COIN: Center for Care Delivery and Outcomes Research (CCDOR)
Director: Steven Fu, M.D., M.S.C.E.
About the COIN
CCDOR’s mission is to develop and evaluate interventions and implementation strategies that improve healthcare delivery, Veteran engagement in healthcare, and Veterans’ health and functioning in their communities. The Center achieves this mission by seeking to elevate the quality, consistency, and equity of healthcare and outcomes for all Veterans through innovative health services and implementation research.
Research Focus Areas
The Center’s work focuses on the following:
- Trauma recovery
- Chronic pain and opioid harms reduction
The Trauma Recovery research group’s expertise focuses on PTSD and other trauma-related conditions, including traumatic brain injury, amputation, and post-deployment community reintegration. In addition, since PTSD does not occur in isolation, Trauma Recovery investigators examine clinical complexity among Veterans with trauma histories and collaborate with CCDOR’s Pain and Opioid Harms Reduction investigators to improve treatment and outcomes for Veterans with PTSD, pain, and opioid use disorders.
Chronic Pain and Opioid Harms Reduction
Chronic Pain and Opioid Harms Reduction investigators have made foundational contributions to defining the challenges in this area and to informing current high-priority efforts to address opioid harms and improve pain outcomes. Examples include research documenting racial differences in chronic pain treatment, which was recognized as a Science Advance in Pain Research award by the Interagency Pain Research Coordinating Committee, and development and validation of the PEG 3-item pain scale, which was distributed in the 2016 Turn the TideRx pocket guide by the Office of the Surgeon General to over 2.3 million physicians and other health professionals.
Additional Research Areas and Core Structure
Research outside of CCDOR’s two priority areas contributes to the overall mission of the Center and positions CCDOR to expand its portfolio in areas of emerging importance. While “additional research” includes a diverse set of research interests and studies, of particular salience is CCDOR’s research on cancer prevention and control, including tobacco cessation and colon cancer screening; healthy aging research; and evidence synthesis.
The Center’s work is achieved via a robust core structure that includes dedicated personnel in the following areas:
- Statistics & Data Management
- Implementation Science
- Veteran Engagement
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
Promoting Effective, Routine, and Sustained Implementation of Stress Treatments
Principal Investigator: Nina Sayer, PhD
The overall goal of this project is to measure and improve the reach of evidence-based psychotherapies (EBPs) for PTSD in collaboration with the Office of Mental Health and Suicide Prevention (OMHSP) and National Center for PTSD (NCPTSD). The measurable five-year impact goal is to increase the average level of reach of EBPs for PTSD nationally and to reduce the number of VHA PTSD clinics with low rates of utilization of EBPs for PTSD. Specific objectives are to: a) Evaluate the feasibility and value of providing OMHSP, NCPTSD, and VHA PTSD teams with reports to monitor use of EBPs for PTSD over time in light of other dashboards and VHA’s transition to CERNER; b) Integrate critical elements of the web-based toolkit to improve reach of the PTSD Mentoring Program for further spread; c) Identify a set of effective implementation strategies to improve reach of EBPs for PTSD in hard-to-change, low reach PTSD teams; and d) Collaborate with OMHSP, NCPTSD, and other researchers to identify additional methods to measure and improve EBP reach and the quality of care delivered to Veterans with PTSD.
Each COIN works closely with operational partners throughout the VA healthcare system. CCDOR's partners include: