COIN: Center to Improve Veteran Involvement in Care (CIVIC); Portland, OR
Director: Steven Dobscha, M.D.
About the COIN
CIVIC’s mission is to conduct research that empowers Veterans to improve their health through engagement in self-care, engagement with VA and non-VA healthcare systems, and engagement in the research process.
Research Focus Areas
- Conducting research that helps Veterans with mental health conditions, including pain, improve their health and safety.
- Conducting research that helps Veterans, their supports, and their clinicians create and sustain effective healthcare relationships.
Within these focus areas, CIVIC’s investigators conduct research that seeks to:
- Promote Veterans’ healthy behaviors, self-care, and active participation in mental health care.
- Decrease risks for suicide and suicide behaviors.
- Decrease risks associated with prescription opioids, and optimize use of effective non-opioid pain treatments.
- Develop and test innovative tools and strategies that facilitate Veteran-clinician communication, decision-making, and trust.
- Develop and test tools and strategies that facilitate communication, collaboration, and coordination within and among care teams.
A major strength of CIVIC’s research efforts is that many investigators actively work directly with patients in clinical settings.
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
Patient-Centered Decision Support for Veterans Making Choices About Where to Get Their Health Care: “Should I Stay or Should I Go?”
Principal Investigator: Christopher Slatore, MD, MS
The goal of this project is to increase the ability of patients to make informed decisions that incorporate their individual values and preferences about the potential benefits, harms, and burdens of choosing between direct VA care vs. community care. As VA expands access to community care for Veterans who reside in both rural and urban settings, it will be important to consider and incorporate patients’ informational needs along with their values and preferences when choosing how their health care will be delivered. The project’s ultimate aim is to create and test feasible, readily-implementable, decision support tools for Veterans. The Roadmap for accomplishing this goal includes a series of activities that are designed to have an impact on Veteran care from its inception: 1) quantitative analyses, including discrete choice experiments, of patients’ perceived barriers and facilitators to direct VA care and to care in the community; 2) qualitative studies of patients, and VA and non-VA stakeholders (clinicians, frontline facilitators, contractors, researchers, and VA leadership), to assess patients’ information needs, values, and preferences, and barriers and facilitators to improve, enhance, and standardize the process of selecting where and how to receive care; 3) development and pilot testing of a patient-facing decision support tool based on a theoretic model of shared decision-making; and 4) submission of one or more HSRD IIRs for pragmatic trials of the decision support tool to be used in different settings and situations
Education and Veteran Engagement
The Center is host to a VA Advanced Fellowship in Health Services Research & Development, which provides two years of advanced, interdisciplinary training to physicians, psychologists, and doctorally-prepared social scientists and nurses in research and quality improvement methods in HSR&D.
The Center maintains a Veteran Engagement Group (VEG), which is comprised of Veterans from various service eras, branches, and backgrounds who regularly come together to meet with investigators. VEG members provide diverse and individualized feedback to CIVIC investigators at all stages of the research process. The incorporation of VEG members’ perspectives, especially as users of the VA healthcare system, can bolster translation to practice and help CIVIC research be more patient-centered.
Each COIN works closely with operational partners throughout the VA healthcare system. CIVIC's partners include VA’s:
Whole Health Initiative (Office of Patient-Centered Care and Cultural Transformation)