Seattle-Denver Center of Innovation (COIN)

COIN Investigators & Staff

COIN Investigators

Leah M. Haverhals, PhD, MA, BA

Title: Health Research Scientist,
Co-Director Qualitative Core,
Communications Director for the Denver-Seattle Center of Innovation for Veteran-Centered & Value-Driven Care
Assistant Professor, Division of Health Care Policy and Research, School of Medicine, University of Colorado Anschutz Medical Campus

Contact: Leah.Haverhals@va.gov

Location: Denver

University of Colorado webpage

 

See Dr. Haverhals's Dimensions profile that includes: publications, grants, datasets, patents and clinical trials

 

I am a social and behavioral scientist, implementation scientist, and health services researcher. I work primarily as a principal investigator and qualitative methodologist at the Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care at the Department of Veterans Affairs (VA) Eastern Colorado Health Care System in Denver, Colorado. In the past 20 years as a researcher I have designed and managed large national research, evaluation, and quality improvement projects in areas of aging, geriatrics and extended care, telehealth, access to care, health technology, disaster preparedness and recovery, using photography to manage Veterans’ health issues, and applying implementation science frameworks to national evaluations to improve Veterans’ quality of care and to assess implementation of nationwide VA initiatives.
I choose to do this work because I value improving quality of life for older Veterans and their caregivers particularly in times of crises and during major life transitions. I believe this work is best done in collaboration and working with wonderful colleagues at the VA allows for connections to be made to conduct the research needed to better both health services and Veterans’ and caregivers’ lives.
I hope the research I do continues to improve long-term care options for Veterans, as well as provide needed support for their caregivers. My work will continue to assess, study, and evaluate large VA programs and initiatives with the goals of constantly improving these programs through gathering Veterans’ and their caregivers’ perspectives to create and improve programs they value, use, and need.

The following images visualize Dr. Haverhals' work. The word cloud is drawn from publication titles. The research collaboration map shows research relationships (click the image to enlarge):

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Grants & Awards

Grants

Medical Foster Homes: A Safe, Cost Effective Substitute for Nursing Homes?

Role: Co-I; PI: Cari Levy
The VA Medical Foster Home Program is an unprecedented initiative to care for Veterans who are nursing home eligible but prefer to receive care in a private home with qualified caregivers. The study will conduct interviews and available data to understand why Veterans choose care in a private medical foster home instead of a nursing home. How characteristics of Veterans differ by the site of care, program attributes that support their decision, and whether the program is safe and cost-effective.
Understanding Veteran characteristics associated with successful enrollment can lead to medical foster home staff improving enrollment efficiency and identifying types of Veterans not currently served by the program who would benefit from the program.
Dissemination of project results to a broad audience ranging from front-line staff to national policymakers will improve recruitment strategies and ensure that medical foster homes are a safe and cost-effective alternative to nursing home care.
Funder: Veterans Administration
NIH website
Publications of note:
— The Veterans Health Administration’s Medical Foster Home Program: Where Heroes Meet (Older) Angels
— Launching Medical Foster Home Programs: Key Components to Growing This Alternative to Nursing Home Placement
— Fostering Excellence: An Examination of High-Enrollment VHA Medical Foster Home Programs
— A qualitative evaluation of a new community living model: medical foster home placement

Preferences Elicited and Respected for Seriously-Ill Veterans through Enhanced Decision-Making (PERSIVED)

Role: Co-I; PI: Cari Levy
This program aims to promote Veteran choice and deliver goal-concordant care by consistently conducting goals-of-care conversations and documenting Veterans’ preferences for care in actionable, portable medical orders.
Our program focuses on two groups of Veterans at high risk for receiving non-beneficial, unwanted care:
— Those enrolled in home-based primary care programs and
— Those receiving Veterans Health Administration (VA)-paid care in community nursing homes.
Our interdisciplinary team will use two implementation strategies:
1) audit with feedback and action planning and
2) facilitation will focus on coaching clinical champions, who will work with VA and non-VA clinicians to document Veterans’ preferences in durable, portable orders that can be honored across settings.
This program will improve the care and outcomes for seriously ill Veterans by addressing the VA’s modernization priorities of committing to zero harm and reducing unwanted variation in care delivery.
Funder: Veterans Administration
NIH website
Publications of note:
— PERSIVED QUERI Program
— Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED): a protocol for an implementation study in the Veterans Health Administration
— Applying the Tailored Implementation in Chronic Diseases framework to inform implementation of the Preferences Elicited and Respected for Seriously Ill Veterans through enhanced decision-making program in the United States Veterans Health Administration
— Health Services Research & Development Impacts

National Evaluation of the Cleland-Dole Act to Expand Mental Health Care to State Veterans Nursing Homes

Role: Co-Lead
This legislation will expand mental health services to Veterans residing in State Veterans Nursing Homes in two Veterans Integrated Service Networks (VISNs). Will design and conduct evaluation of these expanded services as part of a national team.

Rapid Evaluation of Advance Care Planning (ACP) Documentation and Content in the Electronic Medical Record for Seriously Ill Veterans

Role: PI
Rapid response project connected to the PERSIVED quality improvement project. Oversee team of five to review electronic health records of Veterans to determine what type of Advance Care Planning (ACP) documentation exists in the electronic health record for an identified subset of Veterans who have a serious illness, to characterize the content (e.g., goals and preferences) of each type of documentation, and to assess alignment between goals and preferences in ACP documents.

Pilot study of Moderate-to High-Intensity Home-Based Rehabilitations Program in Older Adults Hospitalized for Heart Failure (BAMS-HF)

Role: Qualitative Methodologist
Conducting phone interviews with 20 Veterans who completed intervention of home and office-based cardiac rehabilitation program. Developed interview guides and analytic plan. Mentoring principal investigator in qualitative methods.

Modification of the Capacity cOaching And exerCise after Hospitalization for Heart Failure (COACH-HF) Intervention

Role: Qualitative Methodologist
This intervention aims to improve physical functioning of Veterans hospitalized for heart failure, and improve their ability to participate in physical rehabilitation. Conduct focus groups and analyze data to inform the program.

Advancing Symptom Alleviation with Palliative Treatment (ADAPT) research study

Role: Co-I and Qualitative Methodologist
Conducted interviews with ADAPT project team members, including registered nurses, social workers, cardiologists, primary care providers, and other specialists, to evaluate this intervention to improve care for Veterans with heart failure, interstitial lung disease, and chronic obstructive pulmonary disease (COPD). This work will inform the design of future interventions on specialty and primary care coordination at two different VA Medical Centers. Leading analytic team of five in triangulating and analyzing data using an inductive and deductive approach as well as applying the Consolidated Framework for Implementation Research (CFIR) from 30 surveys, 31 phone interviews, and four focus groups.

COVID-19 Impact on Biopsychosocial Factors of Loneliness in Rural Older Veterans & Caregivers

Role: Co-I and Qualitative Methodologist
Funded by VA Health Services Research & Development. Conducted phone interviews with rural and urban Veterans and their caregivers about social isolation and loneliness experienced related to the COVID-19 pandemic. Explores their perspectives on strategies to overcome biopsychosocial risk factors of loneliness, advance care planning preparedness, and access resources especially related to telehealth interventions or VA-community partnerships in rural settings. Developing analytic plan and analyzing data for manuscripts and presentations.

VA Redefining Elder Care in America Program (RECAP)

Role: Co-I, Qualitative Methodologist & Implementation Scientist
Funded by VA Geriatrics & Extended Care. Responsible for designing the qualitative evaluation and implementation science approach for the evaluation of the VA RECAP pilot program currently at two VA sites. Oversee a team of six to design interview guides, analytic plan, and process mapping plan to assess the pilot stage of the RECAP program with program coordinators, Veterans, and their caregivers.

Awards

Carter & T. Franklin Williams Geriatric Award for the best paper on geriatric healthcare
for the manuscript Dedicated to the Mission: Strategies VA Home Based Primary Care Teams Apply to Keep Veterans at Home, October 2020.

University of Colorado Denver Health & Behavioral Sciences PhD Student Research Award
May 2019.

Calvin L. Wilson Scholarship for Future Leaders in Global Health
April 2019 from the University of Colorado Center for Global Health.

Presidential Poster Session Selection
For research on Strategies Used by Home-Based Primary Care Teams to Keep Veterans at Home. Annual Scientific Meeting of American Geriatrics Society. Portland, OR, May 2-4, 2019.

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Recent Publications

2023

Ha DM, Nunnery MA, Klocko RP, Haverhals LM, Bekelman DB, New ML, Randhawa SK, Stevens-Lapsley JE, Studts JL, Prochazka AV, Keith RL. Lung cancer survivors' views on telerehabilitation following curative intent therapy: a formative qualitative study. BMJ Open. 2023 Jun 23;13(6):e073251. doi: 10.1136/bmjopen-2023-073251.
PMID: 37355268
Learn more about this publication on Dimensions

Cornell PY, Magid KH, Corneau E, Haverhals LM, Levy C. Decline in Veterans' Admissions to Nursing Homes During COVID-19: Fewer Beds, More Fear, and Finding Alternative Care Settings. J Am Med Dir Assoc. 2023 Jan 5:S1525-8610(22)00999-9. doi: 10.1016/j.jamda.2022.12.021. Epub ahead of print. PMCID: PMC9812817. PMID: 36708741
Learn more about this publication at Dimensions

2022

Haverhals LM. How Social Determinants of Health of Individuals Living or Working in U.S. Department of Veterans Affairs Home-Based Long-Term Care Programs in Puerto Rico Influenced Recovery after Hurricane Maria. Int J Environ Res Public Health. 2022 Oct 14;19(20):13243. doi: 10.3390/ijerph192013243. PMCID: PMC9603221. PMID: 36293827
Learn more about this publication at Dimensions

Ersek M, Sales A, Keddem S, Ayele R, Haverhals LM, Magid KH, Kononowech J, Murray A, Carpenter JG, Foglia MB, Potter L, McKenzie J, Davis D, Levy C. Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED): a protocol for an implementation study in the Veterans Health Administration. Implement Sci Commun. 2022 Jul 20;3(1):78. doi: 10.1186/s43058-022-00321-2. PMCID: PMC9296899. PMID: 35859140
Learn more about this publication at Dimensions

Haverhals LM, Manheim CE, Katz M, Levy CR. Caring for Homebound Veterans during COVID-19 in the U.S. Department of Veterans Affairs Medical Foster Home Program. Geriatrics (Basel). 2022 Jun 15;7(3):66. doi: 10.3390/geriatrics7030066. PMCID: PMC9223204. PMID: 35735771
Learn more about this publication at Dimensions

Wyte-Lake T, Manheim C, Gillespie SM, Dobalian A, Haverhals LM. COVID-19 Vaccination in VA Home Based Primary Care: Experience of Interdisciplinary Team Members. J Am Med Dir Assoc. 2022 Apr 4:S1525-8610(22)00258-4. doi: 10.1016/j.jamda.2022.03.014. Epub ahead of print. PMCID: PMC8977493. PMID: 35443215
Learn more about this publication at Dimensions

Magid KH, Galenbeck E, Haverhals LM, Cornell PY, Moyo P, Mochel AL, Corneau E, Rudolph JL, Mor V, Levy C. Purchasing High-Quality Community Nursing Home Care: A Will to Work With VA Diminished by Contracting Burdens. J Am Med Dir Assoc. 2022 Apr 13:S1525-8610(22)00238-9. doi: 10.1016/j.jamda.2022.03.007. Epub ahead of print. PMID: 35429454
Learn more about this publication at Dimensions

Carpenter JG, Scott WJ, Kononowech J, Foglia MB, Haverhals LM, Hogikyan R, Kolanowski A, Landis-Lewis Z, Levy C, Miller SC, Periyakoil VJ, Phibbs CS, Potter L, Sales A, Ersek M. Evaluating implementation strategies to support documentation of veterans' care preferences. Health Serv Res. 2022 Mar 8. doi: 10.1111/1475-6773.13958. Epub ahead of print.
PMID: 35261022.
Learn more about this publication at Dimensions

Kenney RR, Haverhals LM, Stryczek KC, Fehling KB, Ball SL. Site visit Standards Revisited: A Framework for Implementation. American Journal of Evaluation. February 2022.
doi:10.1177/10982140221079266.
Learn more about this publication at Dimensions

Haverhals LM, Magid KH, Blanchard KN, Levy CR. Veterans Health Administration Staff Perceptions of Overseeing Care in Community Nursing Homes During COVID-19. Gerontol Geriatr Med. 2022 Feb 15;8:23337214221080307. doi: 10.1177/23337214221080307. PMCID: PMC8855220.
PMID: 35187203.
Learn more about this publication at Dimensions

2021

Magid KH, Solorzano N, Manheim C, Haverhals LM, Levy C. Social Support and Stressors among VA Medical Foster Home Caregivers. J Aging Soc Policy. 2021 May 28:1-21. doi: 10.1080/08959420.2021.1927619. Epub ahead of print.
PMID: 34047675.

Magid KH, Manheim C, Haverhals LM, Thomas KS, Saliba D, Levy C. (2021). Who Receives Care in VA Medical Foster Homes? Fed Pract. 2021;38(3):102-109. doi:10.12788/fp.0102.

Marshall V, Stryczek KC, Haverhals L, Young J, Au DH, Ho PM, Kaboli PJ, Kirsh S, Sayre G. The Focus They Deserve: Improving Women Veterans' Health Care Access. Womens Health Issues. 2021 Feb 10:S1049-3867(20)30157-2. doi: 10.1016/j.whi.2020.12.011. Epub ahead of print.
PMID: 33582001.

Manheim C, Haverhals L, Gilman C, Karuza J, Olsan T, Edwards S, Levy C, Gillespie S. VA Home Based Primary Care Teams: Partnering with and Acting as Caregivers for Veterans. Home Health Care Serv Q. 2021 Jan-Mar;40(1):1-15. doi: 10.1080/01621424.2020.1869634. Epub 2021 Jan 7. PMID: .
PMID: 33411588.

2020

Moldestad M, Stryczek KC, Haverhals L, Kenney R, Lee M, Ball S, Au D, Kirsh S, Sayre G, Young J. Competing Demands: Scheduling Challenges in Being Veteran-centric in the Setting of Health System Initiatives to Improve Access. Mil Med. 2020 Dec 8:usaa520. doi: 10.1093/milmed/usaa520. Epub ahead of print. PMID: .
PMID: 33289838.

Haverhals LM, Gilman C, Manheim C, Bauers C, Kononowech J, Levy C. Implementation of VA's Life-Sustaining Treatment Decisions Initiative: Facilitators and Barriers to Early Implementation Across Seven VA Medical Centers. J Pain Symptom Manage. 2020 Nov 3:S0885-3924(20)30863-0. doi: 10.1016/j.jpainsymman.2020.10.034. Epub ahead of print.
PMID: 33157178.

2019

Haverhals LM, Manheim C, Gilman C, Karuza J, Olsan T, Edwards ST, Levy CR, Gillespie SM. Dedicated to the Mission: Strategies US Department of Veterans Affairs Home-Based Primary Care Teams Apply to Keep Veterans at Home. J Am Geriatr Soc. 2019 Dec;67(12):2511-2518. doi: 10.1111/jgs.16171. Epub 2019 Oct 8.
PMID: 31593296.

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Media (webinars, podcast, etc.)

Webinar: Using Multiple Qualitative Methods to Study Changes in Care Delivery, In-Home Vaccination, & Social Isolation of Home-Based Veterans and Caregivers During the COVID-19 Pandemic

by Leah Haverhals, PhD, MA ; Tamar Wyte-Lake, DPT, MPH
Seminar date: 12/9/2021

Description: In this cyber seminar we will share how we used multiple qualitative methods to gather perspectives from different key stakeholders around studying adaptations in home-based care delivery for Veterans during the pandemic. We will describe how we: 1) analyzed a large volume of open-ended qualitative data from a national online survey we fielded to VA Home Based Primary Care (HBPC) staff, and 2) designed a qualitative study to gather perspectives from Veterans receiving VA HBPC care, and their caregivers, on both changes in care delivery and social isolation.

Find the PDF handout and transcript

Webinar: Virtual Care in Context During COVID-19: VA Telehealth in Primary Care, Community Care Urgent Care, and State Veterans’ Nursing Homes

NOTE: Due to technical difficulties the video for this presentation is not available.

by Kristina Cordasco, MD, MPH, MSHS ; Claudia Der-Martirosian, PhD ; Leah Haverhals, PhD, MA
Seminar date: 12/1/2021

Description: The rapid onset of COVID-19 caused dramatic shifts in care delivery across settings in the VA, including the need to offer Telehealth as an alternative care modality. While various settings faced unique clinical challenges, a common experience among them was heterogeneity in virtual care uptake at the patient, provider, and site levels, as well as identifiable barriers and facilitators to adoption of telehealth. This cyberseminar is comprised of three presentations of research findings gathered from Primary Care, Community Care Urgent Care, and State Veterans’ Nursing Homes.

Find the PDF handout and transcript

What’s at the Core? Intro to the VA Qualitative Methods Learning Collaborative (QMLC) and scoping of Qualitative Cores-how they operate and what resources they offer

by Gemmae Fix, PhD ; Christine Kowalski, MPH ; Haverhals Leah, PhD, MA ; Jane Moeckli, PhD

Seminar date: 2/11/2021

Description: The Qualitative Methods Learning Collaborative (QMLC) is a new group formed in 2020 with the mission of advancing qualitative methods, building a community of qualitative researchers (VA and non-VA), and learning and teaching qualitative methods. There are over 250 members in this group. We will discuss the origins of the group, what we hope to accomplish, and review results from one of our first assessments—a scoping of national VA qualitative research cores/centers. We will present comparisons across those centers including details on how they operate and what resources they offer. One of the goals of the QMLC and this presentation is to share best practices and develop strategies for others interested in building their qualitative communities and expertise.

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