Health Services Research and Development Service: Then and Now
Health services research was a new science in the mid-1970's and its value not clearly understood. The Veterans Health Administration (VHA) understood the potential of this new science early and started a small program to help address complex systems issues.
Health services research cuts across many disciplines- medicine, nursing, economics, technology, sociology, public health, rehabilitation, and more. Support for health services research through the years has kept VHA at the forefront in addressing health care issues such as aging, access, physician and nursing practices, mental health, utilization, implementation of practice guidelines, and more. VHA is also better able to respond to the unique health care issues of special veteran populations with conditions such as spinal cord injury, Post -Traumatic Stress Disorder (PTSD), or homelessness.
In the beginning... In 1976 the new HSR&D Service was expected to:
contribute to health science knowledge;
develop new methods to improve health of veterans and non-veterans;
generate information to meet manager, provider, and consumer needs;
improve research quality and ensure valid information; and
encourage managers and providers, through dissemination and education, to apply research results.
In the early 1980's, HSR&D's focus turned to integrating research findings into VHA operations. As research became a management tool, HSR&D developed a system to ensure that research was relevant to VA and integrated with clinical and administrative management.
From the beginning, HSR&D projects have all been peer reviewed. Funding of any HSR&D study requires review by VA and non-VA experts to assure that the design of the investigation meets rigorous standards. Annual progress reviews are required, and final reports are evaluated by the Service.
Funding With a small funding base in the early years, HSR&D supported a limited number of studies. Results from these studies showed the promise of the new Service and more funds were appropriated. As funding increased, the number and scope of the studies expanded. In 1976 HSR&D had a budget of $3.6 million and 7 funded studies; by 2001 HSR&D's budget was $45 million with 143 active studies.
Creating Field Resources Early HSR&D leaders realized that developing a VA HSR&D research presence across the nation would provide the opportunity to:
affiliate with growing nationally-recognized university health services research programs, and
recruit new researchers.
In 1975, the VA-University Affiliation Program was established to encourage VA Medical Centers to collaborate with health services research centers newly created by the National Center for Health Services Research (now the Agency for Healthcare Research and Quality).
By 1981 VA had Affiliation Programs with 7 universities in 9 VA Medical Centers. The Affiliation Programs were the seed for the later Field Programs which, by the 1990's, had become HSR&D Centers of Excellence. Today there are 13 Centers of Excellence (COEs) across the US, each with a special health services research focus.
In 1992 HSR&D established the Management Decision and Research Center (MDRC) to facilitate the integration of information from the research community and the management and policy-making community. In 1998 and 1999 HSR&D established two additional national Resource Centers, the VA Information Resource Center and the Health Economics Resource Center. These three Resource Centers support HSR&D management and the COEs by providing data, consultation, and focused research on management issues, health economics and systems.
Capacity Building Throughout its growth, HSR&D had to address increasing concerns about its capacity. In 1990 HSR&D established theHSR&D Career Development Programto encourage interested clinicians and doctoral level non-clinicians to pursue careers in VA health services research.
HSR&D also developed other initiatives to build capacity. Between 1975 and 1981, the VA Office of Academic Affairs (OAA) & HSR&D Service initiated collaborative post-doctoral fellowships for training health professionals in health services research.
The OAA continues to provide stipends for doctoral training and post-MD fellowships in HSR&D.
HSR&D TODAY HSR&D continues to meet the important needs of the VA health care system. It is well positioned to continue:
funding and supporting individual research studies,
developing and implementing large national initiatives,
building its national presence through COEs and Resource Centers,
collaborating with other Federal Agencies to improve generalizibility of our work, and
engaging and developing new researchers.
The Quality Enhancement Research Initiative (QUERI) is a good example of current HSR&D focus. Quality improvement and translating research into improved clinical practice are high priorities for VHA. Launched in 1998, QUERI is a national quality improvement program that:
promotes outcome improvements through system-wide implementation of research based evidence and
advocates quality improvement.
Teams of managers and clinician investigators are working together to evaluate best clinical practices and developing strategies to insure that clinical decisions are based on research evidence and improve quality and outcomes. Currently QUERI focuses on 9 conditions: colorectal cancer, chronic heart failure, diabetes, HIV/AIDS, ischemic heart disease, mental health, spinal cord injury, stroke, and substance abuse.
Besides quality improvement, other HSR&D initiatives include
patient safety,
ethnic and cultural variations,
access,
management research and
collaborative efforts with other federal agencies to increase the power of our research results.
THE FUTURE....
Health Services Research continues to be important to VHA in the continuing quest for the most cost-effective approaches to delivering high quality health services to our nation's veterans.
HSR&D's structure, organization, and research have been developed to take VHA into the 21st Century with the ability to use evidence-based research to improve the quality of veteran care and the population as a whole.
In 1975, the VA-University Affiliation Program was established to encourage VA Medical Centers to collaborate with health services research centers newly created by the National Center for Health Services Research (now the Agency for Healthcare Research and Quality).