Research News

HSR&D Investigators Present Findings at SGIM Annual Meeting

April 25, 2017

Several VA HSR&D investigators presented important findings at the 2017 SGIM Annual Meeting held in Washington, DC from April 19-22. Erin Krebs, MD, MPH, part of HSR&D's Center for Chronic Disease Outcomes Research (CCDOR), presented findings during one of the meeting plenary sessions from the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) randomized trial that compared the benefits and harms of opioid therapy versus non-opioid medication therapy over 12 months. Study participants - seen in VA primary care - included 240 Veterans with moderate to severe chronic pain or hip/knee osteoarthritis (OA) pain despite the use of analgesics. Veterans were randomized to one of two treatment arms: opioid therapy or non-opioid medication therapy. Findings showed no significant advantage of opioid therapy compared with non-opioid medication therapy. Over 12 months, pain-related function improved for Veterans in both arms of the trial: 59% for opioids and 60% for non-opioids, while the proportion of pain intensity response was 41% for opioids and 54% for non-opioids. These results support the recent CDC recommendation that non-opioid therapies are preferred over opioids for chronic pain.

Thomas O'Toole, MD, Director of VA's National Center on Homelessness among Veterans and part of HSR&D's Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, and Stephan Fihn, MD, MPH, Director of Analytics and Business Intelligence for VHA's Office of Informatics and Information Governance, were part of a plenary session armchair discussion on housing and health. VA has incorporated universal homeless screening in primary care, and it shows that between 50,000 to 60,000 Veterans are homeless - or are at risk of being homeless each year. Dr. O'Toole stated that "housing is healthcare." In this spirit, reducing homelessness among Veterans has been a VA priority for several years, and rates of homelessness have decreased as a result of VA initiatives such as Housing First. The panel called this initiative a "game changer," as it allows homeless Veterans to acquire housing before they enter into treatment, so that treatment and other support systems are wrapped around Veterans as they obtain and maintain permanent housing. The Housing First model is implemented through the U.S. Department of Housing and Urban Development (HUD) and the VA Support Housing (VASH) program via HUD-VASH vouchers.

VA HSR&D investigators also presenting at the SGIM Annual Meeting included:

• Sonya Borrero, MD, MS, part of HSR&D's Center for Health Equity Research & Promotion (CHERP), chaired a panel session on "Reproductive Health Research in Women Veterans," which discussed research that informs capacity building and efforts to ensure comprehensive reproductive care for all women Veterans.
• Ann-Marie Rosland, MD, MS, also part of CHERP, led a session titled "Caring for High-Need, High-Risk Patients: Lessons Learned about Supporting PCPs and Preventing Burnout in the Veterans Affairs System" that described characteristics of complex patients, as well as a novel use of existing health system data to identify subgroups of high-risk patients for targeted interventions.
• Christian Helfrich, PhD, part of HSR&D's Center of Innovation for Veteran-Centered and Value-Driven Care, led a session titled "Employee Burnout: Longitudinal Trends, Mitigating Factors, and Corollaries in VHA," which reported findings related to employee burnout within the VA healthcare system. Results provided insight into potential strategies for reducing burnout, particularly in the context of large-scale organizational change.
• William Becker, MD, part of HSR&D's Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, led a session titled "Improving the Quality of Chronic Pain Care" that used the Consolidated Framework for Implementation Research (CIFR) to guide session participants in developing action plans for addressing system-level challenges related to improving the quality of chronic pain care at their institutions and/or care settings.
• Barbara Trautner, MD, PhD, part of HSR&D's Center for Innovations in Quality, Effectiveness and Safety (IQuEST), led a session titled "Antibiotic Stewardship in the Hospital and Beyond," which provided research updates on approaches to antibiotic stewardship in hospitals and during transitions to post-acute and long-term care settings.

Additional VA HSR&D sessions focused on topics such as obesity, patient-aligned care teams, and mind-body medicine.

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