Health Services Research & Development

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COIN: Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center; West Haven, CT


Director: Lori A. Bastian, MD MPH


About the COIN

PRIME's mission is to study the interactions between pain and associated chronic conditions and behavioral health factors. This will help to develop and implement effective interventions that can reduce pain, its negative impacts on emotional and physical functioning, and overall disease burden by employing principles of medical informatics, behavioral science, and health services research.

Focused Areas of Research

With a focus on pain and pain management research, the Center's strategic goals are to:

  • Enact a strategic research agenda that will advance scientific knowledge and have a significant impact on improving care for Veterans with pain and associated chronic conditions;
  • Foster innovative health services research outside the focused area;
  • Establish a strong infrastructure that supports mentoring and career development, including partnered, system-oriented research; and
  • Promote interdisciplinary, cross-institutional collaborations and research networks in priority areas of interest.

The PRIME Center's current research portfolio and priorities for future research are guided by four strategic objectives:

1) Promote organizational change that can increase health-related quality of life and reduce symptoms burden for Veterans with pain and associated chronic conditions.

2) Promote access, continuity, and sustainability of safe and effective interventions for pain and pain-related disability.

3) Increase respect for patient risks, preferences, and priorities.

4) Reduce ethnic/racial, geographic, gender- and age-related disparities in access and delivery of effective pain care.

The centerpiece of the PRIME Center's current portfolio is the CREATEtitled, "Pain Management and Patient Aligned Care." Comprised of three specific projects, this CREATE will accelerate transformation of pain management in the VHA primary care setting by Patient Aligned Care Teams (PACT), and will serve as a model for similar efforts related to other chronic conditions, as well as transformational efforts of other healthcare organizations. Specific impacts will include:

  • Enhancing Veterans' access to empirically validated and guideline concordant pain care,
  • Leveraging health information technology to promote better pain care for Veterans, and
  • Building sustainable improvements in pain care that are applicable beyond CREATE.

Affirmed by the Institute of Medicine's (IOM) recommendation that self-management should be the starting point for all pain care, PRIME will continue to focus on developing effective interventions for chronic pain that empower Veterans and promote effective pain control, optimal physical and emotional functioning, and quality of life. PRIME's current and planned projects utilize a variety of technologies, including interactive voice response (IVR), the Internet, smart phone applications, and video conferencing to address this challenge. PRIME also will provide leadership in the development of Veteran-reported outcome measures, especially measures of patient-reported functioning, and using technology to integrate these measures into the VA's electronic health record (EHR). The projects addressing this objective have the potential to redefine how VA measures and improves its clinical performance.

PRIME's research focuses on designing and enacting interventions that are tailored to each Veteran's experience and that employ a patient-centered approach to addressing risks, preferences, and priorities. PRIME investigators also will continue to identify system-, provider-, and patient-level barriers to resolving disparities among women Veterans, ethnic/racial minorities, and older Veterans, and to design, evaluate, and employ health services research and implementation of strategies to reduce disparities in access to and delivery of care.

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Partner Offices

Each COIN works closely with patient care services and operational partners throughout the VA healthcare system. The PRIME Center's partners include:

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