Updates from HSR&D Central Office
| 2021 Archive |
Seeking Partner for Long-Term Commitment
September 26, 2021
By David Atkins, MD, MPH, Director of HSR&D
David Atkins, MD, MPH, Director of HSR&D
One of the key goals of the new realignment being developed in the Office of Research and Development is to deepen the involvement of and support from clinical program partners in ORD research. The principles of “partnered research” have a long history, going back to community-based participatory research, which grew out of objections from marginalized communities that academic researchers were using the communities to advance the goals of the researchers rather than those of the communities. They rest on the idea that if you want research to make a difference you need to make sure you are asking questions that your audience cares about and developing solutions that they can embrace and help implement.
HSR&D has been engaging in partnered research for over two decades, but we have steadily raised the expectations of partner engagement and invested in mechanisms to support it. Signing a letter of support for a research proposal doesn’t constitute meaningful engagement. We expect researchers to ask themselves, “Who will own the implementation of your findings if the research is successful?” and to show that they understand constraints and incentives influencing their partners.
Meaningful engagement takes time and money, so we have increased support for infrastructure to facilitate it. The Women’s Health Research Network has served as a model of close partnership with diverse program offices and they have championed a model of multi-level stakeholder engagement that ensures input of multiple stakeholders from women Veterans to clinicians to local and national leaders. The Consortia of Research (CORes) that HSR&D established also have been critical for coordinating and strengthening connections to clinical program partners.
At the end of the day, partnerships happen on the level of individual relationships and cannot be orchestrated at a distance. COVID made partnerships harder by eliminating face-to-face meetings and by crowding out the time needed to nurture new partnerships. Critical to effective partnership is a sense of trust that partners understand each other’s perspectives and have some areas of common interest. This was brought back to me at a recent in-person meeting in Salt Lake City to discuss the Cerner implementation and patient safety. The chance to meet in person over an extended period with partners from the Office of Electronic Health Record Modernization, the Office of Health Informatics, researchers, and leaders from HSR&D and DEAN accomplished what no number of TEAMs meetings ever could. We emerged with a better sense of the priorities and pressures facing each group and a new sense of trust that we could find ways to collaborate. One of my favorite aphorisms to describe committed partnerships was passed along to me some time ago by Jon White, the ACOS-R for Salt Lake City and convener of the recent meeting. Using the example of bacon and eggs, the hen contributes but the hog is committed.
August 15, 2022
By Melissa Braganza, MPH, QUERI Deputy Director
Melissa Braganza, MPH, QUERI Deputy Director
The passage of the Foundations for Evidence-Based Policymaking Act of 2018 (Evidence Act) has led to exciting opportunities to advance how evidence-based policy is done in VHA. Since 2019, QUERI has been working with the VHA Chief Strategy and Finance Offices to create an enterprise-wide approach to evidence development and evaluation. The success of these efforts has led to the establishment of the Evidence-based Policy Subcommittee (EBPS) to serve as VHA’s principal hub for aligning and focusing evaluation efforts and resources to inform evidence-based policy, the expansion of QUERI’s national systematic process to identify priorities for Evidence Act evaluations, and the launch of QUERI-funded Evidence-based Policy Evaluation Centers to tackle complex policy questions.
With the recent approval of the EBPS charter, ORD, for the first time, has a seat at the table with VHA clinical operations leadership to support prioritization of national evaluation goals, and thus, help drive the use of high-impact evidence and evaluation to enhance efficiency across the enterprise. By regularly bringing together policy, strategy, and finance leaders and HSR&D/QUERI investigators, we have an opportunity to implement Learning Health System goals on a broader level, leveraging resources across VHA to address health challenges that cut across multiple clinical program offices, service lines, and VISNs. As QUERI Deputy Director, I am helping to integrate these policy efforts with QUERI’s bottom-up implementation efforts to support providers in delivering evidence-based care.
Since joining QUERI six years ago, I have seen it grow tremendously – partnering with VISNs to move the needle on quality of care, expanding training opportunities for VA employees, developing pathways to support early career investigators and staff – and I am looking forward to seeing how we can bring QUERI’s decades of experience in implementation, evaluation, and stakeholder engagement to help foster evidence-informed program, policy, and budget decisions across VHA.
July 11, 2022
By Crystal Henderson, EdD
Scientific Program Manager
Crystal Henderson, EdD
Scientific Program Manager
In the ever-evolving world of healthcare, VA remains the largest healthcare system in the US. Thus, it is a good laboratory for studying disparities because it removes the dominant role of coverage and access. In the VA system, 30% of users are from underserved populations with 39% of those under age 65. Therefore, in step with VA’s research mission, “To discover knowledge and create innovations that advance the health and care of Veterans and the nation,” the study of disparities within VA is vital.
HSR&D Diversity, Equity, and Inclusion (DEI) Research
Efforts to promote Diversity, Equity, and Inclusion (DEI) within health services research stems from the Office of Research & Development’s (ORD) strategic priority #4: to actively promote diversity, equity, and inclusion within our sphere of influence. To foster success with this priority, over 400 studies have been conducted of health disparities in VA. The disparities studied included patient preferences/attitudes/beliefs/behaviors, trust, decision-making, health-literacy; patient-provider communication, implicit bias, cultural competency, and decision making; access, patient-centered care, and social determinants of health. In HSR&D, active DEI funding for FY22 exceeds $56 million. With ongoing DEI efforts in VA research, it is easy to describe disparities, a little harder to understand them, and really hard to fix them. VA has worked to reduce some disparities in some areas, but others remain. Lastly, to fix disparities in health outcomes, VA must continue to focus upstream on various social determinants of health including (but not limited to) housing, discrimination, economic security, and education.
June 8, 2022
By Christine Nguyen, MHA, BS,
Health Science Specialist
Christine Nguyen, MHA, BS, Health Science Specialist
Prior to joining HSR&D in February 2022, I was serving as a Data Analyst for the Office of Head Start (OHS) at the Administration for Children and Families (ACF), managing the development of a database platform using Agile method. This position required foundational knowledge in research, IT, and project management. As a new employee with VA, I am excited to contribute my knowledge and experiences. Two weeks into the position, I was assigned to facilitate the HSR&D Strategic Planning Initiative. Quickly, I stood up two work groups: Advancing Research Impact and Building Research Workforce. Through this process, I got to learn more about different centers and interact with various stakeholders from Central Office and in the field. In addition to the HSR&D Strategic Initiative, I am managing the Data Safety Monitoring Board (DSMB) and organizing the Annual DSMB Review Meeting. As I am still learning about the DSMB, to my surprise, the virtual annual DSMB meeting in April concluded with a success, not even with a technological hiccup. Thank you to HSR&D leadership and supportive colleagues for providing the institutional knowledge and helping me adapt to the organization. I feel very fortunate to have found a home.
May 12, 2022
By Tiffin Ross-Shepard, BS,
Scientific Merit Review Manager
Tiffin Ross-Shepard, BS, Scientific Merit Review Manager
The past two years have been a whirlwind serving as the Health Services Research and Development (HSR&D) Scientific Merit Review Board (SMRB) Program Manager. I started working in January 2020, attended the in-person SMRB in March 2020, and then the world as we knew it changed forever. It is normal for new employees to expect challenges learning procedures and policies, but nothing about 2020 was going to be “normal.” To say starting a new job during a raging pandemic presented a unique learning environment is an understatement! But I have learned that challenging situations tend to bring out the best in us and this was a unique opportunity to be innovative and possibly improve processes. The work still needed to be done and we had no choice but to figure things out. We had to stick with what worked in the past while implementing change and innovation to accomplish current tasks and future goals.
In the 24 months I have been in the role of SMRB Program Manager, my biggest accomplishment was creating a process to provide a seamless transition from the standard in-person SMRB meetings to completely virtual SMRB meetings. A reframing of how we accomplished this goal was born out of necessity due to mandatory remote work, and despite initial growing pains, it was a success. The integrity and quality of the reviewed applications was not diminished, and we streamlined some processes, becoming more technology dependent.
During this time, I also served as the HSR&D Just-In-Time (JIT) Manager and was a member of the Office of Research & Development (ORD) JIT to eRA Working Group. This group worked closely with NIH to develop the eRA VA JIT module, a module which HSR&D recently transitioned to. I think in time the new process will be worth the initial growing pains because all review application documents are in a unified database.
A colleague jokingly referred to me as a “fixer” and a “detective.” Funny but true! I find these skills beneficial to the job. I enjoy working with my HSR&D colleagues to find solutions and point them in the right direction. Equally, I enjoy responding to the various emails sent to the HSR&D Scientific Review and JIT mailboxes about our processes and when I don’t know an answer, I enjoy the research required to find out the answer or solution.
To conclude, these last two years have been a whirlwind. This position offers a wealth of opportunity to learn and grow and I can’t wait to see what’s next!
April 25, 2022
By Eric Enone, MPH, PMP, Senior Management and Program Analyst
Eric Enone, MPH, PMP Senior Management and Program Analyst
In the past 7 months, I have been a key staff member and instrumental in the recruitment of new staff at Health Services Research and Development (HSR&D) and Office of Research and Development (ORD). It has been an experience that has shown how human resources and recruitment policies, processes, and assessments are critical in helping in the recruitment and retention of the best possible candidates.
In the recruitment process, retention also starts. Reaching out to candidates and scheduling their first interview is really the beginning of an assessment of the candidates. Conversely, the candidates also get an opportunity to begin making an assessment of your team’s unit, program, office, or organization which eventually helps them develop an informed opinion or view of your unit, program, office, or organization. That is, what is the organization, office, or program all about? What is the “culture” and environment like? It is important to view your first and subsequent interactions/assessments with candidates as a key recruitment tool that could play a small or big role in both recruiting and retaining the best possible candidates.
It is important to have a consistent recruitment structure and plan in place as this will help make the hiring process smoother and act as a qualifying guideline for assessing and hiring the best possible candidates.
March 22, 2022
By David Atkins, MD, MPH, Director of HSR&D
David Atkins, MD, MPH, Director, HSR&D
One of the lasting effects of the pandemic is likely to be the disruption of traditional office work. Even as COVID cases decline and restrictions relax, it is clear that many offices will never return to their pre-pandemic work schedules. Having shown we can work effectively while being remote, the Office of Research and Development (ORD) has already made plans to reduce our office footprint and continue a maximal telework schedule. Allowing virtual work has allowed ORD to recruit from a much larger and more diverse pool of people who are not interested in moving to a high-cost city like DC. And most employers have found that allowing telework is a precondition for attracting their top candidates.
At our recent COIN Directors meeting in February, the Directors organized a fascinating session on the future of work. Most Directors indicated their centers were likely to return to a hybrid schedule but worried about losing valuable office space on campus. A presentation by University of Iowa Business School professor Stephen Courtright noted that while remote work is favored by workers it is harder on managers. It is workers’ preferences that are likely to rule the day, however, in a competitive labor market.
There are many important advantages to telework, especially in large cities where commuting can easily eat up 2 hours a day. Telework reduces driving, commuting stress, and air pollution, allows parents to be home when kids return from school, reduces commuting costs, and provides employees time for self-care during the day. Telework is especially important for parents of young children and caregivers. There are even advantages of Zoom compared to the usual office meeting, in that it may allow more people to participate via the chat function. But we also need to acknowledge what we lose in a remote setting and be thoughtful about how to build some of that into a more virtual work life. Face-to-face interactions, non-work conversations, and social celebrations like birthday parties build connections that are harder to develop on Zoom. Physical proximity allows brief consultations about problems that may be avoided if they require a phone call. Seemingly random conversations may trigger new ideas. New employees have a harder time absorbing work culture and learning who to consult on specific issues. Some workers, especially extroverts, will miss the energy they draw from a lively office. Small tensions may escalate over email instead of getting resolved with a quick office chat. And employees who are struggling are likely to go longer before being recognized or helped. It’s no wonder that managers find the virtual environment harder.
I admit that I miss seeing my HSR&D colleagues regularly at work. I miss the celebratory breakfasts after our SMRB meeting. I have been thrilled with the new employees we’ve been able to recruit as we offer a wider range of work options, but I also have enjoyed going back to the office to meet with the new fellows we’ve recruited. Of note, I realized that I have begun to lose track of who I had worked with in person or not, which I expect is a good sign. But please, invest $20 in a better camera for your laptop.
February 22, 2022
By Kevin J. Chaney, MGS,
Scientific Program Manager
Developing an Informatics Research Agenda
Kevin J. Chaney, MGS,
Scientific Program Manager
Prior to joining the HSR&D Team as the informatics lead, I was privileged to lead a variety of efforts at AHRQ and the Office of the National Coordinator for Health IT (ONC) advancing scientific discovery and knowledge generation through the innovative use of technology and analytics. These projects focused on pushing the boundaries of health IT (e.g., electronic health records [EHRs]), digital health tools and solutions, data standards, and high input computing to improve both care and research. Identifying essential collaborators to develop, implement, and refine these technologies and solutions on limited budgets and quick timeframes was exciting but also very challenging.
Joining VA with the opportunity to continue its long and storied commitment to the field of health IT and informatics research is incredibly exciting. VA is one of the few places if not the place with all the right partners, stakeholders, and dedicated experts necessary to develop, test, implement, evaluate, refine, and inform care delivery, technology, and policy. In the coming months, I’ll be working with our informatics and VA research community formulating a VA Health IT research agenda – to specify areas of focus in the coming years. ONC’s National Health IT Priorities for Research: A Policy and Development Agenda serves as an initial blueprint and has assisted other federal agencies in shaping programs and policies. I’m excited to engage with the VA community to identify specific gaps and opportunities to propel critical areas of research. What might some of these areas be?
Even as VA finds itself in a crucial stage of modernizing its own health IT infrastructure, it will be important to continue to learn from and inform our own processes [e.g., EMPIRIC QUERI] and share best practices for the field. HSR&D’s continued commitment to understand and advance health IT and data science research is key during this transition – especially for providers, and most importantly - our Veterans and their caregivers.
Additionally, VA has an opportunity to showcase how the rich and robust historical health data it has can be augmented by the expounding bevy of digital health data at our fingertips (patient reported outcomes, social determinants of health data, just to name a few). I believe our researchers and providers offer that unique ability to develop and understand how the latest technologies and techniques can be applied to best understand how data can be leveraged for knowledge generation and appropriate integration for care.
Lastly, application programming interfaces (APIs) and cloud-based services and tools will be important for how data is not only exchanged but also stored, accessed, and utilized. For two decades APIs have enabled interconnectivity and seamless data sharing, transforming the banking, shopping, and travel industries - just to name a few. The Cures Act Final Rule explicitly requires electronic health record (EHR) providers to support open standardized APIs and reduce the effort it takes to access, exchange, and use electronic health information, for patients, providers, and researchers. Just as APIs have revolutionized other areas of our lives, there is great anticipation health care and research are next. How rapidly and successfully that change happens depends on our research enterprise’s interest to develop, implement, and understand how these technologies can and should be deployed, and how we can iterate and build upon those. I’m excited to work with the dedicated scientists, researchers, and providers of the VA community to build a health IT enabled research infrastructure so research can happen more quickly and effectively.
January 19, 2022
By Lynne Padgett, PhD, FAPOS, Scientific Program Manager
Aging/Long-term Support Services and Mobility/Activity/Function portfolios
Lynne Padgett, PhD, FAPOS, Scientific Program Manager
Approximately 60% of our Veterans are Medicare eligible, which provides an opportunity to initiate innovative programs and enhance ongoing geriatric programs and research. The current report from the Geriatrics and Extended Care program office estimates the largest areas of growth in VHA enrollees will be older Veterans (85 years and over), particularly women in this age bracket. Given the aging population, the need for long-term care settings, home-based care, and helping older Veterans maintain independence continues to grow.
When examining geriatric care trends, several gaps and attendant priorities emerge for health services research opportunities in VA. One manner of classifying research priorities is by thinking through the continuum of aging and care settings. Health promotion and fitness programs help older Veterans age in place by preventing or slowing functional decline. Gerofit, for example, is a VHA “Best Practice” program that has been disseminated to 17 VA sites. Gerofit is a fitness program for Veterans ages 65 and older that has demonstrated robust improvements in Veteran quality of life, physical function, and mental health. Moreover, research has demonstrated a positive association of decreased hospitalization for participants. The program has also served as a model for both national dissemination and conversion to telehealth at the onset of the SARS CoV-2 pandemic.
Aging in place is not only for the healthy and high functioning, as surveys suggest Veterans prioritize staying in their home environment even if they are no longer fully independent in daily activities. Ongoing research examining care delivery, quality, and cost in both home-based care and long-term care settings (e.g., Community Living Centers, State Veteran Homes) is essential when Veterans need additional care in the community. Caregiver research and palliative care remain priority areas also, as they are key components in quality Veteran care at various critical stages. Lastly, as many VA sites pursue designation as an Age Friendly Health System, health services research can establish the evidence base for successful design, implementation, quality, and cost effectiveness for our Veterans throughout the aging process.