Mark S. Bauer, MD and Stephanie Taylor, PhD
Mark S. Bauer, MD and Stephanie Taylor, PhD are recipients of the 2019 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. As part of HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR), Dr. Bauer earned the Impact Award for his work on developing and implementing “Evidence-Based Teams for Mental Health Care,” which has transformed VA’s general mental health clinics into an evidence-based model that can address priorities including suicide prevention and opiate abuse in an outpatient setting. Co-Director of the Complementary and Integrative Health (CIH) QUERI Partnered Evaluation Initiative, Dr. Taylor earned the Impact Award for several large-scale projects that have had numerous national impacts and are guiding VA policy and optimal provision of CIH care for Veterans.
Evidence-Based Teams for Mental Health Care
VA is one of the largest single providers of mental health services in the U.S., and suicide prevention is one of VA’s highest priorities. Beginning in 2015, Dr. Bauer and his team collaborated with partners in VA’s Office of Mental Health and Suicide Prevention to enhance the Behavioral Health Interdisciplinary Program (BHIP) Initiative, which was developed as a staffing model to support Veteran-centered, collaborative, and coordinated care in general mental health clinics. This partnership co-designed a QUERI-funded trial (Bauer et al., JAMA Open Network, 2019) to implement and assess the effects of the evidence-based Collaborative Chronic Care Model (CCM) in BHIP teams across nine VA medical centers. The trial showed that implementation improved team function, and that the BHIP-CCM model reduced hospitalization rates for team-treated Veterans, and improved mental health status for Veterans with complex clinical presentations. Importantly, this work took the CCM beyond the sphere of research trials to successfully implement it in a broad array of mental health clinics across five VISNs. This partnership then expanded to include Transformational Coaches from the Office of Veterans Access to Care. Led by Dr. Bauer, the collaborative team trained 17 Coaches in the BHIP-CCM method, and these Coaches then provided one year of facilitation support to 21 additional VAMCs in 11 VISNs. A nationwide assessment of each BHIP team is currently planned for release to the field in 2020. Thus, Dr. Bauer and his team have already achieved impact across multiple VAMCs and VISNs, and continue to stimulate and support substantive system change throughout VA mental health clinics nationally. These efforts are improving care for tens of thousands of Veterans with mental health issues, and are enhancing the work of thousands of VA providers.
Expanding and Enhancing VA Complementary and Integrative Health
More than half of Veterans report musculoskeletal pain, often with mental health comorbidities. Complementary and integrative health (CIH) therapies are important non-pharmacologic treatment options for these conditions, as well as for general wellness. One of the national leaders in CIH research, Dr. Taylor’s first national impact came from her large-scale project (2014-2015) that examined the implementation of CIH therapies across VA. Results from this study were considered the “implementation bible” for VA’s Office of Patient-Centered Care & Cultural Transformation (OPCC&CT) and directly shaped a variety of implementation efforts such as developing CIH educational materials for providers and Veterans, improving coding of CIH therapies in the medical record, and gaining leadership buy-in for facilities across the VA healthcare system. Dr. Taylor’s teams also conducted two national surveys in 2017 and 2018. The first was conducted among Veterans to determine their interest in, use of, and satisfaction with 26 CIH therapies for a variety of health conditions. Prior to this, VA had little sense of Veteran demand for these therapies. The second survey was the first rigorous, detailed survey of CIH provision and implementation at all VA healthcare systems. The information generated from these national surveys was of great interest to the Cover Commission—the Congressionally-appointed committee overseeing VA’s compliance with the Comprehensive Addiction and Recovery Act (CARA)—used for briefing Congressional staffers. Results also have been used by VA CIH Program leads across the country to garner support from their facility leadership for local and regional CIH program implementation. Given Dr. Taylor’s impacts and CIH research leadership, the VA OPCC&CT also asked her to help plan the first National VA CIH Research Summit, held in 2018, and to help draft VA’s response to Congress on its plan to evaluate and implement evidence-based CIH. Moreover, she is regularly invited to brief Congressional staffers on her CIH results – and briefs the Cover Commission, ensuring that her and others’ CIH research has broad impacts on national policy. Currently, Dr. Taylor (along with Dr. Steve Zeliadt) leads an HSR&D funded large-scale trial comparing the effectiveness of practitioner-delivered CIH (acupuncture, chiropractic massage) combined with self-care (yoga, tai chi, mindfulness) versus either practitioner-delivered CIH or self-care alone among Veterans with chronic pain. This study is an NIH-VA-DoD Joint Initiative.
HSR&D thanks Drs. Bauer and Taylor for their outstanding work 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; they include: