HSR&D Research Briefs disseminates news and information to the HSR&D investigator community. In this issue:
Spotlight: VA/CDC Collaboration on Infection Prevention Practice-Based Research Network
A new and unique infection control-focused, practice-based research network (PBRN) will be jointly-funded by VA and the Centers for Disease Control and Prevention (CDC). Within VA, Eli Perencevich, MD, MS, Director of HSR&D's Center for Comprehensive Access & Delivery Research and Evaluation (CADRE) and CADRE Associate Director, Heather Reisinger, PhD, will be leading the initiative. Dr. Perencevich will lead the 15-site PBRN for which the CDC provides funding, and Dr. Reisinger will lead the VA-funded implementation core that will support the new network. In the following interview, Drs. Perencevich and Reisinger discuss aspects of the collaboration, and how it may eventually impact care within VA and beyond.
Q: Was there a specific need or needs–in regard to Veterans and/or the VA healthcare system–that gave rise to the collaboration? If not, how did the joint venture form?
EP: If we are to improve the quality of care by reducing healthcare associated infections (HAIs) in the VA healthcare system, we must continue to develop and test new interventions and new bundles while assessing optimal implementation strategies. To evaluate interventions in infection prevention, we need "clusters" of wards, ICUs, or hospitals to complete these studies and, therefore, a network of hospitals is needed. Other countries have these networks, but the US and VA lack these study networks.
HR: Through the MRSA Prevention CREATE, we have had the privilege of working with infection control and prevention teams at 10 VA healthcare networks across the country. We conducted observations and qualitative interviews at all of the facilities, giving us a wealth of rich knowledge about the infection control and prevention context at each site. The infection prevention PBRN in partnership with CDC is a natural extension of this work and will allow us to rapidly implement and test a wide variety of infection prevention and antimicrobial resistance interventions.
Q: VA has a long history of research that has eventually expanded to become standard practice throughout the US healthcare landscape. Is there a practice or treatment that might arise from this work that you hope follows a similar trajectory?
EP: Every intervention and every implementation strategy we test in these networks could become standard throughout the US healthcare system. One of the unique aspects of this network is that each member VA has an affiliated non-VA university hospital. Thus, several interventions will also be tested in non-VA hospitals.
HR: As the Implementation Core Director for the PBRN, I am excited to work to move some of the implementation research we do in VA into standard practice in the broader US healthcare landscape. We are piloting an innovative approach, in which we are training research coordinators at each of the sites to conduct targeted, qualitative interviews and observations to inform the choice of implementation strategies for the infection control interventions. In a national healthcare system, a network of people skilled at doing rapid assessments to inform implementation strategies and processes could have a major impact on spreading innovations. We plan to develop a toolkit for training individuals to skillfully conduct these assessments.
Q: Is there a near-term outcome that will directly impact the health of, and care for, Veterans using VA care?
EP: To add to what Heather mentioned, one study will test improved implementation of a post-operative surgical site infection prevention bundle, and this could be quickly implemented in VA.
HR: Near term, we may be able to deploy effective environmental cleaning bundles more quickly and reduce the number of inappropriate antibiotic prescriptions. These two interventions could reduce the spread of microorganisms in VA healthcare settings – and reduce the negative impact of unnecessary antibiotics on patient outcomes. The goal is to test these innovations within the network and rapidly spread them throughout VA, if effective. CDC then hopes to leverage the intervention to disseminate toolkits and guidelines to healthcare more broadly.
Learn more about the VA-CDC infection control PBRN here, or visit the HSR&D website's CREATE section to read abstracts of the original studies that comprised the MRSA Prevention CREATE.
Research News & Calls for Submission
- VA Joins NIH and DoD to Announce Pain Management Research Partnership. Through an interagency partnership, the National Institutes of Health, Department of Defense, and VA announce a research collaboration focusing on non-drug approaches for pain management that address the needs of service members and military Veterans. Learn more...
- HSR&D Research Performance Progress Report Change. HSR&D will implement a new annual reporting requirement for all its funded studies. Reporting will occur within the VA Office of Research and Development (ORD) Research Performance Progress Report (RPPR) function in NIH eRA Commons. Learn more...
- Project Modification and Funding Notice Changes. As of September 27, 2017, HSR&D will no longer be communicating Project Modification Request Notifications or Funding Notifications via official letter format.
- Use of ORD Budget Workspace SharePoint Site. VA's Office of Research and Development (ORD) Budget Workspace SharePoint Site may be utilized for some minor fiscal transactions. Stations should use the ORD Budget Workspace SharePoint site to send requests for all transfers and pullbacks. Learn more...
- Easy-to-Use Advance Care Planning Tools Increase Planning among Older Veterans. HSR&D investigator Rebecca Sudore, MD, and colleagues published, "Effect of the PREPARE Website vs. an Easy-to-Read Advance Directive on Advance Care Planning Documentation and Engagement among Veterans: A Randomized Clinical Trial" in the August 1, 2017 issue of JAMA Internal Medicine.
- Investigator Insights Podcasts. The HSR&D podcast series includes brief interviews and discussions of current research with investigators throughout VA. The following podcasts have recently been posted.
- Treatment of PTSD in Veterans, featuring Natalie Hundt, PhD.
- Telehealth in VA and electronic medical record best practices, featuring Jane Anderson, MD.
- Audit and feedback in clinical care coordination, featuring Sylvia Hysong, PhD.
- Veteran community engagement committee, featuring Lindsey Martin, PhD, and Ashley Gendrett, MPH.
- QUERI eNEWS. The September 2017 issue of the Quality Enhancement Research Initiative eNews is now available on the QUERI website.
- HSR&D FORUM. The Summer 2017 issue of FORUM looks at rural health, Veterans' access to care, and the Veterans Choice program, and the Fall 2017 issue addresses the role nurses play in managing Veterans' care.
- Evidence Synthesis Program. HSR&D's Evidence-Based Synthesis Program (ESP) was established to provide syntheses of targeted healthcare topics of particular importance to VA managers and policymakers, and to disseminate these findings throughout VA. Many reports are embargoed pending journal publication, but are available for internal VA use via the ESP's intranet page http://vaww.hsrd.research.va.gov/publications/esp/reports.cfm. Access to intranet-only publications is limited to those with a VA intranet connection.
Recent ESP reports available on the HSR&D website:
Recent ESP Reports available on the ESP intranet page at http://vaww.hsrd.research.va.gov/publications/esp/reports.cfm (**access from within VA firewall ONLY**):
- Challenges and Opportunities for Pay-for-Performance as Veteran Care Moves into the Community
- Management of Antiplatelet Therapy among Patients on Antiplatelet Therapy for Cerebrovascular or Peripheral Vascular Diseases Undergoing Elective Non-cardiac Surgery
- Evidence Review: Social Determinants of Health for Veterans
- Integrated Outpatient Palliative Care in Oncology
- Effectiveness of Interventions to Improve Emergency Department Efficiency: An Evidence Map
- Enhanced Recovery After Surgery (ERAS) Programs for Patients Undergoing Colorectal Surgery
- In Progress. This quarterly, topic-specific publication highlights ongoing HSR&D research–some of which has produced early findings, presentations, and publications. The Fall 2017 issue focuses on research designed to improve care for a variety of mental health
- HSR&D Monthly Spotlight. The HSR&D website publishes a monthly feature highlighting ongoing and recently concluded HSR&D- and QUERI-funded investigations focused on a single topic. The following topics have been recently featured:
Eve Kerr, MD, Elected to National Academy of Medicine. VA HSR&D investigator, Eve A. Kerr, MD, MPH, Director of HSR&D's Center for Clinical Management Research, has been elected as a member of the National Academy of Medicine (NAM). Dr. Kerr will be inducted to the NAM in October, 2018. Learn more...
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.
Looking for published research? The search tools for articles, presentations, citations, and HSR&D internal publications include the following:
- Research by Topic. A search keyed to VA's priority topic areas. Results collect all current HSR&D projects, citations, reports, Cyberseminars, videos, or other products and resources available on the HSR&D website.
- Citations. Search citations from journals, meetings, conferences, and reports credited to HSR&D researchers.
- Publications. A search option for HSR&D and QUERI-produced publications, as well as Evidence Synthesis Reports.
- Women's Health Literature. A database of citations, studies, and publications about women Veterans health and healthcare
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 managed project, and for publications authored/co-authored by an HSR&D-supported investigator, regardless of funding source. To submit your notification, 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.
Find links to studies for which funding began within the last three months.
If you have feedback about Research Briefs, or suggestions for topics of interest about which you'd like to read, please send an email to: HSRDWeb.Boston@va.gov.