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HSR&D Research Briefs

NOTE: beginning in December, 2018, HSR&D Investigator Quarterly replaces HSR&D Research Briefs.

HSR&D Research Briefs – Spring 2012

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April 2012

HSR&D Research Briefs is an electronic newsletter designed to disseminate news and information to the HSR&D investigator community. In this issue:

Special Feature

Making First Contact with Hard-to-Reach Study Populations

by Ellen P. Fischer, Ph.D.; P. Adam Kelly, Ph.D.; Dana Perry, M.A.; Ann Cheney, Ph.D.; Karen Drummond, Ph.D.; Xiaotong Han, M.S.; Teresa J. Hudson, Pharm.D.; Kenneth Pietz, Ph.D.; Shubhada Sansgiry, Ph.D.; Nancy Schoenberg, Ph.D.; Melonie Shelton; Annette Walder, M.S., and Irmgard Willcockson, Ph.D.

Application of the Health Information Portability and Accountability Act (HIPAA) to research has made it more challenging to find ways to make initial contact with potential study participants that will be both effective and acceptable to local institutional review boards (IRBs). There is little literature on recruitment strategies, especially in the Veteran population. In addition, the acceptability of specific recruitment strategies to local IRBs changes over time and varies by facility.

In that context, South Central MIRECC surveyed its affiliated investigators about the effectiveness of various strategies they have used in contacting potential research participants. A brief electronic questionnaire was distributed in spring 2011 (principal investigators on multiple studies were asked to complete a separate questionnaire for each study). Twenty-seven investigators reported on 35 unique primary-data-collection studies. Most studies (60%) were experimental.

Strategic Approach

Respondents were asked to indicate which of the following common strategies they had used in each study.

  1. posting flyers at clinical sites
  2. posting flyers in community sites
  3. asking clinicians to refer potentially eligible Veterans
  4. asking Veterans already participating in the study to refer other eligible Veterans
  5. identifying potential participants through registries
  6. contacting Veterans through the mail using opt-in* letters
  7. contacting Veterans through the mail using opt-out* letters

*Opt-in letters stated that Veterans would be contacted by study personnel only if they responded to the initial letter indicating that they were interested in the study; opt-out letters stated that Veterans would be contacted unless they indicated that they did not want to be contacted.

The most frequently used strategies were:

  1. clinician referral (62% of studies)
  2. flyers in clinical sites (49%)
  3. opt-out letters (36%)
  4. participant referral (23%)

In addition to the specific strategies, investigators surveyed also reported additional methods:

  1. doing community outreach through educational presentations (n=2)
  2. approaching potential participants during clinical visits (n=2)
  3. advertising in local military newspapers (n=1)
  4. being approached by a VA-affiliated non-profit group that had learned about the study on and wanted to make its membership aware of the study (n=1))

Results and Effectiveness

Respondents were first asked to rate the effectiveness of each strategy used. Most strategies were considered effective by at least 50% of those who responded to the question; however, only 25% rated flyers posted at community sites effective, and only 21% rated flyers posted at clinical sites effective.

Respondents who had used multiple strategies (23 studies) were also asked to indicate which strategy had been most effective. Strategies most often ranked "most effective" were opt-out letters (50%), and registries (50%). Those least likely to be ranked "most effective" were community flyers (0%), opt-in letters (0%), and flyers in clinical sites (10%).

Key Lessons and Discussion

When asked what lessons about recruitment they would like to share with others, respondents' main messages were:

  • Recruiting—especially recruiting OEF/OIF/OND Veterans—is difficult.
  • If you can only use one approach, make it the opt-out letter and try to avoid having to go through providers for permission to contact their patients.
  • Active clinician buy-in is hard to get, especially if you are not a clinician, but it is invaluable if you can really get it.

While recruitment remains a challenge, several effective approaches were identified: opt-out letters, registries, and clinician referral. Registries of Veterans who have agreed to be contacted for future research offer an efficient as well as effective strategy; unfortunately, there are few such registries. Registries that are solely lists of Veterans with a given diagnostic or other characteristic (such as deployment or service period) allow for efficient identification of potential participants, but do not obviate the need for approval of an actual contact strategy. Clinician referral appears to be most effective when the principal investigator is also a practicing clinician who has good relations with referring clinicians and can offer something in exchange.

For non-clinicians, registries of Veterans willing to be contacted for research are ideal. When such registries are not available, requesting approval to use opt-out letters as an initial strategy seems indicated. In the past, IRBs have often required evidence that other approaches had failed before approving use of opt-out letters. The experience of these MIRECC investigators regarding the effectiveness of opt-out letters and the lack of effectiveness of three common strategies (opt-in letters, flyers placed in either community or clinical settings) may be useful in convincing IRBs to approve opt-out letters as an initial strategy.

To learn more about this study, please contact Dr. Adam Kelly at


News, Notices, & Recent Dissemination

Research News

2012 HSR&D/QUERI National Conference

The 2012 HSR&D/QUERI National Conference will be held during the week of July 16 at a location to be determined. The conference theme, "Transforming Veteran Healthcare through Partner-Oriented Research," was selected because of HSR&D/QUERI's commitment to examining best practices in implementing state-of-the-art healthcare for Veterans that is highly relevant to all corners of our health system. The conference is being planned and co-hosted by HSR&D's Center for Health Services Research in Primary Care, located at the Durham VAMC, and QUERI (Quality Enhancement Research Initiative). Dates and location will be posted on the National Conference website as soon as they are available.

HSR&D Names New Deputy Director

Sara J. Knight, Ph.D., has been named Deputy Director of VA HSR&D, effective March 11, 2012. Dr. Knight previously served as Acting Director of HSR&D's Program to Improve Care for Veterans with Complex Comorbid Conditions, located in San Francisco, CA. This Research Enhancement Award Program (REAP) was created to support scientific investigation that contributes toward improved quality of healthcare for Veterans with complex comorbid conditions. Learn more...

Two Centers Funded to Evaluate Specialty Care Transformation Initiative

As described in the late October issue of Research Briefs online, VA HSR&D's Quality Enhancement Research Initiative (QUERI) and VA's Office of Specialty Care Transformation (OSCT) would be funding two centers to evaluate four Specialty Care Transformation Initiative projects. Awards went to two Evaluation Centers, whose goals will be two-fold: First, they will assess the transformational initiatives and discern how to improve those initiatives; second, they will seek to identify variations in aspects of implementation for those initiatives.

New: Career Development Awardee Spotlight

The Career Development Program is an important investment in human capital to conduct high quality, cutting edge research. The goal of the program is to attract and retain the best and the brightest, and for more than 20 years, the program has provided qualified post-doctoral investigators in health services research with a supportive, Veteran-focused clinical and mentoring environment. To further highlight the HSR&D scholars in this program, we have created a new CDA Awardee "Spotlight" page on the web. Visit the new CDA spotlight page to read interviews with highlighted awardees. Visit the CDA home page to read about all current CDA participants, alumni, and research career scientist awardees.


Merit Review Board Updates

  • Winter 2012 Merit Review. The Winter 2012 Scientific Merit Review Board meeting was held from March 6-8, during which 156 applications were reviewed including 119 investigator-initiated research (IIR) projects, 1 service directed project, and 36 CREATEs. Scores were released on March 13 via eRA to all principal investigators (PIs), and summary statements with key points were released to all CREATE project PIs on March 23. Project notifications to IIR PIs will be released by April 4. Funding decisions for IIRs will be finalized by April 1, and the Notification of Review Outcome letters are scheduled to be released to the field via ART during the second week in April. A secondary review for the CREATEs will be held on April 23rd and funding decisions will be released on May 4th.
  • Summer 2012 Merit Review. Nine RFAs for the Summer 2012 Merit Review are now available online at the ORD RFA and Program Announcements web page. An updated CREATE RFA will be posted soon. Key dates in this review cycle:
    • April 2: ITS opens in ART
    • May 1: ITS closes in ART
    • May 15: The first day to submit applications to eRA/
    • June 8: Last opportunity to submit and utilize the 2 business day examination window*
    • June 13: Last possible submission date for applications
    • June 18: eRA verification deadline

*Note about submission window: The last opportunity to submit an application and utilize the two-day business examination window is Friday June 8. The two-day review period will occur from June 11 - 12, and any changed or corrected applications must be entered no later than June 13. Submissions sent on June 13 cannot use the two-day business examination window, as any resubmission after this date will miss both the June 13 submission deadline and the June 18 eRA verification deadline.

NIH Sponsors 2012 Summit on the Science of Eliminating Disparities

The National Institutes of Health, in coordination with the Department of Health & Human Services, Office of Minority Health, and the National Institute on Minority Health Disparities will be holding the 2012 Summit on the Science of Eliminating Health Disparities—Integrating Science, Policy and Practice; Building a Healthier Society—from October 31 through November 3, 2012 at the Gaylord National Resort and Convention Center in National Harbor, Maryland. For more information about this conference, please contact

Academy for Healthcare Improvement Meeting

The Academy for Healthcare Improvement is sponsoring a two-day meeting in Arlington, VA on May 7- 8, 2012 on "Advancing the Methods for Quality Improvement Research." The meeting program includes experts on quality improvement research. For more information, or to register for this conference, visit:

Calls for Submissions

  • Journal of General Internal Medicine: Papers are requested for a special supplement on Women Veterans' Health and Health Care. Submissions should provide insight for clinicians, educators, researchers, administrators, and policymakers regarding issues related to care for women Veterans. All manuscripts must be submitted by May 7, 2012.
  • Medical Care: VA HSR&D's Quality Enhancement Research Initiative (QUERI) program is sponsoring a special supplement issue in Medical Care on health information technology (HIT) strategies to support quality improvement (QI) research. All manuscripts must be submitted by May 1, 2012.

Recent Dissemination

Articles by VA HSR&D Investigators in December Issue of Translational Behavioral Medicine

The December 2011 issue of the journal, Translational Behavioral Medicine, features articles by VA HSR&D investigators, clinicians, and policymakers working to implement evidence-based behavioral medicine practice in VHA clinical settings. Topics covered include cancer screening, weight management, stroke, and mental health policy, and articles feature empirical research, case studies, conceptual models, and commentaries that illustrate the substantial translational efforts that have been initiated in VHA.

New ESP Reports Published

VA HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP) was established to provide timely and accurate syntheses of targeted healthcare topics of particular importance to VA managers and policymakers — and to disseminate these reports throughout VA.

The latest reports available online include:

Available on the VA intranet only:

  • Family Involved Psychosocial Treatments for Adult Mental Health Conditions
  • Working Conditions on Patient Care


Awards & Honors

HSR&D investigators conduct groundbreaking research, much of it recognized nationally and/or internationally.

2012 Under Secretary's Award for Health Services Research

Elizabeth Yano, Ph.D., M.S.P.H., is the recipient of the 2012 Under Secretary's Award for Outstanding Achievement in Health Services Research—the highest honor for a VA health services researcher. Dr. Yano is co-Director of HSR&D's Center for the Study of Healthcare Provider Behavior in Sepulveda, CA, and has been a part of the Center since its inception. She also has been part of the VA Greater Los Angeles Healthcare System for more than 20 years. Learn more...

To learn more about your colleagues who've been honored for their research and professional efforts, visit the Awards & Honors page on the HSR&D website.

Newly Funded HSR&D Studies and QUERI Projects

Find links to studies for which funding began within the last three months.


Publications, Citations, and Search Tools

Looking for published research? The search tools for articles, presentations, citations, and HSR&D internal publications include the following:

  • For citations from journals, meetings, conferences, and reports that were credited to HSR&D researchers, use the HSR&D citations search feature.
  • For HSR&D-produced publications and Evidence Synthesis Reports, use the HSR&D publications search feature.

Publication Notification

Please let us know as soon as you have an article accepted for publication. This applies to all publications based on an HSR&D-funded, or HSR&D-managed project, or authored/coauthored by an HSR&D-supported investigator, regardless of funding source. To submit your notification, please use the VA Intranet-based PubTracker system. Instructions for accessing PubTracker are available on the Publication Notification Requirement page of the For Researchers section on the HSR&D website.



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