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VA Center for Clinical Management Research

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Current Funded Research Projects

In 2014 CCMR investigators were funded for nearly 90 different research projects. Our investigators served as principal investigators on 14 HSR&D IIR grants, 1 CREATE, 1 CSR&D IIR, 2 HSR&D SDRs, 2 QUERI SDPs, 7 QUERI RRPs, 7 grants from VA partners, 3 Cooperative Study Projects (as site PIs), and 20 NIH grants, as well as grants from the Robert Wood Johnson Foundation and Blue Cross Blue Shield Foundation of Michigan. In the paragraphs below we highlight the new HSR&D-funded projects that started in FY 2014.

Will Veterans Engage in Prevention after HRA-guided Shared Decision Making? (CRE 12-288; Damschroder and Oddone, co-PIs).

VHA has made significant improvements in addressing conditions that lead to heart disease in Veterans, yet fewer gains have been made in addressing the underlying behavioral factors that increase a person’s risk for heart disease. The objective of this study is to determine if both a telephone-based Shared Decision Making (SDM) intervention, using VHA's newly released Health Risk Assessment (HRA), and a Prevention Coach will increase patient activation and enrollment in prevention programs compared to usual care. This project will be the first to test an on-line health risk assessment program using a SDM framework in the context of a large healthcare system.>

Promoting Veteran-Centered Colorectal Cancer Screening (IIR 12-144; Saini, PI).

Colorectal cancer (CRC) screening is a widely recommended, evidence-based preventive service that has traditionally been underused. Over the last decade, organized efforts by VHA to increase population screening for CRC among Veterans have been successful. But these population-centered efforts have increased screening utilization in a way that is not always concordant with screening benefit, particularly among older Veterans. As patients get older and acquire health problems, the benefit of screening decreases and the potential harm of screening increases. This study will test a three-part intervention that involves: (1) a decision aid to help Veterans make informed screening decisions; (2) education for providers on how the benefits of screening vary according to a patient’s age and health status; and (3) modification of performance measurement and clinical reminder systems to promote informed decision-making about screening. The intervention will be tested in a pragmatic cluster-randomized controlled trial at two sites in the VA Ann Arbor Healthcare System. Lessons learned from this work may ultimately provide a model for delivering preventive care in a more Veteran-centered way.

Identifying and Reducing Catheter-Related Complications (IIR 12-395; Krein, PI).

Urinary catheter and peripherally inserted central catheters (PICCs) are important for the medical management of many patients in the hospital setting, but they can also cause serious and potentially life-threatening complications. This study will provide critical information about the complications associated with urinary catheters and PICCs and help to identify and test strategies to prevent or reduce the occurrence of these complications. The research will be conducted at the VA Ann Arbor Healthcare System and the Michael E. DeBakey VA Medical Center in Houston.

REcovery after in hoSpital Cardiac arrest: late outcomes and Utilization (ResCU) (IIR 13-079; Iwashyna and Nallamathou, co-PIs).

In-hospital cardiac arrest (IHCA) is common, life-threatening, and resource intensive. This study will: (1) measure long-term outcomes (including health status) and healthcare utilization in patients after IHCA within VHA and determine key patient-level factors that are linked to adverse outcomes; (2) identify hospital-level factors that are associated with long-term outcomes and healthcare utilization; and (3) determine the extent of variation in long-term, risk-adjusted outcomes across hospitals and VISNs. Findings will be used to develop new strategies for quality improvement both within VHA and elsewhere.

Optimizing Veteran-Centered Prostate Cancer Survivorship Care (IIR 12-116; Hawley, PI).

Prostate cancer survivors often experience significant side effects from treatment (surgery or radiation therapy) that can persist for years, including incontinence, erectile dysfunction, and metabolic syndrome. Currently VHA does not have a program for assessing ongoing symptom burden in survivors and directing them to receive appropriate primary or specialty care if needed. This three-site study is a randomized controlled trial designed to evaluate a personally tailored, automated telephone symptom management intervention for improving symptoms and symptom self-management. It will also explore how symptom burden is associated with use of appropriate services in VHA.

Technologically Enhanced Coaching (TEC): A Program for Improving Diabetes Outcomes (IIR 12-412; Heisler, PI).

Recent research has shown that peer support programs can improve glycemic control among Veterans who have diabetes and poor control. The purpose of this study is to test the effectiveness of a technology-enhanced peer coaching (TEC) program in improving glucose control relative to peer coaching without technology enhancement. The technological tool is an iPad application that encourages interaction by providing choices of materials to view, using audio-visual elements, and incorporating a goal-setting process for developing self-management action steps and questions that patients can discuss with their doctor at their next clinic visit. Ongoing weekly contact between the Veterans is supported by a confidential phone system. If found to be effective, this program will serve as an important complement to usual care by providing sustained, flexible between-visit support.