COIN: Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans; Providence, RI
Director: James Rudolph, MD
About the Center
As Veterans become more dependent, the Office of Geriatrics and Extended Care (GEC) offers long-term services and support (LTSS) programs to keep Veterans in their environment for as long as possible. The LTSS COIN’s vision is to empower Veterans and the nation to overcome the challenges of aging, disability, or serious illness. Working in close collaboration with VA GEC, the LTSS COIN leads research programs involving multiple regional and national partners focused on improving the access, quality, and value of LTSS for Veterans. This work is accomplished by stimulating and developing research that enhances the implementation of programs to support the mission of VA's GEC Service in maximizing Veterans' social participation and quality of life in the least restrictive setting possible.
The Center’s primary mission is to develop research on measurement, implementation, and quality of VA long-term services and support that enhances access to and value of care delivered to vulnerable Veterans to improve the access, quality, and value of VA LTSS programs.
Research Focus Areas
Research at this Center focuses on:
- Quality of Care in Nursing Homes and Home and Community Based Services
- High Risk Veteran Populations (Palliative Care, Dialysis, and Cognitive Impairment)
- Policy and Economic Analysis of Long-Term Care Programs
- Antimicrobial Stewardship in the Long-Term Care Community
- Mental Health and Homelessness
- End of Life Care
- Discharge from Hospital to Community
- HEDIS mediation dispensation
- Food Insecurity
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
Research Impacting Veterans Using LTSS and Experiencing Transitions (RIVULET)
Principal Investigator: Whitney Mills, PhD
Veterans who lose function can use long-term services and supports (LTSS) delivered in the home or a facility in the community to maximize independence and quality of life. VA’s Office of Geriatrics and Extended Care envisions a dynamic LTSS system that emphasizes community living, with provision of short-term, recuperative, and rehabilitative institutional care enhanced by community-based LTSS. Guided by this vision, the impact goal for this project is to 1) build an LTSS Research Network and 2) understand and improve transitions between providers in the LTSS system. Investigators will monitor success over the five-year period through development of an LTSS Network, creation of a shared research agenda, research outcomes, a collaborative grant submission focused on LTSS transitions, and dissemination of findings to facilitate development of pragmatic innovations to prevent and/or improve transitions for Veterans.
Education and Other Programs
The Center is host to a VA Advanced Fellowship in Health Services Research and Development. Program goals aim to train both physician and non-physician researchers to become successful independent investigators in health services research and health system improvement; to give trainees didactic as well as "hands-on" supervised experience in health services research; and to teach health services research methods as well as content material relevant to gerontology, long term care, and chronic disease management.
Each COIN works closely with operational partners throughout the VA healthcare system. The partners associated with this COIN include the following: