Christopher Bever, MD, MBA
Deputy CRADO for Investigators, Scientific Review, and Management
March 14, 2023
By Christopher Bever, MD, MBA, Deputy CRADO for Investigators, Scientific Review, and Management
The Enterprise Transformation Initiative: VA, led by the Office of Enterprise Integration, has embarked on a transformation to support better integration across the organization to provide better services to Veterans. Following this lead, the Office of Research and Development (ORD) is undergoing a transformation to better integrate research across the organization. As part of this process, the ORD Services (Rehabilitation R&D, Health Services R&D, Clinical Science R&D, and Biomedical Laboratory R&D) are being combined into a new organization: Investigators, Scientific Review and Management (see below).
Organizing VA research funding around the needs of Veterans: An important part of the enterprise transformation will be to shift funding from portfolios related to research disciplines and methods to portfolios of Veteran need, such as Precision Oncology, Pain and Opioid Use Disorders, Health Services and Behavioral and Mental Health, Traumatic Brain Injury, Suicide Prevention, Gulf War Illness, and Military-related Exposures. Importantly, this will enhance integration of research across disciplines, support collaboration with our VA clinical program office partners and other important stakeholders, facilitate the translation of VA research to clinical care and show Congress and other important stakeholders how the research appropriation is being used to address the health needs of Veterans. While the final design of the new portfolio organization has not been determined, it is likely to be a combination of focused portfolios [also referred to as actively managed portfolios (AMPs) (i.e., suicide prevention)] and broad portfolios (i.e., behavioral and mental health).
A year of designing and testing: The transition to portfolios of Veteran need poses a number of challenges which require a period of iterative designing and testing. How to best organize the managed portfolios must be determined and we are currently in the process of pilot testing several different AMPs (see the figure below). We are testing out an AMP led by a senior portfolio manager and an AMP led by a team of portfolio managers. We are also testing out a new accelerated review process as part of one of the AMPs. We will be doing tabletop modeling in the next few months to determine how to structure the funding decision process in the managed portfolio process and what changes will be needed in the VA financial systems to support this new organizational structure.
How can you help? The health services research community, both in the field and in the Office of Research and Development, has played a key role in the design process by coming forward with helpful suggestions and directly supporting the development and testing process. I look forward to your continued active engagement in this process and welcome your ideas and suggestions on how we do the best job possible with the reorganization and in the process support the growth of the health services research program (including the QUERI program).
February 16, 2023
By Amelia Schlak, PhD, RN, AAAS Science and Technology Policy Fellow
Amelia Schlak, PhD, RN, AAAS Science and Technology Policy Fellow
It was great to meet so many HSR&D and QUERI colleagues at the annual meeting after connecting with several of you over the past seven months. For those I have not had the chance to meet, I am working in HSR&D as a AAAS Science & Technology Policy Fellow on research portfolios focused on nursing, Long COVID, and burnout. As a nurse and health services researcher, I am excited to grow and sponsor research in emerging priority areas.
One such area is nursing. Nurses span the entire care continuum and are involved in virtually every aspect of patient care. VA is also the largest employer of nurses nationally and has unique data on nurses which has largely been untapped so far. To address this, I am working across HSR&D, QUERI, and Rehabilitation R&D to develop a nursing research agenda. As a former VA nurse and as a nursing workforce researcher, I am incredibly excited and grateful to be leading this effort along with experts from the field and the Office of Nursing Services.
To develop a nursing research agenda, we are planning a Nursing State-of-the-Art (SOTA) Conference for Fall/Winter 2023. The Nursing SOTA will bring together VA investigators, external experts, and other stakeholders to set the nursing research agenda. Our SOTA will inform a future RFA on nursing-related issues. For example, we are considering how future research can improve nursing care at the bedside or in the clinic by considering nurse staffing, education, diversity, retention, and other areas. If we have not gotten the chance to connect and you are interested in the nursing research agenda, please reach out and share more about your research and interest in the nursing research agenda.
Another constantly evolving area is COVID-19, and more particularly, Long COVID. In my role, I’ve been working to manage and grow the Long COVID research portfolio and am excited to share that HSR&D is launching the Long COVID Practice-Based Research Network (PBRN). There are currently 23 VA Long COVID clinics (and counting!). The Long COVID PBRN will lead and organize research efforts across these sites, working alongside internal and external VA stakeholders to develop best practices for Long COVID care.
In partnership with another AAAS fellow, Dr. Karen McNamara, I am working to develop burnout and well-being focused research. As much of my own research has focused on nursing burnout and solutions for it, I am excited to help shape the direction of this research in VA. The pandemic has highlighted the untenable circumstances that many individuals face in their workplace. For clinicians, most of these issues were not new, but rather exacerbated by the pandemic. You may have heard of REBOOT, or the VA-wide taskforce working to “Reduce Employee Burnout and Optimize Organizational Thriving” (REBOOT). In alignment with this national effort, HSR&D is working to develop and support research to improve VA workforce outcomes, with particular emphasis on system-wide interventions.
January 17, 2023
By Jessica Cleveland, MSOR, AAAS Science & Technology Policy Fellow
Happy “new calendar year”, everyone. I hope you were able to find time to do what energizes you over these last few weeks, whether that’s being with family, traveling, or just sitting at home enjoying a nice cup of tea or coffee. For those of you I haven’t yet met, I am a AAAS Fellow who joined the HSR&D office in September. Prior to that, I spent the bulk of my career at Dana-Farber Cancer Institute in Boston working in the informatics and analytics space applying systems engineering techniques to the design and implementation of tools for quality improvement and clinical decision support. From building simulation models to redesigning workflows to developing performance measures, my goal has always been to optimize data and technology around clinical practice.
In this fellowship experience I look forward to continuing to be a bridge between research and operations and expanding on my experience from a large academic medical center to better understand VA’s journey in becoming a learning health care system. As part of the ORD realignment (https://vaww.hsrd.research.va.gov/realignment/ - intranet only), I am working on building out the Quality, Safety, and Value (QSV) priority area within the new cross-cutting Health System Portfolio. The new QSV priority area will focus on studies that validate and implement measures of QSV, compare interventions across settings including direct vs community care, as well as studies that aim to understand the organizational context of care and workforce burnout. As part of this effort, I have begun meeting with key offices including the Office of Quality Management, National Center for Patient Safety, and the Office of Analytics and Performance Integration to help identify areas where research could provide the most value in helping them meet their goals or address issues they have identified.
VA Secretary Denis McDonough (left) Jessica Cleveland, MSOR, AAAS Science & Technology Policy Fellow (right)
I am also working to establish pathways for projects within the Office of Health Innovation and Learning (OHIL) to collaborate with researchers when appropriate. For example, there is a growing interest in making Virtual Reality technology part of standard of care. With over 160 VA facilities participating in projects that have numerous clinical use cases and increased Veteran interest (showcased at the recent Veteran eXpeRience event), it is imperative to establish rapid pipelines to study the effectiveness and implementation of these new technologies.
From making awkward small talk with the SecVA as we pose for a holiday picture to flying out to Salt Lake City to meet some of the many distinguished investigators within this system, this fellowship has already been such a rewarding experience. I look forward to partnering with and meeting many more of you in the field as we work together to better understand and deliver the best care to our Nation’s Veterans.