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PROGRAM ANNOUNCEMENT

HSR&D PRIORITIES FOR INVESTIGATOR-INITIATED RESEARCH

1. Purpose

The Department of Veterans Affairs (VA) Health Services Research and Development Service

(HSR&D) is identifying in this announcement current research priorities. Veteran-centric

proposals clearly responsive to this announcement will be given priority funding

consideration through the funding protocol articulated in paragraph 3 below.

Cross-Cutting Priority Areas

The following priority areas have been developed by HSR&D scientific program staff in

consultation with specially convened scientific advisory groups and with input from senior VA

leaders. Several previously identified priorities remain important and have been updated in

this announcement. Current priorities are listed in alphabetical order:

A. Healthcare Access/Rural Health

B. Healthcare Equity and Health Disparities

C. Healthcare Informatics

D. Long-Term Care and Caregiving

E. Mental and Behavioral Health

F. Women’s Health

Applicants are encouraged to consider the above priorities within the context of

post-deployment health. Post-traumatic stress disorder, other post-deployment related mental

disorders, traumatic brain injury, reintegration into the community, and overall quality of life

are examples of areas of interest.

Each priority area is described briefly and illustrated with sample topics, which may be

relevant to more than one area.

2. Background

Health services research is a multidisciplinary field concerned with the effects of social factors,

financing systems, organizational structures and processes, technology, and human behavior

on health care access, quality, costs, and outcomes. In VA, health services research focuses

on understanding how to organize, deliver, finance, monitor, and improve health care to meet

the needs of Veterans and to ensure that their health care is consistently excellent.

HSR&D supports the highest quality scientific research related to this broad mission and

encourages work in specific priority areas detailed in this announcement. HSR&D has a

special interest in research that results in important innovations in clinical practice, health

service delivery, organizational management, and research methodology. Please note: we

discourage studies that seek to add incrementally to our knowledge by applying an established

intervention, approach or method to a different but related target condition, data set or

population, unless there is compelling justification that the work will substantially expand the
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body of scientific knowledge, inform important programmatic decisions or increase our

understanding of underlying models or mechanisms.

When research has practical applications for health care providers, managers, and

policymakers and where its findings are likely to directly impact specific clinical or operational

program offices, proposals should indicate that the office has been engaged (where

appropriate) or that the investigator has thought carefully about how the research aligns with

current clinical or operational program priorities. Investigators should provide evidence that

the proposed interventions are feasible within the current VHA context and are highly likely to

still be important and relevant at the conclusion of the project. Particular attention should be

given to support the sustainability of novel approaches after the research project has ended.

Finally, researchers are encouraged to consider how interventions will be implemented and

where possible should include evaluation of barriers and facilitators to implementation in

studies testing efficacy or effectiveness of an intervention.

3. Funding Decision

To encourage investigators to conduct Veteran-centric research in areas of high interest to

HSR&D, proposals that respond to priority areas will be given special consideration for funding

provided they are reviewed favorably by scientific merit review. The scientific merit review

score, which is based on significance, approach, innovation, and environment, will continue to

serve as the main determinate for funding decisions. The funding protocol below will be

followed:

a) HSR&D rank orders all applications by scientific merit review score after each merit

review round.

b) The HSR&D Director determines the fundable range of scores.

c) Proposals that fall within the fundable scoring range and are responsive to priority

areas or special solicitations will receive priority consideration for funding.

d) Proposals that are not specifically responsive to HSR&D’s priorities but are scientifically

meritorious and Veteran centric (for example, care of complex chronic disease, health

services genomics, organizational management, research methodology,

rehabilitation) will be considered for funding depending upon service priorities,

portfolio needs and availability of funds.

4. Cross-Service Collaboration Encouraged

VA HSR&D Service recognizes that some of the greatest opportunities and most important

work for Veterans’ health care might lie at the interface of different scientific disciplines

including areas supported by other services within the VA Office of Research and

Development (ORD). Such collaborative work is encouraged. Investigators considering such

collaboration should contact the appropriate scientific program manager for advice and

guidance prior to initiating the research application.
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5. Priority Areas with Sample Research Topics

Priority A– Access/Rural Health

Interventional Studies on Access to Care for Rural and Vulnerable Populations

As VA experiences an influx of new Veterans, HSR&D seeks studies that identify, develop

and test innovative approaches to improve access for new Veterans with special needs (e.g.,

TBI, PTSD), vulnerable Veteran populations (e.g., women, homeless, those with serious SMI

or multiple comorbidities), and Veterans living in rural areas. Studies should build the body of

research on the organization and management of VA health care services with innovations in

service delivery for all Veterans. Studies focusing on merely documenting variations in access

are discouraged unless the research is framed so that the findings are likely to be actionable

or contribute directly to possible interventions. Studies that examine common approaches to

improving access for rural populations (such as telehealth interventions) should clearly explain

how the proposed research will add substantially to the existing body of knowledge about the

intervention, its implementation, or the outcomes.

Sample Research Topics:

1. Determine the impact of different organizations and structures of care on access for

specific populations (e.g., regionalization of care; contract and fee-for-service care for

rural Veterans; collaborative care or residential treatment for homeless Veterans).

2. Assess innovative approaches to improve access, including technological,

procedural and structural changes in care; expanded social, family and community

networks; and partnerships with other entities and the community.

For inquires regarding this priority area, please contact Linda Lipson, M.A., at

linda.lipson@va.gov or (202) 443-5737. To indicate that an application is responsive to this

priority area choose “Access” from the drop down menu in the “Addresses Specific HSR&D

Priority Area?” field on the Intent to Submit notification.

Priority B – Equity and Health Disparities

Interventional Studies to Reduce Racial and Ethnic Minority Health Care Disparities

Research funded by VA has documented disparities in health and health care and has

contributed to our understanding of important determinants of these disparities, such as

Veteran-physician communication, Veteran attitudes and beliefs, and health literacy.

Additional factors relating to Veterans, providers, health care facilities, and health care

systems may also contribute to health care disparities. HSR&D has a special interest in

studies that develop and test interventions which promote equitable health care services and

health outcomes for all Veterans. Studies focusing on merely documenting racial and ethnic

disparities are discouraged unless the research is framed so that the findings are likely to be

actionable.

Sample Research Topics:

1. Assess interventions targeted at system-wide or facility-specific policies (e.g.,

regarding family members, organ donation, autopsy) and resources or services (e.g.,
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bilingual staff, community outreach, religious accommodations) that can reduce

variations in treatment or outcomes.

2. Develop and evaluate decision aids and information tools with the potential to enhance

knowledge and engagement among minority Veterans and those that focus on

overcoming barriers due to health literacy or language and cultural differences.

3. Assess interventions designed to encourage Veterans to become more active

participants in their health care by improving communication and interactions between

health care providers and Veterans.

4. Develop and assess innovations that inform clinical interventions to reduce adverse

consequences of bias and inequity.

For inquires regarding this priority area, please contact Linda Lipson, M.A., at

linda.lipson@va.gov or (202) 443-5737. To indicate that an application is responsive to this

priority area choose “Equity” from the drop down menu in the “Addresses Specific HSR&D

Priority Area?” field on the Intent to Submit notification.

Priority C- Healthcare Informatics

Healthcare Informatics to Improve Veteran Care

Healthcare informatics is the integration of biomedical knowledge systems with technology to

improve decision-support systems, evidence-based practices, collaboration and continuity of

care among providers, and Veteran and provider education. Healthcare informatics also

facilitates the development of Veteran databases and tools needed for knowledge discovery

and public health surveillance. Proposals responsive to this priority area should be clearly

distinct from operational development and maintenance of IT systems. Informatics activities

are expected to be research-oriented and to incorporate a well-developed evaluation plan and

rigorous methodologies articulated in HSR&D Handbook 1204.1, posted on the HSR&D

website at: http://www.hsrd.research.va.gov/for researchers/policies/Handbook-1204-1

Sample Research Topics:

1. Evaluate and develop knowledge engineering, knowledge representation, machine

learning, and/or artificial intelligence technologies for research applications.

2. Develop and evaluate models of care constructed on a theoretical basis supported by

information systems.

3. Assess information system architecture, including systems to coordinate Veteran’s VA and

non-VA health care by integrating data across different systems of care.

4. Develop and evaluate decision support systems that incorporate Veteran preferences and

enhance management of complex chronic conditions.

5. Assess simulation models to explore hypotheses about aggregated performance

measures.

For inquiries regarding this priority area, please contact Merry Ward, Ph.D., at

merry.ward@va.gov or (202) 443-5746. To indicate that a proposal is responsive to this priority

area choose “Informatics” from the drop down menu in the “Addresses Specific HSR&D

Priority Area?” field on the Intent to Submit notification.
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Priority D – Long-Term Care & Caregiving

Improving Quality of Life for Veterans and their Caregivers

Informal caregivers (usually family members or friends) frequently provide long-term, in-home

care for Veterans. Demand for services that are geared toward providing support for maximum

possible recovery and reintegration for severely disabled or aging Veterans and their families

will continue to increase. In addition, recently deployed Veterans returning home to rural or

geographically isolated areas that lack traditional inpatient or rehabilitation facilities may

require management of complex conditions and long-term care in the home environment.

Studies that focus on the health status of these Veterans, their quality of life, and the quality of

care VA provides must also consider the contributions of informal caregiving to these

outcomes

Sample Research Topics:

1. Examine the interactions among Veterans’ conditions, the capacity of the informal

caregiver, and specific formal services that have the potential to optimize Veteran recovery

and reintegration.

2. Develop and evaluate innovative education, training, and decision support for informal

caregivers to reduce caregiver burden, enhance caregiver competency and capacity to

provide care, and promote integration with the professional caregiving team.

3. Assess the impact of transitioning between home care and institutional care on

4. Veteran outcomes, as well as caregiver status and outcomes.

For inquiries regarding this priority area, please contact Pauline Sieverding, M.P.A., J.D.,

Ph.D., at pauline.sieverding@va.gov or (202) 443-5742. To indicate that a proposal is

responsive to this priority area choose “Long Term Care” from the drop down menu in the

“Addresses Specific HSR&D Priority Area?” field on the Intent to Submit notification.

Priority E – Mental and Behavioral Health

Improving Mental and Behavioral Interventions

Mental Health is broadly defined to include issues ranging from substance use and

depression to post-traumatic stress disorders and serious mental illness. HSR&D has a

special interest in innovative approaches to improve earlier identification and treatment of

post-traumatic stress disorders and suicidality, enhance the continuum of care for substance

use disorders, and refine recovery-oriented treatment approaches, particularly

evidence-based programs and peer-support services, especially for Veterans in rural areas.

Sample Research Topics:

1. Identify pre-deployment risk and resiliency factors that contribute to post-deployment

mental health and behavioral issues.

2. Develop and test interventions to support families in new caregiving roles. Evaluate

methods to enhance the integration and coordination of mental health services with

primary care and specialty services, including the organization and management of

services for Veterans with dual diagnoses.

3. Evaluate innovative strategies to improve earlier identification and treatment of post
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traumatic stress disorders and related mental health disorders (substance

use and depression), especially in returning Operation Iraqi Freedom (OIF) and

Operation Enduring Freedom (OEF) Veterans.

4. Identify risk factors and accuracy of assessment of suicidality and evaluate best

practices for suicide prevention. Research on these topics should especially consider

the suicide risks of Veterans who are experiencing post-traumatic stress disorder,

Veterans returning from OEF and OIF, and elderly Veterans.

For inquires regarding this priority area, please contact Robert O’Brien, Ph.D., at

robert.obrien7@va.gov or (202) 443-5741. To indicate that a proposal is responsive to this

priority area choose “Mental Health” from the drop down menu in the “Addresses Specific

HSR&D Priority Area?” field on the Intent to Submit notification.

Priority F - Women’s Health

Research on Women Veterans’ Health Care Delivery and Quality of Care

HSR&D has a special interest in ensuring that the unique health care needs of women

Veterans are addressed. Studies to evaluate the access, availability, equity, quality and cost

of key healthcare services and organizational approaches to enhancing the

comprehensiveness and continuity of healthcare for women Veterans are encouraged.

Sample Research Topics:

1. Assess the quality of care associated with different approaches to serving women

Veterans, including evaluations by location and organization (e.g., large VA medical

centers vs. small community-based outpatient clinics, urban vs. rural) and by type of

provider (e.g., fee-basis or contract providers, generalist vs. specialists, same-gender

providers).

2. Evaluate the outcomes of care associated with the various systems of care (e.g., different

models of care, VA vs. non-VA care, dual users of VA and non-VA care), including health

status and Veteran satisfaction.

3. Identify, develop, and evaluate innovative models for improving quality care to women

Veterans, including interventions or programs to facilitate coordination of care across

settings and among providers over time.

For inquires regarding this priority area, please contact Linda Lipson, M.A., at

linda.lipson@va.gov or (202) 443-5737. To indicate that a proposal is responsive to this priority

area choose “Women” from the drop down menu in the “Addresses Specific HSR&D Priority

Area?” field on the Intent to Submit notification.

6. Eligibility

Investigators must have a paid VA appointment of at least 5/8 time at the time of funding.

Questions about eligibility may be referred to the Eligibility Coordinator, Rita Lysik at 202-

443-5739 or rita.lysik@va.gov.
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7. Funding Duration and Limits

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 research

design is expected to be appropriate and efficient, with all budget categories well justified.

Moreover, projects that exceed $350,000 in any one year or a total of $1,100,000 will not be

accepted without a previous waiver approved by the scientific program manager and signed

by the Director, HSR&D Service. In planning project budgets, applicants are reminded to

adhere to HSR&D guidelines regarding allowable use of research funds for specific items and

restrictions on the use of research funds for equipment and development of computer

software (see VHA Handbook 1204.1, Paragraph 8, HSR&D Funding for "Development"),

available at

http://www.hsrd.research.va.gov/for researchers/policies/Handbook-1204-1.

8. Application Process

HSR&D uses Grants.gov and eRA Commons for electronic submission and processing of

applications. Contact information and an overview of the application process are

contained in the Appendix. Specific guidelines concerning the application process, forms,

due dates, and program contacts are available on the intranet at

http://vaww.research.va.gov/funding/electronic-submission.cfm.

Please read all instructions carefully and use the checklists provided to ensure that all

formatting and other requirements for submission, (e.g., waivers) are met. Proposals that

are not consistent with these requirements are administratively removed from further

consideration.