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

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

and Health Policy

continued on page 2

HSR&D at 25: Celebrating the Past and Anticipating the Future

By John G. Demakis, M.D., Director

FORUM

TRANSLATING RESEARCH INTO QUALITY HEALTH CARE FOR VETERANS

VA HEALTH SERVICES RESEARCH & DEVELOPMENT FEBRUARY 2002

At this year’s Health Services

Research and Development Service

(HSR&D) Annual Meeting, we will

celebrate 25 years of congressional

funding for HSR&D. It seems appropriate to take the time to celebrate

the past and anticipate the future.

Celebrating the Past

In 1976, as the first seven HSR&D

projects were funded, the total

HSR&D budget was $3.6 million.

The field of health services research

was in its infancy in theory and

methodology. The proper place and

use of health services research in

VA’s health care delivery system

were still unknown and tentative. 

Twenty-five years later, in fiscal

year 2001, HSR&D had 143 active

projects with an annual budget of $45

million in congressionally appropriated funds, and $49 million in medical support funds. In addition, our

researchers have competed for an

estimated $8.3 million in other federal and non-federal grants and

received $4.8 million in VA funds

from Central Office or VISNs for

management consultation. In all,

HSR&D investigators are doing a

total of $107.1 million of research

as we start our 26th year of funding.

HSR&D is now well-grounded in

theory and our methodologies have

become more sophisticated. VAfunded research now appears regularly in all the major medical journals

as well as several health services

research journals. VA clinicians

and managers increasingly turn to

HSR&D to help answer difficult

health systems problems.

Over the years, HSR&D built a

solid infrastructure and communication channels to enable us to

answer the growing needs of VA

clinicians and managers. The

establishment of the VISN/HSR&D

Liaison Committee resulted in

identification of new health services research questions, which led

to new solicitations for proposals in

access to care, primary care, minority health issues, gender issues,

patient safety, and others. 

Creating Resources 

for Research

Since 1998, four new Centers of

Excellence (COE) have been established to join the existing nine.

The new COEs were chosen to fill

important gaps in our research

portfolio: evidence-based medicine,

chronic disease, minority health,

and rehabilitation outcomes. 

Two new Resource Centers were

funded to serve as national resources

for the VHA: the VA Information

Resource Center (VIREC) and the

Health Economics Resource Center

(HERC). Our newest Resource

Centers join our Management 

C OMMENTARY

Decision and Research Center

(MDRC).

Our Research Career Development and Career Scientist programs

continue to train new investigators

and give them a solid foundation in

health services research. Approximately 10 to 15 new investigators

“graduate” each year. The great

majority of these talented men and

women remain in VA and become

successful VA investigators. 

The Quality Enhancement

Research Initiative (QUERI) is an

ambitious attempt to bring together

managers and clinician investigators

to develop a data-driven, outcomesoriented approach to systematize

quality improvement. Presently,

nine conditions have been targeted

by QUERI: colon cancer, chronic

heart failure, diabetes, HIV/AIDS,

ischemic heart disease, mental

health, spinal cord injury, stroke,

and substance abuse. 

Although each QUERI group is

at a different phase in its progress,

several have already contributed to

improving patient outcomes. The

recent Institute of Medicine report,

Crossing the Quality Chasm, highlighted QUERI as “one of the

strongest examples of synthesizing

the evidence base and applying it to

clinical care.”

SPECIAL 25TH ANNIVERSARY ISSUE

In this issue, FORUM looks back on and commemorates 25 years of funding for VA’s Health Services Research

and Development Service (HSR&D). To everyone who has contributed to HSR&D’s growth and success over the

years, thank you for your excellent work. We look forward to the next 25 years.
2

Looking Ahead

While we have much to celebrate in

VA HSR&D, there is still much to do.

We have entered a new era in

health care, where change is the

only constant and fast-paced

change is the norm. Changes will

continue to unfold within our

health care organization, in medical

technologies and, of course, in the

needs of our veterans. In addition,

we have a new Secretary of Veterans Affairs and will soon have a

new Under Secretary of VHA.

Undoubtedly, they will have their

own vision for our agency and will

propose new initiatives and directions. Each of these changes will

require changes in our health care

delivery system and provide opportunities for HSR&D to continue to

make significant contributions. 

How can HSR&D prepare for the

many changes ahead? Hockey

great Wayne Gretzky was once

asked how he became such a prolific

scorer. He answered that he never

skated to where the puck was, but

where he expected the puck to be.

He was the master of anticipation.

We also need to look ahead to

where health care will be in the

next five to 10 years and prepare

for these expected changes. Some

top priorities include:

■ Quality Improvement: Systematizing quality improvement

should continue to be a major focus

of our efforts. Through QUERI, we

have become leaders in the field but

we still have much to learn. Moving research findings from the laboratory to the bedside is what

translation is all about. We are

only now learning what works and

what doesn’t work. 

We will continue to fund Service

Directed Projects that concentrate

on translating research findings

into improved patient outcomes in

the nine QUERI conditions.

QUERI must be expanded to

Commentary

continued from page 1

C OMMENTARY

include other high-risk conditions

for veterans such as chronic lung

disease, pneumonia, and dementia.

In 2002, we plan to publish our

first findings on what works and

what does not in translation – a

manual on lessons learned. 

■ Databases: VHA has excellent

clinical databases on inpatient, outpatient, and long-term care. Yet

they are lacking in condition-specific

measures that would help us track

patient outcomes. Presently,

expensive and laborious chart

reviews must be done to determine

the outcomes of new medical or

systems interventions. With the

addition of a few variables, most of

which have already been identified,

VHA could have an excellent outcomes-oriented database that

would help us to better treat our

patients. 

■ Management Research: With

the increased emphasis on organizational change, we need to significantly increase our management

research portfolio. We need to

understand more about the organization, structures, and management of our health care system.

We have already studied the implementation of service lines, looked

at hospital integrations, developed

integration scorecards, and evaluated community-based outpatient

clinics. Several of these initiatives

were commissioned by our Under

Secretary and/or VISN Directors.

We will continue to work closely

with VA managers to identify new

areas to investigate and evaluate

and to expand and enrich VA’s

management databases.

■ Patient Safety: Patient safety

is a high priority in the public’s

mind and certainly a high priority

in VA. There are many opportunities

for HSR&D to contribute to patient

safety. We should work to enhance

and expand our relationships with

our patient safety colleagues in the

field and work together on developing strategies and tools that prevent adverse events and ensure

appropriateness of care. 

■ Cooperation with Other 

Federal Agencies: We will strive

to increase our cooperation with

other federal funding agencies. We

envision a series of joint solicitations in which projects would be

jointly funded and carried out both

in VA and non-VA settings. This

will increase the power and validity

of our results and improve generalizability. This will also be an excellent opportunity to compare

outcomes in VA and non-VA health

care settings.

We have already started down

this path with modest success. In a

joint project with CDC, we are currently comparing outcomes of diabetic

patients in VA and non-VA hospitals.

We will also soon release a joint

solicitation with the Agency for

Healthcare Research and Quality

on the translation of research findings

into practice. Again, the projects

will be jointly funded and include

VA and non-VA health care systems.

The National Cancer Institute

has funded VA’s newest QUERI

group on colon cancer. The findings from the Colon Cancer QUERI

will be used to enhance other cancer outcome projects funded by

NCI. This is the latest example of

two federal agencies working

together to improve patient care.

■ Capacity: For HSR&D to continue to be responsive to the needs

of VHA, we must have personnel

and infrastructure in place. In

addition to the COEs, Resource

Centers, and a growing number of

well-trained investigators, we have

recently started the Research

Enhancement Award Program,

which encourages facilities with

three or more funded investigators

to apply for core funds. 

Finally, although change will be

with us for the future, what will

not change is the dedication of VA

researchers to improve the health

and care of veterans and the

nation. We will continue to seek

ways to improve the accessibility,

quality, cost and efficiency of the

health care services we provide. 
3

R ESPONSE TO COMMENTARY

HSR&D Is Poised To Help VA Meet New Challenges

By Robert H. Roswell, M.D., Director, VISN 8

During the past 25 years, VA’s

HSR&D program has made many

notable achievements, as Dr. John

Demakis describes in this issue of

FORUM. Dr. Demakis also provides

a strong sense of direction for the

future of HSR&D in a new era of

health care. Just as health care

has changed dramatically over the

last 25 years, so have VA’s health

care delivery infrastructure, services, and programs, along with the

demographics of the veterans we

serve. These changes will continue

to present VHA with new challenges,

and as Dr. Demakis suggests, we

must rely upon our strong HSR&D

programs for help in meeting these

challenges.

VHA has become a nationally

recognized leader in quality and

patient safety. Yet budgetary constraints, coupled with a tremendous increase in users, threaten

our ability to safeguard our

patients and the care they receive.

These concerns are paramount as

we implement the Secretary’s

recent decision to continue open

enrollment for all veterans, which

will present significant management challenges, including:

■ How will we monitor the health

status of those veterans waiting to

enroll in VA care and those waiting

for their initial appointment?

■ How will we assess the most significant needs of all veterans –

including those who are not current users of our system but who

will need VA care in the years

ahead?

■ How will we assure that the

infrastructure needed to provide

this care is preserved? 

■ How will we meet the long-term

care and end-of-life needs of current veterans without irrevocably

committing our capital resources to

care lines that may not be needed

by future generations of veterans? 

■ How will we preserve and

enhance those services that meet

the specialized needs of veterans? 

Clearly, these are areas where

HSR&D’s management research

can be very helpful as we plot the

course of VHA.

The QUERI program that Dr.

Demakis speaks of is a remarkable

step forward in our efforts to focus

research on specific conditions seen

with a high prevalence among veterans, and then apply these

research findings to improving

patient care. Yet despite the success of this program, it is limited to

a relatively small number of disease states, and most of the outcomes are associated with the

management of a particular disease

process in an individual patient. 

■ How should VA evaluate the

veteran population in its selection

of areas for new QUERI programs? 

■ Can the QUERI process address

the health management and outcomes of a disease cohort in contrast to individual veterans? 

■ How can QUERI help us reach

those veterans with undiagnosed

and untreated disease? 

■ And, ultimately, can QUERI

improve the health of the entire

veteran population – and do it costeffectively? 

While somewhat ambitious,

these challenges are ready and

waiting for our HSR&D talents.

Recent events have underscored

VA’s fourth mission to provide contingency medical support to the

Department of Defense, and to

respond to national emergencies.

We have developed thorough plans

to evacuate military casualties

from a remote battlefield and airlift them to a U.S. receiving center,

where transfer to a VA medical

center will proceed in an orderly

fashion. Sadly, however, a major

portion of our current war is being

waged on U.S. soil. 

■ How will VA respond to large

numbers of domestic casualties of a

chemical agent or nuclear event

staged by a terrorist group? 

■ What steps should we take to

enhance surveillance and early

identification of a biological agent

weaponized against the U.S. population? 

■ Even more significant, like the

Gulf War, our current conflict involves

the possible exposure to a number

of potentially hazardous agents. 

What steps must be taken now to

assure our ability to track potential

exposures, monitor any adverse

health outcomes, and provide necessary health care to those who

may be exposed? 

Although finding these answers

will be difficult, our efforts must be

supported by our HSR&D expertise.

Twenty-five years of growth and

expansion have led to a world-class

HSR&D program. This is a precious resource that VA must use as

we face ever-increasing challenges

in assuring that needed health care

services are available for both current and future generations of veterans. I look forward to an

exciting and promising future for

our nation’s veterans health care

system, with enhanced management decision support from VHA’s

own HSR&D program. 

W e must rely upon our

strong HSR&D programs

for help in meeting VA’s

challenges.
1973 1975 1976 1979

■ HSR&D created to coordinate and consolidate health

services research (HSR) activities within the VA health care

system

■ Carleton Evans, MD, first

Director of HSR&D

■ HSR&D establishes Affiliation

Programs

■ Congress provides first funds

for HSR&D projects

■ Seven Investigator-Initiated

Research (IIR) projects funded

■ Richard Greene, MD, Direc

of HSR&D 

1985 1986 1987 1988

■ Service Directed Research

Program (SDR) established

■ New Field Program 

established: Palo Alto, CA 

■ First HSR&D Bulletin 

published, “Chest Pain 

Diagnosis” 

■ HSR&D sponsors national

invitational conference on 

Decision Support Technology

(DST)

■ Prakash L. Grover, PhD, 

Acting Director of HSR&D 

■ Second HSR&D Bulletin 

published, “Foley Catheter Care”

■ Dennis E. Roth, MBA, Acting

Director of HSR&D 

■ Field Program Review group

established 

■ HSR&D Bulletins published: 

— “The Impact of Algorithms 

on the Cost and Quality of

Health Care Provided by Nurse

Practitioners in a VA Setting” 

— “Prospective Modeling and

Prediction of Influenza Vaccine”

■ Daniel Deykin, MD, Directo

HSR&D 

1993 1994 1995 1996

■ SOTA II, “Databases: A

Resource for Research and

Decision Making” 

■ First HSR&D Management

Lecture, “Managing for the

Future: Enriching the 

Collaboration Between 

Management and Health 

Services Research” 

■ Research Agenda-Setting

Conference, “Oral Health for

Aging Veterans” 

■ New COE established: 

Sepulveda, CA 

■ Management Lecture, “The

Future of Hospitals and Health

Care Management Under Health

Care Reform”

■ VHA reorganizes into 22 

Veterans Integrated Service

Networks (VISNs)

■ Nursing Research Initiative

established 

■ Management Lecture, “How

to Turn a Hospital System into

a Health Care System”

■ SOTA III, “Technology

Assessment: A Tool for 

Technology Management and

Improved Patient Outcomes” 

■ Primary Care in VA Primer

published 

■ John R. Feussner, MD, MP

Chief Research & Developmen

Officer 

■ Shirley Meehan, MBA, PhD

Acting Director of HSR&D 

■ SOTA IV, “Leading 

Organizational Transformatio

■ Health Care Technology

Assessment in VA Primer 

published

■ First issue of VA Practice

Matters: Influenza Immunizat

HSR&D: Highlights 
1981 1982 1983 1984

■ Peter G. Goldschmidt, MD,

DrPH, DMS, Director of HSR&D 

■ Affiliation Program includes

nine VAs in affiliation with seven

university HSR programs

■ Applications to start

HSR&D Field Programs are

solicited

■ HSR&D funds first new Field

Programs: 

Durham, NC; Ann Arbor, MI;

Seattle, WA; and Little Rock, AR 

■ First HSR&D Annual Meeting

hosted by the Durham Field 

Program 

■ New Field Program funded:

Hines, IL 

■ Special Projects Program in

Perry Point, MD, established 

■ New Field Programs 

established:

West Roxbury, MA; Iowa City, IA;

and Salt Lake City, UT

1989 1990 1991 1992

■ “Evaluating Geriatric

Assessment Units: A Conference

to Determine Future Research

Directions,” sponsored by VA

HSR&D, The Robert Wood 

Johnson Foundation, and the

National Institute on Aging 

■ VA becomes cabinet-level

organization 

■ All Field Programs reviewed;

some reconfigured; all become

Centers of Excellence (COE) with

a particular HSR focus 

■ Career Development Program

established

■ Two new COEs established:

Bedford, MA, and Houston, TX 

■ First Career Development

awards funded 

■ First Centers for Cooperative

Studies in Health Services

(CSHS) established: 

— Palo Alto Medical Center in CA 

— VA Hospital in Hines, IL

■ Developmental Project 

Program established

■ HSR&D postdoctoral program

established to train associated

health professionals 

■ New CSHS Center 

established at Seattle VAMC 

■ Management Decision and

Research Center (MDRC) 

established 

■ State of the Art Conference

(SOTA I), “Community-Based

Long-Term Care” 

1997 1998 1999 2000 2001

■ John G. Demakis, MD,

Acting HSR&D Director

■ CSHS program 

incorporated into

OR&D/CSP

■ Three Primers published: 

— Using Outcomes to

Improve Health Care Decision Making

— Program Evaluation for

Managers

— Risk Adjustment: 

A Tool for Leveling the

Playing Field

■ John G. Demakis, MD, Director of

HSR&D 

■ The Under Secretary's Award for 

Outstanding Achievement in Health 

Services established 

■ VA Information Resource Center

(VIREC) established 

■ Two new COEs established: 

San Antonio, TX, and Minneapolis, MN 

■ Quality Enhancement Research 

Initiative (QUERI) established 

■ Management Lecture satellite 

broadcast, “Quality Care for Veterans:

Truths and Myths about Implementing

Clinical Practice Guidelines”

■ Clinical Practice Guidelines Primer 

published

■ Health 

Economics

Resource Center

(HERC) established

■ Rudolf Moos,

PhD, receives

Under Secretary’s

Award

■ Organizational

Change Primer 

published

■ Nelda Wray, MD,

MPH, receives

Under Secretary’s

Award

s of a Journey Through Time

■ Two new COEs 

established: 

Pittsburgh/Philadelphia

and North Florida/

South Georgia VA

Health Care System

■ Research 

Enhancement Award

Program (REAP) 

established 

■ Colorectal Cancer

QUERI group established 

■ SOTA V, “Making

Informed Consent 

Meaningful”

■ Lisa Rubenstein, MD,

MSPH, receives Under

Secretary’s Award
6

P ERSONAL PERSPECTIVE

Looking Back: HSR&D Then and Now 

(or “Reflections Of An Old-Timer”)

By Shirley Meehan, M.B.A., Ph.D., Deputy Director, HSR&D

What a difference a few decades

make.

When VA established the Health

Services Research and Development

Service (HSR&D) in 1973 within

the Office of Research and Development, it combined a small planning

and evaluation unit with an administrative research group and a medical automated data processing

(ADP) systems group. The HSR&D

Service was created with the

express purpose of bringing the

evolving tools of management science and operations research to

bear on the increasingly complex

problems of managing a growing

health care system. HSR&D was

expected to use diverse tools and

methods such as medical sociology,

cost-effectiveness analysis, information systems, statistics, and health

planning to better understand and

manage the complex issues facing

the VA health care system.

In the early days, we focused on

issues involving prevention, health

maintenance organizations, and

automating patient records. Central Office staff planned and conducted the projects. We solicited

projects from field investigators and

conducted our first HSR&D peer

review session (an ad hoc review

group) in the summer of 1975. 

We reviewed 13 projects and

funded the first seven investigatorinitiated research projects in fiscal

1976. The VA-University Affiliation

Program was established with modest funding – $50,000 – to encourage VA medical centers to

collaborate with health services

research centers newly created by

the National Center for Health Services Research (now the Agency for

Healthcare Research and Quality).

This early effort planted the seed

for the subsequent HSR&D Field

Programs and ultimately the current Centers of Excellence.

Nurturing the Health 

Services Research Enterprise

Not surprisingly, health services

research was not well recognized

or understood among VA researchers.

Most early studies tended to focus

on narrowly defined clinical problems specific to a particular facility. As a result, projects initially

supported by HSR&D tended to

compare alternative programs at

an individual hospital.

The first director of HSR&D

was Carl Evans, M.D. Following

Carl’s move to the Institute of

Medicine, physicians Richard Greene

and then Peter Goldschmidt took

over leadership of HSR&D. Dr.

Greene emphasized prevention as

a major initiative but found his time

at HSR&D cut short when he was

asked to take on additional responsibilities, ultimately becoming assistant chief medical director for R&D. 

Peter Goldschmidt (1981-1986)

stressed the importance of applying health services research as a

management tool. He expanded

capacity by creating the HSR&D

Field Programs and a Special Projects Office. He involved Central

Office managers in assessing

research ideas and the potential

application of research findings to

health care practice. Top managers sought help with reducing

waiting times in clinics through

special research projects, and commissioned other projects in

response to congressional mandates (for example, evaluation of

adult day health care). 

During the 1980s, both the science

and the resulting HSR&D products

steadily improved. The Service

also recognized the importance of

highlighting and disseminating key

research findings for broad application within the VA system.

Managers helped identify and synthesize research results for publication in bulletins targeted explicitly

to those most likely to implement

this information – for example,

stressing the value of postcard

reminders for improving flu shot

compliance to associate chiefs of staff

for ambulatory care. Despite progress,

we sometimes felt like we were

spreading news into a silent abyss.

A Personal Journey

I began my career with VA’s medical ADP group in 1971 as a management intern, and was one of the

computer systems analysts transferred to the new HSR&D Service.

I was thrilled with the move into

R&D, since it coincided with graduate

courses I was taking in management of R&D at George Washington

University. I became interested in

how other major health care

organizations were trying to apply

research to practice. 

By the mid-1980s, I began my

dissertation, focusing on the dissemination and application of

knowledge. I sought out other large

health care organizations with

internal health services research

units and explored how they used

study results. The case studies I

conducted suggested that successful

implementation of research results

hinged on whether and how much

an organization’s leaders valued

evidence-based management.

As we moved into the 1990s

under Dr. Dan Deykin’s leadership,

top VA managers began to recognize the importance of health services research and how it could help

solve the emerging problems they

faced. Dr. Deykin was particularly

interested in positioning the Field

Programs as Centers of Excellence

and national expert resources.

continued on page 8
7

W ITH APPRECIATION

In celebrating the 25th anniversary

and 20th annual meeting of the

HSR&D Service, we naturally take

the time to reflect upon the Service’s spectacular growth and

accomplishments, for they are truly

remarkable. Equally remarkable

has been one constant throughout

these two and a half decades of

tumultuous change: the dedicated

and loyal service of Shirley Meehan. Shirley’s ubiquity, coupled

with her quiet competence and selfeffacing demeanor, might make it

easy to overlook her critical role in

the successes of HSR&D. To those

familiar with HSR&D, however,

Shirley’s contributions are difficult

to overestimate. 

Shirley received her undergraduate education at the University of

California, from which she graduated with great distinction, earning a

degree in medieval history (perhaps

accounting for her perceptive

understanding of the Byzantine

ways of the VA). She then spent

time in Okinawa as a columnist for

the Japanese Times and as a public

relations officer. In 1971, she took

her first position with the Veterans

Administration as an intern in the

Department of Data Management.

Shortly thereafter she became a

management intern for the associate chief medical director for data

processing, followed by a stint as a

computer systems analyst. 

In 1973, Shirley assumed her

first position in the fledgling

HSR&D Service as a project leader

and computer systems analyst.

Within eight months she was

appointed as the assistant to the

director of the HSR&D Service.

The rest is history. 

In 1975, Shirley was assigned

responsibility for oversight of the

Merit Review (IIR) Program. In

1976, she became the program

planning specialist – looking after

the increasingly complex portfolio

that the HSR&D Service was accumulating. And in 1992 she was

appointed deputy director, a position she has held through the present, punctuated by periods as

acting director in 1995 and in 1996.

Along the way, Shirley earned

both an M.B.A. and a Ph.D. from

George Washington University and

published several papers. She also

has a son who graduated from

Williams College last year. 

This chronology, however, tells

only a part of the story. Consistently throughout her career in VA,

Shirley has delivered unstintingly

dedicated service that has made her

name practically synonymous with

HSR&D. It is, in fact, hard to

imagine an HSR&D Service without her. Her constructive input has

been felt in almost every facet of

HSR&D’s expansion and operations.

She, more than anyone else in the

HSR&D program, has been the 

“go-to” person for thorny problems

and, almost without fail, she has

delivered thoughtful and imaginative solutions. She has been the

right hand of several HSR&D directors. She has been a steadying

influence when times were tough

and the engine that moved HSR&D

forward when times were good.

Throughout it all, Shirley has

won the admiration and affection of

the entire HSR&D Service, ranging

from the naïve new investigator to

the seasoned center director and

the hard-boiled service director.

Her kindness, optimism, and unassuming manner have universally

endeared her to those with whom

she has worked.

Shirley’s contributions have also

been noticed outside the HSR&D

Service. Recently, she was awarded

the Elnora M. Rhodes Service Award

by the Society of General Internal

Medicine, acknowledging the substantial influence that her work has

had on promoting research in general internal medicine — and, in

turn, advancing the careers of

young physicians who are dedicated

to conducting this research.

It is no overstatement to say

that HSR&D’s accomplishments

during the past 25 years have been

due in large part to the dedication

and proficiency of Shirley Meehan.

For this, all who have worked on

behalf of the HSR&D Service are

grateful.

Shirley Meehan: HSR&D’s Guiding Hand Over the Years

By Stephan D. Fihn, M.D., M.P.H.

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

Mary Darby, Editor

Geraldine McGlynn, Co-editor

ADVISORY COMMITTEE

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, M.H.A., FACHE, VA Medical

Center, Fresno, CA

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

Bay Pines, FL

Hanna B. Rubins, M.D., M.P.H., VA HSR&D

Center of Excellence, Minneapolis

FORUM is a publication of the VA Office of Research &

Development, Health Services Research & Development

Service, Management Decision and Research Center, in

conjunction with the Academy for Health Services Research

and Health Policy.

F O R U M
8

Meehan

continued from page 6

However, Central Office could

only act like a loosely structured

switchboard in linking the health

services research needs of VA managers with the appropriate expertise

in our Centers. In response, Dr.

Deykin conceived and developed

the HSR&D Management Decision

and Research Center (MDRC) to

help managers clarify questions

and develop appropriate research

or consultation approaches.

HSR&D Flourishes

Dr. Deykin also addressed growing

concerns about HSR&D capacity by

establishing the HSR&D Career

Development program for clinicians

and the Research Career Scientist

program for non-clinician doctorates. HSR&D continued to thrive

under the leadership of Ken Kizer

as Under Secretary, Jack Feussner

as Chief R&D Officer, and, soon

thereafter, John Demakis as HSR&D

Director. Dr. Demakis continued

the expansion of national HSR&D

resources with a database and information resource center, a health

economics resource center, and a

team for measurement excellence.

In December 2001, we completed

the 25th year of HSR&D appropriated funding. The differences

between then and now are striking

in many areas.

■ Then, our appropriated funds

were approximately $3 million. Now,

they are $50 million for fiscal 2002. 

■ Then, we reviewed approximately 13 investigator-initiated research

(IIR) projects at our first review

session. Now, we review approximately 40 twice annually. 

■ Then, we had seven IIR projects.

At the close of fiscal year 2001, we

had 118. Then, we had 10 Affiliation Programs. Now, we have 13

Centers of Excellence. 

■ Then, we had no resource centers. Now, we have three – plus a

special projects office and a major

measurement initiative. 

■ Then, we had no career development, research career scientist, or

training programs. In fiscal year

2001, HSR&D supported 61 Career

Development awardees and six

research career scientists. 

■ Then, dissemination was purely

ad hoc; now, we have a special

information dissemination program. 

■ Then, we thought about how to

get our research results noticed.

Today, we are leaders in the field of

translation research and spearhead

an entire program, the Quality

Enhancement Research Initiative

(QUERI), designed to translate

research findings into practice to

improve health care quality. 

■ Then, we relied on investigatorinitiated research ideas almost

exclusively. Now, we have a balanced program of solicited and

unsolicited investigator-initiated

research, as well as service-directed research. 

■ Then, we were seeking to develop high-quality tools. Now, we are

seeking better ways to get our recognized products into practice and

measure their impact. 

■ Then, we were struggling to plan

new initiatives; now, we are succeeding in getting the terrific ideas

of our excellent researchers and

managers fully implemented. 

■ Then, we were struggling to create demand for our products; now,

we are struggling to meet it. 

■ Then, we were striving to create

a new program. Today, we strive

to ensure continued excellence and

to identify and support research

that will address the needs of

tomorrow.

I’ve worked in the VA health

services research system for

almost 30 years. It has been and

continues to be an exciting experience. I’ve had the great privilege

of participating in the growth of a

new field and working with some

of the most inspiring researchers

and managers I ever could have

known. I am continually

impressed and humbled by the

dedication, expertise, and contributions of the researchers, VA

clinicians, managers, and my fellow HSR&D staff members.