Seattle-Denver Center of Innovation (COIN)

COIN Investigators & Staff

24 August 2021

COIN Investigators

Jessica A Chen, PhD

Title: Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Washington

Contact: Jessica.Chen663@va.gov

Location: Seattle

University of Washington webpage

Dr. Chen is a clinical psychologist, chronic pain specialist, and health services researcher. She is a staff psychologist at the VISN 20 Pain Medicine & Functional Restoration Center and an Assistant Professor at the University of Washington. Her research focuses on social determinants of health and the implementation of evidence-based psychosocial interventions for chronic pain and trauma. Dr. Chen is currently supported by a VA HSR&D Career Development Award and other VA and NIH grants focused on increasing patient involvement in treatment decision-making and leveraging VA’s national healthcare system data to examine disparities in access to telehealth treatments for chronic pain and co-occurring opioid use disorder.

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Recent Publications

The following research fields have been used to summarize Dr. Chen's publication (the number in parentheis is the times that research field has appeared):

• Clinical Research (17)
• Mental Health (14)
• Brain Disorders (14)
• Behavioral and Social Science (12)
• Post-Traumatic Stress Disorder (PTSD) (12)
• Substance Abuse (9)
• Alcoholism, Alcohol Use and Health (8)
• Anxiety Disorders (8)
• Health Services (6)
• Mind and Body (6)
• Depression (4)

2021

Chen JA, Jakupcak M, McCann R, Fickel JJ, Simons CE, Campbell DG, Stryczek KC, Hoerster KD, Chaney EF, Oishi SM, Miner MN, Bonner LM, Fortney JC, Felker BL. Posttraumatic stress disorder collaborative care: A quality improvement study in veterans affairs primary care. Fam Syst Health. 2021 Jun;39(2):198-211. doi: 10.1037/fsh0000623.
PMID: 34410768.

Williams EC, Chen JA, Frost MC, Rubinsky AD, Edmonds AT, Glass JE, Lehavot K, Matson TE, Wheat CL, Coggeshall S, Blosnich JR. Receipt of evidence-based alcohol-related care in a national sample of transgender patients with unhealthy alcohol use: Overall and relative to non-transgender patients. J Subst Abuse Treat. 2021 Jul 8:108565. doi: 10.1016/j.jsat.2021.108565. Epub ahead of print.
PMID: 34274175.

Chen JA, DeFaccio RJ, Gelman H, Thomas ER, Indresano JA, Dawson TC, Glynn LH, Sandbrink F, Zeliadt SB. Telehealth and rural-urban differences in receipt of pain care in the Veterans Health Administration. Pain Med. 2021 Jun 18:pnab194. doi: 10.1093/pm/pnab194. Epub ahead of print.
PMID: 34145892.

Chen JA, Matson TE, Lehavot K, Raue PJ, Young JP, Silvestrini MC, Fortney JC, Williams EC. Provider Perspectives on Implementing Shared Decision Making for PTSD Treatment in VA Primary Care. Adm Policy Ment Health. 2021 Feb 24. doi: 10.1007/s10488-021-01119-5. Epub ahead of print.
PMID: 33625623

Williams EC, Frost MC, Rubinsky AD, Glass JE, Wheat CL, Edmonds AT, Chen JA, Matson TE, Fletcher OV, Lehavot K, Blosnich JR. Patterns of Alcohol Use Among Transgender Patients Receiving Care at the Veterans Health Administration: Overall and Relative to Nontransgender Patients. J Stud Alcohol Drugs. 2021 Jan;82(1):132-141.
PMID: 33573731

Frost MC, Blosnich JR, Lehavot K, Chen JA, Rubinsky AD, Glass JE, Williams EC. Disparities in Documented Drug Use Disorders Between Transgender and Cisgender U.S. Veterans Health Administration Patients. J Addict Med. 2020 Nov 25. doi: 10.1097/ADM.0000000000000769. Epub ahead of print.
PMID: 33252409

2020

Chen JA, Glass JE, Bensley KMK, Goldberg SB, Lehavot K, Williams EC. Racial/ethnic and gender differences in receipt of brief intervention among patients with unhealthy alcohol use in the U.S. Veterans Health Administration. J Subst Abuse Treat. 2020 Dec;119:108078. doi: 10.1016/j.jsat.2020.108078. Epub 2020 Jul 15. PMCID: PMC7641963.
PMID: 32736926

Goldberg SB, Fortney JC, Chen JA, Young BA, Lehavot K, Simpson TL. Military Service and Military Health Care Coverage are Associated with Reduced Racial Disparities in Time to Mental Health Treatment Initiation. Adm Policy Ment Health. 2020 Jul;47(4):555-568. doi: 10.1007/s10488-020-01017-2. PMCID: PMC7357226.
PMID: 31989399

Glynn LH, Chen JA, Dawson TC, Gelman H, Zeliadt SB. Bringing chronic-pain care to rural veterans: A telehealth pilot program description. Psychol Serv. 2020 Jan 16. doi: 10.1037/ser0000408. Epub ahead of print.
PMID: 31944817

Lehavot K, Beckman KL, Chen JA, Simpson TL, Williams EC. Race/Ethnicity and Sexual Orientation Disparities in Mental Health, Sexism, and Social Support among Women Veterans. Psychol Sex Orientat Gend Divers. 2019;6(3):347-358. doi: 10.1037/sgd0000333. PMC6703561
PMID: 31435497

2019

Chen JA. Capsule Commentary on Sullivan et al., Primary Care Opioid Taper Plans Are Associated with Sustained Opioid Dose Reduction. J Gen Intern Med. 2020 Mar;35(3):980. doi: 10.1007/s11606-019-05520-7. Epub 2019 Nov 11. PMCID: PMC7080926.
PMID: 31713038

Browne KC, Chen JA, Hundt NE, Hudson TJ, Grubbs KM, Fortney JC. Veterans self-reported reasons for non-attendance in psychotherapy for posttraumatic stress disorder. Psychol Serv. 2019 Jul 22:10.1037/ser0000375. doi: 10.1037/ser0000375. Online ahead of print. PMC7147996
PMID: 31328929

Goldberg SB, Simpson TL, Lehavot K, Katon JG, Chen JA, Glass JE, Schnurr PP, Sayer NA, Fortney JC. Mental Health Treatment Delay: A Comparison Among Civilians and Veterans of Different Service Eras. Psychiatr Serv. 2019 May 1;70(5):358-366. doi: 10.1176/appi.ps.201800444. Epub 2019 Mar 7. PMC6510540
PMID: 30841842

Spottswood M, Fortney J, Chen JA, Davydow D, Huang H. Posttraumatic Stress Disorder in the Primary Care Setting: Summary of Recommended Care. Harv Rev Psychiatry. 2019 Mar/Apr;27(2):87-93. doi: 10.1097/HRP.0000000000000201.
PMID: 30614927

Chen JA, Fortney JC, Bergman HE, Browne KC, Grubbs KM, Hudson TJ, Raue PJ. Therapeutic alliance across trauma-focused and non-trauma-focused psychotherapies among veterans with PTSD. Psychol Serv. 2020 Nov;17(4):452-460. doi: 10.1037/ser0000329. Epub 2019 Feb 11. PMCID: PMC6689461.
PMID: 30742471

2018

Owens MD, Chen JA, Simpson TL, Timko C, Williams EC. Barriers to addiction treatment among formerly incarcerated adults with substance use disorders. Addict Sci Clin Pract. 2018 Aug 21;13(1):19. doi: 10.1186/s13722-018-0120-6. PMD: 30126452. PMC6102909

Lehavot K, Goldberg SB, Chen JA, Katon JG, Glass JE, Fortney JC, Simpson TL, Schnurr PP. Do trauma type, stressful life events, and social support explain women veterans' high prevalence of PTSD?. Soc Psychiatry Psychiatr Epidemiol. 2018 Sep;53(9):943-953. doi: 10.1007/s00127-018-1550-x. Epub 2018 Jun 23. PMD: 29936598. PMC6521967

Lehavot K, Katon JG, Chen JA, Fortney JC, Simpson TL. Post-traumatic Stress Disorder by Gender and Veteran Status. Am J Prev Med. 2018 Jan;54(1):e1-e9. doi: 10.1016/j.amepre.2017.09.008. PMD: 29254558. PMC7217324

Chen JA, Owens MD, Browne KC, Williams EC. Alcohol-related and mental health care for patients with unhealthy alcohol use and posttraumatic stress disorder in a National Veterans Affairs cohort. J Subst Abuse Treat. 2018 Feb;85:1-9. doi: 10.1016/j.jsat.2017.11.007. Epub 2017 Nov 22. PMD: 29291765. PMC5753430

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Grants

The following research categories have been used to summarize Dr. Chen's grants/funding (the number in parentheis is the times that research category has appeared):

• Health Services (1)
• Clinical Research (1)
• Behavioral and Social Science (1)
• Clinical Trials and Supportive Activities (1)
• Prevention (1)
• Chronic Pain (1)
• Pain (1)
• Substance Abuse (1)
• Comparative Effectiveness Research (1)
• Mental Health (1)
• Rural Health (1)
• Post-Traumatic Stress Disorder (PTSD) (1)

Current/Recent Grants

Patient Readiness for Improvement through Motivation, Engagement, and Decision-making for PTSD (PRIMED-PTSD)

Role: PI

Grant number: IK2HX002866

Funding amount: $0.00

Start/End date: 9/1/2020 - 8/31/2025

Abstract:
Over 1 million Veterans have PTSD and most (80% or more) do not receive first-line treatments, evidence-based psychotherapies, despite significant VA investment to increase access to these treatments. Clinicians often struggle to engage Veterans in evidence-based psychotherapies because they can be emotionally challenging treatments. Engagement could be catalyzed by mental health providers integrated into primary care (i.e., VA’s Primary Care-Mental Health Integration, or PC-MHI) to maximize the reach of engagement efforts beyond specialty PTSD settings. Shared decision making, a process by which the patient and provider discuss treatment options, weigh benefits and risks, and select a treatment that meets the patient’s needs, addresses known patient and provider barriers to evidence-based psychotherapies, including knowledge, self-efficacy, and trust. However, no study has examined shared decision making for PTSD in primary care. The proposal will address this knowledge gap by developing and refining a shared decision making intervention for PTSD, Patient Readiness for Improvement through Motivation, Engagement, and Decision-making (PRIMED), using input from Veterans with diverse perspectives, PC-MHI providers, and VA operational partners to optimize integration of shared decision making into clinical care. We will collect acceptability and feasibility data to support an application for a future effectiveness-implementation trial. Significance/Impact: Dr. Chen’s proposed research addresses three HSR&D and VA priorities: 1) increase engagement and retention of Veterans in evidence-based PTSD treatments, 2) advance health services research methods, specifically implementation science and user-centered design, which focuses on thorough integration of Veteran and frontline provider input, and 3) support suicide prevention efforts through effective treatment of PTSD, a major risk factor for suicide. Innovation: The proposed project will promote significant change in current VA clinical practice. PC-MHI providers typically refer out patients with PTSD and defer discussions about treatment options to specialty providers. This proposal will help PC-MHI providers use a formal engagement strategy, shared decision making, to improve patients’ knowledge of first-line PTSD treatments and to build motivation for care. Specific Aims: 1) Refine PRIMED using user-centered design methods and diverse Veterans’ perspectives, 2) Beta test PRIMED in one rural and one urban PC-MHI clinic to optimize integration into clinical workflow and achieve satisfactory acceptability and feasibility across a range of settings, 3) Conduct a small, randomized pilot trial (N=40) of PRIMED vs. usual care in two VA PC-MHI clinics to assess the feasibility of study procedures, which will inform a future larger trial. Methodology: In Aim 1, Dr. Chen will conduct qualitative interviews using user-centered design methods with 25 VA PC-MHI patients with PTSD, oversampling women veterans and racial/ethnic minority veterans, to refine the PRIMED intervention protocol. In Aim 2, Dr. Chen will use rapid, iterative beta-testing with approximately 20 patients to optimize the acceptability and feasibility of delivering PRIMED in the clinical setting and its integration into clinical workflow across varied settings (small rural clinics and large urban clinics). In Aim 3, Dr. Chen will conduct a pilot randomized feasibility trial (N=40) to assess the feasibility of recruiting and randomizing Veterans and measuring treatment engagement and clinical outcomes. Next Steps/Implementation: The research and training activities will prepare the nominee to conduct a multi- site, hybrid type 1 effectiveness-implementation trial to test the effectiveness of PRIMED for increasing receipt of first-line PTSD treatments and to begin to assess implementation barriers and facilitators. Future work to move this research into practice would involve collaborating with operational partners to improve VA SAIL performance measures in mental health, which are weighted to encourage evidence-based psychotherapies.

Public Health Relevance Statement:
PTSD is one of the most common mental health conditions affecting Veterans and is associated with significant burden. Highly effective treatments exist for PTSD, evidence-based psychotherapies, but very few Veterans receive them. Although VA has trained over 8,500 providers in evidence-based psychotherapies for PTSD over the past 10 years, only 6% of the 650,000 VHA patients with PTSD receive an evidence-based psychotherapy. It is critical that we connect Veterans with our most effective PTSD treatments and that we do so in a way that is Veteran-centered. Shared decision making is a patient-centered approach to choosing healthcare treatment options. It has been shown to increase patients’ motivation for treatment and ability to stay in treatment long enough to get benefit. It has also been shown to help providers align their practice with evidence-based guidelines. This proposal will refine and pilot test a shared decision making intervention for PTSD to be used in VA primary care clinics, where the vast majority of Veterans with PTSD are treated.

Funder: United States Department of Veterans Affairs (VA)

NIH website: http://projectreporter.nih.gov/project_info_description.cfm?aid=9950882

Evaluating the National Implementation of Virtual Interdisciplinary Pain Care Teams - TelePain

Role: PI

Grant number: 1I50HX003430-01

Funding amount: $0.00

Start/End date: 4/1/2021 - 3/31/2024

Abstract:
Chronic pain is a leading cause of disability and a major contributor to the opioid epidemic and suicide. Providing evidence-based pain care to Veterans is vital, yet nearly 1 in 3 VA facilities lacks an interdisciplinary, multimodal pain management program. Interdisciplinary, multimodal pain treatment (IMPT) has been recognized as the standard of care for high-impact chronic pain; however, outside of VA, community pain clinics primarily offer unimodal treatment focused on high-reimbursement medical procedures instead of IMPT. Pain management is one of VA’s highest-cost community care expenditures, yet VA facilities that lack an IMPT team rely heavily on community care for pain management. To address the lack of pain specialists at smaller VA facilities and the gaps in community pain care, the National Pain Management and Opioid Safety Program (PMOP) is rolling out a telehealth model of virtual specialty pain teams, TelePain, to deliver evidence- based IMPT to under-resourced regions. Our operational partners are building on VISN 20’s success to scale up TelePain nationwide, starting with 3 VISNs per year in June 2021. PMOP needs rigorous evaluation support to assess the impact of this high-priority TelePain initiative. Given its national scope and range of implementation settings, the rollout of TelePain presents a unique opportunity to evaluate the implementation of this program in the VA, with the goal of yielding actionable findings to inform not only the current effort but also future implementation efforts to spread similar programs across the VA. The purpose of the proposed Partnered Evaluation Initiative is to use systematic evaluation methods to continually improve TelePain implementation and monitor the impact of TelePain on patient outcomes and costs at 9 VA facilities. Project objectives: To assess the impact of the TelePain initiative, the Specific aims of this project include: 1.) To assess the acceptability, feasibility, adoption, fidelity, reach, and costs of TelePain implementation at each new VISN, 2.) To prospectively evaluate patient-reported clinical outcomes, comparing TelePain to referral to community care or no specialty pain care (usual care control groups), to ensure that TelePain is benefitting Veterans relative to usual care, 3.) To compare use of low-value pain care (e.g., injections, unnecessary imaging, spinal fusion surgery) among patients referred to TelePain relative to control groups. Project Methods: The proposed activities will be conducted as quality improvement. We will conduct a mixed methods, quasi-experimental multisite evaluation to examine implementation outcomes and costs (Aim 1), clinical outcomes, including both patient-reported outcomes and administrative data (Aim 2), and economic impact of TelePain (Aim 3). Data sources for this project include administrative and electronic health record data from VA’s Corporate Data Warehouse (CDW), Pharmacy Benefits Management Services, the Suicide Prevention Applications Network, the National Death Index, the Managerial Cost Accounting Office, the Fee Basis files in the Program Integrity Tool, patient surveys administered electronically via Qualtrics or paper- based via postal mail, and semi-structured interviews with patients and providers. A novel aspect of the proposal is the prospective cohort patient survey (Aim 2). For this, we will identify potentially eligible patients across three comparison groups (TelePain, matched 1:1 to TelePain but referred to community pain care, matched 1:1 to TelePain but without referral to specialty pain care) on a weekly basis and enroll them in a 6- month longitudinal survey with 3 times points. The prospective, multisite design will provide a rigorous evaluation of TelePain using patient-centered outcomes that are of key importance to our operations partners. Project Impact: The results from this evaluation will inform and enhance our operational partners’ ongoing national implementation of TelePain. Our findings will provide evidence regarding the clinical outcomes of TelePain and its impact on pain care costs, both of which are needed to support a business case for the long- term sustainment of TelePain.

Public Health Relevance Statement:
Chronic pain is one of the most prevalent and disabling conditions affecting Veterans. One of the Veterans Health Administration’s (VHA’s) most pressing national clinical priorities is to increase access to non- pharmacological pain management and improve the safety of opioid prescribing. The National Pain Management and Opioid Safety Program (PMOP) is implementing virtual interdisciplinary pain management teams, TelePain, to improve access to evidence-based pain care among rural Veterans and those served by smaller VA facilities. The proposed evaluation, developed closely with PMOP, uses a rigorous prospective design to evaluate TelePain’s impact on clinical outcomes for Veterans and costs to VHA, while also evaluating TelePain’s impact on access to care and other implementation outcomes. These findings will provide actionable information to improving ongoing TelePain implementation efforts and inform VHA of the potential sustainability of TelePain as a model of care.

Funder: United States Department of Veterans Affairs (VA)

NIH website: http://projectreporter.nih.gov/project_info_description.cfm?aid=10316573

For more information and a well done infographic

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Media (Video, Podcast, Other)

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