Health Services Research & Development

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State of the Art (SOTA) Conferences

SOTAs bring together an invited multidisciplinary group of VA and non-VA experts to:

  • Synthesize what we know and what we need to know about topics critical to the health and well-being of veterans;
  • Promote implementation of findings that improve quality of care; and
  • Contribute to more effective management and more relevant research.

Papers are commissioned prior to the conference and are provided to the conference participants, who work to move the knowledge base forward.

A variety of post-conference products are developed to disseminate the conference findings and recommendations throughout the VA system, and often to the non-VA health care community.

Karen Bossi, MA
Portfolio and Special Projects Coordinator
Telephone: 857-364-5690

Past State of the Art (SOTA) Conferences

SOTA XI: Next Generation Clinical Performance Measures:
Patient-Centered, Clinically Meaningful, and High Value

January 21, 2014

Regarding next-generation clinical performance measures, identify:

  • the current state of the evidence – what do we know now?,
  • the evidence gaps – what are the important areas to research?, and
  • areas that are ready to implement now.

Participants will develop research agenda and implementation recommendations in four key areas:

  • Making Measures More Personalized and Clinically Meaningful
  • Incorporating Patient Preferences into Performance Measurement
  • Measuring Value
  • Implementing Measurement Strategies


  • SOTA XI: Clinical Performance Measures (February 2014)
  • Special issue of the Journal of General Internal Medicine (JGIM), in press, expected publication date: February 2016


SOTA X: Access

September 21 - 22, 2010


  • Identify what we know and what we need to know about the relationship of access to individual needs/characteristics, community networks/characteristics, utilization (VA and non-VA), and patient outcomes.
  • Define best strategies for outreach programs to improve access including resources, relationships, infrastructure, and policies.

Participants were charged with developing recommendations for a research agenda, as well as policy change in the areas of:

  • Defining access, constructs, and a conceptual framework with focus on measures
  • Identifying access issues for special populations
  • Impact of access on utilization, quality, outcomes, and satisfaction
  • Impact of policy and organization of care on access
  • Adoption and implementation of IT


  • A special issue of the Journal of General Internal Medicine comprising papers commissioned for the conference, as well as additional papers featuring empirical research on access was published in November 2011.
  • Research agenda forwarded to VA Office of Research and Development.
  • Executive Summary and policy recommendations forwarded to VHA leadership.


Research on Traumatic Brain Injury SOTA IX: Traumatic Brain Injury Research

April 30 - May 2, 2008

Goals: to identify what we know and what we need to know about:

  • The basic science of TBI
  • Comorbidities and Pain Issues in TBI
  • Care Management from Department of Defense through VA
  • Rehabilitation and Community Reintegration
  • Sensory Deficits in TBI
  • Neuro-imaging for TBI

Additionally, participants were charged to develop a research agenda to address knowledge gaps, methods, models of care, and vehicles for translation.



ORD took several actions in response to the SOTA, including:

  1. Released a new RFA including many of the research recommendations generated through the SOTA.
  2. ORD's Rehabilitation Research and Development Service released a solicitation for Centers of Excellence on topics of TBI, regenerative medicine, and social re-integration/vocational rehabilitation.
  3. A clinical fellowship in collaboration with the VA Office of Academic Affairs was established that provides for 75% protected research time.
  4. VA representation on the Federal Interagency Brain Injury Research Group which will coordinate research activities in TBI and disseminate information.
  5. Papers commissioned for the SOTA were published as a special supplement to the Journal of Rehabilitation Research and Development in 2009.

All of these efforts will yield important insights and results aimed at moving VA and the greater health care community forward toward a better understanding of mild to severe traumatic brain injury and how to provide the best care to those who have suffered a traumatic brain injury.


SOTA VIII logoSOTA VIII: Managing Complexity in Chronic Care

September 13-15, 2006

Goals: To identify current knowledge and knowledge gaps about improving the care and management of patients with complex chronic care needs.

Key Discussion Topics:

  • The spectrum of complexity in caring for patients with complex, challenging, and chronic illnesses and managing complex care
  • Defining best practices
  • Resources, relationships, infrastructures, and policies that are needed to ensure quality care and successful care management for complex patients

Products: Published a special issue of the Journal of General Internal Medicine in December 2007 (Vol 22, Supplement 3). In addition, a research agenda for CCC was submitted to Central Office.


SOTA VII logoSOTA VII: Implementing the Evidence: Transforming Practices, Systems, and Organizations

August 30 - September 1, 2004

Goals: To identify current knowledge and knowledge gaps about best strategies for implementing evidence into practice to make recommendations for further research, processes, or policies that will help fill the gaps and advance knowledge in this area.

Key Discussion Topics:

  • Attributes of an Ideal Integrated Informatics System That Supports Implementation of Evidence
  • How Does Evidence Inform What an Organization and Its Providers Do?
  • Incentives for Implementation and Organizational Change
  • How Does the Research Infrastructure Need to Change to Make Implementation Easier?

Products: Publication of special issue of the Journal of General Internal Medicine, February 2006


SOTA VI logoSOTA VI: Leading the Way to Quality Long-Term Care: Lessons from the Past, Strategies for the Future

September 15-17, 2003

Goals: 1.) Identify what is currenly known and what we need to know regarding long-term care demand, coordination, outcomes, cost-effectiveness, quality, and satisfaction, as well as long-term care resources, relationships, and infrastructures needed to ensure the highest quality long-term care. 2.) Develop recommendations and a research agenda that will assist VA and the larger health care community in providing the highest quality, most cost-effective long-term care.

Key Discussion Topics:

  • Projecting Long-Term Care Demand and Planning Resources
  • Improving Long-Term Care Structures for Patient-Focused Care
  • Improving Processes to Ensure Coordination of Care
  • Innovations and Models in Long-Term Care
  • Measuring the Quality of Long-Term Care

Products: Policy recommendations sent to Under Secretary for Health, planned publication of several conference papers in a special section of The Gerontologist.


SOTA V logoSOTA V: Making Informed Consent Meaningful

March 7-9, 2001

Goals: To identify existing knowledge about informed consent in both theory and practice; to identify what the VA and others can do to improve the practice of informed consent; and to outline a research agenda identifying and filling in the most important gaps in our current knowledge.

Key Discussion Topics:

  • Informing Subjects (content)
  • Informing Subjects (process)
  • Decision-Making Capacity
  • Voluntariness of Consent
  • Decision-Making Dynamics
  • Impact of Existing and Emerging Technology on Informed Consent
  • Informed Consent Issues Across the Health Care Continuum



SOTA IV: Leading Organizational Transformation

April 8-10, 1996

Goals: To determine the state of the art of integrated delivery systems and its relevance to VA's organizational vision; to identify the following: tools and resources for change, information dissemination vehicles, high priority topics for research, and to provide a forum for discussion.

Key Discussion Topics:

  • Integrated Delivery Systems
  • Designing Strategic Alliances
  • Changing Organizational Culture and Managing the Human Side of Change
  • Recruiting, Nurturing, and Rewarding Desired Leadership Competencies
  • Forging New Relationships within the Community


  • Special Supplement Issue:The Journal of the Foundation of the American College of Healthcare Executives Vol 42, No 3, Fall 1997
  • Organizational Change: A Primer (253 KB, PDF)


SOTA III: Technology Assessment: A Tool for Technology Management and Improved Patient Outcomes

January 23-25, 1995

Goals: Assess the current state of health care technology assessment, identify gaps in current knowledge, identify and prioritize recommendations, identify stategies for implementation.

Key Discussion Topics:

  • Developing an Organization's Approach to Technology Assessment
  • Methodological Aspects of Conducting Technology Assessment
  • Dissemination and Implementation of Technology Assessment Recommendations
  • Monitoring and Evaluating the Dissemination of Technology Assessment Recommendations

Products: Health Care Technology Assessment in VA: A Primer (491 KB, PDF)


SOTA II: Databases: A Resource for Research and Decisionmaking

November 8-10, 1993

Goals: To improve the delivery of health care through recommendations for advancements in the design and use of data and information systems supporting policy, management and clinical decisionmaking and health services research.

Key Discussion Topics:

  • Needs and Demand
  • Access and Utilization
  • Outcomes and Effectiveness
  • Quality Assessment and Improvement
  • Costs
  • Resource Allocation
  • Ambulatory Care Services
  • Geriatric and Extended Care Services


  • Databases: A Resource for Research and Decisionmaking (Annotated bibliography)
  • Databases: A Resource for Research and Decisionmaking (Recommendations)


SOTA I: Community-Based Long Term Care: What We Know and Need to Know

September 23-25, 1992

Goals: Improve the delivery of community-based long term care services to the veteran population by disseminating what is known from the research literature and best practices to managers, clinicians, and policymakers.

Key Discussion Topics:

  • Current and future needs and demands for VA community-based long term care services
  • Outcomes from the provision of community-based long term care services
  • Delivery coordination of community-based long term care services (VA-wide, VAMC, individual patients)
  • Characteristics of specific programs and services made available as part of VA community-based long term care


  • Community-Based Long Term Care Resource Guide, Community-Based Long Term Care Executive Summary
  • Community-Based Long Term Care, VA Programs and Services