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VA researchers were well-represented in academic sessions at
June's AcademyHealth Annual Research Meeting. Highlights
included:
- an in-depth consideration of the relationship between
the future of genomic medicine and the unique veteran
population, with an emphasis on the connection between
genetic markers and many of the common chronic
conditions with which our veterans must cope;
- a policy roundtable discussion focused on the near- and
long-term implications of OEF/OIF veterans’ needs for
quality, access, and coverage as they return to civilian life;
- the value and impact of the Evidence Synthesis Program
(ESP) and how ESP can provide a springboard for larger
scale policy changes; and
- updates on military sexual trauma, women’s health, and
geriatric health.
The Alice S. Hersh New Investigator Award was presented for
the second year in a row to a VA HSR&D researcher.
As the ranks of women veterans continue to increase, VA is
determined to provide optimal care for their unique healthcare
needs. Health services researchers are contributing significant
data to support evidence-based clinical approaches for
women veterans. Rachel Kimerling, PhD, part of HSR&D’s
Center for Health Care Evaluation in Palo Alto, and Becky
Yano, PhD, MSPH, with HSR&D’s Center for the Study of
Healthcare Provider Behavior in Los Angeles presented two
recent pieces of research specific to women in VA.
In a roundtable session chaired by Ron Gimbel of the Uniformed
Services University of Health Sciences, Kimerling
presented her recent work, "Developing Gender Specific
Indicators of Care of Military-Related Sexual Trauma."
Kimerling’s work examined military sexual trauma (MST),
which is defined as sexual assault or repeated, unsolicited
threatening acts of sexual harassment. Kimerling’s objective
was to develop a clinically relevant indicator for MST
screening and treatment based on a series of recent legislative
mandates.
By gathering information from VA administrative data, and
studying the frequency and use of clinical reminders over a
five-year period, Kimerling’s team assessed screening rates
for MST for veterans currently in mental health treatment.
They determined that universally screening those in mental
health care for MST was both effective and appropriate for
both women and men.
Becky Yano, PhD, MSPH, presented an overview of her
recent work, "What Does Women’s Health Care Look Like
in the VA?" Yano and her colleagues assessed organizational
surveys and national census data from all VA health care
facilities serving 200 or more women to evaluate how VA
women’s health care is organized, and how well VA is adapting
to women veterans’ health care needs.
The implications for Yano’s work include some early evidence
demonstrating better outcomes for separate women's clinics
that address gender-specific processes of care and higher
patient ratings of care for accessibility and continuity.
Kimerling’s and Yano’s work has wide-ranging implications,
as VA will continue to face challenges in ensuring highquality
care for women veterans.
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VA health services researcher Ashish Jha, MD,
MPH, was the recipient of the Alice S. Hersh
New Investigator Award for his work on quality
efforts and racial disparities in care in the VA
healthcare system. Dr. Jha is a staff physician
at the Boston VA Medical Center and a faculty
member at the Harvard School of Public Health.
In his acceptance speech, Dr. Jha spoke about
the transformation VHA has made in healthcare
delivery over the past 12 years and noted that VA
"…has used lessons from health services research
to identify areas of need, lessons from health
services research to craft policies, and has used
health services research to evaluate the impact of
the reforms."
He went on to say, "In 12 short
years, quality has gone up, costs
stayed stable, safety has gotten
better, and I think it is not an
exaggeration to say there are tens of
thousands of veterans who are alive
today because care was improved
based on health services research
that researchers engaged in."
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The completion of the Human
Genome Project provided researchers
an unprecedented opportunity
to further their understanding of
genetics and disease. For health services
researchers, the integration of
genomics into clinical practice offers
a potential new model for the delivery
of care. The session, "Health
Services Genomics: Opportunities
and Challenges," chaired by Maren
Scheuner, MD, of VA's Center for
the Study of Healthcare Provider Behavior in Sepulveda, CA,
shed more light on the role health services research will play in
shaping the delivery of care derived from genomic medicine.
The session's opening remarks were presented by Francis
Collins, MD, PhD. Dr. Collins is Director of the National
Institute of Health’s National Human Genome Research Institute,
and led the Human Genome Project to its successful
completion. In addition to an introduction to the challenges
associated with finding a firm correlation between a gene and
disease, Dr. Collins shared his belief that a significant segment
of future genomic research lies in identifying markers
for many chronic diseases. Further, he emphasized the potential
value to genome researchers of VA’s patient population in
locating those genetic markers.
Timothy O'Leary, MD, PhD, VA's Acting Deputy Chief
Research and Development Officer, elaborated on Collins’s
comments about how VA is uniquely positioned to contribute
to—and benefit from—advances in genomic medicine.
O’Leary described how VA’s volume of patients, integrated
healthcare system, and electronic medical record all work together
to provide health services researchers with the unparalleled
ability to collect and link genetic information, which
can be used to focus on improved patient outcomes, and care
delivery models.
Adding a note of caution, Paul Shekelle, MD, PhD, of
HSR&D's Center for the Study of Healthcare Provider
Behavior in Los Angeles, offered insight into the overall
readiness of VA and other healthcare systems to cope with
the impact of genomic medicine. Dr. Shekelle conducted a
comprehensive literature review showing that while consumers
are cautiously optimistic, the healthcare workforce
(providers in particular) is inadequately trained to handle genomic
medicine, and there is very limited evidence currently
available that demonstrates positive outcomes.
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Taking valid research evidence and implementing it is critical
for improving the health of our veterans. In 2005, HSR&D
established the Evidence Synthesis Program (ESP) to provide
policymakers with a rigorous analysis of available evidence
to support their decision-making efforts. This roundtable
session was chaired by Mark Helfand, MD, MPH, FACP of
the Portland VAMC. Panelists included Joe Francis, MD,
MPH, of VA’s Office of Quality and Performance, and Paul
Shekelle, MD, PhD.
Drs. Francis and Shekelle discussed the processes through
which topics can become part of ESP, and how ESP
topics may move forward from assessment to eventually
become an implemented, system-wide policy. Current
ESP reports are available on the HSR&D website at
www.hsrd.research.va.gov/publications/esp/.
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