Health Services Research & Development

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2000 HSR&D National Meeting

More than 500 researchers, clinicians and policy makers came together in Washington, DC for the Eighteenth Health Services Research & Development Service (HSR&D) National Meeting . The theme for the year 2000 meeting was "Systematizing Quality: Approaches that Work." During the course of the two-and-a-half day conference attendees participated in an array of activities, including paper sessions, exhibits, workshops and a poster session - all focused on systematizing quality of care. Hosted by the Veterans Evidence-Based Research, Dissemination and Implementation Center (VERDICT) in San Antonio, TX, and its Director, Jacqueline A. Pugh, M.D., the conference addressed topics such as performance monitoring, practice guidelines, evidence-based decision making, provider payment mechanisms, and organizational theory. Attendees also explored the linkages between scientific activities, VA policy development, and clinical services delivery.

State of the Service
John Demakis, M.D., Director of HSR&D, looked back over the many highlights of the past year and presented a "State of the Service" address. With a research budget of $42 million, approximately 13% of VA's $321 million research budget, HSR&D's mission is to advance knowledge and promote innovations that improve the health and care of veterans and the nation. About 50 percent of these dollars directly support merit-reviewed research projects: 40% to investigator-initiated research and 10% to service-directed research.

There are 113 ongoing HSR&D funded research projects, in areas of high priority such as:
- access to care
- ethnic and cultural issues
- gender issues
- implementation of clinical practice guidelines,
- patient-centered care,
- patient safety, and
- telemedicine.

A few highlights of the past year noted by Dr. Demakis included funding of HSR&D's Health Economics Resource Center (HERC); the first meeting of the National Advisory Group, which will meet annually; the convening of a Nursing Research Panel that will make recommendations as to how VA can improve and encourage nursing research; and the expansion of the Quality Enhancement Research Initiative (QUERI), a data-driven, outcomes based quality improvement program that facilitates the translation of research findings into better health care practices.

Meeting Highlights
Presentation of the Undersecretary's Award. Nelda P Wray, MD., M.P.H. was presented with the Under Secretary's Award for Outstanding Achievement in Health Services Research by Thomas L. Garthwaite, M.D., Deputy Under Secretary for Health and VHA's highest ranking official. Dr. Wray is an active clinician, pre-eminent researcher, respected mentor, and vigorous contributor to HSR&D. She was recognized with VHA's highest research award for her outstanding career accomplishments, particularly her work on the use of administrative databases to assess and improve the quality and effectiveness of health care, and the development of techniques that allow for understanding of patient preferences and how to incorporate these into decision making.

Throughout an exceptional career, Dr. Wray has applied these methodologies in areas of particular importance to veterans such as heart failure and prostate cancer. In addition, as a teacher and mentor she has inspired new investigators, while enhancing the visibility and reputation of VA research through national leadership such as current appointments to the National Advisory Committee for HSR&D and the Agency for Healthcare Research and Quality. Continuing her work at the Houston VA Center of Excellence, Dr. Wray has created an environment and infrastructure that fosters interdisciplinary health services research. In accepting her award, Dr. Wray spoke about the principles that have guided her career: "setting high standards for yourself and those you work with, encouraging an environment of collegiality and team spirit, and recognizing our strength through interdependence."

Research Highlights
Current health services research showcased at the meeting included 86 studies chosen for oral presentations, 14 offered through workshops, and 51 poster presentations. Concurrent paper sessions, workshops and poster/exhibits presented during the National Meeting covered an array of health care issues such as epidemiology and prevention, quality measurement and improvement, special populations, and interventions in health services. Researchers also addressed a wide scope of diseases/conditions affecting veterans, to name a few: pulmonary function in spinal cord injury, prostate cancer, binge drinking among female VA patients, PTSD among ambulatory VA patients, and the relationship between post-stroke depression and quality of life.

There were also several special HSR&D exhibits presented by the: Agency for Healthcare Research and Quality, Allocation Resource Center, Healthcare Analysts and Information Group, Health Economics Resource Center (HERC), HSR&D Headquarters, Management Decision and Research Center's Information Dissemination Program, Planning Systems Support Group, VA Management Sciences Group, VHA Office of Special Projects, VISN Support Services Center, and the VA Information Resource Center (VIReC). In addition, a Special Interest Group Roundtable Luncheon was held in which Meeting attendees had the opportunity to meet with other investigators in small groups and discuss health care issues of mutual interest.

Invited Speakers
In my opening remarks, I noted HSR&D's contribution to VA's continuing efforts to improve patient outcomes and systems efficiencies; in particular, HSR&D's current focus on systematizing quality that is specifically designed to operate at the interface between evidence, practice, and systems efficiencies.

This year's meeting featured several eminent guest speakers including John H. Wasson, M.D., the Herman O. West Chair and Distinguished Professor of Geriatrics, and Director of the Center for Aging, Dartmouth Medical School, Hanover, NH; Ed Wagner, M.D., M.P.H., a clinician at the Group Health Cooperative of Puget Sound Center for Health Studies in Seattle, WA; Harry Cummings, Professor at the University of Guelph in Ontario and President of Harry Cummings and Associates, also in Guelph; and Deputy Under Secretary Garthwaite.

Dr. Wasson's inspiring keynote address, titled "Putting the 'P' in Interaction," focused on taking advantage of today's technology to improve and systematize the quality of time spent between patient and provider. Dr. Wasson is working to help organizations provide the right care, at the right time, to the right patient, and to make that become routine.

Dr. Harry Cummings discussed his experiences with regulated health care in Ontario, Canada and integrating quality assurance (QA) and evaluation into this environment. For example, the College of Midwives has several required QA regulation components that include: provision of clinical information, continued education and professional development, peer case review, and quality of care evaluations. However, Dr. Cummings stressed the fact that there is very little evaluation research on QA being done.

Dr. Ed Wagner spoke about his organization's efforts to assist other health care organizations to improve functional and clinical outcomes for patients with chronic illness. Themes in the chronic care model they use concentrate on productive patient/provider interaction by focusing on evidence-based, population-based, and patient-centered improvements in care. Deputy Under Secretary Garthwaite also addressed attendees about quality assurance, speaking about the strides VA has made during the past five years. The quality of VA patient care has improved throughout an impressive VA organizational transformation that saw a dramatic decrease in inpatient care, which closed one-half of its acute care hospitals, while ambulatory care greatly increased. A few of the ways VA has improved patient outcomes during the past several years are through increased: - influenza and pneumonia vaccination,

- use of beta-blockers after AMI,
- follow-up for mental health illness after hospitalization, and
- increased breast cancer and cervical cancer screening.

Looking Ahead
Future HSR&D plans include further expansion of QUERI, a state-of-the-art conference that will focus on informed consent, increased management research, the establishment of a new Health Services Research Center of Excellence, and a continued commitment to improving the quality of patient care through the implementation and systemization of evidence-based research. HSR&D's 19th National Meeting will be held in Washington, DC on February 14-16, 2001 and will be hosted by the Center for Chronic Disease Outcomes Research, Minneapolis, MN.