Research Impacts & Service to VA - Seattle-Denver Center of Innovation (COIN)
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Seattle-Denver Center of Innovation (COIN)

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Research Impacts & Service to VA

Fiscal Year 2014 
Analyzed VA Patient Aligned Care Team (PACT) initiative, then used to brief VA Secretary and President
Our research showed that the VA Patient Aligned Care Team (PACT) initiative has not been a major financial risk for the Veterans Health Administration. We analyzed data for fiscal years 2003 - 2012 to see how trends in health care use and costs changed after the implementation of PACT. The PACT program continues to mature and trends in costs and use are favorable.

This research received national exposure both inside and outside VA and was presented by national PACT leadership to then VA Secretary Shinseki, who in turned briefed President Obama.

Click here for the PubMed abstract
Click here for the full text article from Health Affairs 
Funding:  VHA Patient Centered Medical Home Demonstration Laboratory Coordination Center (XVA-61-041)

Revised pre-operative guidelines for cardiology
This work examined post-percutaneous coronary intervention (PCI) patients who underwent non-cardiac surgery in the two years following their stent procedure. Researchers found the length of time between stent procedure and surgery and stent type was less predictive of major adverse cardiac events than originally believed. Pre-operative guidelines for cardiac patients were revised based on this information.

Click here for the PubMed abstract
Click here for the full text article from JAMA
Funding:  Cardiac Risk and Stent Effect on Adverse Perioperative Events (VA HSR&D IIR 09-347)

Developed and adopted a new index, then added as a VA Priority Goal, National Performance Review criteria 
This research developed an index to measure the extent to which the patient-centered medical home (PCMH) model was implemented, describe variation in implementation, and examine the association between the index and key outcomes such as patient satisfaction, hospitalization rates, emergency department use rates, quality of care, and staff burnout. Patient satisfaction was significantly higher among sites that had effectively implemented the PCMH model.

The manuscript describing this research was awarded Best Paper of the Year by VA HSR&D.  

Click here for the Pub Med abstract
Click here for the full text article from JAMA
Funding:  VHA Office of Patient Care Services 

Identified and distributed guidelines for managing chronic kidney disease in older adults
This work used national VA and renal registry data to review the appropriateness of practice guidelines for the managing chronic kidney disease in older adults. The lead researcher is working with the Center of Disease Control (CDC) to build a system that monitors chronic kidney disease across the United States, both inside and outside VA. 

Provided data analysis to direct Medical Foster Home Program
Budgetary data was requested by the Office of Geriatrics and Extended Care Home and Community Based Services to support discussions on the national expansion of the Medical Foster Home Program. Additional data on outcomes and recommendations for program implementation were provided to national program coordinators for use in presentations to VA leadership at facilities also considering the Medical Foster Home Program. 

Impacts & service before the formation of the Seattle-Denver COIN 
Developed system to track invasive cardiac procedures
In the early 2000s VA had no reliable method for assessing the number of procedures, quality of procedures, or patient experience associated with an invasive cardiac procedures such as percutaneous coronary intervention (PCI). Seattle and Denver HSR&D researchers worked with VA operational partners to develop the Cardiovascular Assessment Reporting and Tracking (CART) software system. CART was folded into the VA's electronic medical record (EMR) and distributed to all VA catheterization laboratories so cardiologists could easily document invasive cardiac procedures. CART is now included in VA's national quality improvement process, VA's national patient safety program, and a FDA surveillance tool. CART serves as a template for other VA medical specialties that perform invasive procedures such as gastroenterology and pulmonology.        

Cardiac Care Clinical Follow-up Study
This project looked at the quality of care for Veterans admitted to VA hospitals with acute coronary syndrome. The team developed a national database and specifically aligned the data so VA can benchmark its care against non-VA care. This work has many impacts. One example is that researchers identified an interaction where proton pump inhibitors reduced the effectiveness of the medication clopidogrel. This finding contributed to the FDA issuing a black box warning on clopidogrel and the VA Pharmacy Benefits Management (PBM) warning all VA providers to this safety concern. 

Developed screening tool for alcohol misuse
Our researchers developed, validated, and tested the current VA screening tool for alcohol misuse called the Alcohol-Use Disorders Identification Test-Consumption Questions (AUDIT-C). Since its launch, our researchers have incorporated the AUDIT-C into VA healthcare, resulting in over 90% of VA outpatients being routinely screening for alcohol misuse and 77% of those who screen positive receiving a brief intervention.