable asset,

its worth is clear, but it

needs to be protected.
7

Research Highlights

continued from page 5

nificantly. In FY 1998, the mean

fasting HbA1c value among veterans from 105 facilities was 7.8 percent, compared to 8.4 percent in

1996. The mean values were lower

in patients on oral agents, and

highest in patients on insulin. In

regression analysis the monitoring

costs were correlated with higher

HbA1c values in both groups, suggesting that clinicians monitored

their highest risk patients more frequently. It was not possible to evaluate the effect of monitoring upon

HbA1c levels using the cross-sectional data; longitudinal analyses

are planned. 

Increasing costs may result, in

part, from the introduction of

newer, more expensive oral agents,

primarily metformin. Although

acarbose was introduced in 1996

and troglitazone in 1998, the use of

these drugs remained relatively

small, and their unit price did not

change significantly, while sulfonyureas costs decreased. The VA

Clinical Practice Guidelines, which

were available during this time,

recommended initiation of oral

therapy with sulfonylurea drugs,

which are the least expensive oral

glycemic control medications.

Met-formin was considered the second-line oral agent. The unit price

of the most commonly prescribed

oral glycemic control medication,

glyburide, decreased during this

time.

However, the greatest change

was the rise in expenditures for

monitoring supplies. The percentage of patients using self-monitoring supplies and the unit cost of

monitoring supplies did not change

significantly, but the overall number of monitoring strips dispensed

significantly increased. It is

unclear whether all these strips

were necessary and/or used by all

patients. The increased use and

cost of monitoring supplies, however, represented a major source of

the higher pharmacy costs. 

These results have immediate

and direct implications for the

treatment of veteran patients with

diabetes. First, the average age of

the veteran with diabetes in the VA

is 67, and the prevalence of diabetes

increases with age. Second,

although VA formulary guidelines

did not prevent clinicians from prescribing medications for a specific

patient, they recommended a

sequence of sulfonyurea agents,

metformin, and troglitzone for persons with type 2 diabetes, based

upon the effectiveness of the medications. In addition, while recognizing that monitoring may be

beneficial for an individual patient

with type 2 diabetes, the guidelines

emphasized that no controlled studies have ever demonstrated a benefit. Even so, there was a significant

increase in glycemic control costs.

Hopefully, VA researchers will be

able to use these data in their continuing efforts to improve the quality and efficiency of diabetes care for

veterans.

1

The NCCC recently changed its organizational name to the Health Care Analysis and

Information Group.

T he challenge for

researchers is clear: how

to develop diabetes management programs that

rein in costs without compromising quality of care. 

Quality is Focus of HSR&D Annual Meeting

How can health services research advance the quality of VA health care?

Find out at the HSR&D Service 18th Annual Meeting, Systematizing

Quality in Health Care: Approaches that Work, to be held March 22-24,

2000, at the Renaissance Washington DC Hotel, Washington, DC.

Throughout the conference, attendees will be encouraged to articulate

the linkages between scientific activities, VA policy development, and

clinical service delivery. The program will feature invited speakers,

competitively selected oral and poster presentations, workshops, and

exhibits. 

Deadline for registration is Jan. 25, 2000. Additional information on

registration, pre-meeting activities, and special interest round tables is

available at the HSR&D web site, www.va.gov/resdev/hsrd2k.htm.

AHSR 2000 Annual Meeting: Health Care 

in the New Millenium

Learn about cutting-edge research and debate current policy issues at

the AHSR 2000 Annual Meeting, Research to Action: Shaping the

Health System in the New Millenium, to be held at the Westin

Bonaventure in Los Angeles, June 25-27, 2000.

Interested in presenting your latest research findings? Watch for the

AHSR Annual Meeting Call for Abstracts brochure, due out early

November. Abstracts are due Jan. 14.

Visit the AHSR website, www.ahsr.org, or call 202/223-2477 to request

the call for abstracts and conference brochure.
8

Martin P. Charns, D.B.A., Editor-in-Chief

Mary Darby, Editor

Laurel Long, Co-editor

ADVISORY COMMITTEE

Carol M. Ashton, M.D., M.P.H., VA HSR&D

Center of Excellence, Houston

John G. Demakis, M.D., Director, VA HSR&D

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

Center of Excellence, Ann Arbor

David H. Law, M.D., VA Medical Center, 

Bay Pines, FL

Shirley Meehan, M.B.A., Ph.D., VA HSR&D

Alan S. Perry, VA Medical Center, Roseburg

Robert M. Roswell, M.D., VA Network #8,

Bay Pines, FL

Forum is a Publication of the VA Office of Research &

Developemnt, Health Services Research & Development

Service, Management Decision and Research Center, in

conjunction with the Association for Health Services

Research.

F O R U M

VA researchers are now examining the DSS to determine if its cost

data will be useful. More than 400

VA staff are involved in creating

DSS, undertaking the difficult task

of assigning costs to VA health

care products and services. DSS

cost estimates are only as good as

the data in VA’s data systems,

which sometimes lack information

on inpatient procedures. Another

issue is the difficulty of accessing

DSS data, which are separated into

22 regional databases. 

The lack of a uniform VA policy

on DSS access poses another problem for researchers. A draft policy

is under review. When that policy

is enacted, and when a nationallevel encounter extract of DSS

estimates is released and validated,

researchers will be able to make

much better use of DSS cost data.

Several resources on cost-effectiveness analysis are available to

VA researchers. They should be

sure to consult the U.S. Public

Health Task Force Guidelines on

Cost-effectiveness in health and

medicine. HSR&D has developed

an informational paper, Cost

Analyses: Information for

Applicants and Reviewers, for

applicants and reviewers of cost

studies. A special April 1999 supplement to the journal Medical

Care describes VA cost methods. 

Methodology

continued from page 4

Information on how to obtain

these publications can be found on

the web page of the new VA Health

Economics Resource Center. (See

box above.) 

References

Gold, MR, Siegel JE, Russell LB,

Weinstein, MC. Cost-effectiveness in

health and medicine.

New York: Oxford University Press;

1996.

VA Health Services Research and

Development Service. Cost Analyses:

Information for Applicants and

Reviewers. Washington, D.C., 1997.

Barnett, PG, Hendricks A.

Developments in Cost Methodology:

Lessons from VA Research. Medical

Care. 1999; 37(4 Supplement). 

Health Economics Resource Center Will Help

Shed Light on VA Costs

The new HSR&D Health Economics Resource Center (HERC) is a national center dedicated to improving VA’s capacity to conduct high-quality

health economics research and cost-effectiveness studies. The research

supported by the Center will help VA evaluate the efficiency of VA programs and providers, as well as make better-informed decisions about

whether new health care interventions are sufficiently cost-effective for

use throughout the VA system. Initially, HERC will focus on helping

researchers determine the costs of VA health care. The Center will offer

training courses, publish handbooks, support micro-cost methods, and

provide cost estimates for VA hospital stays and outpatient visits. 

Information about the Center may be found at: http://www.

palo-alto.med.va.gov/herc. Its research consulting service will open on 

Jan. 3, 2000, when it may be reached by calling 650/617-2630 or by

sending e-mail to herc@mailsvr.icon.palo-alto.med.va.gov. HERC is

located at the VA Palo Alto Health Care System in Menlo Park, Calif.