1. Jan 14, 2009 Presentation to: 2009 ORD Local Accountability for Research Seth Eisen, MD, MSc Director, Health Services Research & Development HSR&D: The “Bedside Investigators”

2. Define Health Services Research (HSR), Describe VA HSR’s priorities, Present VA HSR characteristics, Describe recent HSR initiatives, Present recent HSR results. Presentation

3. Office of Research & Development (ORD) Biomedical Laboratory Clinical Science RehabilitationHealth Services Director: Micky Selzer, MD, PhD Director: Seth Eisen, MD, MSc Director: Tim O’Leary, MD, PhD Chief Research and Development Officer: Joel Kupersmith, MD Director: Ron Przygodzki, MD Deputy CRADO: Tim O’Leary, MD, PhD QUERI * Director: David Atkins, MD * Quality Enhancement Research Initiative

4. “The Bedside Investigators” Access, Patient Preferences, Outcomes, Quality, Delivery, Implementation, Organization, Costs / Effectiveness. Health Services Research

5. HSR&D Priorities Disease Oriented: Mental Health (PTSD, substance abuse, suicide) Post Deployment Health (TBI, polytrauma, pain) Care of Complex, Chronic Conditions Women’s Health Health Services Genomics Sociological & Cultural: Equity & Health Disparities Long-Term Care & Caregiving Methodological: Research Methodology Implementation & Management Research Access/Rural Health Healthcare Informatics

6. 2008 Budget: ~ $88 m (HSR&D + QUERI) Investigators: ~ 600 Career development awardees: ~ 50 Active research projects: ~ 400 Centers of Excellence & Research Enhancement Award Program (REAP) PI’s: 27 HSR&D Statistics

7. Clinical Research Strengths Outstanding, university affiliated investigators, Electronic medical record, Centralized clinical databases, Integrated national system, Implementation focused organization.

8. Primary Funding Mechanisms Investigator Initiated Research (IIR) Request for Proposals (RFP) Service Directed Project (SDP)

9. Recent Initiatives Veterans Informatics, Information, & Computing Infrastructure (VINCI) Consortium for Healthcare Informatics Research (CHIR) Provider education to Improve Patient Outcomes Health Services Genomics

10. Health Other (e.g., Medicare, DoD, Investigator) Administrative VINCI (Continuously Update) Investigator Data Sources VINCI Research Initiative VA Research & IT Provide VINCI Oversight

11. Advantages of VINCI Concept More data available, More data available, Enhanced data security & privacy, Enhanced data security & privacy, Real time mirror with clinical data will facilitate clinical & decision support research, Real time mirror with clinical data will facilitate clinical & decision support research, Text data promotes research, Text data promotes research, Substantial computing power, Substantial computing power, Rapid adoption of technical computer advances, Rapid adoption of technical computer advances, Rapid sharing & dissemination of informatics products. Rapid sharing & dissemination of informatics products.

12. Consortium for Healthcare Informatics Research (CHIR) Create a virtual informatics research consortium, Create a virtual informatics research consortium, Extract, cleanse, reformat, de-identify text, Extract, cleanse, reformat, de-identify text, Prepare text for data mining Prepare text for data mining Apply text processing to clinical issues, Apply text processing to clinical issues, Encourage non-consortium investigators to develop informatics research projects that include text data. Encourage non-consortium investigators to develop informatics research projects that include text data.

13. Provider Education to Improve Patient Outcomes Emphasizes: o o Impact of provider education on patient outcomes, o o Collaboration with OAA, EES, health educators, o o Development of education measurement tools, o o Understanding the education process, o o Creating & evaluating alternate education methodologies

14. CDA Awardees Since 1998 Training Category% of Total Physician Internists74 % Surgeons5 Psychiatrists5 Non-Physician Clinical Psychologist10 Nurse4 Clinical Pharmacist2 Grand Total100% (97)

19. Health services researchers are the ‘bedside investigators’ VA HSR: o o priorities address issues related to post- deployment health & VHA quality of care o o is implementing several innovative research programs o o results are important to both VHA & the nation. Summary