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Health Systems Research

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CREATE: Promoting Value & Access in VA's Substance Use Disorder Services

Director: Keith Humphreys, Ph.D.

Principal Investigators:

About the CREATE

Substance use disorders (SUDs) have substantial negative consequences on Veterans' mental and physical health, work performance, housing status, and social functioning. The population of Veterans with SUDs, other than nicotine dependence, increased from 270,991 (6% of VHA patients) in FY02 to 461,927 (8% of VHA patients) in FY10. Moreover, it is estimated that Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom have a 27% higher rate of substance use disorder diagnoses than Veterans of other conflicts who receive VA healthcare services.

The mission of this CREATE is to increase value and accessibility across the continuum of substance use disorder care, through the validation and refinement of access and process quality metrics; the evaluation and dissemination of low-cost, high-impact service innovations; and the promotion of patient and provider knowledge about evidence-based treatment for substance use disorders.


Partner Offices

Each CREATE works closely with operational partners throughout the VA System. Operational partners associated with this CREATE include:

  • The Office of Mental Health Services
    "The CREATE proposal will facilitate implementation of the VHA Handbook on Uniform Mental Health Services at VA medical centers and clinics, which is the primary focus of Mental Health Services in VA Central Office. I am confident this collaborative effort will inform and motivate our efforts to improve the accessibility, quality, efficiency, and effectiveness of the service system for Veterans with substance use disorders and co-occurring conditions."
    - Daniel Kivlahan, Ph.D., Deputy Director for Addictive Disorders, VA Office of Mental Health Services
  • The Office of Public Health
    "This CREATE's innovative study of alcohol use among Veterans with Hepatitis C could give us an inexpensive, easily scalable technology that we could make available VA-wide."
    - Janet Durfee, R.N., M.S.N., A.P.R.N., Deputy Chief Consultant, Clinical Public Health, VA Office of Public Health
  • Mental Health Operations
    "The projects in the substance use disorder CREATE have great potential to make a positive contribution to my office's central mission, which is to implement the VA mental health handbook, reduce variability, and improve the accessibility, quality and effectiveness of the $6 billion per year national VA mental health service system."
    - Mary Schohn, Ph.D., Director, Office of Mental Health Operations


This CREATE initiative includes four funded projects:

  • SUD Treatment and Staffing Handbook Implementation: Impact on Patient Outcome
    This project is designed to produce quick answers to critical questions about how to fund substance use disorder treatment services and whether staffing levels influence patient outcomes. Fenced funding (centrally monitored and controlled special purpose monies) and staffing guidelines are not viewed favorably by many VA networks; however, others believe that those funding models are useful. Findings of this study will determine whether fenced funding is effective, and will also contribute to an examination of alternative approaches to funding substance use disorder treatment services.
    (PI: Austin Frakt, Ph.D.)
  • Web-based Intervention to Reduce Alcohol Use in Veterans with Hepatitis C
    This multi-site, randomized clinical trial of a self-administered web-based brief alcohol intervention to reduce alcohol consumption in Veterans with hepatitis C virus (HCV) is important because the VA Office of Public Health considers improving HCV patients' access to quality alcohol treatment among its highest priorities. However, cost and organizational barriers have limited the adoption of face-to-face alcohol counseling methods in HCV clinics. This self-administered, electronic brief alcohol intervention may provide a lower-cost and more easily implemented and disseminated alternative. Should this intervention prove effective, the VA Office of Public Health and the Office of Mental Health Operations are committed to implementing it throughout the VA healthcare system.
    (PI: Keith Humphreys, Ph.D.)
  • Improving Quality of Addiction Treatment Quality Measures
    This project aims to validate 41 newly-developed measures of addiction treatment quality. For clinicians and clinical managers, validated quality measures help define and motivate guideline-congruent care, can identify gaps in the continuum of care, and can help identify high- and low-performing facilities so that quality improvement efforts can be targeted. Validated measures of addiction treatment quality also provide Veterans with a means to compare the quality of care provided at different health care facilities.
    (PI: Alex H. Harris, Ph.D., M.S.)
  • Telemonitoring to Improve Substance Use Disorder Treatment after Detoxification
    This multi-site, randomized clinical trial will look at telephonic monitoring and support intervention to improve care transitions and outcomes among Veterans who have received detoxification for substance use disorders. The investigation responds to the VA Office of Mental Health Operations' concern that most of the 25,000 addicted Veterans who receive inpatient detoxification each year do not go on to be engaged in substance use disorder treatment. Even modest success in this arena would dramatically reduce costs for VA, while significantly promoting the health of Veterans struggling with substance use disorders.
    (PI: Christine Timko, Ph.D.)

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