Health Services Research & Development

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COIN: Center for Innovation to Implementation (Ci2i): Fostering High Value Care; Palo Alto, CA

Director: Steven M. Asch, M.D., M.P.H.

About the COIN

Ci2i's mission is to produce health services research that informs how VHA operational partners pursue healthcare through better access, higher quality, and wiser use of resources.

Focused Areas of Research

Ci2i's focused areas are:

  • Fostering high value mental health care
  • Fostering high value medical specialty care
  • Advancing value-oriented health services research methods


Ci2i will focus on care now most often delivered by specialists, because that is the context in which many of the opportunities to improve value currently lie. The Center's two clinical areas of focus include:

  • Mental healthcare, where suboptimal access and underuse are common (e.g., for substance use disorder); and
  • Medical specialty care for chronic disease (e.g., for heart, liver, and renal disease), where costly hospitalizations, procedures, and drugs demand better management.

Ci2i's mental health work will be enhanced though its sponsorship of the CREATE program-project grant Promoting Value & Access in VA's Substance Use Disorder Services.

These two clinical areas provide a generalizable portfolio of diverse domains in which value opportunities lie. Ci2i's purview is not confined to specialists' offices; for example, improving value may mean transforming some care now delivered in specialty settings to lower-cost, more accessible venues, such as primary care or even self-care. Methodological innovations, especially in modeling and informatics, will support the Center's work and advance this field of inquiry.

Other emerging areas of health services research concentration at Ci2i include geriatrics and women Veterans' health. Ci2i also will embrace the same spirit of innovation in its educational work, using new electronic means to link like-minded fellows and career development awardees around the country.



Partner Offices

Each COIN works closely with operational partners throughout the VA healthcare system. Ci2i's partners include:

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