Health Services Research & Development

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HSR&D Investigator Quarterly

SPRING 2019 issue:

  • Spotlight: HSR&D Awardees
  • Research News: Highlights and deadlines for grant and paper submissions
  • Recently Published: Papers, briefs, and other work by or featuring HSR&D investigators
  • Awards & Honors: Links to recent recipients of national awards, honors, or significant career achievements

NOTE: HSR&D Investigator Quarterly replaced HSR&D Research Briefs (archived here).
Recommended Reading
"Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients with Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial," by Erin Krebs, MD. Dr. Krebs received the 2018 HSR&D Best Paper award for this article describing her groundbreaking work in pain management. The article was ranked by JAMA as its third most talked about article published in 2018.

"Prevalence of Stranger Harassment of Women Veterans at Veterans Affairs Medical Centers and Impacts on Delayed and Missed Care", by Ruth Klap, PhD, Jill Darling, MSHS, Alison Hamilton, PhD, et al, looks at the impact that harassment of women Veterans has on their ability and decision to get care at VA medical centers.

Spotlight
2018 HSR&D Award Winners

Established in 2015, the HSR&D Awards are comprised of three categories: Best Research Paper, Health System Impact, and the Daniel Deykin Mentor Award. These awards are designed to recognize and honor significant and meritorious achievements that have had a direct impact on the VA healthcare system, its practitioners, and Veterans' care.


Erin E. Krebs, MD, MPH

Erin E. Krebs, MD, MPH, received the 2018 HSR&D Best Research Paper Award, which honors a single article or collection of articles resulting from one or more HSR&D- or QUERI-funded investigations. Research studies also must involve Veterans, with results that are important to Veterans' health and care, and to the VA healthcare system.

Dr. Krebs's article, "Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients with Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial," was published in JAMA. Funded by HSR&D, this landmark study is the first randomized trial to report long-term pain, function, and quality of life outcomes of opioid therapy for chronic pain. Investigators randomized 240 VA patients with chronic back pain or osteoarthritis pain that was moderate-to-severe despite analgesic use. Veterans were recruited from 62 Minneapolis VA primary care clinicians (June 2013 to December 2015). Patients were then randomized to one of two intervention groups: opioid therapy or non-opioid medication therapy. Each intervention had its own prescribing strategy. In the opioid therapy group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the non-opioid group, the first step was acetaminophen or a non-steroidal anti-inflammatory drug. The primary outcome was pain-related function over 12 months, and the main secondary outcome was pain intensity. Study findings show that opioids did not result in better pain-related function or pain intensity compared to non-opioid drugs in Veterans with chronic pain. These results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip/knee osteoarthritis pain.

Dr. Krebs is part of HSR&D's Center for Chronic Disease Outcomes Research (CCDOR). Her professional goal as a general internist and health services researcher is to improve the management of chronic pain in primary care. She currently leads an HSR&D nationwide study of VA patients on long-term opioid therapy and a Patient Centered Outcomes Research Institute (PCORI)-funded VA multisite trial testing approaches to improve pain and reduce opioid use among Veterans on high-dose long-term opioid therapy.

George Sayre, PhD
George Sayre, PhD

George Sayre, PhD, is the recipient of the 2018 HSR&D Health System Impact Award. This award honors HSR&D- and QUERI-funded research that has had both a direct, important impact on clinical practice or policy within the VA healthcare system, and that has been successfully translated into VA's policy or operations. Dr. Sayre earned the Impact Award for critical contributions to VA's efforts to ensure and improve Veterans' access to care.

Findings from Dr. Sayre's work have provided the Veteran Office for Access to Care and other VA central offices with invaluable insights into the experience of Veterans, VA providers, frontline staff and community stakeholders, ensuring that their voices are heard by policymakers. For example, during the 2014 waitlist stand-down, Dr. Sayre was tasked by the VA Office of Analytics and Business Intelligence to analyze brief interviews from frontline staff at every VA healthcare facility.

In 2018, Dr. Sayre published an evaluation of the 2014 Veterans Choice Act (VCA), "Accessing Care Through the Veterans Choice Program: The Veteran Experience". In it, Dr. Sayre and colleagues identified significant barriers (complexity and lack of available local providers) that are most likely to impact the very Veterans who need access to community care the most—those who have cognitive impairments, more complex health issues, declining self-management capacity, and/or live in rural communities. Findings from the ongoing Choose VA access evaluation also identified negative impacts from the VCA on relationships with local community providers that may impact the implementation of the VA Mission Act of 2018. The Mission Act combines seven VA community care programs, including the VCA, into one program to make efficient use of VA healthcare resources. Dr. Sayre was recruited to examine the Mission Act. Drawing on findings from his previous and ongoing access research, he identified critical potential challenges to effectively implementing the Mission Act, most notably, that the possibility that any increased burden placed on community providers to comply with future VA quality standards will result in decreased participation and, thus, negatively impact access to care in the community. These findings have been shared with the Mission Act Quality Workgroup and will be incorporated into VA's report to Congress.

Dr. Sayre is Director of the Qualitative Research Core for HSR&D's Center of Innovation for Veteran-Centered and Value-Driven Care. In addition, he provides methodological support for a wide variety of local and national research projects, including as qualitative lead for two HSR&D/QUERI national programs: Improving Safety and Quality and Virtual Specialty Care, in addition to the VA Collaborative Evaluation Center. Dr. Sayre also is principal investigator of the Choose VA access evaluation.

Michael Fine, MD, MSc
Michael Fine, MD, MSc

Michael Fine, MD, MSc, is the recipient of the 2018 HSR&D Daniel Deykin Award for Outstanding Mentor, which is presented each year to an HSR&D researcher(s) who exhibits outstanding dedication in mentoring the next generation of researchers. Skills of particular importance include fostering appreciation for the vital input provided by VA stakeholders, including VA policymakers and Veterans, as well as guiding mentees toward a thorough understanding of the positive impact research can have on the health and care of Veterans.

Dr. Fine has advised and/or trained 68 mentees within the VA Pittsburgh Healthcare System and/or its academic affiliate, the University of Pittsburgh. These mentees include two former HSR&D Career Development Awardees—doctors Walid Gellad and Steven Weisbord, who now lead independent research programs that have improved the health and care of Veterans. Dr. Gellad called him, "a model mentor…the real-life version of the idealized mentor we all read about and hear about as we begin our careers in health services research." Dr. Gellad also notes that a key to his success as an investigator "has been the way Michael impressed upon me the importance of ensuring that my work has direct relevance to the VA healthcare system and Veterans." Dr. Weisbord was "immediately struck by the sincere interest he [Dr. Fine] took in me both as a young physician attempting to navigate the challenging transition from trainee to junior attending—and as an aspiring investigator with no practical experience or formal research training. Since that time and over the past 15 years, Michael has been my primary mentor and driving force behind my professional development and success."

Dr. Fine's esteem as a mentor also stems from his personal qualities and actions. He dedicates substantial time and personal interest to the success of his mentees. He facilitates their professional collaborations and partnerships, advocates for new responsibilities and leadership roles, and identifies new professional opportunities, while emphasizing the importance of work-life balance. Moreover, he effectively role models the professional behaviors of a successful clinician-investigator and mentor. Dr. Fine has been a consummate mentor and role model for over a generation of health services research investigators that represent diverse medical professionals across all phases of career development. Both Dr. Fine's and his mentees' success is magnified by the impact their scholarship has had in shaping health services research, patient care, and healthcare policy.

Dr. Fine is Co-Director of HSR&D's Center for Health Equity Research and Promotion. He is also a general internist with a 25-year track record conducting research on the quality and equity of care for vulnerable patients (e.g., racial and ethnic minorities, women, elderly, HIV+) with common medical problems (e.g., pneumonia, diabetes).

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Research News
Research news highlights and deadlines for grant and paper submissions

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Recently Published
Papers, briefs, and other recent work by or featuring HSR&D investigators

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Awards & Honors
Recent recipients of national awards, honors, or significant career achievements

To submit an award notice for possible publication on the HSR&D website, be sure that the award is recognized at a national and/or international level. Internal awards, such as departmental awards, are not accepted. The award can be for a Center-wide achievement or for an individual investigator.


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