John G. Demakis, MD - Director Shirley Meehan, MBA, PhD - Deputy Director Presentation to

1. Health Services Research and Development John G. Demakis, MD - Director Shirley Meehan, MBA, PhD - Deputy Director Presentation to Administrative Officers for Research February 25, 2004

2. HSR&D Mission To advance knowledge, develop VA health services researchers and leaders, and promote innovations that translate into advances in health care for veterans and the nation

3. HSR&D FundingFY 1999-2003 ($ in millions) $120 108 104 94 56 $100 54 88.4 87 49 Budgeted HSR $ $80 47 45 Medical Care Research $ $60 52 50 $40 45 42 41.4 $20 $0 2001 2002 2003 1999 2000 % 13.1 13.1 12.9 13.6 13.3ORD

4. HSR&D Funding DistributionFY03 • Service Specific Projects • Regular SDR • QUERI SDR • VISN Collaboration Projects • Undersecretary’s Awards Investigator Initiated Basic IIR Nursing Research Special Solicitations QUERI IIRs Other Centers Resource Centers 6% 35% 6% 26% 20% Capacity BuildingCareer Development Research Career Scientist Associate Investigator OAA Training Supplements MREP REAPS TREPs Research Experience Awards 5% Centers Centers of Excellence Joint RR&D Center Administration Durham Review Costs Travel *Based upon $52M Budget

5. VA HSR&D Goals link to ORD, VHA and VA Goals VA Goal 3: Honor and serve veterans in life and memorialize them in death for their sacrifices on behalf of the nation. Objective 3.1: Improve the overall health of enrolled veterans including specialpopulations of veterans through a health care system characterized by convenient access, high quality, satisfied patients and cost efficiency.

6. VA HSR&D Goals link to ORD, VHA and VA Goals (cont’d.) VA Enabling Goal 4: Contribute to the public health, socioeconomic well being, and history of the nation. Objective 4.1: Advance VA medical research and development programs to better address the needs of the veteran population and to contribute to the Nation's knowledge of disease and disability.

7. Restructuring to Emphasize Priority PROBLEMS Problem Dimensions include - continuum of care - staying healthy (prevention) - getting better (treatments) - living with illness or disability - end-of-life care - components of care (structure, process, outcomes) - care factors (access, cost, quality) - care system level (patient, provider, micro-system(s), macro-system) [and interactions] - preferred methodological/discipline area for addressing problem/issue - perceived best process/ state-of-the-art for addressing problem/issue (e.g., pilot, IIR, SDR, qualitative research, RCT)

8. Quality Enhancement Research Initiative (QUERI)Program • Aim: Identify and address quality care gaps in priority veteran areas • Recruiting new leader • Enhancing Guidance, Implementation links • Collaborating with OQP, others to select needed implementation projects (national advisory committee) • Continuing peer review and management of Coordinating Centers • Adding amputation QUERI • Reporting results, impacts, opportunities and budget (medical care) documentation

9. QUERI Potential Cost Savings • If all effective QUERI interventions were implemented throughout VHA: • Potential cost savings ~ $880 million annually • Potential 35,000 lives saved over a 10-year period • Includes $255 million in avoided CHF readmission • $12.6 million in lower antipsychotic costs • $484 million in lower costs for diabetes care and admissions • $117 million in avoided admissions for major cardiac events

10. QUERI Lessons Learned • Importance of senior leadership support and buy-in • Importance of the strength of evidence • Formative or process evaluation is critical to successful generalization of knowledge from one study to another • Timing of implementation • Rapid response to barriers is essential to successful implementation • Keeping up momentum is critical

11. Implementation and Management Program Aim: Systematize what works and encourage management research. Research topics include: • Integrating evidence-based practices into routine clinical and administrative operations • Organizational change • Service-Directed projects on implementing research into practice

12. Management Consultation Aim: Help managers clarify and address issues through existing evidence or consultation • Helping managers clarify and address operational issues and develop consultation projects • Identifying VA investigators to conduct consultation projects • Serving as a liaison between consultation project investigators and managers • Growing with demand and requestors' continued budgetary support

13. Equity and Special Populations Portfolio Aim: Enhance equity and address specific population needs. Research topics include: • Racial/ethnic and gender equities. • Health care needs of special populations, including those with mental illness and substance abuse disorders, disabilities, homeless, and those from rural areas. • Nursing research

14. Quality Measurement and Effectiveness Portfolio Aim: Improve Health Care Quality (IOM areas and chronic, complex and other foci not in QUERI) Research topics include: • Quality measurement and effectiveness of health care, including clinical outcomes studies. • Studies to develop/test quality measures, methods, tools and indicators. • Patient-centered care, long-term care, access/timeliness, efficiency of care, and chronic disease areas.

15. Research Methodology Portfolio Aim: Improve HSR Methodology Research topics include: • Econometric modeling, innovative economic approaches • Evidence syntheses techniques • Innovative approaches to multi-site trials • Qualitative and mixed research approaches • Decision analysis techniques • Utility assessments • Enhanced technological communications, use of in databases

16. HSR&D ServiceCapacity Program Aim: Ensure excellent infrastructure • Centers of Excellence • Resource Centers • Research Enhancement Award Program (REAP) • Targeted-Research Enhancement Program (TREP)

17. HSR&D Service Capacity Program Aim: Ensure excellent personnel • Career Development Awards • Research Career Scientist Awards • Associate Investigator Awards • Research Experience Program • Merit Review Entry Program • Training Programs • Nursing Initiative

18. HSR&D Organizational Structure HSR&D Director John D. Demakis, M.D. Deputy Director Shirley Meehan, MBA, Ph.D. QUERI Brian Mittman, Acting* Linda McIvor Management Consultation Neil Thakur* Capacity Bldg. Phil Crewson Susan Schiffner Rob Small Implementation & Management Caryn Cohen* Equity & Special Pop. Martha Bryan Serena Chu Quality Measurement & Effectiveness Pauline Sieverding Research Methodology Christine Elnitsky *ORD-Wide Programs

19. HSR&D Future Directions • Implementation Research • Quality Improvement • Patient Safety • Management Research • HSR Research Methods

20. New Initiatives • HSR&D/VISN Implementation Collaborative: Innovations to Implement Evidence-Based Clinical Practice • Supplements to Support Collaboration between VA and Academic Experts in Implementation Research • Ethnic/Racial/Gender Issues

21. HSR&D Active Solicitations • HSR&D Priorities for Investigator Initiated Research • Access • VA Managed Care • Implementation of Clinical Practice Guidelines • Telemedicine • Pain Management • Ethnicity and Culture • Patient-Centered Care • Women’s Health

22. HSR&D Active Solicitations (cont.) • Nursing Research Initiative • Prevention of Errors and Injuries in Clinical Care • HSR&D/VISN Collaborative Health Services Research Projects • Costs, Cost-Effectiveness and Health Economics • Terrorism • Sensory Disorders and Loss

23. HSR&D ServiceCooperation with Other Federal Agencies • Agency for Healthcare Research and Quality • National Cancer Institute • Centers for Disease Control • Centers for Medicare & Medicaid Services (CMS) • National Institutes of Health

24. HSR&D National Meeting http://www.hsrd.research.va.gov/about/national_meeting/2004/

25. HSR&D Issues for Administrative Officers Final Reports Publication Notifications E-mail: VHACOHSRD@mail.va.gov Citation database: www.hsrd.research.va.gov/publications/citations Budget Sheets Modifications

26. Visit HSR&D on the Webhttp://www.hsrd.research.va.gov