COIN: Center for Healthcare Organization and Implementation Research (CHOIR)
Bedford, MA and Boston, MA
Directors: Barbara Bokhour, PhD (Bedford) and Allen Gifford, MD (Boston)
About the COIN
CHOIR's mission is to improve Veterans' health outcomes by developing, studying, and applying evidence-based practices that will be widely implemented and sustained.
Research Focus Areas
The Center’s work focuses on:
- Recovery-Oriented Care for Vulnerable Populations (Recovery).
- Medication Management & Outcomes (Medications).
- Healthcare Communications (Communications).
Through the focal area of Enhancing Recovery-Oriented Care for Behaviorally Vulnerable Populations (Recovery), CHOIR strives to enhance the transformation of VA to a recovery-oriented health care system, and to improve recovery-oriented outcomes for behaviorally vulnerable Veterans, specifically those afflicted with a mental health condition or those who are homeless, or are at risk of being homeless. Major operational partners include Mental Health Services and the National Center on Homelessness Among Veterans as well as increasing collaboration with Mental Health Operations.
The Medication Management & Outcomes Program (Medications) is dedicated to providing optimal medication treatment to Veterans, which is a critical goal for CHOIR, and supports many VA priorities regarding safer, more effective, patient-centered, and cost-efficient prescription practices. Existing tools allow CHOIR's operational partner, Pharmacy Benefits Management (PBM), the ability to ensure medication optimization for patients
CHOIR addresses traditional and emerging media used to deliver and exchange information about public health priorities to Veterans both in and outside of VA care. Healthcare Communications (Communications) priorities include large-scale adverse events, deployment environmental health risks, and health behavior change. There remain important gaps regarding best practices in communicating information to improve VA care, maximizing trust in care, and encouraging Veterans' self-management. CHOIR's Communication Focus will provide an evidence base and tools for communicating about a range of health issues, using optimal communication channels such as social media and mobile health platforms to create effective messaging that empowers Veterans to prioritize their health.
Other Research Areas
CHOIR also conducts health services research in four other emerging and well-established areas: health services genomics, long-term care, organization and implementation, and patient safety.
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
Lung Cancer Screening: Whole Health Approach to Implementing Shared Decision Making (LCS WISDOM)
Principal Investigator: Renda Wiener, MD, MPH
The goal of this project is to implement and spread best practices to promote shared decision-making for lung cancer screening in VISN1, as part of VHA’s Whole Health approach to care, which is a patient-centered model predicated on what matters most to Veterans. Given that lung cancer is the leading cause of cancer death among Veterans, screening has great potential to improve the health of Veterans. Discussing smoking and lung cancer screening can be challenging for patients and providers due to the stigma associated with smoking and fears about lung cancer. Thus, investigators propose to develop a tailored implementation plan addressing these barriers to ensure effective implementation of shared decision making for lung cancer screening in VISN1.
Each COIN works closely with operational partners throughout the VA healthcare system. CHOIR's partners include: