COIN: Informatics, Decision-Enhancement and Analytic Sciences Center; Salt Lake City, UT
Director: Matthew Samore, M.D.
About the COIN
IDEAS’ mission is to advance scientific discovery, implement novel interventions, promote cross-center collaboration, increase research capacity, and engage Veterans and operational partners to improve Veteran health.
Research Focus Areas
This Center's areas of research include:
- Combatting antimicrobial resistance
- Identifying and mitigating Veterans’ health risks across periods of vulnerability
- Improving medication safety as VA transitions to a new electronic health record
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
Scaling the SLC Veterans on Anticancer Medications in Community and Rural Environments Support (VA CARES)
Principal Investigator: Brian Sauer, PhD
The goal of this project is to improve the effectiveness, safety, and efficiency of medication management for expensive and high-risk oral cancer medications in VISN 19, by improving care coordination between VA Oncology Clinical Pharmacy Specialists (CPS) and community prescribers of oral antineoplastic treatments (OATs, which may be administered by patients daily in their home
environment) during VA’s expansion to MISSION-funded community care. To accomplish this goal, investigators will provide enhanced informatics tools to support VA CARES, a VISN 19 comprehensive OAT medication management program for Veterans who lack access to oncology CPS to co-manage their cancer therapy. A mixed-methods research approach will inform implementation strategies tailored to the care setting (i.e., VA medical centers, Community Based Outpatient Clinics (CBOCs), and Community Care Clinics (CCSs)), provide iterative feedback to revise tactics when confronted with unexpected barriers, and guide the development of quantitative measures to evaluate clinical outcomes and cost avoidance.
Combatting Antimicrobial Resistance
The Center’s vision is to see a transformed VA leading the national fight against antimicrobial resistance. Center leadership envision a VA where powerful population analytic and cognitive support tools are used nationwide across the spectrum of Veteran healthcare with dramatically reduced risk of infection and mortality among Veterans and declining levels of antimicrobial resistance. To support this vision, Center research focuses on: 1) advancing the science of antimicrobial stewardship and infection prevention, and 2) implementing broad, system-wide surveillance of resistant organisms. Center staff are improving the application of causal inference methods to increase the speed with which salient questions in this field can be answered and interpreted. Analysis products are discussed with policy-makers to inform decision-making on all levels in VA.
- Identify questions that are of highest relevance to VA in the field of infectious diseases, as well as other fields where externalities should not be ignored
- Investigate the causal relationships between exposure to antimicrobial agents, exposure to infectious sources, and infection control policy, including the direct effects on the individual patient and indirect effects on others.
- Implement transformational changes to decrease Veteran mortality due to healthcare-associated and antimicrobial-resistant infections
Identifying and Mitigating Veterans’ Health Risks Across Periods of Vulnerability
Research at the Center seeks to develop and implement innovative strategies to mitigate adverse health outcomes in Veterans during periods of high vulnerability. Timely, proactive interventions have the potential to reduce mortality due to suicide and substance use disorder. Veterans’ periods of vulnerability are difficult to track with conventional data resources, such as the transition from DoD to VHA and from VHA to community care, and the Center studies will use diverse data sources and new methods to pinpoint periods of elevated risk and high need, often reflected as the absence of care, and to generate evidence about comparative effectiveness of alternative care strategies.
- Develop models to identify individuals at high risk for adverse outcomes (e.g., suicidality, overdose, homelessness, SUD, mortality) at and after separation from military service.
- Develop vulnerability risk scores that incorporate structured and unstructured electronic health record data from such diverse data sources as VA, Department of Defense, Veterans Benefits Administration, Centers for Medicare and Medicaid Services, Community Care, and publicly available data sources
- Use stakeholder input to develop a set of targeted interventions to engage Veterans in risk mitigation and care models that are tailored to their geographic location (e.g., rural/urban), personal circumstances, and personal preferences
Improve Medication Safety in VA’s New EHR
As VA transitions to a new electronic health record, the Center’s vision includes VA as an exceptional patient safety environment based on a confluence of informatics, health information technologies, and tools that improve medication safety. Center leadership envisions VA as a learning healthcare system that anticipates safety impacts and rapidly incorporates lessons learned.
- Characterize medication safety in VHA before and after implementation of its new commercial electronic health record using simulation tools to evaluate potential risks and statistical models to estimate rates of actual events.
- Apply advanced analytics to process both text and structured data. This will lead to the creation of additional tools to support real-time surveillance of hazards and harms related to health information technology.
- Use methods drawn from sociotechnical system analysis to examine causes of breakdowns and identify solutions (i.e. usability improvements).
Each COIN works closely with operational partners throughout the VA healthcare system. IDEAS partners include: