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Health Systems Research

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CREATE: Transforming Prevention into Action

Director: Eugene Oddone, M.D.

Principal Investigators:

About the CREATE

Heart disease, cancer, chronic lung disease, and stroke are the leading causes of death in the United States and are highly prevalent among Veterans. More than half of all deaths, and much of the chronic illness found in Veterans can be attributed to four modifiable risk factors: tobacco use, overweight/obesity, physical inactivity, and alcohol use. VA has made significant improvements in controlling the conditions that lead to heart disease, cancer, and stroke (e.g., hypertension and hyperlipidemia), and a priority initiative focused on preventive measures that addresses underlying factors (e.g., obesity, tobacco use, and physical inactivity) is underway. The cornerstone of that prevention initiative is based on reorganizing primary care through the patient-aligned care team, or PACT model. This CREATE will support that approach by using rigorous health services research methods to evaluate novel prevention strategies.


Partner Offices

Each CREATE works closely with operational partners throughout the VA System. The partner(s) associated with this CREATE include:

  • Linda Kinsinger, M.D, M.P.H., Director of the National Center for Health Promotion and Disease Prevention


The four projects within this CREATE seek to advance the science of prevention research and simultaneously provide key information for VA system partners about how best to provide prevention services to Veterans. Studies will test prevention services using novel media (e.g., telephone, smartphone and Internet); link prevention services and findings into PACTs to ensure that patients receive targeted support and encouragement from their providers; and will provide a roadmap for policy decisions about how best to effectively implement VA's Health Risk Assessment tool. Projects include:

  • Will Veterans Engage in Prevention after HRA-guided Shared Decision Making?
    The objective of this implementation trial is to determine whether a shared decision-making approach using Health Risk Assessment (HRA) increases Veterans' engagement in healthcare prevention services. Investigators will focus on unhealthy lifestyle behaviors identified by the HRA that are linked to cardiovascular disease risk. The project will occur coincident with a natural rollout of VA's HRA, and will inform how best to use the HRA in a primary care setting.
    (Co-PIs: Eugene Oddone, M.D., and Laura Damschroder, M.P.H.)

  • Randomized Controlled Trial of Group Prevention Coaching.
    This implementation trial seeks to determine if a group prevention clinic visit for patients with moderate to high levels of cardiovascular risk improves lifestyle behaviors and lowers cardiovascular risk. Group clinics have been tested in the context of chronic disease management, but not in prevention. Prevention and risk factor control are sometimes difficult to work into routine clinic visits with patients who have comorbid illness, so effective alternatives are important. This project targets a higher risk group of Veterans enrolled in primary care.
    (PI: David Edelman, M.D., M.H.S.)

  • Stay Strong: A Physical Activity Program for Afghanistan and Iraq Veterans.
    This randomized controlled trial tests a novel intervention designed to maintain or improve levels of physical activity for younger Veterans to prevent the rapid weight gain and inactivity that can accompany discharge from military service. This e-health intervention will utilize a web and cell phone-based activity program with e-coaching to intervene before chronic conditions arise. The Stay Strong intervention extends beyond traditional web-based intervention delivery, by incorporating continuous objective monitoring of physical activity and automated tailored electronic feedback.
    (PI: Laura Damschroder, MS, MPH)

  • Risk Stratification and Tailoring of Prevention Programs.
    The purpose of this observational study is to leverage a comprehensive set of patient characteristics that will be captured in the three other CREATE projects in order to evaluate the heterogeneity of treatment effects across the three prevention trials. Using state-of-the-art methods, this project will determine which characteristics of Veterans are associated with treatment response from HRA shared decision-making, group prevention clinics, and web-based physical activity interventions.
    (Co-PIs: Matthew Maciejewski, Ph.D., and Maren Olsen, Ph.D.)

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