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As a cohesive and organized field of study, health services research hasn’t been in
existence for that long, however, the contributions made by VA researchers in the field
will stand the test of time. VA was an early adopter for this young field, establishing
the Health Services Research and Development Service (HSR&D) in 1973. For the
first time, tools and activities associated with health services research—data systems,
planning and evaluation, cost effectiveness analysis—were coordinated across a discrete
service area within the Office of Research and Development.
In 1975, VA HSR&D began a cooperative relationship with the National Center for
Health Services Research (NCHSR), then a part of the Department of Health, Education,
and Welfare. NCHSR had established regional health services research centers at 8
locations, and VA agreed to provide analogous support to participating VA hospitals. This
move marked the beginning of the HSR&D affiliation program, which would evolve into
Field Programs, and eventually become today’s Centers of Excellence.1
As VA HSR&D has evolved, it has
never lost focus on its central mission:
to advance knowledge and promote
innovations that improve the health
and care of veterans and the nation.
And throughout its brief existence, VA
HSR&D research has been used within
and outside VA to explore strategies for
improving health outcomes, evaluate
the cost-effectiveness of services and
therapies, and to assess new technologies
such as telehealth and computer
reminders. Some milestone contributions
include:
1970’s
Improving care for veterans coping
with alcoholism and substance abuse.
This critical study showed that patients
with problems related to alcohol or drug
abuse benefitted more from targeted
treatment rather than treatment focused
on overall health status.2
Evaluating a new patient interview and
clinical assessment tool, the Addiction
Severity Index (ASI). This groundbreaking
study showed that not only was
the ASI easy to administer and highly
effective in the prediction of treatment
outcomes, it eventually became the
standard for screening on a national and
international basis.3
1980's
Improving the overall rates of flu vaccination
in veterans. Two studies conduct-
ed from 1981 to 1986 examined the rates
of flu vaccination, and ultimately resulted
in the adoption of a national VA policy
on annual flu shots.4
Re-evaluating the risks and benefits
of coronary bypass surgery among
the elderly. In this study, concluded in
1989, researchers determined that for
some elderly, traditional coronary artery
bypass surgery outweighs the risks associated
with major surgery. 5
1990's
Quality Enhancement Research Initiative
(QUERI) established. In collaboration
with VA’s Central Office, Veterans
Integrated Service Networks, and facilities,
the nine QUERI centers conduct a
diverse portfolio of research projects that
develop or adapt effective quality enhancement
tools and strategies into multifaceted
quality improvement programs.
Implementing national primary care
assessment tools through the Veterans
Health Study (VHS). The VHS
resulted in the creation of a modified
short form health survey (SF-36) to assess
functional status. That form is now
in use nationwide throughout VA. 6
2000's
Assessing quality report cards for
healthcare organizations. The advent of
quality improvement initiatives throughout
large healthcare organizations formed
the basis for this investigation. The study
examined how well current "report cards"
do in delivering data on individual physician
performance. 7
Implementing collaborative care
models for depression. Translating
Initiatives for Depression into Effective
Solutions (TIDES) is a major undertaking
designed to incorporate collaborative
care for depression in the primary
care setting. Preliminary findings show
that a high percentage of patients with
depression can be successfully treated in
primary care.8
Improving screening for HIV. In this
study, researchers addressed the need
to improve rates of HIV screening by
implementing a nurse-based rapid testing
pilot program. The program was
highly successful and is currently being
adopted by several VA clinics.9
From its beginnings in 1973, VA’s health
services research program has continued
to strengthen and expand its reach. Its
collaborative relationships with both VA
operations and VA’s academic affiliates
are invaluable to researchers and provide
a critical forum for their investigations.
In the future, HSR&D will work to
continue to provide a rich and thriving
research environment and to support
studies that will ultimately provide better
care for our veterans and the nation.
To learn more about VA HSR&D
studies, findings, and citations, visit our
web site at www.hsrd.research.va.gov.
- VA Dept. of Medicine & Surgery, Briefing 1-5
(3/9/81): A Paper on the Affiliation Program,
p.159
- "Evaluation of Substance Abuse Treatment,"
McLellan, A. T. (1977–1981) Philadelphia, PA.
3 "Evaluation of the Addiction Severity Index,"
McLellan, A. T. (1979–1980) Philadelphia, PA.
- "Prospective Modeling and Prediction of
Influenza," Carter, W. (1981–1983) Seattle,
WA.
- "Program in the Economics of Health Care of
the Elderly," Garber, A. (1987–1989) Palo Alto,
CA.
- "The Veterans Health Study." Kazis, L. (1994–
1999) Bedford, MA.
- "HSR&D Career Development Award: Where
Report Cards Fear to Tread." Hofer, T. (1995–
2001) Ann Arbor, MI
- Rubenstein, L.; Yano, E.; Chaney, E.; et. al. ed.
Collaborative Care for Depression in a Primary Care
Setting: A Primer on VA’s Translating Initiatives for
Depression into Effective Solutions (TIDES) Project.
(August 2008) Boston, MA.
- "Improving HIV Screening by Nurse Rapid
Testing, Streamlined Counseling," Asch, S.
(2005–2007) Los Angeles, CA.
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