COIN: Center of Innovation for Veteran-Centered and Value-Driven Care; Seattle, WA and Denver, CO
Director: David Au, MD, MS; Acting Director: Michael Ho, MD, PhD; Associate Director: Steven B. Zeliadt, PhD, MPH; Acting Associate Director: Christine D. Jones, MD, MS
About the COIN
This Center's mission is to conduct outstanding health services research that promotes Veteran-centered and value-driven care, generate and disseminate knowledge that contributes to the well-being of Veterans, partner with VA policy and operational leaders to implement research findings into clinical care, and train the next generation of health services researchers and leaders.
Research Focus Areas
The Center focuses on the following:
- Promote Veteran-centered care and improve patient experiences in VA healthcare and community settings.
- Advance value-driven care by providing Veterans the highest quality care at lowest financial burden.
Research to Impact for VeteRans (RIVRs)
The Research to Impact for VeteRans (RIVRs) program is a new HSR&D funding mechanism that gives researchers the opportunity to pursue a five-year impact goal. Each RIVR impact goal aligns with VA priority areas including VA legislative priorities (e.g., MISSION Act); cross-cutting ORD priorities (e.g. PTSD); other HSR&D defined clinical priorities (e.g. Health Equity); and HSR&D methodological priorities (e.g. Data Sciences, Implementation Sciences, Systems Engineering). Impact goals for RIVRS could include changes in VA policy or clinical guidelines, spread of operational processes across VISNs, scaling of an effective intervention to 2-3 additional sites, advancements in health services research methods, or any other impacts that have real-world effects on Veteran health and satisfaction.
Current RIVR project
Evaluating and Enhancing Women’s Health Care Quality through the Cerner Transition
Principal Investigator: Kristen Gray, PhD
The overarching goal of this project is to ensure women Veterans receive high-quality health care as VA transitions to the Cerner Electronic Health Record (EHR). VA has made major advances in providing high-quality, comprehensive, gender-specific health care to women Veterans, and the Cerner transition presents both opportunities and challenges to move VA forward in these efforts. This project will expand a developing team of women’s health experts housed within the COIN with strong operational and clinical partnerships. Building on learning health care system principles, the team will leverage early Cerner transition experiences at VA Puget Sound Health Care System to develop interventions to optimize the transition in women’s health and evaluate these strategies with implementation science methodologies. This work will assist VA in delivering effective, safe, timely, and efficient care to women Veterans.
Advancing Veteran-Centered Care
The Center will promote Veteran-centered care and improve patient experiences in VA healthcare and community settings. To achieve this goal, we will 1) develop methods to incorporate patient-reported outcomes (PROs) in routine clinical care and test interventions to improve PROs; 2) improve patient adherence and self-management behaviors through interventions targeting patients, providers, and health systems; and 3) innovate the delivery of specialty, mental, and/or primary healthcare services to patients using patient-centered approaches that bridge socioeconomic and geographic disparities.
Advancing Value-Driven Care
We will advance value-driven care by providing Veterans the highest quality care at lowest financial burden. To achieve this goal, we will 1) develop new approaches to care that help VA efficiently utilize, integrate, and coordinate health services received within VA and in the community; 2) improve the quality and safety of care through appropriate implementation and de-implementation of healthcare services; and 3) identify methods to improve workforce development, deployment, and provider satisfaction and well-being within VA.
The Virtual Specialty Care QUERI is evaluating the effectiveness of more and less intensive (and expensive) implementation strategies for PTSD tele-mental health services, a mobile app supporting a treatment called “prolonged exposure” for PTSD, and improved information exchange between VA and community care. The Long-Term Care QUERI is using feedback interventions coupled with action planning through learning collaboratives and rapid tests of different designs within these strategies to overcome barriers to implementing the national Life-Sustaining Treatment Decisions Initiative which is designed to ensure that medical treatment is concordant with Veterans’ care preferences. The goal of the Triple Aim QUERI (TAQ) is to leverage healthcare data to identify actionable care gaps, and to implement innovative healthcare interventions to improve the Triple Aims of VA healthcare. The projects identify and address gaps in care, access to care, opioid safety, telehealth technology, rural Veterans, and developing best practices. The Safety/Quality QUERI is assessing how facilitation can be adapted for de-implementation of harmful, low-value therapies. The program will contribute to our understanding of factors that affect de-implementation and budget impacts of de-implementation efforts.
The Center also participates in the VA Advanced Fellowship Program in Health Services Research and Development that trains and mentors the next generation of VA HSR&D scientists and physician scientists. Both the Seattle and Denver locations offer MD and PhD fellowships.
Each COIN works closely with operational partners throughout the VA healthcare system. The partners associated with this COIN include:
- Office of Patient Centered Care and Cultural Transformation
- Office of Veteran Access to Care
- Office of Patient Care Services
- Primary Care Services
- Specialty Care Services
- National Center for Health Promotion and Disease Prevention (NCP)
- Care Management and Social Services
- VA Office of Healthcare Transformation
- VISNs 19 and 20
- Office of Rural Health
- Office of Connected Care
- Office of Geriatrics and Extended Care
- Office of Community Care
- Office of Nursing Service