Health Services Research & Development

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COIN: Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP); Los Angeles, CA

Director: Elizabeth Yano, Ph.D., M.S.P.H.

About the COIN

CSHIIP's mission is to develop and test innovations for improving the effectiveness and value of VA healthcare.

Focused Areas of Research

CSHIIP's focused areas of research include:


Improving Primary Care Practice in the Context of Patient-Aligned Care Teams

Most VA healthcare users receive the majority of their preventive, urgent and chronic disease care in VA primary care settings. Current data suggest that, while VA primary care compares favorably with community standards, VA has yet to achieve the level of continuous, coordinated, comprehensive, and the Veteran-responsive care that VA planners envision. VA's patient-centered medical home model—VA Patient-Aligned Care Team (PACT)—was launched in 2010 as a next step toward achieving Veteran-centered primary care. Though based on the best available prior evidence, PACT implementation efforts have revealed numerous issues critical to PACT success. CSHIIP investigators will conduct research to:

  • Better understand the multi-level factors that influence the implementation and success of VA primary care delivery models, including their links to specialty care, hospitals and emergency care;
  • Develop and test innovations to support primary care/PACT goals; and
  • Develop and test methods for implementation, spread and sustainability of successful primary care/PACT innovations.


Accelerating Implementation of and Access to High-Quality Care for Women Veterans

Women Veterans using the VA healthcare system have doubled in number since 2000, and are projected to comprise 10% of all VA users by 2018. These changes have substantially altered the demographics of VA patients, hastening the need to better address a wide spectrum of services meeting women Veterans' complex needs. Even with their growth in VA, women's numerical minority has created challenges to assuring equitable access to high-quality comprehensive care in the context of gender-specific needs (i.e., reproductive health), gender awareness (i.e., clinical understanding of gender differences in risk and treatment), and gender sensitivity (i.e., attributes of care that reflect relational and other preferences for care). As a result, improving women Veterans' access to one-stop, gender-sensitive comprehensive care in every VA is a top priority. CSHIIP investigators will seek to:

  • Identify the patient, provider and organizational determinants of variations in care for women Veterans;
  • Develop and evaluate innovative care models and treatment strategies for reducing gender disparities and improving women Veterans' care; and
  • Design and conduct implementation research to improve the impact and value of care delivered to women Veterans.

CSHIIP also is home to the VA Women's Health Research Network and the VA Women Veterans' CREATE, a five-project multi-site research initiative designed in partnership with VA Women's Health Services and VA Mental Health Services to accelerate the implementation of comprehensive care for women Veterans.


Conducting Research that Improves Care for Vulnerable Veteran Populations

While the VA's mission is to care for all Veterans, the VA healthcare system is uniquely positioned to provide care for Veterans who are disabled as a result of military service or who cannot afford treatment elsewhere. As a result, the Veterans who receive VA healthcare are at greater risk for having complex and chronic illnesses, cognitive deficits, functional limitations, and challenging socioeconomic situations. CSHIIP investigators have nationally recognized expertise in the areas of serious mental illness, long-term care/aging, palliative care, and homelessness. They conduct research designed to improve care for vulnerable Veteran populations, identifying synergies that inform each others' work. Investigators seek to:

  • Characterize patient, provider and organizational determinants of variations in care and outcomes;
  • Develop and evaluate new care models and innovations that improve care; and
  • Evaluate strategies for the implementation and spread of evidence-based practice.


Emerging Innovative Research

While the majority of the CSHIIP's research is within the focused areas noted above, the Center has fostered development of several areas of research that reflect important innovations (i.e., clinical genetics, complementary and alternative medicine), build on areas of existing expertise (i.e., infectious diseases), or break new ground in HSR&D (i.e., emergency management). Research in CSHIIP's emerging areas is framed around the same emphasis on:

  • Examining determinants of variations,
  • Developing and testing interventions to improve care, and
  • Evaluating approaches to accelerating implementation and spread of high-value innovations.



Partner Offices

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

  • Primary Care Program Office: Gordon Schectman, M.D., Chief Consultant, Primary Care, and Richard Stark, M.D., Director of Primary Care Clinic Operations. CSHIIP also is home to the Veterans Assessment & Improvement Laboratory, one of five national PACT Demonstration Laboratories funded by the Primary Care Program Office within VA's Office of Patient Care Services (PCS).
  • Women's Health Services: Patricia Hayes, Ph.D., Chief Consultant of Women's Health Services
  • Mental Health Services: Susan McCutcheon, R.N., Ed.D., Director of Family Services, Women's Mental Health and Military Sexual Trauma
  • Office of Informatics & Analytics: Joseph Francis, M.D., M.P.H., Director of Clinical Analytics and Reporting
  • The Center also benefits from an array of project-specific partnerships with many VA Offices for specific vulnerable Veteran populations (e.g., Mental Health Services, Mental Health Operations, Geriatrics and Extended Care, Nursing Services, National Hospice and Palliative Care Program).

Related Resources

Improving Housing Outcomes for Chronically Homeless Veterans by Sonya Gabrielian, MD