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1999 HSR&D National Meeting

The Health Services Research and Development (HSR&D) Service Seventeenth National Meeting was held in Washington, D.C. on February 24-26, 1999. The conference theme, Health Services Research at the Interface, focused on the new partnerships that are required for HSR&D to have a true impact on the health care system it serves; partnerships that will enhance comprehensive, accessible, cost-effective, and patient-centered care.

Hosted by the VA Center for Health Services Research in Primary Care in Durham, NC, and its Director, Eugene Z. Oddone, M.D., this year's National Meeting reflected a remarkable year for HSR&D. Exploring the linkages between scientific endeavors, policy and clinical service, nearly 500 people attended this year's meeting, making it the largest HSR&D National Meeting yet.

An exciting year in review
Opening the meeting, John G. Demakis, M.D., Director of HSR&D, noted many of the significant and exciting HSR&D contributions of this past year. Stressing HSR&D's emphasis on new studies to improve health care for veterans, Dr. Demakis spoke of research solicitations in five areas of priority:

- patient access to care,
- managed care,
- ethnic/cultural issues,
- gender issues,
- and implementing clinical practice guidelines.

Special solicitations were also put forth in patient-centered care, patient safety, prevention of adverse events, and crosscutting issues in telemedicine. Future initiatives include studies on end of life care, homelessness, and what VA considers to be the 5th vital sign - pain management. HSR&D is also leading the important new Quality Enhancement Research Initiative (QUERI) that was developed by Kenneth W. Kizer, M.D., MPH, VA's Under Secretary of Health, and John R. Feussner, M.D., VA's Chief Research & Development Officer. Focusing on conditions that have the highest risk and prevalence in VA patients, QUERI's mission is to translate research discoveries and innovations into better patient care and systems improvements. Over the next few years, QUERI will have a dramatic impact on VA policies, practice and patient outcomes.

Meeting Highlights
Congressman David Price Addresses Participants
Reflecting his deep commitment to the VA, the Honorable David E. Price, Ph.D., Democratic Representative of North Carolina's District 4, talked to conference attendees about the "major contributions HSR&D makes toward health care for veterans." Noting the direct link between research and patient care, Congressman Price stressed the importance of making the public aware of the work being done by HSR&D to improve the lives of veterans. He spoke of the "investments we make in research today that will pay off for years to come," and observed that "as our VA population ages, the ability to keep veterans healthier, longer is one of the primary ways we can keep Medicare costs down in the future."

Emphasizing the benefit of an investment in research dollars, Congressman Price stated, "Every dollar that we spend to conduct research in VA medical facilities, such as the stroke prevention program that's underway now in Durham (at an HSR&D Center of Excellence), will be saved many times over in a healthier population and lower health care costs for veterans and all Americans."

Presentation of the Undersecretary's Award
VA Research maintains its pursuit of excellence through the dedication, commitment and quality of its investigators. In acknowledgment of this excellence, the Undersecretary's Award for Outstanding Achievement in Health Services Research was established. The first recipient of this prestigious award is Rudolf H. Moos, Ph.D., a leading scientist and Director of HSR&D's Center of Excellence in Palo Alto, CA. One important result of Dr. Moos' work is the development of the objective scales that have become the "gold standard" used by the entire health care industry to measure the efficacy and cost-effectiveness of mental health and substance abuse treatment programs. Dr. Moos has spent 35 years bringing scientific distinction to the VA through his contributions to health services research. Deputy Under Secretary Thomas L. Garthwaite, M.D., presented the award.

Research Highlights
Current health services research showcased at the meeting included four studies selected for the Plenary Session, 72 studies chosen for oral presentations, 10 offered through workshops, and 60 presented during the poster/exhibit session.

Dan R. Berlowitz, M.D., M.P.H. began the plenary session with his presentation titled "Are we improving the quality of nursing home care: The case of pressure ulcers," and Stephan D. Fihn, M.D. discussed his paper, "Variations in condition-specific health status among VA general internal medicine clinics." "Patient preferences in PSA screening: The impact of shared decision-making videos" was presented by Edwin G. Wilkins, M.D., and the final plenary paper, "Effectiveness of VA primary care firm systems: Preliminary testing," was presented by Elizabeth Yano, Ph.D..

Concurrent paper sessions, workshops and poster/exhibits presented during the National Meeting covered a host of conditions and health care issues including diabetes, telemedicine, cancer, HIV, Hepatitis C, mental health, chronic diseases, quality of life, quality of dying, HMOs, Medicare, addictive disorders, epidemiology, special populations, and organizational change. In addition, a Special Interest Group Roundtable Luncheon was held in which Meeting attendees had the opportunity to meet with other investigators in small groups and discuss health care issues of mutual interest.

In an additional plenary session, Epidemiologic Research and Information Centers (ERIC) in Boston, Durham and Seattle presented information about epidemiologic technical support they provide to VA researchers as well as highlights of current ERIC research on health issues such as sleep disorders in Persian Gulf veterans, post-traumatic stress disorder (PTSD), hypertension, diabetes, cancer, and Hepatitis C.

Invited Speakers
Throughout the two day meeting, several speakers addressed the participants. Barbara K. Rimer, Ph.D., Director of the Division of Cancer Control and Population Sciences at the National Cancer Institute, gave the Keynote Address titled "Cancer-related health services research: Many questions, too little research. Robert A. Petzel, M.D., Director of Veterans Integrated Service Network (VISN) ##13 (upper mid-west), spoke about how HSR&D's work interfaces with VISN policy. Noting VA's shift from an organization based on discipline to one based on function or service lines, Dr. Petzel spoke of HSR&D's important role in facilitating these changes in organization by providing the most current information on cost effective, evidence-based practice.

Earl Steinberg, M.D., MPP, Vice President of Convance Health Economic and Outcome Services, Inc. and Director of Quality Assessment and Improvement Systems, and Co-Director of Outcome Studies Group in Washington, DC, discussed how HSR&D's research interfaces with the private sector; and John R. Feussner, M.D., who spoke to the heart of HSR&D research: Translating research into practice. Dr. Feussner discussed several HSR&D initiatives that were designed to operationalize research results; in other words, translating research results into better standards of care. The National Surgical Quality Improvement Study (NSQIP), a study Dr. Feussner called "a remarkable collaboration among policymakers, researchers, and clinicians," was one. NSQIP had three goals: to improve the care of veterans; to identify and create a data set; and to develop performance measures for chiefs of surgery." The results? Significantly lower 30-day post-operative mortality and morbidity rates have proven NSQIP's success. Another example of translation comes from the Management Decision and Research Center's Technology Assessment Program (TA). The TA assessment of Positron Emission Tomography guided VHA's policy on the utilization of this diagnostic tool.

Continued Commitment
Dr. Demakis closed the meeting by encouraging investigartors to continue the the discovery and development of new methods for improving health care for veterans and the nation. Next year's HSR&D National Meeting , will be the first of the new millennium. It will be held in Washington, D.C. on March 22-24, 2000 and hosted by The Veterans Evidence-Based Research, Dissemination, and Implementation Center of Excellence (VERDICT), San Antonio, TX.

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