The Friends of VA Medical Care and Health Research (FOVA), in partnership with the Department of Veterans Affairs (VA) Office of Research and Development, hosted a May 16 congressional briefing titled “VA Research from Bench to Bedside,” in conjunction with National VA Research Week.
Panelists included David Atkins, MD, MPH, acting VA chief research and development officer; Amy Kilbourne, PhD, MPH, director, VA Quality Enhancement Research Initiative (QUERI) and professor, University of Michigan Medical School; David Oslin, MD, director, VISN 4 Mental Illness, Research, Education and Clinical Center (MIRECC), chief of behavioral health, Philadelphia VA Medical Center, and professor of psychiatry, University of Pennsylvania; and Julia Prentice, PhD, Steve Pizer, PhD, and Austin Frakt, PhD, of the Partnered Evidence-Based Policy Research Center (PEPReC). The panel was moderated by Rick Starrs, chief executive officer, National Association of Veterans' Research and Education Foundations.
The panel discussed ways in which VA-conducted or funded research can impact patient care to create a “learning health care system”—one that takes research, innovations in care coordination, integrated care and information technology and uses them to apply “strategies at the provider and healthcare organization level to improve the quality of care and overall experience for veterans,” according to Starrs.
“It’s not enough just to do research and say we found something that works better. It’s the challenge of getting a health system to actually do it, and do it well,” Dr. Atkins said. “How do we get more of the research that gets published in journals actually showing up in the care that gets delivered?”
Much of the research presented dealt with mental health, which is a priority for VA research and care. Dr. Kilbourne pointed out that the VA is one of the largest single employers of social workers, psychologists, and other mental health providers in the country and one of the only sole source providers for mental health care, especially for veterans in rural areas.
Specific topics included using evidence-based implementation strategies to assist providers in re-engaging patients with serious mental illness, the use of precision medicine in mental health care and anti-depressant prescription, and program evaluations of opioid abuse and suicide risk management assessments.
Dr. Prentice, Dr. Pizer and Dr. Frakt also discussed their research into access and how that work had been translated into new scheduling policies at VA health centers. They worked to first validate the access metrics, showing that they were tied to self-reported patient satisfaction or health outcomes. They then use the metrics to improve scheduling policies. “Now that we know the access metrics that the VA is using are valid, we need to set up the scheduling policies in health care systems to balance the access needs of this diverse veteran population,” Dr. Prentice said.
Providing a specific example of this work, Dr. Prentice discussed how VA health centers schedule follow up appointments, either at the initial appointment or a few weeks before it was needed. “When you wait and schedule the follow up appointment closer when it needs to occur, you are actually doing a better job of balancing access for new and returning patients,” Dr. Prentice said.
As part of the discussion of the value of translational research, Dr. Oslin noted that it takes time to take research from the bench or desk to the bedside. “We rarely get an answer that totally changes the world; it’s an iterative process. We learn a lot. We learn what we need to apply and then we have to learn how to apply it, he said.”
Addressing questions about the applicability of this research to the general population, Dr. Atkins responded, “People used to say veterans are different from non-veterans. I think we’ve increasingly shown that’s not really true and some of the problems the VA has in having patients who are, on average, sicker than the general population are the same problems that everyone else is confronting.”
Meanwhile, the House of Representatives May 19 approved its FY 2017 appropriations bill, and Senate action is expected to follow shortly. Thus far, both bills have fallen short of the VA Research funding level recommended by FOVA [see Washington Highlights, April 15]. AAMC is a member of the FOVA executive committee.