Health Services Research & Development

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COIN: Center for Chronic Disease Outcomes Research (CCDOR) Minneapolis, MN

Director: Steven Fu, M.D., M.S.C.E.

About the COIN

CCDOR's mission is to enhance (through research, education, dissemination and implementation activities) patient engagement in and provider use of evidence-based practices for chronic disease.

Focused Areas of Research


Evidence-Based Therapies for PTSD

Post-traumatic Stress Disorder (PTSD) is very prevalent among Veterans—combat Veterans in particular; thus, treating PTSD is a high priority for VA. To support the goal of providing effective, evidence-based treatment for Veterans affected by PTSD, HSR&D has funded the CREATE initiative, "Evidence-Based Therapies for PTSD," with the overall goal of improving Veteran access to and engagement in evidence-based PTSD treatments. Funded projects within this initiative include:

  • Helping Families Help Veterans with PTSD and Alcohol Abuse: An RCT of VA-CRAFT will test an innovative web-based tool that delivers an online version of Community Reinforcement and Family Training (VA-CRAFT) to families to promote Veteran involvement in care for PTSD and problem drinking.
  • Web and Shared Decision-Making for Reserve/National Guard Women's PTSD Care will build on an earlier intervention to address women-specific barriers to care, and test a strategy to link Veterans with needed VA care.
  • Promoting Evidence-Based Pharmacotherapy for PTSD in Community-based Outpatient Clinics (CBOCs)will test an intervention to enhance CBOC primary care providers' competence in and comfort with PTSD pharmacotherapy.
  • Promoting Effective, Routine, and Sustained Implementation of Stress Treatment (PERSIST)seeks to improve the reach of two evidence-based psychotherapies: Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) among Veterans with PTSD, and to ensure sustainability of PE and CPT among providers.


Cancer Prevention and Screening

Cancer is the leading cause of death in the United States in people aged 45-64 years and the second leading cause of death among those over age 65. Because these age groups include 79% of the Veteran population, optimizing the provision of cancer prevention and screening services is highly relevant to improving Veteran health. Moreover, tobacco use is the leading cause of premature death in the United States and a major risk factor for cancer; it also is more prevalent among Veterans than in the general population. To support the goal to optimize the provision of cancer prevention and screening services to improve patient outcomes within the VA healthcare system, CCDOR investigators will pursue a number of projects to develop, evaluate and disseminate novel interventions to reduce the prevalence of tobacco use, and to optimize the appropriate use of cancer screening services, including:

  • Collaborative project with VA's National Center for Health Promotion and Disease Prevention (NCP) to implement motivational interviewing for tobacco cessation in the VHA Patient Aligned Care Team (PACT) model of primary care;
  • Pilot project to develop an intervention that combines physical activity components with tobacco cessation assistance;
  • National Cancer Institute (NCI)-funded project to identify inappropriate colorectal cancer screening within the VA and its association, if any, with colorectal cancer screening clinical reminder characteristics and performance measure scores; and
  • Collaborative project with the NCP to develop an intervention to address patient and provider concerns about discontinuing prostate cancer screening.


Chronic Pain

Chronic pain is a major public health problem affecting more than 100 million adults in the United States and resulting in at least $560-$635 billion in healthcare costs and lost productivity each year. Additionally, treatment of pain with opioid analgesics has led to a second public health problem in recent years—an epidemic of prescription drug abuse and overdose. In the VA healthcare system, a majority of Veterans report at least moderate pain interference with daily activities, and overdose death rates are twice those in the general population. Chronic pain research is an emerging area for CCDOR, with a goal to reduce harms and improve functional outcomes for Veterans with chronic pain.



Partner Offices

Each COIN works closely with operational partners throughout the VA healthcare system. CCDOR's partners include:

  • National Center for Health Promotion and Disease Prevention (NCP)
    • Jane Kim, MD, Acting Chief Consultant, Preventive Medicine
    • Terri Ann Murphy, R.N., M.S.N.
    • Michael Goldstein, M.D, Health Promotion and Disease Prevention Program Team.
  • VHA Pain Management (Program Office): Rollin Gallagher, MD, Director

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