Cyberseminar, November 28, 

Seth Eisen, MD, MSc and David Atkins, 

Health Services Research and Develo

Partnered Health Services 

CREATE

(Collaborative Research to Enhance Transforma
VETERANS HEALTH ADMINISTRATION

Agenda

• CREATE Overview (History and Rationa

• Partner and Investigator Responsibilitie

• CREATE Examples

• Lessons Learned

• CREATE Timelines

• COIN (brief description)

• Questions and Discussion
VETERANS HEALTH ADMINISTRATION

Why Did HSR&D Need

a New Funding 

• Single, disconnected projects produce 

• Investigators’ vision of the issues and p

important to the health care system m

• Researchers often only engage partner

completing their research

• Lack of VHA leadership engagement (fi

reduces likelihood of health system ad

• Design of projects may not promote im
VETERANS HEALTH ADMINISTRATION

Recommendations from O

HSR&D Workgroup

• Communication – Enhance researcher c

with local, regional, and national clinical 

• Coordination – Provide mechanism to su

related projects

• Collaboration

‐ Enhance research – heal

collaboration; provide incentives for cro

research collaboration

• Implementation – Increase attention to 

in health services research projects and 

opportunistic “real world” implementati
VETERANS HEALTH ADMINISTRATION

Work Group concepts evolved into:

CREATE and CO

(“A Culture Change for HSR Investigators an

VHA Stakeholders”)
VETERANS HEALTH ADMINISTRATION

CREATE Elements

•

3 to

5 coordinated, focused, multi

‐site research pr

• Veteran Impact integrated into objectives

• Health

‐system partner(s) engaged at outset and m

throughout

•

A “ground level” approach to determining VHA pr

• Commitment among investigators, partner(s), and 

CREATE projects

• To increase rapidity of evaluation

& funding, CREA

Directed Program

• Duration: CREATE maximum

=

5 years

o Individual project maximum

=

4 years

o Budget: $1.1m annually, $4.5m total (additio

coordination)
VETERANS HEALTH ADMINISTRATION

Goals of CREATE

• Accelerate pace of HSR&D research in critical 

• Promote more effective research

‐health syste

• Enhance research collaborations

• Speed implementation of research findings

• Demonstrate tangible impact of research on 

outcomes

“Whole that is greater than the sum o
VETERANS HEALTH ADMINISTRATION

CREATE: Investigator

‐Part

Culture Change

• Investigators commit to:

o Understand partner viewpoint and needso Engage with partners in developing researco Communicate with partners throughout res

• Partners commit to:

o Maintain engagement throughout the reseao Implement research products into health cao Protect integrity of research resultso In

‐kind and/or direct support at local, VISN 

levels
VETERANS HEALTH ADMINISTRATION

CREATE: Challenges for Successfu

Researcher Collaboratio

• Research Mission: Partners tend to focus on pr

investigators on model

‐based, hypothesis drive

• Idea

‐to

‐Project

‐Start Timetable – Partners tend 

months, researchers

a year minimum

• Project

‐Start

‐to

‐Finish Timetable: Partners ten

months to

2 years, investigators envision

3

‐

5 ye

• Project Impact – Partners tend to focus on imm

of results, researchers on their research passio

advancement

• Proposal Rejection – Partners tend to expect ap

researchers expect rejection.
VETERANS HEALTH ADMINISTRATION

Identify

a suite of model based, hypo

projects that address core health sysgreat importance to both investigato

partners, are sufficiently complex thalikely to be sought for years, and tha

amenable to both early and late ‘win

CREATE: Basis for Successful P

Researcher Collaboratio
VETERANS HEALTH ADMINISTRATION

Perceived Access

• Geographical• Temporal• Financial• Cultural• Digital

Perceived Need

• Symptom burden• Susceptibility• Stoicism• Treatment efficacy• Self efficacy

• Face-to-face• Digital

• Access to care• Quality of care• Outcomes of care

• Geographical• Temporal• Financial• Cultural• Digital

VA Provider Characteristics

Actual Access

Veteran 

Perceptions

Veteran Characteristics

Utilization

Satisfaction

VA System Policies

External Partnerships

Access to Care Model

1 Fortney J et al
VETERANS HEALTH ADMINISTRATION

CREATE Timelines – First So

• Open only to CoEs and REAPs

• 25 Letters of Intent submitted in July; 17 appro

Concept Papers

• Travel funding provided for researchers and pa

• 17 Concept Papers reviewed in September

o

8 investigator

‐partner groups approved to s

• Full proposals due mid

‐December

• Scientific review of proposals in March, 2012

• Program review and approval in April, 2012

• Aim: Fund

4

‐

5 CREATEs

o Individual projects within non

‐funded CREA
VETERANS HEALTH ADMINISTRATION

Approved Concept Papers from Firs

(PI, Topic, Partners)

• Humphreys (Palo Alto) – Promoting Value and Access to Subst

o Mental Health Operations (10N), Off Mental Health Service, Heal

• Kerns (West Haven) ‐ Enhancing Pain Management in PACT

o Patient Care Services, Office of Specialty Care, OMHS

• Mann (Gainesville) ‐ Improving Health of Rural Veterans with D

o Office of Rural Health, PM&R National Program

• Mor (Providence) ‐ Transforming Veteran Long Term Care

o Geriatrics

& Extended Care, Community Living Centers

• Petersen (Houston) ‐ Improving Quality

& Safety using Informa

o Primary Care, Office Nursing Services, Health Information Initiativ

• Pogach (East Orange) ‐ Improving Diabetes Health Care

o Specialty Care, Pharmacy Benefits Management, Primary Care Op

• Sayer – (Minneapolis) ‐ Improve Patient Engagement in Eviden

o OMHS, Nat’l Cntr for PTSD, Primary Care

• Yano – (Sepulveda) ‐ Accelerating Implementation of Women’

o Office of Women Veterans, Family Services, 
VETERANS HEALTH ADMINISTRATION

Review Criteria for CR

• Importance to health system• Engagement and support of critical pa• Scientific credibility and relevance

o Knowledge advancement

• Integration of projects

• Likelihood that CREATE will substantia

Veteran health
VETERANS HEALTH ADMINISTRATION

Lessons Learned from First 

CREATE Concept Paper R

• Researchers and Clinical partners able to gen

ideas addressing important topics

• Partners eager to lend support to important r• Most common problems among non

‐approve

papers:

o Insufficient science and innovation (e.g. how 

critical knowledge?)

o Projects not sufficiently interrelated (no visibl

have been done as individual projects)

o No clear vision of how the health system will 
VETERANS HEALTH ADMINISTRATION

• One CREATE program proposal per medical cent

• CREATE Program PI must have been an HSRD

‐fu

• Must involve projects from more than one med• Must involve partner(s) at VISN or national leve

partnership insufficient)

• Travel funds to support research/partner planni

• Concept papers due February 1, 2012

o

5 page overview;

2 pages per project; 15 page 

• Concept papers reviewed in April (6

‐

8 approvals 

• Full proposals due June 15

• Aim: Fund

4

‐

5 CREATEs

CREATE Timelines – Second S
VETERANS HEALTH ADMINISTRATION

CREATE Summary

• Engage – Investigators

& Partners

• Horizon – Think what system will need i

• Goals – Research (not program evaluatio

• Knowledge – Accelerate critical knowled

• Impact – Improve Veteran care in measu

• Barrier – Shift in Partner priorities

http://vaww.hsrd.research.va.gov/funding/
Centers of Innova

(COIN)
VETERANS HEALTH ADMINISTRATION

COIN (Centers of Inno

• RFA under concurrence; will be releas• Replace Centers of Excellence and RE• Strategic Plans in Discrete Focus Area

o Engaged Partnerso At least one impact oriented comp

(CREATE or similar)

• Cross Medical Center Collaboration• Mentoring• Service to Partners (analysis, evaluatio• Variable funding based on activity
CREATE:

(Collaborative Research to Enhance Transformat

QUESTION