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
The mission of the Center for Innovation to Implementation (Ci2i) is to foster high-value health care for Veterans. We will do so by identifying opportunities to improve value, and by testing the implementation of innovations that respond to those opportunities, both crucial activities for any learning health care system.
Research Focus Areas
The Center’s focused areas of research are to foster high-value:
- mental health care
- medical and surgical specialty care
- care beyond VA
Ci2i focuses on care now most often delivered by specialists, because that is the context in which many of the opportunities to improve value currently lie. However, the scope of the Center’s work 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. Our third focus is newer, being responsive to VA’s accelerating transformation to being both a payor and provider of care.
Other emerging areas of health services research concentration at Ci2i include geriatrics and women Veterans’ health. Ci2i also embraces 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.
The Center is also home to the CREATE program-project grant Promoting Value & Access in VA's Substance Use Disorder Services.
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
Cataloging and Evaluating Mental Health Care Quality Measures for Better Comparative Performance Management
Principal Investigator: Eric Schmidt, PhD
Monitoring quality of care is central to VA’s transition to a learning health care system, and VA’s options for measuring mental health-substance use disorder (MH-SUD) care quality must expand beyond the current suite of internally developed measures. The goal of this project is to catalogue and evaluate measures for VA to assess and compare the quality of its MH-SUD care and that provided in the community. Investigators will accomplish this goal by systematically evaluating MH-SUD performance measures with the potential to compare the quality of VA and non-VA MH-SUD care and will rigorously describe and test the feasibility and validity of candidate measures. Work proposed in this project will advance the science of cross-system quality measurement and inform VA operations choice of measures on which VA will be compared to community providers.
Each COIN works closely with operational partners throughout the VA healthcare system. Ci2i’s partners include:
- Mental Health Operations
- Specialty Care Services
- Operational Analytics and Reporting
- Clinical Public Health Group