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HSR&D 2004 National Meeting Abstracts

1023. The VISN 1 Experience of MIRECC/Mental Health Service Line Collaborations
Michael J Sernyak, MD, VA Connecticut Healthcare System and MIRECC, ES Rofman, VISN 1 Network Mental Health Service Line Manager, R Rosenheck, Northeast Program Evaluation Center and VISN 1 MIRECC

Objectives: We describe an approach to research designed to ensure clinical relevance by working with systems managers to develop a mutually agreed upon agenda for studies.

Methods: Following the introduction of the atypical antipsychotics, concerns about previously unidentified serious side effects such as hyperglycemia and diabetes were expressed by clinicians and systems managers long before researchers had identified this as an area for research. The VISN 1 MIRECC in collaboration with mental health service line managers designed a series of studies to investigate the issue. These included a cross-sectional study using national administrative data, along with screening programs of patients in VISN 1 receiving clozapine, and a subset of patients receiving other atypicals.

Results: A series of studies showed that, in a national sample of veterans with schizophrenia, those who received atypical antipsychotics were 9% more likely to be diagnosed with diabetes than those treated with typical neuropleptics. Within VISN 1 23% of veterans receiving clozapine and 12.3% of veterans treated with other atypicals who were thought to be euglycemic actually had an elevated fasting plasma glucose. Within twelve months this new knowledge became part of the working information base of clinicians and managers in VISN 1 and a policy of monitoring plasma glucose for patients receiving atypical antipsychotics was implemented.

Conclusions: One of the ways of guaranteeing that today’s research leads to tomorrow’s healthcare is by researchers and administrators jointly setting a research agenda to assure both relevance of the research conducted and enhance the likelihood that findings will improve clinical practice.

Impact: Implications for future research and veterans health: This VISN/MIRECC partnership is an example of a successful partnership that could be reproduced throughout the VA.