HSR&D MERIT: Impact of Combined Recovery Program and Home Telehealth Among Veterans with substance use disorders in the VA Inpatient Setting (PI: Santa Ana) 

This 4-year randomized trial will be conducted in the VA inpatient unit and aftercare setting and will evaluate the relative effectiveness of the Combined Recovery Program (CRP), Stable & Able (S&A) vs. Treatment-as-usual. CRP is designed to enhance the stabilization of Veterans with Substance Use Disorders beyond hospital discharge and consists of ‘Group Motivational Interviewing’, an adaptation of motivational interviewing. To be added to CRP, Stable & Able is a VA Home Telehealth nurse-monitored program providing assessment and self-management skills in the post-hospitalization phase. This project aims to assess the relative effects of Treatment Engagement, Substance Use, and Preventable services.  

HSR&D MERIT: Data-Driven Methods to Identify Social Determinants of Health (PI: Frey) 

The objective of the proposed research is to use a multilevel health informatics approach to determine the extent to which social determinants of health (SDOH) are documented in the Electronic Health Record (EHR) and patients with unmet social needs are identified in the VHA.  

HSR&D MERIT: Randomized Controlled Trial of AboutFace: A Novel Video Storytelling Resource to Improve Access, Engagement, and Utilization of Mental Health Treatment among Veterans with PTSD: (PI: Grubaugh) 

The National Center for PTSD (NCPTSD) developed and launched AboutFace, a public awareness campaign to help Veterans recognize PTSD and motivate them to seek evidence-based care. In addition to providing needed data on the efficacy of AboutFace and identifying strategies for effective implementation within VHA, this study will provide a greater understanding of the role and value of digital storytelling interventions to improve access to care for a wide range of stigmatized conditions.  

HSR&D MERIT: Evaluating Care Coordination for Community Hospitalized Veterans to Improve Outcomes in Dual-Use (ECHOeD): (PI: Axon) 

The VA Office of Community Care’s Acute Care Coordination (VAOCC) is currently developing a multi-component, evidence-based care coordination program to help Veterans receiving acute (ED and hospital) care at non-VA facilities navigate back to the VA system. Our Ralph H. Johnson VAMC team has partnered with VAOCC in developing a perspective, multisite program evaluation using mixed research methods within the context of the VAOCC program national rollout.  

HSR&D MERIT: Impact of neighborhood and workforce deprivation on diabetes outcomes in Veterans: a Spatio-temporal analysis (PI: Neelon/Hunt) 

This study seeks to identify and explain spatial and temporal variation in health outcomes, community resources, VA workforce capacity, and health disparities among patients with type 2 diabetes.   

HSR&D MERIT: Improving Transplant Medication Safety through a Technology and Pharmacist (ISTEP) Intervention in Veterans. (PI: Taber) 

This is a multi-center, prospective, cluster-randomized, parallel-arm study that will test the efficacy of a dashboard-enabled intervention at reducing health care encounters and costs in Veteran organ transplant recipients.  

HSR&D MERIT: Testing a Novel Dry Electrode Headset for Electroencephalography Telehealth (PI: Halford) 

This multi-center study seeks to improve access of Veterans with epilepsy living in rural areas to the most important diagnostic procedure for the care of patients with epilepsy: the routine electroencephalogram (EEG). Investigators will test a new method for recording EEG which uses a novel dry electrode system headset that does not require an EEG technologist to operate. The headset integrates the EEG electrodes and amplifier into a compact system that is easily placed on the head. With minimal training, this approach could make it possible for a nurse or nurse assistant to record an EEG in a rural community-based outpatient clinic (CBOC) as part of an epilepsy telemedicine outreach program along with clinical interviews. We will compare the performance of this dry electrode system to standard EEG when it is used by EEG technologists in three VA medical centers.   

Veterans Crisis Line Outcomes: Treatment Contact and Risk for Non-Fatal Suicide Attempts, Suicide Deaths, and All-Cause Mortality (PI: Mohamed)

This project is sponsored by the Veterans Crisis Line (VCL) and will evaluate the association between increased treatment contact following a VCL call, risk of non-fatal and fatal suicide behaviors, and all-cause mortality among VCL veteran callers regardless of their VHA enrollment. Specifically, results will determine whether increased healthcare contact following a VCL call reduces the risk for non-fatal suicide attempts and suicide deaths among Veterans with no healthcare contact in the month preceding the call, whether increased healthcare contact reduced all-cause mortality, and whether non-VHA healthcare data impacts these outcomes. Results will provide critical data in the evaluation of the pathways whereby the VCL may reduce the risk for suicidal behavior and premature deaths. Additionally, the proposed evaluation will extend the analysis to include non-VHA using Veterans by analyzing claims data from non-VHA sources. 

VISN7 Community Care Value Assessment Project (PI: Axon) 

This 2-year VISN-funded quality improvement project aims to advise operations leaders in VA during the MISSION Act Era by providing information on the quality, cost, and value of VA-purchased community care in selected clinical areas including cancer care, GI care, and orthopedics.  

Patient Safety Center of Inquiry (PI: Axon)  

This 3-year quality improvement program will evaluate the causes of medication-related adverse drug events among Veterans receiving community hospital and specialty care and adapt an existing pharmacist-driven, technology-enabled medication safety program to improve medication outcomes for Veterans.  

RR: Impact of the COVID 19 Pandemic on Chronic Disease Care within the VA (PI: Hunt)  

COVID-19 has profoundly impacted health and care for Veterans who are generally older, sicker, more rural, and more economically vulnerable than the overall U.S. population. Our primary objective is to build capacity for a robust evaluation of the impacts of the pandemic on chronic medical conditions. Specifically, we will (1) examine the pre-post impact of the pandemic, (2) the impact of telemedicine, and finally (3) the impact of neighborhood deprivation as well as racial-ethnic disparities on VAMC's ability to provide care during the pandemic.  

SDR: PRIME Care (PRecision medicine In MEntal health Care) (PI: Hamner) 

Commercial pharmacogenetic (PGx) testing for psychotropic medications has become widespread as a means of implementing "precision medicine”. This multi-site RCT will evaluate the utility of PGx testing in treating Major Depressive Disorder.  

Opioid Use Disorder during COVID 19 (PI: Myers)  

To develop methods required to conduct robust analyses assessing the impact of COVID-19 and related changes in policy and service design on access to care and medication management for Veterans with Opioid Use Disorder.  

VISN 7 Research Development Award: Engagement, Utilization, and Economic Impact of Homebased Telemental Healthcare for PTSD (PI: Myers) 

The goal of this project was to find ways to increase the implementation of Clinical Video Telehealth (CVT) for PTSD. The study aims included retrospectively examining treatment attendance of CVT for PTSD compared to in-person and “hub and spoke” model, examining the effectiveness of CVT for PTSD by studying (a) healthcare utilization and (b) economic impact, and conducting qualitative interviews with Veterans who engage in CVT for PTSD and providers for delivering CVT for PTSD to better understand satisfaction with services. 

DoD: Evaluating the Feasibility of RESCUE: An Adjunctive HAI-Based Intervention for Veterans with PTSD (PI: Grubaugh) 

Post-Traumatic Stress Disorder (PTSD) is a common mental health disorder among Veterans. Currently, there are more Veterans with PTSD who refuse or drop out of treatment than there are Veterans who complete treatment. Recovery through Engagement with Shelter Canines, Understanding, and Exposure (RESCUE), is an adjunctive, Human-Animal Interaction (HAI) intervention that will be developed for integration into Prolonged Exposure (PE) treatment. The goal of RESCUE is to decrease emotional numbing, an important barrier to care and functionally impairing PTSD symptom cluster, and thus improve functioning and increase treatment engagement and completion rates. This study aimed to develop and pilot test the feasibility, acceptability, and efficacy of an adjunct intervention for use with Empirically Based Treatments (EBT) for posttraumatic stress disorder (PTSD) to increase treatment engagement, and treatment completion, and improve treatment response regarding emotional numbing symptoms. Recovery through Engagement with Shelter Canines, Understanding, and Exposure (RESCUE), is an adjunctive, Human-Animal Interaction (HAI) intervention that will be developed for integration into Prolonged Exposure (PE) treatment. 

HSR&D Merit: Story-Call: E-Mobile Support For Community Caregivers Of Veterans With Dementia: (PI: Pope) 

Alzheimer's disease and the isolation it produces imposes a heavy burden on informal caregivers (CGs) of Veterans who are persons with dementia (PWD) and Veterans caring for PWD. Caregiver research indicates that dementia CG carries a greater burden than other chronic diseases. Of the more than 15 million CGs for dementia, nearly half are employed full or part-time and 55% are the primary breadwinner who may struggle with absenteeism, increased personal illness, and greater stress. Mobile technology can reach people who may be isolated, and desire increased social support. The Story-Call feasibility study will deliver personalized story-telling support in the form of short success stories generated by CGs and access to resources via a mobile phone application (APP) delivered to CGs of community-dwelling persons PWD. Hypothesis: The mobile APP is expected to enhance the well-being of working CG, decrease their perceived CG burden, increase their use of community resources and services, and potentially decrease CG costs through delay in the institutionalization of Veterans. 

HSR&D Merit: Group Motivational Interviewing (GMI) For Homeless Veterans in VA Services: (PI: Santa Ana) 

This study promotes access to care for homeless Veterans who are at risk for continued impairment in health and social functioning and whose treatment needs cannot be met by VA housing alone. One hundred and eighty-five Veterans in VA housing services with a diagnosis of alcohol or drug abuse/dependence were enrolled and randomly assigned to (1) GMI or (2) CT, each consisting of 4 sessions, and evaluated at 1, 3, and 6 months. This study was used to investigate the effectiveness of GMI for Veterans with substance use disorders in VA housing as compared to a control intervention, Life Skills Education Group (LSEG), across the following domains: treatment engagement, substance use, and psychosocial adjustment. 

HSR&D Merit: Improving PTSD Service Delivery for Veterans with Severe Mental Illness (PI: Grubaugh) 

Individuals with severe mental illness (SMI) are extremely vulnerable to both the experience of trauma and the subsequent development of PTSD. Despite high rates of trauma and PTSD, little is known about the most effective strategies for treating this subset of trauma survivors, particularly Veterans. As such, the overarching aims of this proposal are to adapt and refine posttraumatic stress disorder (PTSD) interventions for Veterans with severe mental illness (SMI); and effectively implement these interventions within Veterans Affairs Medical Centers (VAMCs). The data gathered from this project will help ensure that cognitive-behavioral exposure interventions are responsive to the unique needs of SMI patients in VA settings. These pilot data will also inform larger randomized trials, including effectiveness trials and efforts to improve the dissemination of interventions for this population (future planned research CDA and/or Merit grant applications). This proposal is responsive to VA research initiatives that emphasize the need to develop and evaluate mental health interventions aimed at reducing disparities in mental healthcare. 

Locally Initiated Project: Veterans Perspectives and Likely Impact of the Veterans Choice Program: (PI: Axon) 

Recent national controversy regarding timely access to primary and specialty care in the VHA has precipitated new operational initiatives and federal legislation slated to cost $17 billion over 5 years and is estimated to affect up to 500,000 Veterans. Specifically, the Veterans Accelerating Access to Care Initiative (ACI) aims to maximize existing clinical access and facilitate referral of Veterans for non-VA community care where wait times for VA care are greater than 30 days. The Veterans Access, Choice, and Accountability Act of 2014 (VACA) mandates extensive expansion of the VA healthcare provider workforce and creates a national program focused on providing non-VA healthcare to Veterans residing more than 40 miles from a VA medical center or community-based outpatient clinic (CBOC). While the prospect of expanding Veterans' access to care is appealing, the optimal means for operationalizing these mandates is unclear as is the likely impact on quality of care, satisfaction, and health outcomes. The Veterans' voice has been largely absent from the discourse thus far, and little is known regarding the viewpoint of patients most likely to be affected by developing initiatives. Further, it is unclear what effects expanded community healthcare access will have on service utilization and net costs from the perspective of the federal government. Our study involves rural Veterans residing more than 40 miles from a VA facility that a) explores Veterans' perceptions and preferences about access to alternative resources for healthcare and facilitators and barriers to implementation of new VA programs, and b) provides estimates for changes in the of the rates and types of healthcare services utilized and associated costs in affected patient populations. This pilot study will generate important preliminary data on the Veterans Choice Program and facilitate planning for a future prospective HSR&D study. 

Our HEROIC investigators have provided key service activities to VA at the local, regional, and national levels as well as to agencies outside the Veterans Administration.  The impact of these activities has brought changes to policy, healthcare practices and training, quality improvement, and organization on how we focus our services.

Presentations to congress: Drs. Kelly Hunt and Brian Neelon presented findings from their project of Spatio-Temporal Analysis of Diabetes During Pandemic to the Veterans Research Health Advisory Committee. This committee includes members of U.S. Congress and provides recommendations to the Veterans Administration Secretary. 

Quality improvement and high-reliability projects: Drs. Charlene Pope and Holly Gauthier-Wetzel coordinate efforts to streamline project development, implementation, and sustainability of quality improvement, evidence-based practice, and research projects completed within the Nursing Service.  

HEROIC investigators provide support to clinicians and clinical researchers interested in conducting health services research both locally and regionally.  

Drs. Sudie Back & Elizabeth Santa Ana conduct training in Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure COPE through the Strong Star Initiative, which conducts Learning Communities with mental health providers through competency-based training in evidence-based treatments for PTSD and related mental health problems. The VA has officially adopted the COPE training protocol. 

Dr. Nichole Tanner is the site lead for the Southeastern VA Lung Cancer Screening and Precision Oncology Consortium which aims to identify and offer screening to all eligible Veterans in VISN-7 at high risk for Lung Cancer. 

Telehealth is a legal option to appropriately prescribe controlled substances however it is not utilized in a way that replicates in-person care. Drs Myers and Grubaugh spearhead projects that focus on understanding and addressing barriers providers face when attempting to provide care via telehealth.  

Dr. Santa Ana provides training, consultation, and clinical support services on substance abuse and treatment for homeless Veterans including multi-day workshops at the RHJ VAMC and webinars through the Home Telehealth National Training Center for nursing and social work staff. Dr. Santa Ana’s Group Motivational Interviewing (GMI) training helps to improve care for Veteran Homelessness/Poly Substance Use. She has conducted three national GMI training at other VA, one of which adopted GMI for their substance abuse outpatient treatment program.   

HEROIC investigators serve on the National Institutes of Health (NIH) scientific review committees and guideline development committees. In addition, HEROIC investigators and staff have published and serve as editors/deputy editors for top tier journals such as the American Journal of Medicine; Annals of Internal Medicine; Journal of General Internal Medicine; Computers, Informatics, Nursing (CIN); Addiction; Clinical Psychology Review; Journal of Traumatic Stress; Journal of Anxiety Disorders; and Behavior Research and Therapy.