VA Office of Research and Development, Health Services Research and Development Service 1

Research and Development RX

By Stephan D. Fihn, MD, MPH

Acting Chief Research and Development Officer

In July 2004, I was asked by Dr. Jonathan Perlin, the Acting Under

Secretary for Health, to assume the leadership of the Office of

Research and Development (ORD) as Acting Chief Research and

Development Officer. This great privilege came with many

challenges. As you know, ORD has been through tumultuous times

over the past two years that resulted in a sense of disorganization,

reduced service to the field, low staff morale, and a loss of prestige

in the VA research program. With your help, my goal is to correct

our course and work to move the ORD organization forward.

In concert with the ORD Service Directors, we have enumerated

our “Top 10 Action Items.” These represent a set of objectives, some

fairly short-term, others very long-term, that we propose to tackle

over the next several months. They are:

• Complete ORD reorganization/space plan

• Complete response to OIG report

• Re-engineer peer review process

• Create model for cross-service collaboration

• Reinvent Cooperative Studies Program

• Update laboratory facilities

• Enhance career development

• Improve support for the field

• Enhance system-wide collaborations

• Develop strategy/infrastructure for IT

Needless to say, most of the issues will take considerable time to

address but it is our intent to begin working on all of them and start

to make progress. Some of these are of more interest to the

HSR&D field than others, so I will highlight those of more general

field interest here. 

In This Issue

Research and 

Development RX . . . . . . . . . . . Page 1

HSR&D Appoints New 

Associate Director . . . . . . . . . . Page 3

Conference Focuses on 

Implementing the Evidence . . . Page 4

Epidemiologic Methods 

is a Hit at Summer Session . . . . Page 5

Research Solicitation . . . . . . . . Page 5

New Centers of Excellence . . . . Page 6

New Resource Center . . . . . . . . Page 7

Targeted Research 

Enhancement Program . . . . . . . Page 7

New Career 

Development Awardees . . . . . . Page 8

New Research Career 

Scientist Awardee . . . . . . . . . . . Page 9

New Merit Review 

Entry Program Awardees . . . . . . Page 10

Newly Funded 

Research Projects . . . . . . . . . . . Page 10

Tran slating

R esearch

into Practice

Continued on page 2

Vol. 3, No. 1 November 2004
2 VA Office of Research and Development, Health Services Research and Development Service

HSR&D Research Briefs NOVEMBER

ORD Reorganization

Critical to our future success are the completion of the

ORD restructuring and the correction of the leadership

gap. We have made significant progress. The split of

the Medical Research Service into two new services,

the Biomedical Laboratory Research and Development

Service and the Clinical Science Research and

Development Service (which includes the Cooperative

Studies Program) has been completed. The four ORD

services and new leadership are as follows:

• Biomedical Laboratory Research and

Development Service (BLR&D) conducts

research that explores basic biological or

physiological principles in humans or animals, but

does not involve intact human beings. Timothy

O’Leary, MD, PhD, now leads this service. Dr.

O’Leary is an actively funded investigator whose

own research interests include molecular changes

in gastric tumors, ultra sensitive detection of

biological toxins, and mechanisms of

formaldehyde fixation.

• Clinical Science Research and Development

Service (CSR&D) carries out research that focuses

on intact human beings, including interventional

and effectiveness studies, clinical,

epidemiological, and technological studies.

(Cooperative Studies Program falls under this

service). This service is led by Brian G. Schuster,

MD, FACP, an active investigator with primary

interests in infectious disease and clinical

pharmacology.

• Health Services Research and Development

Service (HSR&D) examines the organization,

delivery, and financing of health care, from the

perspectives of patients, caregivers, providers, and

managers to improve the quality and economy of

care. HSR&D also focuses on effective ways to

translate clinical knowledge into practice. Shirley

Meehan, MBA, PhD, is Acting Director.

• Rehabilitation Research and Development

Service (RR&D) works to restore as much

functional independence as possible to impaired

and disabled veterans and to improve their quality

of life. Rehab R&D is dedicated to the well being

of America’s veterans through a full spectrum of

research – from approved rehabilitation research

projects, through evaluation and technology

transfer, to final clinical application. Mindy Aisen,

MD, a board-certified neurologist with a focus on

neurologic disorders such as multiple sclerosis and

spinal cord injury, directs this service. 

In addition, we are working to ensure adequate staffing

in Central Office and building a sense of teamwork and

cross-service collaborations. 

Research and Development RX

Continued from page 1

HSR&D Leadership

Dr. Shirley Meehan has

been appointed Acting

Director of HSR&D and

will serve in this capacity

until a new search for

Director is opened.

Past HSR&D Director

John Demakis, MD,

retired in July after 32 years of service to the VA.

Dr. Demakis served as Director of HSR&D from

1998-2004 and left a vibrant and strong HSR&D

program, both in the field and in Central Office.

HSR&D conducted a search last spring and

hoped to have a new Director identified by the

time Dr. Demakis retired. However, even though

the search yielded some excellent candidates,

because of the rapidly changing environment in

Central Office and the imminent turnover in

leadership at several levels, the position will not

be filled at this time. It is anticipated that the

search will be reopened in the near future.

Meanwhile, the HSR&D Directorship will remain

in the very able hands of Dr. Meehan.

Shirley Meehan, MBA, PhD
VA Office of Research and Development, Health Services Research and Development Service 3

2004 HSR&D Research Briefs

Peer Review

We are working to re-engineer the peer review process

into the creation of a clear, responsive proposal evaluation and funding process that includes a system for

adequate reporting, accountability, and documentation

of publications and impacts. As part of this effort, we

are consulting with the Field Research Advisory

Council (FRAC) for input from investigators in the field.

Cross Service Collaborative Research 

Again working with the FRAC and the National

Advisory Council, we will target areas of strength

within each service and build incentives for collaboration. For example, RR&D and HSR&D have a

number of collaborative efforts underway, such as a

jointly funded Stroke Rehabilitation and Outcomes

Research Center and, in the target area of trauma/

amputation, an Amputations QUERI Center is under

development. Other potential areas for ORD service

collaborations include: COPD, dementia, long-term

care, cardiac disease, and obesity.

Cooperative Studies Program

We are in the process of reviewing and updating 

CSP procedures, including those that will ensure 

CSP studies address priority clinical questions, are

expedited in a timely manner, and have greater 

fiscal accountability.

Enhancing Career Development 

Again, with field input we will facilitate the creation

of a clear and seamless career development pathway

to train and retain talented clinician investigators.

We are working to address issues of loan repayment,

citizenship, salary structure, and program policies. 

Supporting the ORD Field 

ORD Central Office and field communications 

have left a lot to be desired. We are working to

remedy this. The Director of Communications

vacancy has been filled as Linda Lutes began work 

in mid-October. In addition to improving basic

commun-ications and coordination with the field, 

we will develop appropriate ACOS/R&D and

AO/R&D training as well as expanded assistance 

to investigators for grant preparation.

Enhancing Opportunities for System-wide

Collaboration

We will enhance opportunities for system-wide

collaborations by examining possibilities such as

creating informal research networks, and creating a

VA-wide IRB.

Information Technology

A sound IT infrastructure for scientific management

is critical to our success. We are taking steps to

establish a process of review of current systems and

planning for new and improved systems.

These are exciting and challenging times for ORD.

With the unwavering support of the Secretary, the

Honorable Mr. Principi; the acting Under Secretary

for Health, Dr. Perlin; and the Acting Deputy Under

Secretary, Dr. Kussman, appropriate input from all

parts of ORD, and with interest and support for

collaborations from other VA and non-VA

constituents, we will continue our tradition as a

world-class research enterprise. I look forward to

working with all of you toward this goal.

HSR&D Appoints New

Associate Director

Joseph Francis, MD, is the newly appointed

Associate Director for Health Services Research and

Development (HSR&D). He is responsible for the

overall administration and coordination of

implementation activities, as well as the Quality

Enhancement Research Initiative (QUERI). Dr. Francis

is board-certified in internal medicine, geriatrics, and

medical management. He was a clinical manager in

VISN 9 before serving as vice president for Data

Management and Quality at St. Vincent’s Hospital in

Indianapolis for the past four years. 

Dr. Francis is delighted to return to the VA, which 

he believes is the ideal laboratory for the implementation of research findings due to its “commitment to

clinical excellence and its unparalleled information
4 VA Office of Research and Development, Health Services Research and Development Service

HSR&D Research Briefs NOVEMBER

infrastructure.” He is particularly excited about the

QUERI program because he believes “that health

services research needs to be integrated into clinical

practice. QUERI isn’t just about educating and

sharing knowledge, it’s about partnering to bring

about real change.” Dr. Francis will visit all of the

QUERI Coordinating Centers to share and gather

information on a broad range of issues, including his

vision for the future of QUERI. He would like to see

QUERI “so embedded into VA’s organizational

framework that clinical care is routinely — and

seamlessly — based on evidence-based practice.” He

also envisions QUERI tools being applied to broader

areas. For example, in addition to patient and disease

concerns, QUERI principles could be extended to

organizational issues. 

One of QUERI’s latest achievements is the completion

of the new “Guide for Implementing Evidence-Based

Clinical Practice and Conducting Implementation

Research.” The QUERI Guide was written for anyone

interested in the implementation of research or

evidence into clinical practice, particularly within the

VA Health Care System. Based on lessons from more

than six years of QUERI experience, the Guide

includes information on: theory and methods for

integrating theory into practice; specific QUERI

research, including lessons learned; and resources for

implementing research into practice, including several

web resources. To access the Guide, visit the national

QUERI website at

www.hsrd.research.va.gov/queri/.

State-of-the-Art Conference

Focuses on Implementing 

the Evidence

The Health Services Research and Development

Service recently hosted a state-of-the-art (SOTA)

conference on “Implementing the Evidence:

Transforming Practices, Systems, and Organizations”.

Held in Washington, DC, the goal of this SOTA was

to assess and define the current state of knowledge

about how to create organizations that can rapidly

implement new knowledge into complex, highly

technical health care delivery systems to improve the

quality of patient care. 

VA has taken a leadership role in research and

implementation of the best ways to move research

into practice effectively and in a timely manner. For

example, initiatives aimed at promoting adoption and

use of clinical practice guidelines based on the best

available evidence have been underway throughout

the Veterans Health Administration (VHA) for more

than 10 years. Over the past decade, several components of VHA have partnered to foster this process,

including the Office of Research and Development,

the Office of Quality and Performance, the Office of

Patient Care Services, and the Office of Information.

Representatives from each of these collaborating

entities, as well as VA researchers, non-VA

researchers, and policy makers attended the SOTA.

Catarina Kiefe, MD, PhD, Director of the Deep South

Center on Effectiveness, Birmingham VA Medical

Center, and Anne Sales, PhD, RN, Implementation

VA HSR&D Research Briefs is a biannual publication

of the Office of Research and Development’s Health

Services Research and Development Service. Each

issue will provide summary information about recently

completed research projects and publications, as well

as descriptions of new initiatives, solicitations, newly

funded studies, and other items of interest to a broad

VA audience. For more information or to provide us

with your questions or suggestions, please contact:

Geraldine McGlynn, Director

Center for Information Dissemination and 

Education Resources 

VA Boston Healthcare System (152-C)

150 S. Huntington Avenue

Boston, MA 02130-4893

Fax: (617) 278-4511

Email: geraldine.mcglynn@med.va.gov

VA HSR&D Research Briefs is available on the Internet

at www.hsrd.research.va.gov or Intranet at

vaww.hsrd.research.va.gov
VA Office of Research and Development, Health Services Research and Development Service 5

2004 HSR&D Research Briefs

Research Coordinator for VA’s Ischemic Heart Disease

Quality Enhancement Research Initiative (QUERI),

co-chaired the conference. The agenda included

work groups and plenary discussions. Highlights

included presentations by Acting Under Secretary for

Health Jonathan Perlin, MD, PhD, and a keynote

address by Kenneth Kizer, MD, MPH, President and

Chief Executive Officer of the National Quality

Forum in Washington, DC, and former VA Under

Secretary for Health. 

Most of the SOTA was devoted to work groups

comprised of various experts in the field of

implementation research. Each work group addressed

one of the following questions:

• What are the attributes of an ideal integrated

informatics system that supports implementation

of evidence?

• How does evidence inform what an organization

and its providers do?

• What is the role of incentives in promoting

implementation of best practices and

organizational change?

• How does research need to be reorganized to

foster organizational and practice change?

The work begun at the SOTA conference will

continue in the form of product development. Papers

commissioned for the conference will be revised

based on input from SOTA participants and will be

submitted to the Journal of General Internal Medicine

for publication.

Epidemiologic Methods Is a

Hit at Summer Session

Understanding study design became much easier 

for students attending the popular Introduction to

Epidemiologic Methods taught by Thomas D.

Koepsell, MD, MPH, and Noel S. Weiss, MD, DrPH,

from the University of Washington. “Fantastic” and

“Best class I’ve ever taken” were reactions to this

course offered at the 6th Annual Epidemiology,

Biostatistics, and Clinical Research Methods Summer

Session, held June 21-25, 2004 at the University of

Washington Campus in Seattle. 

The session was attended by 195 researchers and

clinicians from around the United States who came to

learn new research methodology, from epidemiologic

methods to multilevel data analysis. 

The Summer Session is sponsored by the Seattle

Epidemiologic Research and Information Center

(ERIC), VA’s Clinical Science Research and

Development Program, the VA Employee Education

System, and the University of Washington

Departments of Epidemiology and Biostatistics. The

2005 Summer Session will be held from June 20-24,

2005. For information about the courses now

available for distance/cyber learning through the

Employee Education System, visit the Seattle ERIC

web site at

www.eric.seattle.med.va.gov/education/

seattle_eric_cyber.htm

Research Solicitation:

Deployment Health Services

Research

In July, HSR&D announced a new solicitation to

support research focused on deployment health care

needs and services. A deployment health care need

is defined as a person’s health concern about an event

or activity related to duty in the nation’s armed forces

that involves a military operation, location, command,

or exposure to combat or other hazardous environments. Deployment health care needs may also apply

to individuals who were not deployed (e.g., family

members or informal caregivers), but have health

concerns that relate to a veteran’s deployment. Three

major categories related to deployment health have

been identified as priorities: 1) Health delivery system

organization resources, structures, and processes of

utilization of a continuum of health services; 
6 VA Office of Research and Development, Health Services Research and Development Service

HSR&D Research Briefs NOVEMBER

2) Population characteristics; and 3) Health and

satisfaction outcomes. The results of this research

program will support the delivery of high-quality,

evidence-based, cost-effective health care for veterans

of all deployments, and those actively serving in the

armed forces.

For more information on this and other HSR&D

solicitations, visit the HSR&D web site at

www.hsrd.research.va.gov/for_researchers/

funding/solicitations/.

New Centers of Excellence

In June, HSR&D announced funding for three new

Centers of Excellence (COE), two focused on

implementation and one focused on organization and

management research. These new centers join the 13

existing COEs, representing the diversity and breadth

of HSR&D research. Each COE develops its own

research agenda, is affiliated with a VA Medical

Center, and collaborates with local schools of public

health and universities to carry out its mission. The

research at each COE serves to energize the facility

and network with which it is affiliated, and provides a

constant source of innovation, creativity, and support.

In addition, COEs house HSR&D’s Career

Development and Career Scientist awardees and

provide fertile ground for other mentoring programs.

Following is a brief description of the newest Centers

of Excellence. For more information about HSR&D’s

COE program, visit our web site at 

www.hsrd.research.va.gov/about/centers/

centers_of_excellence.cfm.

Center for Research in the Implementation

of Innovative Strategies in Practice (CRIISP)

Gary E. Rosenthal, MD, Director

Iowa City VAMC

The mission of CRIISP is to conduct innovative

research that advances understanding of strategies

for incorporating knowledge into practice and that

improves veterans’ well being. Research conducted

by CRIISP will be part of an integrated program to:

1) advance understanding of fundamental barriers

and facilitators to the adoption of evidence-based

practices; and 2) apply this understanding to

develop, test, and disseminate novel interventions to

improve quality and lower costs in a variety of

practice settings. The research will be driven by a

conceptual model for introducing innovation into

environments with complex organizational and

social structures that explicitly recognizes the

importance of patient activation in the

implementation and adoption of new practices by

clinicians. Work undertaken by CRIISP will be

designed by interdisciplinary teams, incorporate a

spectrum of quantitative and qualitative methods,

and emphasize conditions for which there is both

evidence to achieve a national consensus regarding

best practices and clearly demonstrated gaps

between evidence and practice.

Center of Excellence on Implementing

Evidence-Based Practice

Bradley N. Doebbeling, MD, MSc, Director

Roudebush VAMC, Indianapolis

The mission of this Center is to improve healthcare

provided to veterans through discovery, evaluation,

implementation, and sustained adoption of

evidence-based best practices in the VA and the

broader national health care system. Strategic goals

include: (1) generating new knowledge about best

practices through clinical and organizational

research; (2) identifying organizational,

environmental, and provider-based aspects of

health systems that influence adoption of these best

practices; (3) designing and testing health system

interventions to support, expand, and sustain the

implementation of evidence-based practice; (4)

making maximal use of research evidence in

routine care; and (5) facilitating the use of research

in the dissemination of best practices.
VA Office of Research and Development, Health Services Research and Development Service 7

2004 HSR&D Research Briefs

Center for Organization, Leadership, and

Management Research (COLMR)

Martin P. Charns, DBA, Director

VA Boston Healthcare System

COLMR’s mission is to develop and apply

knowledge of innovative management practices to

improve the effectiveness and efficiency of health

care services. This mission has two interrelated

research themes: 1) management practices that result

in higher quality, lower costs, and greater access to

health care services, and 2) management practices

that promote successful organizational change for

long-term performance improvement. Within its two

research themes, COLMR will have three research

foci: 1) management practices that result in higher

quality of care, 2) management practices that

promote successful organizational change,

especially change to implement evidence-based

clinical practices, and 3) development of leadership

in health care organizations.

New Resource Center

HSR&D has announced funding for its newest

Resource Center, the Center for Information

Dissemination and Education Resources (CIDER).

CIDER joins the 3 existing Resource Centers (HERC,

VIREC, and METRIC) which each target a specialized

area, such as health economics, informatics, and

measurement. Following is a brief description of

CIDER’s focus and activities. For more information

on HSR&D’s Resource Centers, please visit our web

site at: www.hsrd.research.va.gov/about/centers/

resource_centers.cfm.

Center for Information Dissemination and

Education Resources (CIDER)

Geraldine McGlynn, MEd, Director

VA Boston Healthcare System

With a focus on dissemination and education,

CIDER will track, develop, and disseminate

important information about HSR&D activities to 

a number of audiences, including Congress, VA

policy-makers, managers, clinicians, and

researchers. CIDER will utilize numerous

dissemination modes including print and electronic

products, meetings, conferences, lectures, and

HSR&D’s web site to provide access to research

studies, findings, and HSR&D program information.

CIDER will also provide general information,

guidance, and referrals to HSR&D Centers of

Excellence and field investigators regarding

dissemination activities, and will be responsible for

coordinating with other HSR&D Resource Centers in

the development and implementation of cyber

seminars on new research methods and other

educational programs for HSR&D researchers.

Targeted Research

Enhancement Program

The Targeted Research Enhancement Program (TREP)

assists VA sites affiliated with an academic institution

having significant non-VA federal health services

research funding (e.g. NIH, AHRQ), but which do

not currently have significant VA HSR&D activity.

The primary goal of the program is the development

of VA HSR capacity, by building on the success of

VA’s university affiliates. Funds are provided for the

creation of a core program of investigators,

statisticians, economists, and other social scientists to

support and facilitate the development of HSR&D

research projects and career development. 

HSR&D has recently funded 3 new TREP sites,

described below.

Understanding Racial and Ethnic Variations

in Health Outcomes for Chronic Diseases

Leonard Egede, MD, MS, Director

Ralph H. Johnson VAMC, Charleston, SC

In collaboration with its academic affiliate, the

Medical University of South Carolina, this site will
8 VA Office of Research and Development, Health Services Research and Development Service

HSR&D Research Briefs NOVEMBER

advance knowledge on racial and ethnic variations in

care by focusing on two patient level factors, patient

trust and patient preferences for care. Investigators

will collect clinical data prospectively and use a

behavioral model of health services utilization and

outcomes to evaluate the incremental effect of these

patient level factors on racial and ethnic disparities in

health outcomes for chronic medical conditions highly

prevalent in the veteran population. Initial efforts will

focus on three major chronic conditions: diabetes,

hypertension, and osteoarthritis of the knee.

Program to Integrate Psychosocial and Health

Services in Chronic Disease and Disability

Peter D. Friedmann, MD, MPH, Director

Providence VAMC, Providence, RI

This site will develop, implement, and evaluate

multidisciplinary interventions and integrated service

delivery systems to address the effects of psychosocial

and behavioral factors on chronic disease and

disability, in collaboration with Brown Medical School,

its academic affiliate. Initial pilot projects are designed

to build health services research infrastructure in

primary care firms/community-based outpatient clinics

and the rehabilitation program affiliated with the

Providence VAMC (and eventually VISN-wide), and to

bring together multidisciplinary faculty at Brown and

Providence VAMC to mentor junior investigators.

Atlanta VAMC Targeted Research

Enhancement Program 

Theresa W. Gillespie, PhD, Director

Atlanta VAMC

This site will develop, implement, and evaluate

programmatic initiatives toward development of 

a nationally-recognized program in health services

research, with projects addressing priority issues 

in oncology, geriatrics, and health literacy under 

the unifying theme of clinical effectiveness

evaluation. Projects at this site will help to foster

strong collaborations with Emory University, its

academic affiliate. 

For more information about TREP, contact Susan

Schiffner, RN, BSM, CCM, at susan.schiffner@va.gov.

For descriptions of all funded TREP sites, please visit

HSR&D’s web site at

www.hsrd.research.va.gov/about/centers/trep.cfm

New Career 

Development Awardees

HSR&D Career Development Awards provide VA

clinician researchers with full salary support to

enable them to pursue health services research

training and experience – with minimal clinical

responsibilities – under the guidance of an

experienced mentor. Following are the most recent

awardees, their locations, and areas of research

interest to be pursued through their award. For more

information on this program, visit the HSR&D web

site at www.hsrd.research.va.gov/for_researchers/

professional_development/.

Joseph Agostini, MD

West Haven VAMC

Net Benefits vs. Harm of Total 

Medication Use in Older Veterans

Sherrie L. Aspinall, PharmD

VA Pittsburgh Healthcare System

Antibiotic Prescribing in Veterans with 

Acute Respiratory Infections

HSR&D’s 2005 National Meeting is scheduled

for February 16-18, 2005 in Washington, DC.

This year’s theme is “Improving Care for

Veterans with Chronic Illnesses.” The meeting

will be hosted by the Houston Center for

Quality of Care and Utilization Studies. For

more information, visit the meeting web site at:

www.hsrd.research.va.gov/about/

national_meeting/2005/.

SAVE THE DATE
VA Office of Research and Development, Health Services Research and Development Service 9

2004 HSR&D Research Briefs

Bevanne Bean-Mayberry, MD, MHS

VA Pittsburgh Healthcare System

Assessment of Preventative and Chronic 

Disease Measures in Women Veterans

Christopher Bryson, MD, MS

VA Puget Sound Health Care System

Medication Adherence and 

Cardiovascular Risk Reduction

Lisa Chew, MD, MPH

VA Puget Sound Health Care System

Health Literacy and Outcomes Among 

VA Patients with Diabetes

Mark J. Edlund, MD, PhD

Central Arkansas Veterans Healthcare System

Overcoming Barriers to Mental 

Health Treatment Adherence

Stephen D. Flach, MD, PhD

Iowa City VAMC

Time, Stress, and Quality of Care: 

An Economic Analysis

Shawn Fultz, MD, MPH

West Haven VAMC

Mediators of Hepatic Injury in HIV Infected Veterans

Peter W. Groeneveld, MD, MSc

Philadelphia VAMC

Technology Diffusion in VHA: 

Efficacy, Equity, and Cost-effectiveness

William C. Holmes, MD, MSCE

Philadelphia VAMC

Testing MST and HIV-Specific Quality of 

Life Assessment Methods for VHA

Peter J. Kaboli, MD

Iowa City VAMC

Improving Medication Prescribing, Delivery, 

and Effectiveness in Veterans

Stacey Kovac, PhD

Durham VAMC

NSAID Patient Safety: Integrating 

Behavioral and Improvement Science

Catherine MacLean, MD, PhD

VA Greater Los Angeles Healthcare System

Consumer Quality Assessment of Osteoporosis

Sandra Moody-Ayers, MD

San Francisco VAMC

Health and Mortality Outcomes Across 

Race and Gradients of Socioeconomic Status

Karen Seal, MD, MPH

San Francisco VAMC

Overcoming Barriers to Hepatitis C 

Treatment Among High-Risk Veterans

Brenda E. Sirovich, MD, MS

White River Junction VAM&ROC

Primary Care Office Visits: Inside the Black Box

Brennan Spiegel, MD

VA Greater Los Angeles Healthcare System

Impact of a Model Physician-Patient 

Relationship in Irritable Bowel Syndrome

Michael A. Steinman, MD

San Francisco VAMC

Understanding and Improving 

Antibiotic Prescribing in VA

New Research Career

Scientist Awardee

HSR&D Research Career Scientist awards are for

established, non-clinician, independent investigators

and initially provide up to five years of funding.

Career Scientists at this level must have a minimum

of six years of independent research support (VA or

other), and must have current VA/HSR&D project

support. Below is the most recent career Scientist

Awardee. For more information on this program,

visit the HSR&D web site at

www.hsrd.research.va.gov/for_researchers/

professional_development/.

Keith N. Humphreys, PhD

VA Palo Alto Health Care System

Patterns of Service Use Associated 

with Substance Abuse Treatment
10 VA Office of Research and Development, Health Services Research and Development Service

HSR&D Research Briefs NOVEMBER

New Merit Review Entry

Program Awardees

HSR&D Merit Review Entry Program awards are

intended to provide beginning doctoral-level nonclinicians (no more than 5 years beyond receipt of

their PhD or last research training or fellowship)

interested in health services research with an

opportunity for a period of concentrated mentoring

and research activities. The awards provide three

years of research support designed to prepare

awardees to enter the more competitive VA HSR&D

Merit Review Program. Following are the most recent

awardees, their locations, and areas of research

interest to be pursued through their award. For more

information on this program, visit the HSR&D web site

at www.hsrd.research.va.gov/for_researchers/

professional_development/.

Dean Blevins, PhD

Central Arkansas Veterans Healthcare System

Improving End-of-Life Care for Veterans in 

Skilled Nursing Facilities

Mayur M. Desai, PhD, MPH

West Haven VAMC

Quality of Care for Chronic Medical 

Conditions in Mentally Ill Veterans

Aram Dobalian, PhD, MPH, JD

VA Greater Los Angeles Health Care System

Advance Directives and Resource Use in VA 

Nursing Homes

Kelli L. Dominick, PhD

Durham VAMC

Self-Management for Osteoarthritis: A 

Tailored, Telephone-Based Intervention

Erik J. Groessel, PhD

VA San Diego Healthcare System

A Self-Management Intervention for 

Veterans with Hepatitis C

John F. McCarthy, PhD, MPH

VA Ann Arbor Healthcare System

Health Services Needs of Aging 

Veterans with Schizophrenia

John D. McKellar, PhD

VA Palo Alto Health Care System

Improving Substance Use Disorder 

Outcomes with Telephone Monitoring

Dylan M. Smith, PhD

VA Ann Arbor Healthcare System

Evaluating Measures of Joint Replacement Outcomes

Corrine I. Voils, PhD

Durham VAMC

Self-Management for Hypercholesterolemia: 

A Spouse-Assisted Intervention

Kenneth R. Weingardt, PhD

VA Palo Alto Health Care System

Web-Based Implementation of 

Clinical Practice Guidelines

Newly Funded 

Research Projects

For more detail about these and other HSR&D

research projects, visit the HSR&D web site at

www.hsrd.research.va.gov/research/.

INVESTIGATOR-INITIATED RESEARCH

A Culturally Sensitive Values-Guided Aid for 

End-of-Life Decision-Making

Ursula Braun, MD

Houston VAMC

A Longitudinal Evaluation of the Linkage 

Between Vignettes and Outcomes

John W. Peabody, MD

San Francisco VAMC

A Telehealth Education Program for 

Caregivers of Veterans with Dementia

Mollie Shulan, MD

Albany VAMC
VA Office of Research and Development, Health Services Research and Development Service 11

2004 HSR&D Research Briefs

Aging and Family Outcomes in Supportive 

Care of Advanced Cancer Patients

Julia H. Rose, PhD

Cleveland VAMC

Bioterrorism: Cost-Effectiveness of 

Medical Responses

Brian Schmitt, MD, MPH

Hines VAMC

Comparing VA Health Disparities to 

Health Disparities Outside the VA

Kevin Volpp, MD, PhD

Philadelphia VAMC

Determining the Prevalence of Health 

Literacy Among Veterans

Joan M. Griffin, PhD

Minneapolis VAMC

Economic Effects of Clinical Practice Guidelines

John D. Schneider, PhD

Iowa City VAMC

Effectiveness of a Telecommunications 

System in Asthma Management

David W. Sparrow, DSc

VA Boston Healthcare System

Epidemiology and Cost of Falls in Veterans 

with a Spinal Cord Injury

Audrey L. Nelson, PhD, RN

Tampa VAMC

Estimating the Magnitude of Unmeasured 

Risk in VA Patients

Mary S. Vaughan-Sarrazin, PhD

Iowa City VAMC

Extending Propensity Scores for 

Observational Studies

David B. Nelson, PhD

Minneapolis VAMC

Family Assessment of Treatment at End-of-Life

(FATE) Survey Development

David Casarett, MD

Philadelphia VAMC

Improving Assessment of Patient Preferences in

Localized Prostate Cancer

Sara J. Knight, PhD

San Francisco VAMC

Improving Care for Nursing Home 

Pneumonia in NHCUs and Veterans’ Homes

Evelyn Hutt, MD

Denver VAMC

Measuring Health Outcomes and 

Care Delivery for Parkinson’s Disease

Barbara G. Vickrey, MD

VA Greater Los Angeles Health Care System

Mesh Repair for Ventral Hernia: Which 

Rate is Right?

Mary Hawn, MD, MPH

Birmingham VAMC

Meta-Analysis of the Efficacy of Computer-based

Feedback Implementations

Charlene R. Weir, RN, PhD

Salt Lake City VAMC

Outcomes Associated with Salmeterol Use in

Obstructive Lung Disease

Todd Lee, PharmD

Hines VAMC

Patient-Centered Medication Adherence

Intervention for Schizophrenia

Jeffrey M. Pyne, MD

Central Arkansas Veterans Health Care System

Pharmacy Use in Patients with 

Chronic Heart Failure

Michael Johnson, PhD

Houston VAMC

Physician-Patient Communication in 

Patients with Chronic Heart Failure

Howard S. Gordon, MD

Houston VAMC

Process and Outcomes of Care for 

Veterans with Bipolar Disorder

Amy Kilbourne, PhD, MPH

VA Pittsburgh Healthcare System
12 VA Office of Research and Development, Health Services Research and Development Service

HSR&D Research Briefs NOVEMBER

Quality and Costs of Colon Cancer 

Care in VA and Medicare

Denise M. Hynes, RN, MPH, PhD

Hines VAMC

Quality of Care Indicators for Veterans 

with Stroke in Community Nursing Homes

Christopher E. Johnson, PhD

North Florida/South Georgia Veterans Health System

Randomized Trial of Care Management 

to Improve End of Life Care

Kenneth Rosenfeld, MD, MPH

VA Greater Los Angeles Health Care System

RCT of a Telecommunications System in Sleep Apnea

David W. Sparrow, DSc

VA Boston Healthcare System

Reasons for Disparities in Joint 

Replacement Utilization

Kent Kwoh, MD

VA Pittsburgh Healthcare System

Research Synthesis for QUERI Quality

Improvement/Implementation Research

Brian Mittman, PhD

VA Greater Los Angeles Health Care System

Substance Use Disorder Patients in 

VA Nursing Homes

Sonne P. Lemke, PhD

VA Palo Alto Health Care System

Testing the Effectiveness of Telephone 

Support for Dementia Caregivers

Linda O. Nichols, PhD

Memphis VAMC

Translating Infection Prevention Evidence to

Enhance Patient Safety

Sarah Krein, PhD, RN

VA Ann Arbor Healthcare System

VA and Indian Health Service (IHS): 

Access for American Indian Veterans

Betty Jo Kramer, PhD

VA Greater Los Angeles Health Care System

VA and non-VA Utilization by Veterans with 

Acute Stroke

Huanguang Jia, PhD, MPH

North Florida/South Georgia Veterans Health System

MANAGEMENT CONSULTATION

Research Recruiting and Retention of 

Highly Skilled Physicians in VA

Richard G. Best, PhD

South Texas Veterans Health Care System

NURSING RESEARCH INITIATIVE

Effectiveness of Care Coordination in 

Managing Medically Complex Patients

Bonnie Wakefield, PhD, RN

Iowa City VAMC

Palliative Care Transitions: Factors 

in Patient Experience and Satisfaction

Katherine Bent, PhD, RN

Denver VAMC

SERVICE-DIRECTED PROJECTS

Expanding and Testing VA Collaborative Care

Models for Depression

Lisa Rubenstein, MD, MSPH

VA Greater Los Angeles Health Care System

SERVICE-DIRECTED RESEARCH

Creating HealtheVet Informatics 

Applications for Collaborative Care

Edmund F. Chaney, PhD

VA Puget Sound Health Care System

Evaluation of Parkinson’s Disease Research,

Education and Clinical Centers

Martin P. Charns, DBA

VA Boston Healthcare System

Testing and Validating Changes to the 

Minimum Data Set for Nursing Homes

Debra Saliba, MD, MPH

VA Greater Los Angeles Health Care System

Please take a moment to tell us what you think about

VA HSR&D Research Briefs by sending an email to us

at CIDER.boston@med.va.gov. 

Your comments and suggestions will guide us in our

efforts to provide you with important HSR&D

information in future issues.