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Updates from Central Office and Note to the Community

Archive: 2023

Welcome to Summer and a Special Thanks to our HSR/ORD Scientific Staff

June 17, 2024
By Amy Kilbourne, PhD, MPH, Acting Director of HSR

Amy Kilbourne, PhD, MPH, Acting Director of HSR

Amy Kilbourne, PhD, MPH, Acting Director of HSR

It’s that time of year again: graduation parties, send-offs to summer camps, better parking (if you live near a university), and hopefully the opportunity to take some well-deserved time off. After carefully curating the annual summer reading list, my aspirations were quickly dashed by a backlog of journal paper revise-and-resubmits (which always seem to arrive right before summer break).

This summer our HSR Scientific Staff team in ORD is also working hard to better streamline our investigator-initiated requests for applications and peer-review processes, under our newly reorganized ISRM (Investigators, Scientific Review, and Management) group. Their work is inspirational: many thanks to Tiffin, Cathie, Amanda, Bob, Crystal, Chanel, Amelia, Kara, Christine, and Bonnie for going above and beyond to make the application process more straightforward for our investigators. As much of the ORD Enterprise Transformation draws upon the experiences of QUERI and HSR, notably learning health system-focused partnered research, data infrastructure, and real-world impacts, the HSR scientific team has worked with their ORD colleagues to help create more opportunities for our investigators to apply for funding across the translational spectrum, ensuring “no wrong door” when an application transcends clinical/health systems/rehabilitation topic boundaries. This is crucial as our investigators are increasingly innovating in learning health system methods, especially in emerging areas such as military exposures, traumatic brain injury, social determinants of health, precision health, and artificial intelligence.

By summer we expect to have new cross-disciplinary RFAs with a pre-application process that enables investigators to request their study section and highlight how their proposal is responsive to ORD priorities through Notices of Special Interest. These cross-portfolio RFAs emphasize core HSR concepts such as end-user engagement and implementation planning across the translational spectrum, and HSR continues to invest in VA national priority-focused research that achieves Veteran Quintuple Aim goals (improved access, equity, outcomes, experience, value) using foundational learning health system methods (implementation, data, engagement, systems, policy science). To further build capacity in these emerging areas, we are also expanding the number of Centers of Innovation (COINs), Consortia of Research (COREs), and QUERI Learning Health System Data Science initiatives, encompassing new ORD, VISN, and national operational partners and enhancing enterprise-wide data capacity, governance, and translational science impacts.  Finally, we expect to learn valuable insights from our FY26-30 HSR/QUERI strategic planning process and continue to learn best practices from our colleagues across ORD and beyond to improve the way we can support our investigators especially in this challenging, but hopefully cyclical funding period.  

So have a relaxing and rejuvenating summer- we hope to see you at AcademyHealth (which has a heavy VA presence as always) and thank you again for the innovation and impact you are making towards improving Veteran care!

Out from Behind the Counter—Pharmaceutical Research and Policy Impact

April 22, 2024
By Alex Meredith, PharmD, AAAS Fellow

Alex Meredith, PharmD

Alex Meredith, PharmD, AAAS Fellow

As a pharmacist, I have witnessed first-hand the effect that impactful healthcare programs and policies have on patients. My upbringing in Kentucky—a state with one of the highest poverty rates in the nation—deeply influenced my career path. My interest in developing and tailoring programs to help people was more fully entrenched during my graduate program, where I led the pharmacy team in the foundational development of pharmacy services at a new student-run free clinic for the underserved, and also coordinated pharmacy services at free primary care clinics and homeless shelters in Cincinnati, Ohio.

Primary prevention is an essential task of pharmacists. Typically seen in the traditional roles of a retail pharmacy or hospital setting—and consistently viewed as one of the last stops before the patient leaves a healthcare setting—pharmacists take an active role in public health through effective clinical medication management and health education. Before joining HSR as an AAAS fellow, I was unaware of the many other avenues through which pharmacists can make an impact from other than behind the counter. Working in HSR has allowed me to expand my public health impact by furthering evidence-based policy and practice via the housing and economic insecurity initiative. I hope to continue that impact by working with VA’s Psychedelic Medicine Integrated Project Team to plan the evaluation of psychedelic medicine delivered as part of VA clinical care. In addition, working in VA has allowed me to look at larger-scale public health efforts. While successful at times, these efforts face responsiveness and sustainability challenges, and often fall short at fully tackling a problem at the point-in-time. With thousands of Veterans still homeless or economically insecure, VA’s use of a Learning Health System approach—implementing a national evaluation of Veteran experiences, risk, and resilience factors throughout the entirety of their lives—can inform both new and existing programs to work better on behalf of Veterans. This approach ultimately hopes to answer the questions: How do Veterans become homeless? How can we prevent these crises in the first place?

Working in HSR has been a wonderful experience. I am awestruck by the dedication and determination to better the lives of those who served our country and am excited to continue working alongside these incredible individuals to translate research into practice and inform policies and programs to improve Veterans’ health and outcomes.

Veteran Engagement Panel Contributions to VA’s Next Strategic Plan

March 12, 2024
By Nicholas Bowersox, PhD

Nicholas Bowersox, PhD

Nicholas Bowersox, PhD

VA is preparing its Fiscal Year 2026-2030 Strategic Plan. The VA Strategic Plan (SP) is intended to inform management efforts across the Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), and National Cemetery Service (NCS) to ensure that these aspects of VA are unified in supporting a common vision in supporting Veterans, their families, caregivers, and survivors. The Strategic Plan also sets the stage for VA’s efforts to support resource sharing across Federal departments and agencies. It’s estimated that the next Strategic Plan will guide the use of approximately $1 trillion in government funds over the coming decade through various programs designed to support Veterans.

The process of creating the next SP is being led by the Office of Enterprise Integration, and includes workload contributions by VA personnel across multiple workgroups and offices. The first step in this development process consists of a rapid foundational analysis that has been designed to synthesize information from multiple sources: interviews with Veterans; interviews with VA leadership; surveys of VA employees; reviews of VA policy and evaluation documents; and reviews of relevant literature. This foundational analysis will result in the creation of summary documents that will be shared and refined with senior VA leaders to create the final SP. The process began November 2023 and is expected to continue through September 2025, with the initial rapid foundational analysis being completed by April of this year.

The Quality Enhancement Research Initiative’s Center for Evaluation and Implementation Resources (CEIR) is conducting a rapid evaluation project to generate information related to multiple aspects of the SP’s foundational analysis. These include: interview sessions with Veteran key informants; interview sessions with VA leadership; and review of relevant literature. The most relevant aspect of this project for the VA research community is CEIR’s interviews with Veterans, who were recruited from VA HSR Centers of Innovation (COIN) Veteran Engagement Panels (VEPs). VEPs are made up of Veteran representatives who have agreed to offer their feedback on VA research projects and are consulted regularly by research teams within COINs. CEIR has reached out to all COIN-affiliated VEPs, with the majority of VEPs agreeing to participate in one-hour virtual group interview sessions. These interview sessions focus on topics such as:

  • The most important unmet needs for Veterans over the next 10 years
  • Changes that VA could make to address unmet Veteran needs
  • Benefits or services that VA needs to expand to more effectively address Veteran needs
  • Current VA benefits or services that should receive a lower level of priority
  • Bold, unique, or out-of-the box ideas to improve VA

The COIN VEPs will play an essential role in this evaluation process, as it would not be feasible to otherwise identify, organize, and contact groups of Veterans for inclusion in this evaluation given the very short timeline (2-3 months for primary data collection). As such, without COIN VEP participation in this process, Veterans’ voices would almost certainly not be included in the creation of the next Strategic Plan. Given VA’s focus on meeting emerging Veteran needs—such as engaging with Veterans who are not VA patients; addressing persistent Veteran challenges such as homelessness and suicide; and responding to the needs of a rapidly-changing Veteran population—it is essential that VA is able to include Veterans in this planning process to better understand their concerns, needs, and hopes for the future of VA. Such inclusion sends a strong signal that Veterans serve not just as research subjects to inform such planning, but active partners in helping to shape the future of VA.

Paying it Forward

February 9, 2024
By Corinne Voils, PhD

 Corinne Voils, PhD

Corinne Voils, PhD

As a first-generation college student, I never had a clear path to follow. I applied to two universities, both chosen based on where my friends wanted to go. Little did I know that one of those was an expensive, private university whose annual cost was equivalent to my father’s salary. When that university held an information session in my city and my mom inquired about scholarships, we were told, “The financial aid deadline was yesterday.” We didn’t know what financial aid was, or that there was a deadline. That sealed my fate: I had to attend the only other university I had applied to, and I needed to apply for aid.

I didn’t realize until well into my adult life how being a first-generation student affected my approach to undergraduate and graduate college admissions, educational experience, and career. As an undergraduate, I knew that I wanted to go to graduate school, but I had no idea how to get there. An acquaintance was a member of the psychology honors society and urged me to join since I was a psychology major and had a good grade point average. Through that organization, I learned about an opportunity to do research with a faculty member. I started working with Dr. Michael Zarate, who let me run subjects and advised me on applying to graduate school. Unfortunately, I didn’t listen to all his advice. I didn’t study for the GRE because I didn’t think it was possible to improve my score; either you had it, or you didn’t. My score was okay, but not enough to get into the top graduate programs in my field. Against his advice, I only applied to those top programs the first time around and was not admitted. The next year, I listened to him and developed a more balanced list. I was admitted to two programs. When I see him today at conferences, he laughs and tells people, “She applied to X (highly distinguished) program as her back-up school. It was her back-up because she didn’t want to live there.”

While funny, this anecdote shows just how lost someone can be as a first-generation college student. I feel very fortunate to have been presented with mentorship and opportunities that set me down a productive path. One such opportunity was a postdoctoral fellowship at the Durham Veterans Affairs Medical Center (VAMC). In graduate school, I became disillusioned with academia because my professors did not seem to have work-life balance and undergraduates only seemed to care about grades. Through a professor, I found a job at a small consulting firm that analyzed quality of life and medication adherence data from pharmaceutical trials. Business did not do well following the September 2001 attacks, forcing me to look for another position. Through the same professor, I was connected to Dr. Hayden Bosworth at the Durham VAMC. He had a slot open for a postdoc position. I did not know what health services research was or what I would do after the postdoc. But I was familiar with Veterans and their healthcare struggles because my father had served in the Navy during Vietnam. I had heard many interesting stories about his military experience, and I had often tried to persuade him to stop smoking and to lose weight. During my postdoc, I learned that my background as a social psychologist could be used to develop behavioral interventions to help Veterans make and sustain lifestyle changes. Hayden guided me to develop collaborations with clinicians to ensure I was doing clinically relevant work; told me to trust my gut; and helped me prepare a successful application for the Merit Review Entry Program career development award available for non-clinicians at that time. Through his mentorship as well as that of Drs. Gene Oddone and Morris Weinberger, I started down a career path that I didn’t know existed.

As we know in health services research, sometimes we can change structures to help a lot of people; other times, we must help individuals navigate a suboptimal system. As a mentor, I recruit lab members from university organizations that serve students from underrepresented backgrounds. Even though they made it to college, I see that my students from more privileged backgrounds have an easier time figuring things out. First-generation students need guidance in identifying and creating paths they don’t yet know exist. When I think about what mark I want to leave, it is undoubtedly paying it forward.

Informatics Research and the Implementation Gap

January 18, 2024
By Maren Loe, PhD

Maren Loe , PhD

Maren Loe, PhD

I was honored to join Health Systems Research (HSR) in mid-September 2023, as part of the 51st cohort of the American Association for the Advancement of Sciences (AAAS) Science and Technology Policy Fellowship (STPF). I spent the previous seven years in the combined MD/PhD Medical Scientist Training Program at Washington University in St. Louis. Having completed my PhD in Systems Science and Mathematics, I will return to complete my MD program in 2025. As a physician-scientist in training, I faced various obstacles in my research, some of which resulted from a lack of a unified infrastructure to facilitate the translation of clinical data into knowledge and practice behaviors. When I defended my dissertation, my PhD advisor estimated that it would take at least a decade for my work to change clinical practice. The literature suggests that is an optimistic timeline, and that the so-called “implementation gap” is closer to 17 years from bench to widespread implementation at the bedside. Here in HSR, reducing that gap is within our purview, as are some of the other structural challenges I faced. My job now includes considering questions like how we are using medical data to improve Veterans’ health through a Learning Health System.

Specifically, one of my projects this year is updating our priorities in informatics research, which is being dramatically impacted by the recent explosion of artificial intelligence research, specifically generative AI and large language models (LLMs). These tools hold great promise to improve clinical care through better treatments and interventions as well as for workforce support. As a medical trainee, I saw how time-intensive documentation—like writing insurance appeals letters against prior authorization denials—could take time away from the humanistic side of medical care. I watched many attending and resident physicians spend a large proportion of their time behind a computer, facing a tradeoff between charting during the outpatient visits to save time or working late to finish charts after the patients left. LLMs have already been proposed as a tool to reduce some of this burden of documentation, and start-ups have already begun creating software for electronic health records, while some clinicians have described using ChatGPT to write basic insurance appeal letters.

In this arena, HSR aims to understand questions of appropriateness, safety, and reliability. For example: When the use of a given tool is appropriate, what implementation strategy is best? How can that tool be used to promote patient safety while avoiding any adverse events? As a science and technology policy fellow, it has been fascinating to watch HSR and the National Artificial Intelligence Institute interpret and implement guidance from the White House (Executive Order). I have a front row seat to the creation and implementation of policy that will inform patient care and research that improves Veterans’ lives. I am excited to continue my work in this domain throughout the rest of my fellowship year here at HSR.

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