Research Impacts - Center for Innovations in Quality, Effectiveness and Safety
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Research Impacts

Selected publications represent strong scientific results that improve patient care, health policy and guidelines, and health-system procedures and exemplify our extensive partnerships and collaborations.

 

Publications

A controlled trial of Partners in Dementia Care: Veteran outcomes after six and twelve months.

PMID: 24764496."Partners in Dementia Care" (PDC) tested the effectiveness of a care- coordination program integrating health care and community services and supporting both Veterans with dementia and their caregivers. Delivered via partnerships between VA medical centers and Alzheimer's Association chapters, PDC's 2-fold focus distinguished it from many non-pharmacological interventions. Hypotheses posited PDC would improve five Veteran self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain and 5) depression. Greater impact was expected for more impaired Veterans. A unique feature was self-reported research data collected from Veterans with dementia.

Impact:Partnerships between community and health organizations can meet dementia-related needs and improve psychosocial functioning of persons with dementia.

Focused Area of Research: Mental Health: Improving the Effectiveness of Evidence-Based Mental Health Care in Nonmental Health Settings. (Mark Kunik, MD, MPH, Research Focus Lead)

Partner: Mental Health Services - Mental Illness Research, Education and Clinical Center

 

The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations.

PMID: 24742777. The frequency of outpatient diagnostic errors is challenging to determine due to varying error definitions and the need to review data across multiple providers and care settings over time. We estimated the frequency of diagnostic errors in the US adult population by synthesizing data from 3 studies of clinic-based populations that used conceptually similar definitions of diagnostic error. Impact: Our estimate suggests that diagnostic errors affect at least 1 in 20 US adults. This should encourage policymakers, healthcare organizations and researchers to start measuring and reducing diagnostic errors. Media coverage on this study has been extensive.

Activity Outside of Focused Areas: Emerging Research Goal

Partner: National Center for Patient Safety

 

Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial.

PMID: 24774351 Depression and diabetes cause significant burden for patients and the health-care system and, when co-occurring, result in poorer self-care behaviors and worse glycemic control than for either condition alone. However, clinical management of these comorbid conditions is complicated by patient-, provider-, and system-level barriers especially problematic for rural patients. This ongoing blended effectivenessimplementation design can advance the science and practice of caring for complex medically ill patients within the constraints of a busy patient-centered medical home.

Focused Area of Research: Mental Health: Improving the Effectiveness of Evidence- Based Mental Health Care in Nonmental Health Settings. (Mark Kunik, MD, MPH, Research Focus Lead)

Partner: Mental Health Services - Mental Illness Research, Education and Clinical Center

 

Association of high-volume hospitals with greater likelihood of discharge to home following colorectal surgery.

PMID: 24430092 This study tested the hypothesis that patients having colorectal surgery at high-volume hospitals would more likely be discharged to home rather than to skilled rehabilitation facilities to complete recovery. Impact: Patients having colorectal surgery at high-volume hospitals are significantly more likely to recover and return home after surgery than individuals having operations at low-volume hospitals.

Focused Area of Research: Improving the Fidelity and Reach of High-quality,Veteran-centered Cancer Care (Hashem El-Serag, MD,MPH; and Richard Street, PhD, Focus Area Leads).

Partner: VISN 16: South Central VA Health Care Network

 

Examining clinical performance feedback in Patient-Aligned Care Teams.

PMID: 24715398 The move to team-based models of health care represents a fundamental shift in health- care delivery, including major changes in the roles and relationships of clinical personnel. Audit and feedback of clinical performance has traditionally focused on the provider; however, a team-based model of care may require different approaches. Impact: Although new tools have been created to support higherquality clinical performance feedback to primary care teams, they have not necessarily delivered feedback consistent with a team-based approach to health care. Audit and feedback of clinical performance have remained largely unchanged, despite material differences in roles and responsibilities of team members.

Focused Area of Research: Improving Communication and Coordination of Care in VA Outpatient Primary Care Settings (Laura A. Petersen, MD, MPH, FACP, Research Focus Lead/CREATE PI)

Partner: VISN 12: VA Great Lakes Health Care System

 

Implementation of a regional virtual tumor board: a prospective study evaluating feasibility and provider acceptance.

PMID: 24845366 Tumor board (TB) conferences facilitate multidisciplinary cancer care and are associated with overall improved outcomes. Because of shortages of the oncology workforce and limited access to TB conferences, multidisciplinary care is not available at every institution. This pilot study assessed the feasibility and acceptance of using telemedicine to implement a virtual TB (VTB) program with a regional healthcare network. Conclusions: Implementation of VTB is feasible and highly accepted by participants. Future studies should focus on widespread implementation and validating the effectiveness of this model.

 Focused Area of Research: Improving the Fidelity and Reach of High-quality,Veteran-centered Cancer Care (Hashem El-Serag, MD,MPH; and Richard Street, PhD, Focus Area Leads).

Partner: Office of Rural Health

 

Predisposing, enabling, and need factors as predictors of low and high psychotherapy utilization in veterans.

PMID: 24841513 This study used national administrative data from the VHA to examinepredisposing, enabling, and need factors related to multiple levels of psychotherapyutilization Veterans with posttraumatic stress disorder (PTSD), depression, or anxiety.

Impact: Results suggest many patients may not receive a clinically optimal dose of psychotherapy, highlighting the need to enhance retention in therapy for low users and examine whether very high users are benefitting from extensive courses of treatment. DVA Publication Brief "Study Examines Factors Related to Low, Moderate and High Use of Psychotherapy among Veterans"

Focused Area of Research: Mental Health: Improving the Effectiveness of Evidence-Based Mental Health Care in Nonmental HealthSettings. (Mark Kunik, MD, MPH, Research Focus Lead)

Partner: Mental Health Services - Mental Illness Research, Education and Clinical Center

 

 

System Improvements

 

The Office of the National Coordinator (ONC) for Health IT - SAFER Guides were

released on January 15, 2014.

The Office of the National Coordinator (ONC) for Health IT - SAFER Guides were released on January 15, 2014.They are a suite of tools for health-care organizations to self- assess the safety and safe use of EHRs developed over the last 2 years by Drs. Singh (COIN), Sittig (University of Texas-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Health Sciences Center), and Joan Ash (Oregon Health & Science University). Other COIN members include Drs. Murphy, Smith, Amspoker, Meeks, Meyer, Menon and Ms.Russo and Espadas, who contributed to the development process. Impact: These guides garnered media attention from several national stakeholders. The team hosted several webinars, including 1 sponsored by ONC on January 30, 2014.Coverage also included an article by David Troxel, MD, medical director, The Doctors Company, "SAFER Guides for Electronic Health Record Implementation and Use." This Director's Forum was sent to 75,000 physicians and surgeons, as well as to the PIAA (insurance trade association representing domestic and international medical professional liability insurance companies) and the Medical Group Management Association.

 Activity Outside of Focused Areas: Emerging Research Goal

Partner: Houston - Michael E. DeBakey VA Medical Center (Houston, TX)

 

Centers for Disease Control "Ensuring the Safety and Effectiveness of Laboratory Data in Electronic Health Record Systems" May 15, 2014.

Dr. Singh is a member of the Centers for Disease Control (CDC) Communication in Informatics Workgroup. Their report cited 3 center-authored publications:1.Singh H. pitzmueller C, Petersen NJ, Sawhney MK, Smith MW, Murphy DR. Espadas D. axmisan A, Sittig DF. Primary care practitioners' views on test result management in HR-enabled health systems: a national survey*. J Am Med Infor Assoc. 2013 Jul-Aug;20(4):727-35. PMID: 23268489*.2.Singh H. Ash JS, Sittig. Safety assurance factors for electronic health record resilience (SAFER): study protocol*. BMC Med Inform Decis Mak. 2013 Apr 12:13:46.PMID: 23587208*.Sittig DF, Singh H. Electronic health records and national patient-safety goals*. N Engl JMed. 2012 Nov 8;367(19):1854-60. PMID: 23134389*.

Impact: The CDC Report illustrates the seriousness of laboratory data-related interoperability issues and discrepancies in the way EHR systems display data. The report also proposes 3 focus areas (engagement, data integrity and usability, and innovation) for action by laboratory professionals and organizations to support development of the health IT infrastructure nd ensure safe and effective use of laboratory information.

Activity Outside of Focused Areas: Emerging Research Goal

Partner: National Center for Patient Safety