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Health Services Research & Development

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

Center for  Access & Delivery Research and Evaluation

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

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

About the COIN

CADRE strives to expand access to high-quality care for rural Veterans by developing, implementing, and testing innovative telehealth strategies; and to ensure that the care delivered is safe and free of preventable antibiotic resistant infections.

Research Focus Areas

The Center’s work focuses on the following:

  1. Improving access to high quality care for rural Veterans.
  2. Developing and evaluating interventions targeting the multi-drug resistant organism (MDRO) crisis.
  3. Innovative and collaborative approaches in women Veterans’ health.
  4. Targeting epidemic opioid use and substance use disorders.
  5. Expanding cardiovascular outcomes research.

Research to Impact for VeteRans (RIVRs)

The Research to Impact for VeteRans (RIVRs) program is a new HSR&D funding mechanism that gives researchers the opportunity to pursue a five-year impact goal. Each RIVR impact goal aligns with VA priority areas including VA legislative priorities (e.g., MISSION Act); cross-cutting ORD priorities (e.g. PTSD); other HSR&D defined clinical priorities (e.g. Health Equity); and HSR&D methodological priorities (e.g. Data Sciences, Implementation Sciences, Systems Engineering). Impact goals for RIVRS could include changes in VA policy or clinical guidelines, spread of operational processes across VISNs, scaling of an effective intervention to 2-3 additional sites, advancements in health services research methods, or any other impacts that have real-world effects on Veteran health and satisfaction.

Current RIVR project

Targeting and Implementing Antimicrobial Stewardship During End-of-Life Care

Principal Investigator: Eli Perencevich MD, MS

The 5-year goal of this project is to address the growing public health crisis of antimicrobial resistance through developing, testing, and implementing antimicrobial stewardship interventions to reduce unnecessary antimicrobial prescribing during end-of-life care. The three aims of this multi-disciplinary collaborative project include: (1) quantify antibiotic prescribing during the continuum of end-of-life care in all VHA inpatient facilities to identify optimal targets for intervention, (2) utilize qualitative research methods to uncover clinician, patient, and family-level attitudes along with facility-level factors that influence antimicrobial stewardship at the end-of-life, and (3) conduct a pilot intervention in VISN 23 to test the impact of end-of-life focused antimicrobial stewardship.

Partner Offices

Each Center works closely with operational partners throughout the VA healthcare system. CADRE’s partners include:


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Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.