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VA Center for Clinical Management Research

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CCMR Affiliated Centers

The Ann Arbor CoE contains six programs, each focusing on a different aspect of health services research. These areas of study include diabetes, serious mental illness, health care decisions, patient safety, and complex chronic conditions. A description of each of these programs is provided below.

QUERI Program: Implementing Goals of Care Conversations with Veterans in VA LTC Settings (LTC QUERI)

In VA Community Living Centers (CLCs) and Home-Based Primary Care Programs (HBPCs), identifying and respecting Veteran preferences about where and how they want to be cared for is critical to promoting quality end-of-life care. The updated CLC Handbook includes new guidelines for having thorough conversations about these preferences with patients and their families, which will be implemented throughout VA. LTC QUERI, led by a multi-site team of Anne Sales, Mary Ersek (Philadelphia), and Orna Intrator (Canandaigua), is a group of 4 interrelated projects with the overall goal of helping VA staff implement and expand on these Goals of Care (GoC) conversations.

LTC QUERI is designed to ensure that Veterans in CLCs and HBPCs are able to express their preferences for care, make sure it is documented in a place where the entire team can find it, and make sure that their preferences are acted upon in the care and services they receive. Projects 1 and 3 will support CLC staff in VISN 11 and HBPC staff in VISNs 19 & 21 respectively as they complete and document GoC conversations. Projects 2 and 4 will build on these preferences with personalized care plans for Veterans with dementia in VISNs 4 & 11 (Project 2) and emphasis on physical activity programs in VISNs 19 & 21 (Project 4). The implementation strategy will include an audit with feedback coupled with action plans developed through learning collaboratives.

QUERI Program: PeRsonalizing Options through Veteran Engagement (PROVE)

"One size does not fit all" in healthcare. No two Veterans are alike, nor are any two VA medical centers or community-based outpatient clinics (CBOCs). Decisions in healthcare delivery too often are based on "average" effects. Current guidelines and performance measures frequently recommend prescribing the same treatments to many different types of patients based on the average result of a clinical trial without considering important differences between patients. This QUERI, led by Julie Lowery, Angela Fagerlin and Ann-Marie Rosland, will build on an extensive body of work by the VA HSR&D's Center for Clinical Management Research (CCMR) and the Quality Enhancement Research Initiative (QUERI) on individualizing prevention strategies and treatments to optimize care delivered to Veterans.

The overall goal of PROVE is to improve the prevention and management of chronic conditions by supporting Veterans and providers in making personalized healthcare decisions that take into account individual patient risk and preferences. Investigators will work to improve the appropriateness of care (e.g., decrease overuse and underuse), increase Veteran engagement in their healthcare, and enhance Veterans' experiences. Specific aims include implementing: 1) Patient-centered performance management systems that enhance appropriateness of care and incorporate shared decision-making; and 2) Personalized self-management programs that promote health and prevent disease.

Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC)

CCMR is co-located with the VA’s Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), a program evaluation center in the VA Office of Mental Health Operations, http://vaww.smitrec.va.gov. For more information please contact John McCarthy

Center for Bioethics and Social Sciences in Medicine (CBSSM)

CBSSM is a multidisciplinary unit in the Medical School at the University of Michigan that partners with CCMR to integrate bioethics with key social science disciplines, bringing together in one entity research, education, policy work, and service. CBSSM attracts scholars from across departmental and disciplinary boundaries and in so doing, provides fertile ground for new synergies. CBSSM is co-directed by Drs. Angela Fagerlin and Raymond De Vries.  The Center's Web site can be found at cbssm.org/.*

VA/UM Patient Safety Program

Sanjay Saint, MD, directs the VA/UM Patient Safety Program, which was established with funds from AHRQ in 2001.  The overall goal of the Program is to assemble interdisciplinary teams of investigators, and mentor junior clinician investigators, to conduct creative, high impact research in the following areas:  (1) preventing hospital and nursing home adverse events; (2) enhancing patient safety in ambulatory care; (3) improving medical decision making by physicians and patients as an error reduction strategy; and (4) improving our understanding of the reliability and validity of error assessment.  The Program's Web site can be found at psep.med.umich.edu.*

VA/UM Program on Quality Improvement for Complex Chronic Conditions (QUICCC)

This program, established in May 2006, is directed by Dr. John Piette.  QUICCC’s goal is to coordinate and advance our research projects to develop and evaluate novel interventions that improve the efficiency and quality of care for chronically ill VA and non-VA patients with an emphasis on identifying services that support effective primary care and patient self management.  The program is also designed to provide a forum for developing VA investigators interested in interventional health services research and the resources those junior investigators need to develop ideas and secure funding for larger studies.  The program’s Web site is:  www.med.umich.edu/QUICCC/index.htm.*

The Department of Veterans Affairs does not endorse and is not responsible for the content of these linked websites.