Health Services Research & Development

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VHA's Priorities for Strategic Action

Spotlight on Access: Studies/Resources

October 2015


A number of HSR&D Centers of Innovation are working on access studies; below are links to more information on these studies. Please note that these lists are not intended to be comprehensive. For more information, please visit the Center's website and/or the study/citation search pages on the HSR&D website.

Other


Through different programs and initiatives the Quality Enhancement Research Initiative (QUERI) is addressing the issue of healthcare access.

Quality Enhancement Research Initiative (QUERI) Programs

QUERI Initiatives



HSR&D Centers of Innovation (COIN)

Ann Arbor

Care model linked to improved Veteran care: more access, use of e-records, post-hospital follow-up.

This is the first research publication highlighting VA's national PACT (patient-aligned care team) program and progress, written in collaboration with PACT leaders in patient care and used by VHA leaders to highlight PACT both within and outside VA.

Outreach program to Veterans with serious mental illness lost to care can improve outcomes, including mortality.

Proactive outreach might result in patients returning to care and should be implemented to re-engage this vulnerable group. This research was conducted in collaboration with VHA's Office of the Medical Inspector, and the findings were used by the VHA Office of Mental Health Services to develop and implement an outreach program for patients with SMI lost to follow-up care.

Technologically Enhanced Coaching (TEC): A Program for Improving Diabetes Outcomes.

This study tested the effectiveness of a technology-enhanced peer coaching (TEC) program in improving glucose control relative to peer coaching without technology enhancement. If effective, this program will serve as an important complement to usual care by providing sustained, flexible between-visit support.

Improving Insulin Therapy with Enhanced Care Management and Peer Support
VA patients with diabetes improved their glycemic control after phone calls with peers: Phone calls with a Veteran peer facing the same self-management challenges helped diabetes patients manage their conditions and improve their blood sugar levels better than those who used traditional nurse case management services alone.

Linking National Guard Veterans with Need to Mental Health Care

The program uses peers to provide support to National Guard soldiers who have challenges with reintegration due to behavioral health, legal, financial, or other issues.

Improving Chronic Disease Management in Rural Community Based Outpatient Clinics
This program provides rural patients with support for managing symptoms of chronic illness via automated telephone monitoring and behavior change phone calls for patients with diabetes, depression, and heart failure.

Effective and Efficient Pain Care Using Artificial Intelligence and Mobile Health Tools

This study tests the efficacy of an artificial intelligence-based cognitive behavioral therapy (AI-CBT) that automatically adapts to each Veteran's unique and changing needs compared to standard telephone-based CBT with a therapist. All treatment is delivered by telephone, removing the need for the Veteran to travel to a VA medical center to receive care.

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Charleston

Telepsychology Service Delivery for Depressed Elderly Veterans

The preliminary results of this project indicate that effective mental health therapy for major depressive disorder in an elderly population can be delivered just as effectively by in-home video teleconference as by face-to-face therapy sessions, and that results are sustained at 12 months of follow-up.

Prolonged Exposure (PE) for PTSD: Telemedicine vs. In Person

This study will provide important information regarding whether PE delivered via home-based telemedicine equipment is as effective as traditional in-person delivery of PE for post-traumatic stress disorder.

Improving PTSD Service Delivery for Veterans with Severe Mental Illness

This study will evaluate how to effectively deliver PTSD mental health services to Veterans with severe and persistent forms of mental illness.

Understanding Dual Use and Other Potential Determinants of Heart Failure Outcomes

This study will inform development of systems-level interventions to improve access to care and quality of care for Veterans with heart failure, by investigating dual use and other potential determinants of outcomes.

Personal Health Record-Facilitated Diabetes Self-Management among Rural Veterans

This project offers a potential solution to strengthening Veterans' self-management of chronic disease conditions through intervention to an easily accessible, self-management tool that fosters the knowledge and skill-building aspects of diabetes self-management.

Group Motivational Interviewing (GMI) for Homeless Veterans in VA Services

Group Motivational Interviewing (GMI) has the potential to be offered to larger numbers of Veterans with substance use disorders (SUDs) in VA housing, providing access to those who would otherwise not receive this intervention. This study will investigate the effectiveness, implementation process, and cost of GMI in homeless Veterans with SUDs.

Pilot Evaluation of AboutFace: A Novel Peer Education Resource for Veterans

The purpose of this study is to evaluate the AboutFace peer education website for the purpose of reducing stigma and improving attitudes toward seeking mental health services among Veterans, thereby increasing access to these services.

Veterans Perspectives and Likely Impact of the Veterans Choice Program

This project will provide information on the Veterans Choice Program and its likely impacts on access to care, satisfaction, healthcare costs, and health outcomes for Veterans living in rural settings.

Increasing Access to Mental Health Treatment among Homeless Veterans

This study will examine factors directly influencing service access and completion, including attitudes toward mental health care treatment, perceptions of barriers and facilitators to mental health care, optimal treatment delivery modalities, and perceived usefulness of innovative strategies for increasing treatment engagement.

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Durham

Group Physical Therapy for Veterans with Knee Osteoarthritis

The group physical therapy approach in this study required less overall staff time per patient to deliver, and it could provide services efficiently to larger numbers of patients. Therefore it should be considered as a viable model for health systems to provide this service to Veterans with knee osteoarthritis, potentially increasing access to this service.

Simulation-Guided Systems Redesign in GI Endoscopy

Discrete event simulation (DES) is an operations research methodology that can be applied to improve patient flow and efficiency of clinic operations. This study aims to develop knowledge regarding how DES can be used most effectively to improve efficiency in GI endoscopy and how to facilitate broader implementation of this approach within VHA to improve capacity for colorectal cancer screening.

Organization and Outcomes of Dialysis for Veterans with End Stage Renal Disease

Results from this study will inform VA efforts to improve the quality and efficiency of dialysis care among the growing population of Veterans with end-stage renal disease (ESRD), by identifying which Veterans are best served by receiving dialysis in VAMC clinics, VA Fee Basis, or the Medicare ESRD program.

Evaluation of Videoconferencing vs Telephone Genetic Counseling Consultations

For Veterans for whom in-person genetic counseling is not feasible, the Genomic Medicine Service conducts counseling either via telephone or videoconferencing. Although both of these methods can be effective for delivering genetic counseling, each has its relative advantages and disadvantages. The specific aims of this study are to gain a better understanding of the advantages and disadvantages of these two modalities.

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Hines

Impact of Medicare Drug Benefit on VA Drug Use, Healthcare Use, and Cost

As part of a larger project to examine the impact of the advent of Medicare Part D on Veteran use of health care services, investigators found that while opioid and oxycodone overlap increased within Medicare and across systems after Part D implementation, overlap for the opioid class and for oxycodone decreased within the VA system from 2007 to 2009. Access to VA-only care resulted in better management of pain medication.

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Houston

Telehealth Treatments for Depression with Low-Income Homebound Seniors

This project is studying the acceptability, clinical effectiveness, and value in terms of delivery cost, cost effectiveness, and financial affordability of two tele-mental health delivery models focused on improving access to mental health services for the rapidly growing population of disabled/homebound seniors.

Home Strength to Serve Program

Investigators worked with the Houston VAMC Health Promotion and Disease Prevention Program to secure funding from the AmeriCorps program to expand Veteran access to evidence-based programs in their home communities. A partnership is now in place between the Houston VAMC and Neighborhood Centers-Sheltering Arms Senior Services to ensure Veterans with chronic medical or mental health problems can acquire skills in self-management and physical activity to avoid falls and maintain functioning.

Houston Alliance to Address Dementia (HAAD)

Houston investigators serve on the Leadership Group of this alliance, which is focused on linking medical and human service providers in order to expand provision of effective supportive services to persons living alone with Alzheimer's and dementia-related disorders, including Veterans, and strengthening delivery of behavioral symptom management training and expert consultation for family caregivers. Alliance partnerships help to increase access for Veterans to home and community-based services.

Calmer Life

This project is designed to increase access and reach of evidence-based care for late-life anxiety among older adults in underserved, low income, mostly minority communities. Calmer Life is person-centered, with flexibility in content and delivery options, and community providers are trained to deliver care.

Understanding Veterans' Experiences in PE and CPT

In this project, investigators interviewed Veterans who had completed evidence-based posttraumatic stress disorder (PTSD) treatments to examine the barriers and facilitators to entering care and to discuss with them what might have helped them start treatment, including their thoughts on how peer support for PTSD may have helped engage them in care.

Implementing Clinical Video Telehealth into the Home to Increase Rural Veterans' Access to Evidence-Based Psychotherapy for PTSD

This Clinical Video Telehealth into the Home (CVT-H) project is designed to implement telehealth technology to increase access to mental health treatment for underserved rural Veterans seeking care and to facilitate the adoption of CVT-H by providers.

Expanding the Use of Clinical Video Telehealth to Deliver Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE)

Conducted at eight VAMCs and their associated community clinics – this study employed external facilitation as the primary implementation strategy to increase the number of telehealth providers and encounters.

Clinical Video Telehealth into the Home for Mental Health Treatment: An Implementation Project

This project will expand access to evidence-based practices for eligible Veterans through the implementation of Clinical Video Telehealthinto the Home (CVT-H), pilot an implementation facilitation strategy to promote engagement of CVT-H, and evaluate outcomes of engagement and implementation for participating sites.

Improving Access to Mental Health and SUD Treatment for Justice-Involved Veterans with Telehealth

This pilot project aims to improve access to mental health and substance use disorder treatment for justice-involved Veterans by delivering treatment via clinical video telehealth into the home (CVTHM).

Improving Access to Mental Health and SUD Treatment for Homeless Women Veterans Using Telehealth

In response to poor treatment involvement and retention of women Veterans living in non-VA homeless shelters, we have designed a pilot trial to provide clinical video telehealth into the home (CVTHM) to these facilities.

Improving Access to Services with an Intensive Weekend Treatment for Panic

This study examined the acceptability and preliminary effectiveness of delivering a two-day intensive cognitive behavioral treatment for Veterans with panic disorder. Findings demonstrated high satisfaction with this treatment format, rapid symptom improvement, and a high rate of treatment completion.

Care for Women Veterans with Hepatitis C Virus Infection

The overarching goal of this study is to identify actionable drivers of timely access and receipt of Hepatitis C care in women Veterans.

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Indianapolis

Evaluation of VLER Indiana Health Information Exchange Demonstration Project

Non-VA care can provide Veterans with expanded access to medical services, but the usage, costs, and quality of non-VA care of Veterans is not well understood. This study aims to assess the proportion and predictors of healthcare received by Veterans outside VA, to assess the impact of health information exchange upon the quality of care received by Veterans, and to explore whether the implementation of health information exchange will reduce the economic expenditures of healthcare for Veterans.

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Little Rock

Development and Validation of a Perceived Access Measure

The overall objective of this project is to generate a psychometrically sound patient-centered measure of Veterans' perceived access to mental health treatments, with particular attention to the intersection of perceived access and e-health technologies.

Adapting and Implementing the Blended Collaborative Care Model in CBOCs

The goal of this study is to evaluate the implementation of a "blended" collaborative care model that has been adapted to provide both care management and open access to mental health specialists (i.e., "co-located" collaborative care) through telemedicine technologies. This will enable Veterans seeking care in community-based outpatient clinics (CBOCs) without on-site psychiatrists and psychologists to benefit from the blended care model that is available at medical centers and larger CBOCs.

A Computer-Assisted Cognitive Behavioral Therapy Tool to Enhance Fidelity in CBOCs

This study will test a computer-assisted tool (CALM Tools for Living) that increases fidelity to cognitive behavioral therapy in treating depression and four common anxiety disorders, including PTSD.

Tailoring Interventions for Rural Veterans: What We Need to Know

The primary objective of this study is to understand how attitudinal characteristics associated with rural culture operate to influence mental health service use among Veterans.

Variation in Implementation of the Partners in Care (PIC) Program

Partners in Care (PIC) aims to link National Guard members who need support with local religious congregations. This project evaluated implementation of PIC in five states, including evaluation of the training provided that included evidence-based suicide prevention gatekeeper training (i.e., Operation S.A.V.E.) as one component of PIC, and the extent to which trainees implemented the program.

Telemedicine Outreach for Post-Traumatic Stress in CBOCs

The Telemedicine Outreach for PTSD (TOP) collaborative care intervention consisted of care management combined with enhanced access to mental health specialty care through telemedicine technology. Significantly more patients randomized to the TOP intervention received evidence-based medications and evidence-based psychotherapy; intervention patients also had significantly greater improvements in PTSD and depression severity.

Implementing Telemedicine-Based Collaborative Care for MDD in Contract CBOCs

The purpose of this study was to implement and evaluate a successful telemedicine-based collaborative care model in small contract community-based outpatient clinics (CBOCs). Findings showed that national rollout strategies must target contract CBOCs to ensure access to collaborative care for all Veterans and to prevent future health disparities.

Rural/Urban Differences in Service Utilization among OIF/OEF Veterans

This study examined screening, diagnosis, and treatment of mental disorders among OIF/OEF Veterans living in rural settings. Results suggested that there were no systematic rural/urban differences in screening, diagnosis, and treatment of PTSD, depression, or alcohol use disorders in this cohort of Veterans receiving services.

Post-deployment Assessment of Behavioral Health Barriers in OIF Veterans

The purpose of this study was to conduct an intervention planning assessment to identify needs for and barriers to VA behavioral healthcare from the perspectives of newly returning National Guard soldiers deployed for Operation Iraqi Freedom (OIF) and among key stakeholders in Veteran Service Organizations. Findings suggested that interventions developed to engage Veterans in care must be directed toward contextual and cognitive factors that motivate treatment seeking, particularly in primary care settings where many Veterans seek care.

Telemedicine Intervention to Improve Depression Care in Rural CBOCs

This project implemented collaborative care for depression in small rural primary care practices without onsite mental health specialists, using a combination of depression care management and telemedicine technologies ("Telemedicine-Enhanced Antidepressant Management" – TEAM). Patients randomized to the TEAM condition had significantly better medication adherence and superior improvement in depression symptoms.

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Los Angeles

Implementation of Women's Health Patient Aligned Care Teams (PACT)

PACT aims to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient-driven and patient-centered. The main goal of this study is to develop and test an evidence-based quality improvement approach to tailoring PACT to the needs of women Veterans, incorporating comprehensive care in gender-sensitive environments, thereby accelerating achievement of PACT tenets for women Veterans.

Impacts of Delivery of Comprehensive Women's Health Care in the VA

This study examines VA facility and practice characteristics associated with achieving comprehensive services for women Veterans, and then examines impacts of varying levels of comprehensiveness on women's access, coordination, and quality of VA care.

PACT to Improve Health Care in People with Serious Mental Illness (SMI-PACT)

PACT aims to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient-driven and patient-centered. This study designs and implements a PACT team specifically tailored for Veterans with serious mental illness, with the goal of improving utilization of primary care and physical health outcomes.

ICU Rehabilitation: A Pilot Study

This study explores patient attitudes about self-rehabilitation in the ICU. It tests the safety and feasibility of a new ICU rehabilitation intervention aimed to empower patients and enable ICU physicians and nurses to provide rehabilitation support.

VHA-Indian Health Service Collaborations in Rural Health: HBPC

VHA and Indian Health Service entered into a Memorandum of Understanding in 2010 to improve access to healthcare and clinical collaborations for American Indian (AI) Veterans and cited pilot projects to deliver Home Based Primary Care (HBPC) as an example. This study documents these programs and the outcomes with an aim of making recommendations to expand care for AI and Alaska Native Veterans through similar collaborations.

Improving Care for Women Veterans with Substance Use Disorder

The goal of this project is to develop the foundational evidence needed to improve women Veterans' access to optimal, gender-sensitive substance use disorder care.

Lost to Care: Attrition of Women Veterans New to VHA Care

This study will examine issues such as access, utilization, and quality to understand attrition among women Veteran VA users.

Improving Patient Engagement in VA Supportive Housing

This study will inform intervention development that can decrease premature exits from Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH).

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Palo Alto

Differences in Quality, Cost, and Access between VA and Fee Basis CABG and PCI

VHA purchases Coronary Artery Bypass Graft (CABG) and Percutaneous Coronary Intervention (PCI) from purchased care providers, but there has been no evaluation of the trade-off between quality and travel burden from selective contracting. This study will evaluate the cost-effectiveness of provider selection criteria, including use of a VA provider located within a reasonable travel distance.

Veterans Justice Programs: Improving Access to Mental Health Services

Veterans Justice Program (VJP) specialists conduct outreach efforts with justice-involved Veterans to promote their long-term recovery by increasing access to, and engagement with, mental health and other VA services. Findings from this study have helped address VJP goals of moving toward implementation of empirically-supported interventions to address recidivism risk among this highly-vulnerable, and growing, population.

Justice-Involved Veterans: Mental Health and Substance Use Care of Young Adults

This project focuses on understanding entry to and engagement in mental health and substance use disorder treatment among Veterans involved in the criminal justice system.

The VA Women's Overall Mental Health Assessment of Needs (WOMAN)

The goal of this project was to build on the WOMAN study by adding an emphasis on gender-sensitive access to mental health care and explore the role of patient activation and engagement in women Veterans' access to mental health care.

Access to Specialty Care for Veterans with Complex Conditions

The study will examine how patients access specialty care and the link between specialty care, quality of care, and health outcomes.

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Pittsburgh/Philadelphia

Examining Contraceptive Use and Unmet Need among Women Veterans

This study will provide evidence on the current state of contraceptive provision and use among women Veterans – and how patient and system factors impact contraceptive use in order to generate clinically meaningful, patient-centered strategies to improve contraceptive care and decrease risk of unintended pregnancy.

The Influence of Obesity on Veterans' Quality of Life

In this study, no evidence was found that obese patients were less likely to access and receive recommended care relative to normal-weight patients across multiple, commonly-used measures of outpatient care quality, and success rates were often marginally higher for obese patients. While it may be true that providers often harbor negative attitudes towards obesity, this study indicates that these biases are not borne out in lower quality of care.

Assessing and Responding to Intimate Partner Violence among Women Veterans

This program of research seeks to fill gaps in knowledge about IPV among women Veterans and inform interventions to address the unmet needs within the Veterans Health Administration (VHA).

Development of a Multidimensional Pain Measure for Persons with Dementia

A key factor that contributes to undertreated pain in persons with dementia is impairment in their ability to report pain. Thus, the goal of this study is to develop a pain intensity measurement strategy for persons with dementia or traumatic brain injuries who have limited ability to self-report pain.

Safety of Opioid use among Veterans Receiving Care in Multiple Health Systems

By examining the extent of dual opioid use (use in VA and non-VA healthcare settings), the influences on dual use, and the effects of dual use on safety, VA can design more effective policies and interventions to ensure safe use of opioids for pain management in Veterans.

Staying Positive: An Intervention to Reduce Osteoarthritis Pain Disparities

This project tests a psychosocial intervention to reduce well-documented racial disparities in pain and functioning in Veterans with arthritis. In the future, this program could be used by Veterans with other chronic pain conditions and adapted for widespread implementation using electronic modalities.

Perceived Discrimination and Patient Assessments of Medical Encounters

This pilot study provides preliminary evidence regarding the impact of Veterans' personal history of perceived racial discrimination in healthcare settings on their assessments of medical encounters, thereby addressing an important gap in current understanding of the mechanisms by which discrimination can influence patient interactions with the healthcare system.

Improving Outcomes in Suicidal Veterans with Schizophrenia

This study's objective is to enhance, implement, and test the Health Buddy telehealth system in order to improve the outcomes of Veterans with schizophrenia and suicidality. Findings showed reductions in scores (i.e., improvement) measuring suicidal ideation and depression.

Telemedicine Management of Veterans with PTSD and Chronic Insomnia

This study will compare cognitive behavioral therapy for insomnia administered by video teleconferencing to in-person delivery, among Veterans with PTSD and chronic insomnia. Investigators anticipate the telemedicine intervention will significantly increase access to treatment, particularly for Veterans residing in remote and rural settings, and decrease treatment-related costs.

Cost-Effective Strategy to Evaluate Veterans with Sleep Apnea

Study findings indicate that patients receiving in-lab versus home testing have similar clinical outcomes, and that home testing is more cost-effective than in-lab testing. This should lead to wider acceptance of home testing of patients with suspected obstructive sleep apnea, thus increasing Veterans' access to care and reducing treatment costs.

Determinants of Diabetes Control in Veterans with Serious Mental Illness

Study findings indicate that in a population of Veterans with comorbid serious mental illness and diabetes, patients on average had good medication adherence and glucose control regardless of where they received primary care.

Identifying and Measuring Risk for Homelessness among Veterans

This study will evaluate VA's efforts at identifying Veterans at risk of Homelessness and linking them with services of their choosing that are both efficient and effective.

Understanding Race and Culture in Living Donor Kidney Transplantation

This study determined the extent to which culturally-related factors influence patients' preferences and decision-making in the key steps leading to transplantation, and has the potential to help explain the disparities in access to living donor kidney transplantation among Veterans. This will enable investigators to target interventions at patients when they first arrive to the transplant center and have the greatest opportunity and time to identify potential donors.

Informed Decision Making for Veterans Considering Lung Cancer Screening

The findings in this study will inform approaches to preference assessment and value elicitation to be used for decision support pertaining to accessing lung cancer screening.

Veterans' and Families' Priorities for Palliative Home Care Services

There is rapidly growing interest in alternatives to hospice that meet the palliative care needs of Veterans living at home with serious illness, without the eligibility restrictions that hospice imposes. This study identified preferences and priorities for palliative home care that can be used to design and deliver patient-centered palliative home care to Veterans.

Racial and Ethnic Disparities in Satisfaction with VA Care

This study will use an innovative approach to pinpoint key modifiable areas of dissatisfaction for African American and Hispanic Veterans, such as access and trust/distrust with VA care, as well as Veteran-identified potential solutions to improve care. This will contribute to the development of targeted interventions designed to improve satisfaction with VA healthcare among the growing proportion of Veterans who are racial/ethnic minorities.

Barriers to Initiating Antiviral Therapy for Veterans with Hepatitis C

This study is the first investigation to provide insights into the reasons that the vast majority of potentially eligible Veterans do not initiate or access medically indicated antiviral therapy for hepatitis C virus (HCV). Results suggest that future research efforts should be directed towards the development and testing of interventions at the patient and provider levels to address knowledge gaps and improve communication in order to improve treatment rates for HCV infection in VA.

Photovoice as an Educational Intervention to Improve Care of OEF/OIF Veterans

Photovoice is an innovative participatory research tool that empowers individuals to convey their experiences, perspectives, and needs through visual images and first person narratives. This study aimed to establish the feasibility of Photovoice as a novel approach to engaging Veterans in their own care. Findings included reasons for avoidance of VHA care in general and/or bypassing of particular VA facilities and barriers to accessing mental health care both within and outside VA.

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Providence

Aligning Resources to Care for Homeless Veterans (ARCH)

Primary care directed to homeless Veterans represents an opportunity to engage individuals in care, address unmet health needs, and facilitate receipt of services necessary to exit homelessness. This project will compare and contrast outcomes from four different adaptations and combinations of primary care delivery to homeless Veterans within the construct of the Patient Aligned Care Team (PACT) model for primary care.

Increasing Veterans' Use of Community-Based LTC Living Arrangements via Timely Discharge from VA CLCs

Prompted by the escalating costs of institutional care and the preferences of most Veterans who require these services to remain in the community, the landscape of VA long-term care (LTC) is changing rapidly. This project will examine changes in VA community living centers (CLC) over time, and identify the Veteran, CLC, and home and community-based services market factors associated with length-of-stay and successful discharge to the community, i.e., without readmission to nursing homes or other unintended consequences.

Implementing and Evaluating INTERACT in VA CLCs

The goal of this study is to implement and evaluate an intervention in VHA community living centers (CLCs) that is designed to improve the care of Veterans using CLCs who experience acute changes in their condition and at the same time reduce their rate of hospitalization. From the VA perspective, this means hospital beds will be available for more emergent cases without major increases in VHA costs.

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Salt Lake City

Current Evidence and Early Warning Indicators of Homelessness Risk among Veterans

The objectives of this project are to: 1) develop robust electronic algorithms to identify Veterans who are currently homeless or those who are at risk of homelessness using predictive modeling; and 2) review the extent to which Veterans are accessing and receiving appropriate services.

Veterans Like Mine Cognitive Support for Therapeutic Decision Making

The goal of this project is to develop an informatics tool that will retrieve and present information about other patients similar to the individual patient at hand, to facilitate the management of diagnostic uncertainty, the assessment and access of treatment options, and the prediction of clinical outcomes.

Cognitive Support Informatics for Nurse Medication Stewardship

This study will significantly improve the care of patients with delirium by improving team coordination, and enhancing early detection to enable greater access and more effective tailored response.

Cognitive Support for Shared Decision Making Using Veterans Like Me

The goal of this project is to enhance shared decision-making (SDM) between Veterans and healthcare providers. Investigators will empower patients to participate in SDM by providing graphical information regarding outcomes of interest, along with concrete stories about individuals like themselves.

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Tampa/Gainesville

Geographic Access to VHA Rehabilitation Services for OEF/OIF Veterans

At the time of this study, access to specialized rehabilitation services in the VA had been shrinking. Given the value of these services and the dramatic reduction in the number of specialized rehabilitation units in VA, it becomes critically important that the remaining VA rehabilitation resources are located where there is the greatest need for such services. If new resources are added for rehabilitation services, it is equally important to locate them where they will provide the largest impact in terms of filling service gaps and unmet need.

Identifying Potential Demand for VA Rehabilitation Services for OEF/OIF Veterans

The results of this research identified key catchment areas with the greatest potential demand for specialized VA rehabilitation resources and have confirmed that numerous such areas have potential demand that exceeds minimum optimal scale for rehabilitation units. Consequently, these results establish a strong case for expanded rehabilitation capacity for OEF/OIF Veterans with SCI, TBI, and amputations.

VA and Non-VA Healthcare Utilization and Outcomes by Veterans with Stroke

Findings from this study, including rural vs. urban patient comparisons, indicate that adequate access to needed post-stroke care of rural patients can enhance patients' stroke recovery.

Optimal Locations for VA Traumatic Brain Injury Treatment (RR&D funded, no link)

This project described and demonstrated a comprehensive location-allocation model to provide decision support for the location of VA's TBI treatment units and the allocation of admissions to these units.

Geographic Information System Analysis of Access to VA Acute Stroke Care

The ultimate goal of this project was to make strategic recommendations regarding the locations of VHA facilities capable of delivering acute stroke care, and the use of potential alternate strategies such as tele-stroke care or outsourcing to community stroke centers where VAMCs resources are lacking.

National Geographic Access Assessment

This project created reports for all 21 VISNs examining access to care for existing facilities (primary, secondary and tertiary care). In addition, a set of maps showed change in the percentage of enrollees geographically covered when proposed (but not approved) sites are included. In areas outside of VHA travel time bands, community resources were examined.

Smart Phone Application for Postconcussion Symptom Reduction

The primary goal of this study is to evaluate the efficacy of Concussion Coach, an interactive, self-management smartphone application, for improving clinical outcomes in those with a history of mild traumatic brain injury and to determine what aspects of Concussion Coach are most useful to Veterans.

Utilizing the RESCUE Stroke Caregiver Website to Enhance Discharge Planning

The purpose of this study is to determine the effects of a problem-solving intervention using the RESCUE stroke caregiver website and online text messaging on stroke caregiver outcomes.

Internet and Telephone Support Intervention for Stroke Caregivers

This pilot project will test the impact of an online and telephone intervention designed to improve outcomes of stroke caregivers and Veterans.

Web-based Informational Materials for Caregivers of Veterans Post Stroke

This project used an easily accessible website as a VA patient and family education resource to provide informal caregivers with low literacy-level, informational materials in both Spanish and English to improve the quality of their lives and the rehabilitation of their Veterans with stroke.

Improved Strategies for Disseminating Health Education Materials to Rural Stroke Caregivers

The objectives of this project are to improve and evaluate the dissemination mechanism for health education materials to rural caregivers of Veterans with stroke, in order to increase the access of rural Veterans and their caregivers to quality health education information.

Online and Telephone Skills-Building Program for Caregivers of Veterans with Stroke

This project will implement and evaluate an education and support program to improve outcomes of stroke caregivers.

A Lifeline for Stroke Caregivers: Addressing Rural Health Disparities

This project offered a low-cost strategy to improve informal caregivers' knowledge, skills, and quality of life through the dissemination of previously printed, evidence-based caregiver books, "Lifeline for Stroke Caregivers: Information and Resources to Keep Your Head Above Water."

Web Support for Caregivers of Elderly Veterans with Dementia

The goal is to compare and determine the effectiveness of two different approaches/technologies in support of caregivers of Veterans with dementia (telephone support versus internet-based support) on caregiver and Veteran outcomes.

Comparing Modalities for Tele-health Care Management of Elderly Patients and Their Caregivers

The goal of this project is to determine the relative effectiveness of providing caregiver support through telephone versus internet support.

Rural Veteran's TeleRehabiliation Initiative Expansion, Proliferation and Dissemination Project (RVTRI-EPDP)

The Rural Veterans Tele-Rehabilitation Initiative (RVTRI) delivers rehabilitation therapies from the medical center directly to veterans in their homes via a secure, encrypted, VA approved network. Respiratory and swallowing therapies, cognitive therapy, as well as creative arts therapies are delivered via this network.

Evaluation of a Web-Based Instruction Designed to Promote Rural Veterans' Adoption of VA's Electronic Resources

The goal of this project is to increase rural Veterans' knowledge of and access to VA electronic health resources (i.e., My HealtheVet, telehealth, Vet Link kiosks, Mobile applications) through the development and evaluation of Connect to Your Health (C2YH), an instructional and marketing web-application.

Veterans' Preferences for Exchanging Information Using VHA HIT

This study directly supports the Connected Health Program Efforts to increase Veteran access and meaningful use of health information technologies (HIT), such as My HealtheVet, telehealth, Vet Link kiosks, and Mobile applications.

Rural Veterans Supported Employment Tele Rehabilitation Initiative (RVSETI)

This project aims to increase access to evidence-based employment practices including supported employment and customized employment services in rural areas through existing VA telehealth technology and introduction of mobile televideo connectivity through the use of tablets (iPads).

Veteran-Initiated Electronic Care Coordination (VIECC)

The goal of this project is to train Veterans to access and share their VA Health Summary document with non-VA providers, creating a bridge between the Veteran and their healthcare providers.

Eyes behind the Camera: Partnering with Families for Home Safety

The goal of this project is to test an alternative method of delivering professional home safety evaluations by having caregivers video record the homes of Veterans for subsequent professional evaluation.

The Safe Locomotion in Dementia for Rural Veterans (SLID-R) Project

Rural-residing family caregivers of Veterans with dementia receive instruction on the proper use of wandering management and elopement prevention techniques via iPads/FaceTime app.

The Telehelp Line for Rural Veterans with Dementia Project

Rural-residing family caregivers of Veterans with dementia receive information, referral and REACH (Resources for enhancing Alzheimer's Caregiver Health) via the telephone.

Community-Based Agricultural Initiatives for Transitioning Rural Veterans

The aim of this project is to enhance and improve VA partnerships for increased healthcare outreach and access by assessing the impact of Veteran-oriented community agricultural initiatives on transitioning rural Veterans.

A Mobile Rehabilitation Clinic to Extend Physical Therapy Services to Community-Based Outreach Clinics

The aim of this project is to improve access to specialized rehabilitative services to rural Veterans via a Mobile Rehabilitation Clinic containing advanced rehabilitation technologies and telehealth services delivered by VA therapists.

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West Haven

IVR-based Cognitive Behavior Therapy for Chronic Low Back Pain

This study tested the efficacy of an interactive voice response (IVR)-based cognitive behavioral therapy (CBT) called COPES that is delivered in-home compared to standard in-person CBT delivered at a VA medical center. Findings showed that COPES leads to patient-centered outcomes that are no less effective than standard VA approaches in which CBT is delivered in-person by a therapist.

Cooperative Pain Education and Self-management (COPES) (no link yet, newly funded)

This project will evaluate the effectiveness of a facilitation-based approach on Veteran enrollment in COPES and will specifically target patients receiving their primary care in community-based outpatient clinics who often have limited access to specialty pain management services.

Comprehensive Opioid Management in Patient Aligned Care Teams (COMPACT) (no link yet, not funded)

This study will address quality of care gaps in chronic opioid therapy monitoring, education, and self-management support using a technology supported treatment called the Comprehensive Opioid Management in Patient Aligned Care Teams (COMPACT). COMPACT will use a web-enabled electronic, interactive voice response (IVR) telephone monitoring and care management system to conduct regular opioid monitoring, provide education, and deliver empirically validated self-management support between PACT visits.

Automated, Mobile, Ancillary Care for Substance Abuse Treatment (no link yet, not funded)

This study will evaluate the feasibility, acceptability, and preliminary efficacy of the Veterans' Recovery Line as an ancillary treatment in substance abuse treatment. The previously developed "Recovery Line" is a Cognitive Behavioral Therapy-based interactive voice response system to reduce substance use in patients receiving opioid agonist maintenance treatment.

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Other

Honolulu

Access to PTSD Care among Veterans with and without Substance Use Diagnoses

This study examined whether co-occurring substance use disorders (SUD) impart specific barriers to accessing PTSD specialty treatment. Results suggest Veterans with co-occurring SUD are obtaining their PTSD care in specialty care settings comparable to their non-SUD counterparts, even more so in some cases.

San Francisco

Leveraging HIT to Improve Specialty Care Access and Coordination in HCV

Project SCAN-ECHO is based on a structured remote telemedical model that has been shown to improve hepatitis C (HCV) care outcomes in rural areas outside the VA healthcare system. This study will compare hepatitis C and liver-related quality of care among patients enrolled in VA SCAN-ECHO sites to those in structurally similar control sites.

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QUERI Programs

QUERI for Team-Based Behavioral Health - Little Rock, AR

This QUERI Program will enhance and inform team-based care for Veterans with behavioral health conditions. One component of this program will work to implement a tele-mental health project in rurally located community-based outpatient clinics VISN 20.

Bridging the Care Continuum QUERI - Bedford, MA

The goal of BridgeQUERI is to improve vulnerable Veterans' use of services across the care continuum, "bridging" the continuum by improving outreach and diagnosis, as well as linkage and engagement with specialty care, which will lead to better health outcomes.

Improving Pain-Related Outcomes for Veterans (IMPROVE) - VA Connecticut Healthcare System and VA Palo Alto Health Care System

The primary goal of this Program is to improve safe and effective pain management through partnered implementation of personalized, proactive, patient-centered interventions that optimize access to care.

The Care Coordination QUERI- Los Angeles, CA

The Care Coordination QUERI aims to learn how to improve coordination between the Veteran, his or her primary care team, and the specialty care, emergency department, hospital, and home community resources the Veteran may need.

Precision Monitoring to Transform Care (PRISM) - Indianapolis, IN

Several projects within this program include a focus on access, including testing telehealth modules and electronic clinical quality measures for improving rapid transient ischemic attack care, and a local quality improvement project to implement and evaluate a remote sleep apnea monitoring program.

Virtual Specialty Care QUERI Program - Seattle, WA

While community-based outpatient clinics have dramatically improved access to first-class primary care services, it has been more challenging to deliver specialty care to rural Veterans. This QUERI Program will work to implement and evaluate technology-facilitated clinical interventions designed to improve outcomes for rural Veterans.

The Enhancing Mental and Physical health of Women through Engagement and Retention (EMPOWER) QUERI - Los Angeles, CA

EMPOWER QUERI is designed to improve women Veterans' engagement and retention in evidence-based care for three high-priority health conditions: diabetes, cardiovascular disease, and anxiety/depression.

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QUERI Partnered Evaluation Initiatives

VA Caregiver Support Evaluation Center (VA CARES) - Durham, NC

The Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law:111-163) enacted legislation to enhance access to training, services, and assistance for Veteran caregivers in need through two landmark programs: Comprehensive Assistance for Family Caregivers, and Caregiver Support Services. This project will evaluate the impacts of these programs on Veterans and caregivers, to include how the Comprehensive Program has affected Veteran health care utilization.

Evidence-Based Policy Resource Center - Boston, MA

The Evidence-Based Policy Resource Center's core mission includes refining VA measurements of access to care, productivity, demand, and capacity, as well as investigating relationships among them to improve policy and planning. Of particular interest are the relationships between capacity/demand and productivity/access.

Office of Health Equity-QUERI Partnered Evaluation Initiative - Los Angeles, CA

Among other activities within this initiative, investigators also will evaluate whether characteristics of the healthcare delivery settings (e.g., geography, treatment setting) and of the types of care that individuals use, including new models of care such as telehealth, influence the quality of care that Veterans receive.

Cleveland Evaluation of OSC Specialist Knowledge Management Initiatives - Cleveland, OH

Four initiatives of the Office of Specialty Care Transformation Initiatives Program (OSC) focus on enhancing the ability to take advantage of specialist expertise closer to where a Veteran lives. This QUERI initiative will evaluate the extent to which each of the four OSC initiatives meet the clinical and organizational goals of each program (i.e. improving clinical outcomes, access to care, and patient/provider satisfaction).

Denver-Seattle Specialty Care Evaluation Initiative - Denver, CO and Seattle, WA

The VA Office of Specialty Care Services/Office of Specialty Care Transformation (SCS/OSCT) implemented a number of transformational initiatives designed to improve access and delivery of specialty care. This QUERI Evaluation Initiative aims to partner with SCS/OSCT to evaluate the impact of the specialty care transformation initiatives, as well as to inform decisions about maintaining, modifying, and/or expanding the programs.

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