Health Services Research & Development

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COIN: Center for Comprehensive Access & Delivery Research and Evaluation (CADRE);Iowa City, IA


Director: Eli Perencevich, M.D., M.S.

About the COIN

CADRE's mission is to develop, implement and test innovative strategies that expand access to high-quality primary and specialty care, while ensuring that the care delivered is safe and free of preventable infections.

Focused Areas of Research

Website: http://www.cadre.research.va.gov/

Improving Access to High-Quality Care

Improving access to high-quality care is one of VA Secretary Shinseki's four strategic goals and is a unifying CADRE theme. To address access, CADRE focuses on four high-impact target areas:

  • Rural Health builds upon the strengths of Center investigators and an existing partnership with the VA Office of Rural Health through the Veterans Rural Health Resource Center, Central Region.
  • Specialty Care is an area in which VA is challenged to meet demand and where CADRE is testing innovative approaches to delivering care using tele-health and e-health approaches.
  • Women's Health is a high-priority area for VA due to the increasing numbers of women Veterans and their distinct healthcare needs, and is an area in which CADRE investigators have conducted seminal work.
  • Dual Use targets the high proportion of Veterans who use both VA and non-VA services and addresses the formidable challenges of providing seamless care across VA and non-VA providers.

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Preventing Healthcare-Associated Infections (HAI)

In the past 20 years, the incidence of HAIs has increased 36%. Approximately two million patients develop these largely preventable infections, and nearly 100,000 die annually, making HAIs the sixth leading cause of death in the United States. Moreover, the increasing number of HAIs caused by multiple-drug resistant organisms (i.e., MRSA) leads to added morbidity, mortality, and costs. The optimal approach for preventing HAIs, including MRSA in hospital settings, is unknown. Despite significant efforts in VA to prevent MRSA, 13% of Veterans admitted to acute care hospitals are colonized with MRSA, twice the national average, and 58% of Veterans residing in VA community-living centers are colonized. CADRE HAI prevention research is centered around the CREATE titled "Advancing MRSA Infection Prevention," and other studies that target new emerging pathogens (i.e., carbepenem-resistant Klebsiella pneumonia), as well as infections that manifest beyond hospital settings and that are largely ignored by current surveillance and prevention efforts. This work will be highly coordinated with key operations partners, including VA's Office of Public Health and VA's National Center for Occupational Health and Infection Control (COHIC).

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Partner Offices

Each COIN works closely with a number of operational partners throughout the VA healthcare system. Cadre's partners include:

  • Office of Rural Health (ORH):Gina Capra, Director, and Michael Ohl, Director, VA Rural Health Resource Center, Central Region
  • Office of Public Health
  • Lewis Radonovich, M.D. , Director, Center for Occupational Health and Infection Control
  • National Infectious Diseases Services: Gary Roselle, M.D., Director
  • VA Office of High Reliability Systems and Consultation: Mike Davies, M.D., Acting Director
  • Veterans Integrated Service Network (VISN) 23: Janet Murphy, M.B.A., Director
  • VISN 23 PACT Demonstration Lab: Gary Rosenthal, M.D., Director
  • Iowa City VA Health Care System: Judith Johnson-Mekota, Director

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