Seattle-Denver Center of Innovation (COIN)

COIN Investigators & Staff

31 August 2021

COIN Investigators

Paul L. Hebert, PhD

Title: VA Health Services Research and Development
Research Professor, Health Services, University of Washington

Contact: Paul.Hebert2@va.gov

Location: Seattle

University of Washington webpage

Dr. Hebert is a Core Investigator and economist with HSR&D and was previously Assistant Professor, Department of Health Policy, Mount Sinai School of Medicine. His research interests include racial disparities in health, chronic disease management, and comparative effectiveness analysis. He received his PhD in Health Services Research from the University of Minnesota and a BA in economics from Georgetown University.

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Recent Publications

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

• Clinical Research (106)
• Health Services (52)
• Prevention (31)
• Aging (23)
• Cardiovascular (21)
• Clinical Trials and Supportive Activities (21)
• Behavioral and Social Science (19)
• Kidney Disease (19)
• Infant Mortality (14)
• Pediatric (14)
• Perinatal Period - Conditions Originating in Perinatal Period (12)

2021

Glazer KB, Zeitlin J, Egorova NN, Janevic T, Balbierz A, Hebert PL, Howell EA. Hospital Quality of Care and Racial and Ethnic Disparities in Unexpected Newborn Complications. Pediatrics. 2021 Aug 24:e2020024091. doi: 10.1542/peds.2020-024091. Epub ahead of print.
PMID: 34429339

Scherer JS, Milazzo KC, Hebert PL, Engelberg RA, Lavallee DC, Vig EK, Kurella Tamura M, Roberts G, Curtis JR, O'Hare AM. Association Between Self-reported Importance of Religious or Spiritual Beliefs and End-of-Life Care Preferences Among People Receiving Dialysis. JAMA Netw Open. 2021 Aug 2;4(8):e2119355. doi: 10.1001/jamanetworkopen.2021.19355. PMCID: PMC8339933.
PMID: 34347059

Hebert PL. Enhancing the Collaborative Experience of a Collaborative Game to Achieve Lifestyle Change. JAMA Netw Open. 2021 May 3;4(5):e2110308. doi: 10.1001/jamanetworkopen.2021.10308.
PMID: 34028555

Janevic T, Zeitlin J, Egorova NN, Hebert P, Balbierz A, Stroustrup AM, Howell EA. Racial and Economic Neighborhood Segregation, Site of Delivery, and Morbidity and Mortality in Neonates Born Very Preterm. J Pediatr. 2021 Mar 29:S0022-3476(21)00293-6. doi: 10.1016/j.jpeds.2021.03.049. Epub ahead of print.
PMID: 33794221

2020

Butler CR, Wightman A, Richards CA, Laundry RS, Taylor JS, Hebert PL, Liu CF, O'Hare AM. Thematic Analysis of the Health Records of a National Sample of US Veterans With Advanced Kidney Disease Evaluated for Transplant. JAMA Intern Med. 2020 Nov 23:e206388. doi: 10.1001/jamainternmed.2020.6388. Epub ahead of print. PMCID: PMC7684522.
PMID: 33226419

Keyhani S, Cheng EM, Hoggatt KJ, Austin PC, Madden E, Hebert PL, Halm EA, Naseri A, Johanning JM, Mowery D, Chapman WW, Bravata DM. Comparative Effectiveness of Carotid Endarterectomy vs Initial Medical Therapy in Patients With Asymptomatic Carotid Stenosis. JAMA Neurol. 2020 Sep 1;77(9):1110-1121. doi: 10.1001/jamaneurol.2020.1427. Erratum in: doi: 10.1001/jamaneurol.2020.2784. PMCID: PMC7265126.
PMID: 32478802

O'Hare AM, Butler CR, Taylor JS, Wong SPY, Vig EK, Laundry RS, Wachterman MW, Hebert PL, Liu CF, Rios-Burrows N, Richards CA. Thematic Analysis of Hospice Mentions in the Health Records of Veterans with Advanced Kidney Disease. J Am Soc Nephrol. 2020 Nov;31(11):2667-2677. doi: 10.1681/ASN.2020040473. Epub 2020 Aug 6. PMCID: PMC7608965.
PMID: 32764141

Hebert PL, Wong ES, Reddy A, Batten A, Gunnink E, Wagner TH, Liu CF. Events Associated With Changes in Reliance on the Veterans Health Administration Among Medicare-eligible Veterans. Med Care. 2020 Aug;58(8):710-716. doi: 10.1097/MLR.0000000000001328.
PMID: 32265354

Howell EA, Janevic T, Blum J, Zeitlin J, Egorova NN, Balbierz A, Hebert PL. Double Disadvantage in Delivery Hospital for Black and Hispanic Women and High-Risk Infants. Matern Child Health J. 2020 Jun;24(6):687-693. doi: 10.1007/s10995-020-02911-9. PMCID: PMC7265984.
PMID: 32303940

Janevic T, Zeitlin J, Egorova N, Hebert PL, Balbierz A, Howell EA. Neighborhood Racial And Economic Polarization, Hospital Of Delivery, And Severe Maternal Morbidity. Health Aff (Millwood). 2020 May;39(5):768-776. doi: 10.1377/hlthaff.2019.00735.
PMID: 32364858

Liu CF, Hebert PL, Douglas JH, Neely EL, Sulc CA, Reddy A, Sales AE, Wong ES. Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care. Health Serv Res. 2020 Apr;55(2):178-189. doi: 10.1111/1475-6773.13246. Epub 2020 Jan 13. PMCID: PMC7080399.
PMID: 31943190

Hernandez SE, Sylling PW, Mor MK, Fine MJ, Nelson KM, Wong ES, Liu CF, Batten AJ, Fihn SD, Hebert PL. Developing an Algorithm for Combining Race and Ethnicity Data Sources in the Veterans Health Administration. Mil Med. 2020 Mar 2;185(3-4):e495-e500. doi: 10.1093/milmed/usz322.
PMID: 31603222

Howell EA, Egorova NN, Janevic T, Brodman M, Balbierz A, Zeitlin J, Hebert PL. Race and Ethnicity, Medical Insurance, and Within-Hospital Severe Maternal Morbidity Disparities. Obstet Gynecol. 2020 Feb;135(2):285-293. doi: 10.1097/AOG.0000000000003667. PMCID: PMC7117864.
PMID: 31923076

Liu CF, Hebert P, Wong ES, Nelson K, Maynard C. Midlife mortality in White non-Hispanic male veterans enrolled in Department of Veterans Affairs primary care, 2003-2014. Heliyon. 2020 Jan 31;6(1):e03328. doi: 10.1016/j.heliyon.2020.e03328. PMCID: PMC7002889.
PMID: 32051882

2019

Katon JG, Bossick AS, Doll KM, Fortney J, Gray KE, Hebert P, Lynch KE, Ma EW, Washington DL, Zephyrin L, Callegari LS. Contributors to Racial Disparities in Minimally Invasive Hysterectomy in the US Department of Veterans Affairs. Med Care. 2019 Dec;57(12):930-936. doi: 10.1097/MLR.0000000000001200.
PMID: 31730567

Butler CR, Vig EK, O'Hare AM, Liu CF, Hebert PL, Wong SPY. Ethical Concerns in the Care of Patients with Advanced Kidney Disease: a National Retrospective Study, 2000-2011. J Gen Intern Med. 2020 Apr;35(4):1035-1043. doi: 10.1007/s11606-019-05466-w. Epub 2019 Oct 25. PMCID: PMC7174459.
PMID: 31654358

Rymer JA, O'Donnell CI, Plomondon ME, Hess PL, Donahue M, Hebert PL, Shroff A, Swaminathan RV, Waldo SW, Seto AH, Helfrich CD, Rao SV. Same-day discharge among patients undergoing elective PCI: Insights from the VA CART Program. Am Heart J. 2019 Dec;218:75-83. doi: 10.1016/j.ahj.2019.09.003. Epub 2019 Sep 12.
PMID: 31707331

Zeitlin J, Egorova NN, Janevic T, Hebert PL, Lebreton E, Balbierz A, Howell EA. The Impact of Severe Maternal Morbidity on Very Preterm Infant Outcomes. J Pediatr. 2019 Dec;215:56-63.e1. doi: 10.1016/j.jpeds.2019.07.061. Epub 2019 Sep 10. PMC6981241
PMID: 31519443

Richards CA, Liu CF, Hebert PL, Ersek M, Wachterman MW, Reinke LF, Taylor LL, O'Hare AM. Family Perceptions of Quality of End-of-Life Care for Veterans with Advanced CKD. Clin J Am Soc Nephrol. 2019 Sep 6;14(9):1324-1335. doi: 10.2215/CJN.01560219. Epub 2019 Aug 29. PMC6730503
PMID: 31466952

Wong ES, Maciejewski ML, Hebert PL, Reddy A, Liu CF. Predicting Primary Care Use Among Patients in a Large Integrated Health System: The Role of Patient Experience Measures. Med Care. 2019 Aug;57(8):608-614. doi: 10.1097/MLR.0000000000001155.
PMID: 31295190

Howell EA, Hebert PL, Zeitlin J. Racial Segregation and Inequality of Care in Neonatal Intensive Care Units Is Unacceptable. JAMA Pediatr. 2019 May 1;173(5):420-421. doi: 10.1001/jamapediatrics.2019.0240.
PMID: 30907946

Wong ES, Maciejewski ML, Hebert PL, Fortney JC, Liu CF. Spillover Effects of Massachusetts Health Reform on Mental Health Use by VA and Medicare Dual Enrollees. Adm Policy Ment Health. 2019 Mar;46(2):145-153. doi: 10.1007/s10488-018-0900-z.
PMID: 30343347

Wong SPY, McFarland LV, Liu CF, Laundry RJ, Hebert PL, O'Hare AM. Care Practices for Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis. JAMA Intern Med. 2019 Mar 1;179(3):305-313. doi: 10.1001/jamainternmed.2018.6197. PMC6439687
PMID: 30667475

Hebert PL, Katon JG. Repurposing of Administrative Data for Research: Still Useful but for How Much Longer?. Pediatrics. 2019 Feb;143(2):e20183293. doi: 10.1542/peds.2018-3293. Epub 2019 Jan 9.
PMID: 30626623

2018

Wang V, Coffman CJ, Stechuchak KM, Berkowitz TSZ, Hebert PL, Edelman D, O'Hare AM, Crowley ST, Weidenbacher HJ, Maciejewski ML. Survival among Veterans Obtaining Dialysis in VA and Non-VA Settings. J Am Soc Nephrol. 2019 Jan;30(1):159-168. doi: 10.1681/ASN.2018050521. Epub 2018 Dec 7. PMID: 30530657. PMC6317601

Yu MK, Wong SPY, Liu CF, Hebert PL, O'Hare AM. Clinical presentation at initiation of maintenance dialysis and subsequent survival: A retrospective cohort study. Hemodial Int. 2019 Jan;23(1):106-116. doi: 10.1111/hdi.12690. Epub 2018 Oct 4. PMID: 30285313.

Hebert PL, Batten AS, Gunnink E, Reddy A, Wong ES, Fihn SD, Liu CF. Reliance on Medicare Providers by Veterans after Becoming Age-Eligible for Medicare is Associated with the Use of More Outpatient Services. Health Serv Res. 2018 Dec;53 Suppl 3(Suppl Suppl 3):5159-5180. doi: 10.1111/1475-6773.13033. Epub 2018 Sep 3. PMID: 30175401. PMC6235815

Liu CF, Batten A, Wong ES, Fihn SD, Hebert PL. Fee-for-Service Medicare-Enrolled Elderly Veterans Are Increasingly Voting with Their Feet to Use More VA and Less Medicare, 2003-2014. Health Serv Res. 2018 Dec;53 Suppl 3(Suppl Suppl 3):5140-5158. doi: 10.1111/1475-6773.13029. Epub 2018 Aug 27. PMID: 30151827. PMC6235817

Wang V, Coffman CJ, Stechuchak KM, Berkowitz TSZ, Hebert PL, Edelman D, O'Hare AM, Weidenbacher HJ, Maciejewski ML. Comparative Assessment of Utilization and Hospital Outcomes of Veterans Receiving VA and Non-VA Outpatient Dialysis. Health Serv Res. 2018 Dec;53 Suppl 3(Suppl Suppl 3):5309-5330. doi: 10.1111/1475-6773.13022. Epub 2018 Aug 9. PMID: 30094837. PMC6235811

Janevic T, Egorova NN, Zeitlin J, Balbierz A, Hebert PL, Howell EA. Examining Trends in Obstetric Quality Measures for Monitoring Health Care Disparities. Med Care. 2018 Jun;56(6):470-476. doi: 10.1097/MLR.0000000000000919. PMD: 29668651. PMC6260810

Kwan SW, Harris WP, Gold LS, Hebert PL. Comparative Effectiveness of Transarterial Embolization and Sorafenib for Hepatocellular Carcinoma: A Population-Based Study. AJR Am J Roentgenol. 2018 Jun;210(6):1359-1365. doi: 10.2214/AJR.17.19094. Epub 2018 Apr 9. PMD: 29629806.

Howell EA, Janevic T, Hebert PL, Egorova NN, Balbierz A, Zeitlin J. Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals. JAMA Pediatr. 2018 Mar 1;172(3):269-277. doi: 10.1001/jamapediatrics.2017.4402. PMD: 29297054. PMC5796743

Wong SPY, Yu MK, Green PK, Liu CF, Hebert PL, O'Hare AM. End-of-Life Care for Patients With Advanced Kidney Disease in the US Veterans Affairs Health Care System, 2000-2011. Am J Kidney Dis. 2018 Jul;72(1):42-49. doi: 10.1053/j.ajkd.2017.11.007. Epub 2018 Jan 10. PMD: 29331475. PMC6019112

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Grants & Funding

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

• Clinical Research (8)
• Prevention (6)
• Aging (5)
• Health Services (5)
• Clinical Trials and Supportive Activities (5)
• Behavioral and Social Science (4)
• Comparative Effectiveness Research (3)
• Cardiovascular (2)
• Nutrition (2)
• Obesity (2)
• Hypertension (1)

Current/Recent Grants

Multiphase Optimization Trial of Incentives for Veterans to Encourage Walking

Grant number: I01HX002202

Funding amount: $0.00

Start/End date: 8/1/2020 - 7/31/2023

Abstract:
Guidelines recommend adults should engage in moderate exercise, such as walking, for at least 150 minutes per week in episodes of at least 10 minutes duration. A typical adult can reach this threshold by walking 7,000 steps per day. Unfortunately, only 5% of adults in the United States meet these requirements, and more than 1 in 3 Veterans over age 45 meet the definition of physically inactive. A patient incentive program for physical activity (PA) may help. Behavioral economics suggests that our chronic inability to start and maintain a PA routine may be the result of “present bias,” which is a tendency to value small immediate rewards over large rewards in the distant future. For many people, the immediate gratification of a sedentary activity, such as watching television or surfing the internet, is a more powerful motivator than the intangible satisfaction of a physically active lifestyle. Patient incentives may overcome present bias by moving the rewards for healthy behaviors forward in time. In a patient incentive program, patients are given tangible, timely rewards for achieving specific health goals, such as walking 7,000 steps per day. Significance/Impact: Regular physical activity (PA) is associated with reduced mortality and lower risks of many diseases, including type 2 diabetes, heart disease, and depression. this study addresses the chronic conditions HSR&D priority area. Innovation: There is little evidence on what type of incentive works best for Veterans. We propose to study incentives for PA in a novel form of randomized trial—A Multiphase Optimization STrategy (MOST) trial. Our objectives are to determine the optimal design of a 12-week patient incentive program to encourage walking among physically inactive Veterans age 50-70. The primary outcomes are optimized components of the intervention, which will be tested against a usual care control group in a future, separate randomized trial. Specific Aims: Aim 1: Conduct a 24 factorial designed screening-phase trial of incentives for increasing average steps per day to 7,000 steps over 12 weeks among physically inactive Veterans. We will test four different incentive factors: 1) lottery vs. loss framed incentives, 2) financial vs. non-financial incentives, 3) a pre- commitment postcard reminder of a Veteran’s stated intrinsic reason for commitment to PA vs. no pre- commitment postcard, and 4) a request for PA advice from a Veteran on staying active vs. no request. The primary outcome is change in steps per week from baseline to week 24. Aim 2. Conduct cost analyses and qualitative interviews. The cost of administering each component and qualitative assessments of the acceptability of each component to trial participants will inform the decision of which components to retain for the subsequent refining and confirmatory phase trials. Aim 3. Convene an expert panel to choose components for the next phases of the MOST trial. The panel will weigh each component in terms of its effect on step counts (Aim 1), administrative costs and participant- reported qualitative assessments (Aim 2), and the strength of the theoretical basis for the component’s effect on physical activity. Methodology: We will enroll physically inactive Veterans age 50-70 in the screening phase trial. The intervention is the four different incentive factors described above. The primary outcome is change in steps per week from baseline to week 24. Implementation/Next Steps: The components derived from this screening phase will be used in a refining phase trial that establishes the optimal dose (frequency, duration, and amount) of the incentive. The optimized intervention will then be tested against a usual care control group in the confirming phase trial. The refining and confirming phase trials will be proposed in a separate, future grant submission.

Public Health Relevance Statement:
Regular physical activity is associated with reduced risk of several diseases important to Veterans, including cardiovascular disease and diabetes, and is associated with better mental health. Walking is a safe and effective way to get the recommended amount of physical activity. Unfortunately, more than 1 in 3 Veterans over age 45 meet the definition of physically inactive. Behavioral economics suggests that our inability to start and stick to an exercise routine may be the result of “present bias,” which is a tendency to value the immediate reward of remaining sedentary over large rewards of long-run physical activity. Patient incentives may overcome present bias by moving the rewards for healthy behaviors forward in time. In the proposed study we will determine the optimal design for an incentive program that gives Veterans tangible, timely rewards for walking a target average number of steps per day. If effective, an incentive program may be an economical way to improve Veterans’ physical and mental health without taxing the healthcare delivery system.

Funder: United States Department of Veterans Affairs (VA)

NIH website: https://reporter.nih.gov/project-details/10071022

Financial vs. Non-financial Rewards for Weight Loss and Weight Maintenance: A Randomized Controlled Trial

Grant number: I01HX002123

Funding amount: $0.00

Start/End date: 2/1/2017 - 7/30/2021

Abstract:
Behavioral economics suggests that our chronic inability to make the daily behavioral changes that can help us lose weight may be the result of “present bias,” which is a tendency to value small, immediate rewards over large rewards in the distant future. For many of us, the immediate gratification of eating an unhealthy food is a more powerful motivator than is the elusive dissatisfaction of the long-run health consequences of an unhealthy diet. Patient incentives may overcome present bias by moving the rewards for healthy behaviors forward in time. In a patient incentive program, patients are given tangible, timely rewards for achieving specific health goals, such as losing one pound per week over 16 weeks. Meta analyses of randomized trials have found that incentives for weight loss are effective during the incentive period, but the weight loss was not sustained after the incentive was removed. Thus, the key challenge to an incentive program is not achieving weight loss, but maintaining it. The proposed study tests the hypothesis that the significant weight regain found in prior incentive trials can be attributed to use of financial incentives—e.g., cash or the equivalent of cash—in those trials. Experiments in behavioral economics have found that providing subjects with financial incentives for participating in a study invokes behavior defined by reciprocity—the effort the subjects gave in the study was proportional to the amount of money that they were given. When subjects were given non-financial incentives, they exhibited no reciprocity—the effort was consistently high and did not vary with the quantity of the non-financial incentive. By using financial incentives, prior trials may have invoked money-market norms of reciprocity, such that patients’ efforts toward weight loss were high when incentives were offered, and reduced when they were discontinued. We hypothesize that non-financial rewards, like tickets to a Seattle Mariners baseball game, will not invoke reciprocity or the consequent weight regain. Project Objectives: The goal of this study is to test, through a randomized trial, the effectiveness of providing overweight Veterans with financial or non-financial incentives for a one pound weight loss per week over 16 weeks. The primary outcome is weight loss at 32 weeks—16 weeks after the discontinuation of the incentives. Secondary outcomes include weight loss at 16 weeks and 12 months. Project Methods: We will conduct a three-armed randomized of patient incentives for losing one pound per week over 16 weeks. The three treatment groups will receive financial incentives, non-financial incentives, or no incentives. We hypothesize that: 1) patients who receive non-financial incentives for weight loss over 16 weeks will have greater weight loss at 32 weeks than patients who do not receive incentives; 2) patients who receive non-financial incentives for weight loss over 16 weeks will experience weight loss at 16 weeks that is not inferior to the weight loss of patients who receive financial incentives; and 3) weight regain will be greater among patients who received financial incentives compared to patients who received non-financial incentives or no incentives. We will also conduct post-intervention qualitative interviews and perform a cost analysis.

Public Health Relevance Statement:
Three of every four Veterans are overweight or obese, and weight loss is associated with reduced morbidity and mortality. The VA MOVE! program for weight loss is moderately effective but only reaches a small percentage of overweight Veterans. This proposed study will test whether a patient incentive program that gives Veterans non-financial incentives, such as Seattle Mariners baseball tickets, for losing one pound per week over 16 weeks is effective. An effective patient-incentive program could help more Veterans lose weight without requiring a substantial increase in VA staff.

Funder: United States Department of Veterans Affairs (VA)

NIH website: https://reporter.nih.gov/project-details/10071022

Gamification of MOVE! Group Meetings: A Pilot Study for an Embedded Pragmatic Clinical Trial

Grant number: I21HX002789

Funding amount: $0.00

Start/End date: 9/1/2019 - 5/31/2021

Abstract:
Nearly 60% of Veterans are overweight or obese, and overweight is a leading risk factor for mortality and morbidity. MOVE! is the primary program available to overweight Veterans in VHA, and the centerpiece of the MOVE! program is the weekly MOVE! group meetings in which a cohort of 10-15 Veterans meet over a period of 8-16 weeks. These group meetings offer an ideal environment to design and test novel interventions that leverage group dynamics to help participants meet their weight loss and physical activity goals. The striking results of the recent BE FIT trial suggests that interventions based on gamification are worth exploring. Gamification is the application of game design elements in nongame contexts. Typical game elements include assigning goals, earning points or badges for meeting goals, and using social incentives to increase motivation and engagement. The BE FIT trial enrolled teams of family members. Each week a family was giving 70 points, and each day, a family risked losing 10 points if a randomly chosen person did not meet his/her walking target for that day. This simple game yielded substantial increases in the percent of days on which step goals were achieved, and a 2.6-fold increase in mean daily steps over a control group. The goal of this pilot study is to develop similar group-based gamified interventions that are appropriate for the VHA and could be tested in a large-scale trial using MOVE! group meetings as the experimental unit. The aims are: Aim 1: Develop the games that will constitute the intervention using principles of human-centered design. A workshop to design the games will be facilitated by an expert in human-centered design, and attended by researchers, MOVE! participants from VA Puget Sound, MOVE! coordinators from three VA Medical Centers, and the National Director of MOVE!. Aim 2. Pilot test the games through an iterative testing, refining, and retesting process. We will test the games for feasibility in the five MOVE! groups currently occurring in the Puget Sound VAMC, and assess the acceptability of the games to MOVE! participants and coordinators. Aim 3. Pilot test the data collection process. We will build tools to initiate a game for MOVE! participants, to assign points achieving goals, and to monitor the progress of the games. We will pilot test the collection of physical activity from walking apps on participants smartphones. Methodology: We will conduct a human-centered design workshop to design the games, and quantitative and qualitative methods to assess the games for feasibility in a larger trial. Expected results: The result will be protocols for games that can be tested in a group-randomized trial. Next steps: If the games prove feasible and acceptable to MOVE! participants and MOVE! coordinators we will submit a grant proposal to test these games in a pragmatic, group-randomized trial of gamification using MOVE! group meetings as experimental units. Significance: Maintaining a healthy diet and an active lifestyle is good for you and hard. This pilot study is about building an evidence-base around gamified interventions appropriate for a group-based weight loss programs like MOVE! that can help make difficult tasks engaging and fun. If games could increase engagement and participation in MOVE!, they might also make MOVE! more effective. Innovation: Gamification in health research is an emerging field, and mostly focused on phone apps and video games for pediatric populations. The use of analog games for weight loss and physical activity is novel. Effect of study in other areas: This pilot study would be a first step toward the VA becoming a leader in developing and testing novel gamified applications for improving a variety of health behaviors in group settings. HSR&D Priority areas: This research aligns with the HSR&D Patient-centered Care, Care Management, and Health Promotion priority areas.

Public Health Relevance Statement:
Three of every four Veterans are overweight or obese, and weight loss is associated with reduced morbidity and mortality. MOVE! is the primary program for weight loss in the VA, and most Veterans who participate in MOVE! do so through MOVE! group meetings. The proposed pilot study will design and pilot test interventions for weight loss that are based on gamification and are appropriate for use in MOVE! group meetings. An effective gamified intervention could help Veterans lose weight without requiring a substantial increase in VA staff.

Funder: United States Department of Veterans Affairs (VA)

NIH website: https://reporter.nih.gov/project-details/10071022

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Media (Webinars, podcasts, etc.)

Access and Virtual Care COREs: Complementary Initiatives to Speed the Research Cycle

3 March 2021

The Veterans Access Research Consortium (VARC) and the Virtual Care Consortium of Research (VC CORE) are Consortia of Research (COREs) that support distinct VA research priorities, though they often work synergistically. As a CORE, VARC seeks to improve access by leveraging better measures of access and examining how various interventions, including those involving health information technologies, impact access. The VC CORE aims to investigate the ability of virtual care modalities to increase Veteran access to services, improve workflow and workload of VA clinical team members, and engage and support Veterans to participate in their own care.

During this Cyberseminar, Dr. Stephanie Shimada (VARC) and Dr. Timothy Hogan (VC CORE) will explore the differences between the two COREs and identify opportunities for synergy and collaboration. The Cyberseminar will also feature work from three VA researchers in the CORE research networks:

• Dr. Paul Hebert will present the results of an Office of Primary Care-funded study examining the impact of incorporating Nurse Practitioners into VA call centers on healthcare use, cost, and timeliness of care.
• Dr. Jolie Haun will present results from her study developing implementation strategies to promote PACT team adoption of virtual medical modalities such as My HealtheVet, telehealth, and mobile applications.
• Dr. Charlie Wray, Associate Investigator with the VC CORE, will present the aims of his newly funded HSR&D Career Development Award aimed at improving access to care by identifying, describing, and engaging Veterans who would most benefit from VA Video Connect in order to reduce “no-shows” (missed appointments) in primary care.

Tracking the Effects of COVID-19 Using Data on Symptoms Reported by Veterans on Calls to VA Clinical Call Centers

2/17/2021

Description: When a Veteran calls a VA Clinical Call Center, the symptoms they report as the reason for the call are stored as text notes in the Corporate Data Warehouse. Investigators are using these data to monitor calls for COVID-related symptoms at the VA Medical Center level, and to monitor calls for non-COVID symptoms that might be a consequence of the economic or social fallout of the pandemic. Intended Audience: Clinicians and researchers interested in trends in the burden of symptoms before and during the pandemic.

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