Adam Gordon, MD, MPH; Hildi Hagedorn, PhD, LP; and Ruth Klap, PhD are recipients of the 2020 HSR&D Health System Impact Award. This award honors HSR&D- and QUERI-funded research that has had a direct and important impact on clinical practice or clinical policy within the VA health care system – and that has been successfully translated into VA’s policy or operations.
Adam Gordon, MD, MPH
As part of HSR&D’s Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS) and co-principal investigator for QUERI’s Consortium to Disseminate and Understand Implementation of Opioid Use Disorder (OUD) Treatment (CONDUIT), Dr. Gordon earned the Impact Award for his overall excellence as a clinical investigator, educator, and mentor, and, in particular, his examination of the efficacy, effectiveness, and treatment of persons who have addiction or are vulnerable due to social determinants of health. Substance use disorder (SUD) includes a dependence or addiction to alcohol, illegal and prescription drugs, and/or nicotine. Further, nearly 1 in 10 Veterans has been diagnosed with an SUD (NIDA; Drug Facts). Board certified in internal medicine, Dr. Gordon was one of the first board-certified addiction medicine physicians in the country, and one of the first to provide medication treatment for opioid use disorder (MOUD). His work has had a direct impact on the provision of medical care for patients with opioid use disorder – a critical problem VA faces as part of the national opioid crisis. Focusing research on vulnerable populations, including Veterans with alcohol use disorder, OUD, and those who are homeless has allowed VA to broaden access to care for Veterans who might otherwise be unreachable. For example, Dr. Gordon led the Vulnerable Veteran Innovative PACT (Patient-Aligned Care Team) Initiative – a multi-million-dollar project to enhance the provision of services within primary care for vulnerable Veterans within VISN 19. Dr. Gordon also co-leads the QUERI-funded Implementing Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) Initiative, and he founded one of the first Homeless PACTs in the VA healthcare system. In addition to his outstanding research, Dr. Gordon’s influence is felt through his mentoring of young researchers and VA clinicians, his expert input to VA policies, his collaborations with VA operations partners, and his national influence as a thought leader on addiction and healthcare.
Hildi Hagedorn, PhD, LP
Part of HSR&D’s Center for Care Delivery and Outcomes Research (CCDOR), Dr. Hagedorn earned the Impact Award for her work to increase the implementation of evidence-based treatments for Veterans with substance use disorder, especially as it relates to increasing opioid agonist therapy across the VA healthcare system. Veterans receiving VA care are nearly seven times more likely to be diagnosed with an OUD than civilian populations. Opioid agonist therapy (OAT) has been proven to reduce the morbidity and mortality associated with OUD; however, the implementation of OAT within VA has been limited. Twenty years ago, Dr. Hagedorn began her VA career in the Substance Use Disorder (SUD) Quality Enhancement Research Initiative (QUERI), which sought to increase the implementation of evidence-based treatments for Veterans with SUD. Over the years, Dr. Hagedorn has continued this mission; for example, she led the HSR&D-funded study “Testing a Novel Strategy to Improve Implementation of Medication-Assisted Treatment for Veterans with Opioid Use Disorders in Low-Performing Facilities (ADAPT-OUD)” in order to address the problem of low rates of OAT prescribing. This study resulted in an increase in OAT providers and patients prescribed OAT (i.e., buprenorphine) at low-performing facilities. Dr. Hagedorn then worked with Dr. Adam Gordon and others on the SCOUTT QUERI Initiative. SCOUTT’s Implementation Facilitation Team, led by Dr. Hagedorn, provides external facilitation, training, and mentorship to participating clinical teams through face-to-face meetings and community of practice webinars. To date, clinical teams at 36 sites across 18 VISNs have received external facilitation to increase prescribing of evidence-based medications for OUD. Further, participating clinics saw a 136% increase in the number of Veterans receiving buprenorphine and a 163% increase in the number of buprenorphine providers at these sites. In addition, insights into barriers to medication prescribing for OUD discovered through the facilitation activities have led to VA policy changes to facilitate this evidence-based practice. Dr. Hagedorn’s years of expertise and close collaborations with operational partners have culminated in creating remarkable systemwide change in response to the opioid crisis.
Dr. Klap, part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), received the Impact Award for research to help end harassment of women Veterans in the VA healthcare system. Women Veterans are a rapidly increasing subset of VA’s patient population; however, women Veterans remain a minority patient population at about 7.5% of patients. The dominant presence of male patients in VA healthcare settings poses unique considerations for providing care in a setting or manner that makes women feel welcome. Dr. Klap’s research on the prevalence, drivers, and consequences of harassment of women Veterans on VA grounds has had a direct and widespread impact on VA policy, as well as the spread of evidence-based changes in how women Veterans are treated in VA healthcare settings nationally. Working with a team dedicated to women Veterans’ health, which includes Drs. Karen Dyer, Jessica Moreau, Jillian Shipherd, Karissa Fenwick, and Alison Hamilton, Dr. Klap’s research has shown that 25% of women Veterans report having been harassed by male Veterans either sexually or by denigrating their service or eligibility for benefits when they come to VA for care. Their research also shows that feeling unsafe or unwelcome at VA led to delaying and missing care, especially among women with a history of military sexual trauma. Among LGBT women Veterans, the rates were even worse, and were associated with even higher rates of care avoidance. When Dr. Klap’s paper came out, media attention was swift, as were Congressional inquiries and Veteran Service Organization reactions. The research was mentioned in numerous Congressional hearings and was often quoted by Congressional leaders. A series of papers published by Dr. Klap and her team provided evidence that was noted by the Congressional Women Veterans Task Force. Further, Dr. Klap’s attention to detail, clarity, and methodological rigor has ensured an unusually strong collaboration between legislators and VA Women’s Health Service leaders in service of improved reporting and climate.
HSR&D is very proud and grateful to Drs. Gordon, Hagedorn, and Klap for their remarkable research, dedication, and continuing contributions toward improving the VA healthcare system and the care and health of our Veterans.
HSR&D also greatly appreciates each of the Health System Impact Award Nominees, whose work helps VA improve the system and, thus, healthcare for our Veterans. The nominees are: