Seattle-Denver Center of Innovation (COIN)

COIN Investigators & Staff

11 August 2021

COIN Investigators

Steven B. Zeliadt, PhD, MPH

Title: Research Professor, Health Services, University of Washington

Contact: Stephen.Zeliadt@va.gov

Location: Seattle

University of Washington webpage

Dr. Zeliadt (pictured left in the photo) is the Associate Director for the Seattle-Denver COIN and Research Professor in the Department of Health Services in the School of Public Health at the University of Washington. Dr. Zeliadt is currently the Principal Investigator/Lead for multiple research and quality improvement projects totaling over $20 million in funding to help the Veterans Health Administration better understand a range of topics facing Veterans including the value of non-pharmacological pain management interventions, how to connect Veterans with tobacco and substance use disorders to high quality care, maximizing the value of cancer screening, and delivering optimal diagnostic and ongoing care for Veterans with cancer that maximizes quality of life.

Dr. Zeliadt is the son a Vietnam Veteran (1st Air Cavalry) with over 2500 helicopter combat hours - and many stories - and is the brother of a future Veteran/current Iowa National Guard member who recently returned from deployment. Dr. Zeliadt is a first-generation college student and attended graduate school at the University of Washington and post-doctoral fellowship training at the Fred Hutchinson Cancer Research Center in Seattle.

Dr. Zeliadt’s research is focused on understanding the real-world performance of healthcare interventions in Veteran populations, including using healthcare data and applying comparative effectiveness methodologies in novel ways to understand the value they bring (or don’t) to patients, working to reduce disparities and inequity, and on designing and conducting innovative pragmatic trials to help the healthcare system learn how to deliver optimal care to Veterans.

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Recent Publications

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

• Clinical Research (87)
• Cancer (75)
• Urologic Diseases (44)
• Prostate Cancer (42)
• Aging (39)
• Prevention (33)
• Health Services (28)
• Lung (26)
• Lung Cancer (21)
• Behavioral and Social Science (17)
• Clinical Trials and Supportive Activities (12)

2021

Fritz JM, Davis AF, Burgess DJ, Coleman B, Cook C, Farrokhi S, Goertz C, Heapy A, Lisi AJ, McGeary DD, Rhon DI, Taylor SL, Zeliadt S, Kerns RD. Pivoting to virtual delivery for managing chronic pain with nonpharmacological treatments: implications for pragmatic research. Pain. 2021 Jun 1;162(6):1591-1596. doi: 10.1097/j.pain.0000000000002139. PMCID: PMC8089114.
PMID: 33156148.

Zeliadt SB. Smoking Cessation Resources Can and Should Be Integrated in Lung Cancer Screening. Chest. 2021 Aug;160(2):413-414. doi: 10.1016/j.chest.2021.04.011.
PMID: 34366030.

Heffner JL, Coggeshall S, Wheat CL, Krebs P, Feemster LC, Klein DE, Nici L, Johnson H, Zeliadt SB. Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration. J Gen Intern Med. 2021 Jul 19. doi: 10.1007/s11606-021-07011-0. Epub ahead of print.
PMID: 34282533.

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.

Winn AN, Kelly M, Ciprut S, Walter D, Gold HT, Zeliadt SB, Sherman SE, Makarov DV. The cost, survival, and quality-of-life implications of guideline-discordant imaging for prostate cancer. Cancer Rep (Hoboken). 2021 Jun 17:e1468. doi: 10.1002/cnr2.1468. Epub ahead of print.
PMID: 34137520.

Burgess D, Taylor SL, Giannitrapani KF, Ackland PE, Thomas ER, Federman DG, Holliday JR, Olson J, Kligler B, Zeliadt SB. The Implementation and Effectiveness of Battlefield Auricular Acupuncture for Pain. Pain Med. 2021 Mar 26:pnaa474. doi: 10.1093/pm/pnaa474. Epub ahead of print.
PMID: 33769534.

Cadham CJ, Cao P, Jayasekera J, Taylor KL, Levy DT, Jeon J, Elkin E, Foley KL, Joseph A, Kong CY, Minnix JA, Rigotti NA, Toll BA, Zeliadt SB, Meza R, Mandelblatt J; CISNET-SCALE Collaboration. Cost-Effectiveness of Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Simulation Study. J Natl Cancer Inst. 2021 Jan 23:djab002. doi: 10.1093/jnci/djab002. Epub ahead of print.
PMID: 33484569.

2020

Zeliadt SB, Coggeshall S, Gelman H, Shin MH, Elwy AR, Bokhour BG, Taylor SL. Assessing the Relative Effectiveness of Combining Self-Care with Practitioner-Delivered Complementary and Integrative Health Therapies to Improve Pain in a Pragmatic Trial. Pain Med. 2020 Dec 12;21(Supplement_2):S100-S109. doi: 10.1093/pm/pnaa349.
PMID: 33313736.

Park ER, Chiles C, Cinciripini PM, Foley KL, Fucito LM, Haas JS, Joseph AM, Ostroff JS, Rigotti NA, Shelley DR, Taylor KL, Zeliadt SB, Toll BA; Smoking Cessation at Lung Examination (SCALE) Research Group. Impact of the COVID-19 pandemic on telehealth research in cancer prevention and care: A call to sustain telehealth advances. Cancer. 2020 Oct 13:10.1002/cncr.33227. doi: 10.1002/cncr.33227. Epub ahead of print. PMCID: PMC7675475.
PMID: 33048350.

Coleman BC, Kean J, Brandt CA, Peduzzi P, Kerns RD. Adapting to disruption of research during the COVID-19 pandemic while testing nonpharmacological approaches to pain management. Transl Behav Med. 2020 Oct 8;10(4):827-834. doi: 10.1093/tbm/ibaa074. PMCID: PMC7499692.
PMID: 32885815.

Giannitrapani KF, Ackland PE, Holliday J, Zeliadt S, Olson J, Kligler B, Taylor SL. Provider Perspectives of Battlefield Acupuncture: Advantages, Disadvantages and Its Potential Role in Reducing Opioid Use for Pain. Med Care. 2020 Sep;58 Suppl 2 9S(2 9 Suppl):S88-S93. doi: 10.1097/MLR.0000000000001332. PMCID: PMC7497600.
PMID: 32826777.

Zeliadt SB, Thomas ER, Olson J, Coggeshall S, Giannitrapani K, Ackland PE, Reddy KP, Federman DG, Drake DF, Kligler B, Taylor SL. Patient Feedback on the Effectiveness of Auricular Acupuncture on Pain in Routine Clinical Care: The Experience of 11,406 Veterans. Med Care. 2020 Sep;58 Suppl 2 9S(2 9 Suppl):S101-S107. doi: 10.1097/MLR.0000000000001368. PMCID: PMC7497594.
PMID: 32826779.

Thomas ER, Zeliadt SB, Coggeshall S, Gelman H, Resnick A, Giannitrapani K, Olson J, Kligler B, Taylor SL. Does Offering Battlefield Acupuncture Lead to Subsequent Use of Traditional Acupuncture? Med Care. 2020 Sep;58 Suppl 2 9S(2 9 Suppl):S108-S115. doi: 10.1097/MLR.0000000000001367. PMCID: PMC7497608.
PMID: 32826780.

Becker DJ, Rude T, Walter D, Wang C, Loeb S, Li H, Ciprut S, Kelly M, Zeliadt SB, Fagerlin A, Lepor H, Sherman S, Ravenell JE, Makarov DV. The Association of Veterans' PSA Screening Rates with Changes in USPSTF Recommendations. J Natl Cancer Inst. 2020 Aug 14:djaa120. doi: 10.1093/jnci/djaa120. Epub ahead of print.
PMID: 32797212.

Ciprut SE, Kelly MD, Walter D, Hoffman R, Becker DJ, Loeb S, Sedlander E, Tenner CT, Sherman SE, Zeliadt SB, Makarov DV. A Clinical Reminder Order Check Intervention to Improve Guideline-concordant Imaging Practices for Men With Prostate Cancer: A Pilot Study. Urology. 2020 Nov;145:113-119. doi: 10.1016/j.urology.2020.05.101. Epub 2020 Jul 25.
PMID: 32721517.

Esserman D, Goldstein BA, Levenson M, Platt R, Roe MT, Zeliadt S. University of Pennsylvania 12th annual conference on statistical issues in clinical trials: Electronic health records in randomized clinical trials-challenges and opportunities (morning panel session). Clin Trials. 2020 Aug;17(4):405-413. doi: 10.1177/1740774520928607. Epub 2020 Jul 2.
PMID: 32615793.

Zeliadt SB, Coggeshall S, Thomas E, Gelman H, Taylor SL. The APPROACH trial: Assessing pain, patient-reported outcomes, and complementary and integrative health. Clin Trials. 2020 Aug;17(4):351-359. doi: 10.1177/1740774520928399. Epub 2020 Jun 10.
PMID: 32522024.

Sanchez R, Bailey G, Kaboli PJ, Zeliadt SB, Lang JA, Hoffman RM. Applying a Text-Search Algorithm to Radiology Reports Can Find More Patients With Pulmonary Nodules Than Radiology Coding Alone. Fed Pract. 2020 May;37(Suppl 2):S32-S37. PMCID: PMC7497875.
PMID: 32952385.

Golden SE, Ono SS, Melzer A, Davis J, Zeliadt SB, Heffner JL, Kathuria H, Garcia-Alexander G, Slatore CG. ""I Already Know That Smoking Ain't Good for Me"": Patient and Clinician Perspectives on Lung Cancer Screening Decision-Making Discussions as a Teachable Moment. Chest. 2020 Sep;158(3):1250-1259. doi: 10.1016/j.chest.2020.03.061. Epub 2020 Apr 15.
PMID: 32304776.

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.

2019

Griffith MF, Feemster LC, Zeliadt SB, Donovan LM, Spece LJ, Udris EM, Au DH. Overuse and Misuse of Inhaled Corticosteroids Among Veterans with COPD: a Cross-sectional Study Evaluating Targets for De-implementation. J Gen Intern Med. 2020 Mar;35(3):679-686. doi: 10.1007/s11606-019-05461-1. Epub 2019 Nov 11. PMCID: PMC7080925.
PMID: 31713043.

Donovan LM, Coggeshall SS, Spece LJ, Griffith MF, Palen BN, Parsons EC, Todd-Stenberg JA, Glorioso TJ, Carey EP, Feemster LC, Zeliadt SB, Kirsh S, Au DH. Use of In-Laboratory Sleep Studies in the Veterans Health Administration and Community Care. Am J Respir Crit Care Med. 2019 Sep 15;200(6):779-782. doi: 10.1164/rccm.201902-0313LE. PMC7330508
PMID: 31206308.

Donovan LM, Malte CA, Spece LJ, Griffith MF, Feemster LC, Zeliadt SB, Au DH, Hawkins EJ. Center Predictors of Long-Term Benzodiazepine Use in Chronic Obstructive Pulmonary Disease and Post-traumatic Stress Disorder. Ann Am Thorac Soc. 2019 Sep;16(9):1151-1157. doi: 10.1513/AnnalsATS.201901-048OC. PMC6812159
PMID: 31113231.

2018

Federman DG, Zeliadt SB, Thomas ER, Carbone GF Jr, Taylor SL. Battlefield Acupuncture in the Veterans Health Administration: Effectiveness in Individual and Group Settings for Pain and Pain Comorbidities. Med Acupunct. 2018 Oct 1;30(5):273-278. doi: 10.1089/acu.2018.1296. Epub 2018 Oct 15. PMID: 30377463. PMC6205767

Heffner JL, Krebs P, Johnson H, Greene PA, Klein DE, Feemster LC, Slatore CG, Au DH, Zeliadt SB. Smokers' Inaccurate Beliefs about the Benefits of Lung Cancer Screening. Ann Am Thorac Soc. 2018 Sep;15(9):1110-1113. doi: 10.1513/AnnalsATS.201804-259RL. PMD: 29877728.

Farias AJ, Hansen RN, Zeliadt SB, Ornelas IJ, Li CI, Thompson B. The Association Between Out-of-Pocket Costs and Adherence to Adjuvant Endocrine Therapy Among Newly Diagnosed Breast Cancer Patients. Am J Clin Oncol. 2018 Jul;41(7):708-715. doi: 10.1097/COC.0000000000000351. PMD: 27893470. PMC5441973

Walsh TJ, Shores MM, Krakauer CA, Forsberg CW, Fox AE, Moore KP, Korpak A, Heckbert SR, Zeliadt SB, Kinsey CE, Thompson ML, Smith NL, Matsumoto AM. Testosterone treatment and the risk of aggressive prostate cancer in men with low testosterone levels. PLoS One. 2018 Jun 22;13(6):e0199194. doi: 10.1371/journal.pone.0199194. eCollection 2018. PMD: 29933385. PMC6014638

Graf SA, Zeliadt SB, Rise PJ, Backhus LM, Zhou XH, Williams EC. Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection. J Thorac Dis. 2018 Mar;10(3):1648-1656. doi: 10.21037/jtd.2018.02.51. PMD: 29707317. PMC5906255

Zeliadt SB, Hoffman RM, Birkby G, Eberth JM, Brenner AT, Reuland DS, Flocke SA. Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers. Am J Prev Med. 2018 Apr;54(4):568-575. doi: 10.1016/j.amepre.2018.01.001. Epub 2018 Feb 21. PMD: 29429606.

Joseph AM, Rothman AJ, Almirall D, Begnaud A, Chiles C, Cinciripini PM, Fu SS, Graham AL, Lindgren BR, Melzer AC, Ostroff JS, Seaman EL, Taylor KL, Toll BA, Zeliadt SB, Vock DM. Lung Cancer Screening and Smoking Cessation Clinical Trials. SCALE (Smoking Cessation within the Context of Lung Cancer Screening) Collaboration. Am J Respir Crit Care Med. 2018 Jan 15;197(2):172-182. doi: 10.1164/rccm.201705-0909CI. PMD: 28977754. PMC5768904

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Grants & Funding

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

• Health Services (9)
• Clinical Research (9)
• Cancer (5)
• Behavioral and Social Science (5)
• Prevention (4)
• Lung Cancer (4)
• Lung (4)
• Clinical Trials and Supportive Activities (3)
• Pain Research (3)
• Tobacco (3)
• Tobacco Smoke and Health (3)
• Biomedical Imaging (2)
• Comparative Effectiveness Research (2)
• Mental Health (2)
• Chronic Pain (2)
• Substance Abuse (2)
• Basic Behavioral and Social Science (1)
• Artificial Intelligence and Image Processing (1)
• Brain Disorders (1)
• Complementary and Integrative Health (1)
• Aging (1)
• Information Systems (1)
• Urologic Diseases (1)
• Mathematical Sciences (1)
• Mind and Body (1)
• Prostate Cancer (1)
• Rehabilitation (1)
• Rural Health (1)
• Statistics (1)
• Information and Computing Sciences (1)

Current/Recent Grants

Complementary and Integrative Health for Pain in the VA: A National Demonstration Project

Role: Co-PI

Grant number: IU1HX002607

Funding amount: $0.00

Start/End date: 4/1/2018 - 3/31/2024

Abstract:
Over half of Veterans report musculoskeletal (MSK) pain, often with mental health comorbidities. Complementary and integrative health (CIH) therapies are important non-pharmacologic treatment options for these conditions. However, CIH is not widely available at the VA. Also, practitioner-delivered therapies (i.e., acupuncture or chiropractic) are promising, but providers would like patients to be more active in their pain management by using self-care (i.e., meditation, tai chi, yoga) instead of relying on practitioner-delivered care. A critical question for the field is whether adding self-care CIH to practitioner-delivered CIH is a more effective approach than either strategy alone. However, we are unaware of anyone examining this. Also, to-date, studying CIH in large VA samples has been difficult because few facilities capture CIH use with codes in their electronic health records, and very few use the VA's standardized codes, preventing multi-site studies. In 2016, Congress passed the Comprehensive Addiction and Recovery Act mandating expansion of CIH therapies in VA. In response, 18 VA regional networks committed $5 million/yr to implement CIH therapies at 18 sites beginning in 2018, focusing on five evidence-based therapies: acupuncture, chiropractic, Tai Chi, mindfulness, and yoga. The VA's Office of Patient Centered Care and Cultural Transformation (OPCC&CT) will oversee this effort, including the data collection efforts targeting 1,000 CIH users from each of the 18 sites. We propose addressing the above gaps by continue our longstanding collaboration with OPCC&CT to capitalize on 1) the 2018 rollout of CIH in 18 VA sites and 2) our two current national/multisite studies of the effects of CIH, one on MSK pain and the other which integrates CIH patient reported outcomes (PROs) measurement into clinical care. We propose a large-scale pragmatic comparative effectiveness clinical trial to assess CIH. In the UG3 Planning Phase, as the 18 sites begin implementing CIH, we will develop and implement data collection instruments and processes that we are currently piloting to capture CIH use and PROs: 1) pain and its intensity and interference, 2) global physical and mental health and 3) fatigue. We also will examine opioid use. To inform that measurement, we will use multiple strategies, including an Advisory Board. In the UH3 Implementation Phase, we will conduct a 3-arm pragmatic trial using an encouragement design to assess the longitudinal comparative effectiveness of: 1) practitioner-delivered care (acupuncture or chiropractic care) combined with self-care (Tai Chi, meditation/mindfulness or yoga) compared to 2) practitioner-delivered care alone or 3) self-care alone. We will examine outcomes at 3 and 6 months for OPCC&CT's target sample of 18,000 CIH users. We will use randomized “nudges” (e.g., educational brochures with class listings) tailored to each site to encourage Veterans who use one type of CIH to consider a combination of therapies.

Public Health Relevance Statement:
This study aims to improve the health and satisfaction of Veterans with chronic musculoskeletal pain by better understanding the effectiveness of five types of evidence-based complementary and integrative health, which are non-pharmacologic options to treat their pain and comorbid mental health conditions.

NIH website: https://reporter.nih.gov/project-details/10186550

Promoting Smoking Cessation in Lung Cancer Screening through Proactive Treatment

Role: PI

Grant number: I01HX002172

Funding amount: $0.00

Start/End date: 9/1/2018 - 2/28/2022

Abstract:
Promoting smoking cessation in lung cancer screening through proactive therapy: PROACT VA Medical Centers are beginning to offer eligible Veterans lung cancer screening following national recommendations including the US Preventive Services Task Force's “B” recommendation for annual screening. Preliminary evidence from the VA Lung Cancer Screening Demonstration Project suggests that nearly 2.8 million Veterans will be eligible for screening and over half will be current smokers with a long history of smoking. It is critical that offering screening to current smokers reinforces the importance of cessation and does not reduce motivation to quit. Integrating cessation into lung cancer screening is challenging, in part because of limited time and clinic resources, but also because of misperceptions about the “protective” effect of screening among many current smokers. In the National Lung Screening Trial, primary care providers offering screening adequately addressed smoking cessation with only 10% of current smokers. This project will provide proactive behavioral and pharmacotherapy treatment to all current smokers as part of participating in lung cancer screening. Tobacco treatment will be integrated with the reporting of screening results. In our pilot study of the proactive telephone counseling component of the proposed intervention, we increased participation in behavioral cessation treatment to 36% among intervention participants from 11% among usual care control patients, and quit rates more than doubled to 18% in the intervention group. Screening patients often report being motivated to participate in screening to find out how much smoking has harmed them. Our proposed intervention is designed to convert this new level of patient engagement into an opportunity to encourage cessation. Our proposed proactive care strategy removes the precondition of asking patients if they are ready to quit. Over 14 trials have shown providing opt-out treatment to all current smokers significantly increases quit rates. We will conduct a pragmatic randomized trial with current smokers at VA Puget Sound and VA NY Harbor who are participating in lung cancer screening. Patients will be randomized to receive either proactive care with opt- out treatment accompanying their screening results (n=250) or usual care (n=250). Proactive treatment will be arranged by a radiology-based coordinator, and will include a tailored results letter describing pharmacotherapy, an appropriate prescription ordered in conjunction with the patient's primary care provider, and two proactive telephone-based behavioral counseling sessions. The telephone counseling component will be delivered by counselors at VA's national quitline. The primary endpoint is biochemically confirmed 7-day abstinence 12 months after screening. Based on prior trials of opt-out treatment and our pilot data, the trial is powered to detect an improvement in quit rates from 9% with usual care to at least 18% with opt-out treatment.

Public Health Relevance Statement:
Nicotine replacement treatment (NRT) doubles the chances of successfully quitting, especially when combined with behavioral counseling. However it remains underutilized in Veterans. Routinely providing proactive treatment that includes NRT to current smokers can increase its use and promote cessation. Lung cancer screening is a newly recommended clinical service that offers a fresh opportunity to engage smokers in education about cessation treatments. This project will implement and test a pragmatic workflow strategy for integrating proactive treatment into routine lung cancer screening processes.

Funder: United States Department of Veterans Affairs (VA)

NIH website: https://reporter.nih.gov/project-details/10197054

Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment

Role: Co-PI with Joseph Frank

Grant number: I50HX003009

Funding amount: $0.00

Start/End date: 10/1/2019 - 9/30/2022

Abstract:
Opioid use disorder (OUD) is a major cause of morbidity and mortality among Veterans and a high-priority target for quality improvement in the Veterans Health Administration (VHA). Effective medications for OUD (MOUD) are available but uptake of them has been highly variable across VHA. Additionally, VHA has been at the forefront in the U.S. in promoting alternative therapies for pain, but these are not consistently available to Veterans in great need of them: those with chronic pain and harmful opioid use. VHA, through its Office of Mental Health and Suicide Prevention, has made access to MOUD for all Veterans who need it a system-wide priority. However, successful implementation of complex care processes that face myriad barriers requires intentional, structured, evidence-based implementation efforts carried out by expert teams in close partnership with local leadership. As such, the overarching goal of this project – the Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment (CONDUIT) -- is to unite five inter-related VISN/QUERI pilot Partnered Implementation Initiative projects in a concerted effort to improve access to MOUD among Veterans with OUD and access to alternative therapies for pain in 57 VHA sites spanning six VISNs. CONDUIT will span four critical care settings in the OUD continuum of care: Primary Care; Specialty Care; Acute Care (inpatient and Emergency Department); and Telehealth. These efforts will be connected by Veteran Engagement, Implementation, and Quantitative/Economic Cores that will help CONDUIT teams harmonize on metrics, processes and outcomes. There will also be a Strategic Advisory Group composed of Operations leaders and Veterans that will help CONDUIT remain maximally aligned with VHA and Veteran priorities. CONDUIT will also offer sites the opportunity to implement new evidence-based practices (i.e. ones that were not part of initial launch) in the latter half of the project period. The methods deployed by each of the CONDUIT teams will be similar: expert “external facilitation” teams will lead partnered “internal facilitation” teams at local sites in a process called “Implementation Facilitation (IF)” – a multi-component suite of tools aimed to help the sites effectively adopt evidence-based practices. The five projects piloted and systematically modified IF strategies in Phase 1 and now propose to disseminate those sharpened strategies on a national scale over the next three years, including two new VISNs and dozens of additional sites. In terms of evaluation, CONDUIT will use well-established formative evaluation methods to assess the effectiveness of and to drive refinements to the IF strategies. Additionally, CONDUIT will use cutting edge quantitative methods to assess the impact the work on important clinical targets and to assess the value of the work in terms of costs vs. benefits. Throughout the project period, teams will develop and refine products such as patient and provider educational materials, prescribing and communication guides, and clinic operations manuals. These evaluation and product development efforts will prime successful scale-up and dissemination efforts throughout VHA.

Public Health Relevance Statement:
Opioid use disorder (OUD) is a major cause of morbidity and mortality among Veterans for which effective treatment is a major priority of the Veterans Health Administration (VHA). Relatedly, expanding access to alternatives to opioids for chronic pain management is a leading priority. Effective medications for OUD (MOUD) are available, but their uptake is highly variable across VHA. Thus, our proposal aims to coordinate the efforts of five successful pilot projects (Phase 1) into a consortium to maximize value to VHA and inform future dissemination efforts in improving uptake of MOUD and alternative therapies for pain in VHA nationally (Phase 2). The leads of Phase 1 projects will leverage successful partnerships with VISN leadership to combine into an integrated effort that spans six VISNs and 57 sites.

Funder: United States Department of Veterans Affairs (VA)

NIH website: https://reporter.nih.gov/project-details/10181067

Semi-parametric Statistical Methods for Predicting High-cost VA Patients Using High-Dimensional Covariates

Role: PI

Grant number: I01HX002310

Funding amount: $0.00

Start/End date: 5/1/2018 - 4/30/2021

Abstract:
The rising demands and health care costs make it urgent to develop new statistical methods to accurately predict high-costs VA patients and important risk factors associated with high costs. The ability to prospectively predict high-costs patients is an important step toward controlling future health care costs. It is also important to identify disease areas that contribute significantly to the high health care costs and other risk factors which policy makers can target by future intervention. Health care cost data are characterized by a high level of skewness and heteroscedastic variances. The large number of variables collected in the VA database provides rich information, but at the same time, imposes great challenges for statistical analysis and computation. The administrative and electronic medical record data from VA databases often contain missing data. The new statistical procedure we propose aims to take advantage of the rich databases in VA for analyzing costs data. It employs and develops state-of-art high-dimensional semiparametric statistical procedures to handle the complexity of VA data sets. Objectives: The project aims to develop a High Costs Prediction (HCP) system, which employs novel high-dimensional semiparametric statistical methods and algorithms to analyze large VA database with missing values and occurrence of censoring. The HCP system identifies potential high-costs patients, provides prediction intervals of future costs, and suggests a list of important risk factors for cost control. The outcomes of the project will help VA researchers and policy makers design effective interventions to target those potential high-cost patients and reduce their costs without sacrificing quality of care. The project will collaborate closely with VA Office of Analytics and Business Intelligence (OABI) to analyze costs data for patients receiving primary care within VHA. In particular, we will identify a set of modifiable risk factors (MRF) that are simultaneously important for improving care and reducing costs. Our proposed work fills in an important blank area of VA health care costs data analysis. By combining the HCP system with the existing Care Assessment Needs Scoring (CAN) system, we will make important progress toward the ultimate goal of building a data-driven decision support system. Methods: The project will develop a novel semiparametric procedure for predicting high costs patients. The approach we propose incorporates high-dimensional covariates and nonlinear covariate effects and addresses the challenge of censoring by death, which improves accuracy and increases the flexibility of modeling. It does not require discretizing the cost and hence fully uses the information contained in the cost data. It does not require any parametric distributional assumption. Another major contribution of this project is that we propose weighted semiparametric quantile regression based novel variable selection procedures which can simultaneously identify and estimate significant risk factors for high-dimensional data at the presence of missing values. Our approach will develop a patient level dataset that combines all available cost data from the databases provided through the Decision Support System (DSS) National Extracts. We will link data from the Managerial Cost Accounting System (MCA, formerly Decision Support System or DSS) with three VA databases including: the VA Patient Treatment File (PTF); the VA Outpatient Clinic File (OCF); and the VA Beneficiary Identification and Records Locator Subsystem death file. We will compare the newly proposed methods with existing methods using both the VA data and simulated data.

Public Health Relevance Statement:
The rising demands and health care costs make it urgent to develop new statistical methods to accurately predict high-costs VA patients and identify important risk factors associated with high costs. Our overall goal is to develop a High Costs Prediction (HCP) system that employs novel high- dimensional semiparametric statistical methods to prospectively predict high-costs patients for the next year using data from the current and previous year. We will also identify disease areas and other risk factors that contribute significantly to high health care costs. The project will help improve VA’s use of predictive analytics to more efficiently allocate resources and contribute to building a data- driven decision support system.

NIH website: https://reporter.nih.gov/project-details/10186525

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Media (Webinars, podcasts, etc.)

Compendium on Use of Complementary and Integrative Health Therapies and Chiropractic Care at the VA

1/21/2021

Description: Abstract: As a part of VA’s Whole Health System transformation, there has been a large-scale expansion of complementary and integrative health (CIH) therapies as part of standard medical care. The Data Nexus project of the VA Complementary and Integrative Health Evaluation Center (CIHEC) QUERI Partnered Evaluation Center was funded to conduct an analysis in partnership with the VA Office of Patient Centered Care & Cultural Transformation in 2020 of data from VA electronic medical records and community care claims to examine Veterans’ use of nine CIH therapies and chiropractic care from FY17-FY19. This Compendium on Use of Complementary and Integrative Health Therapies and Chiropractic Care at the VA: Part I reports on the results of those analyses, showing Veterans’ use of these therapies over the past three years and the demographic and health characteristics of those Veterans. Target Audience: VA researchers interested in conducting CIH therapy/Whole Health research and clinicians delivering CIH/Whole Health therapies.

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