The Department of Veterans Affairs within the Office of R&D funds the “Collaborative Research to Enhance and Advance Transformation and Excellence” (CREATE) initiative. The objective for CREATE is to encourage research on high priority issues affecting the healthcare of veterans, perform critical research on PTSD, develop teams to deliver more efficient care, manage pain more effectively, work with veterans with substance use disorders, develop teamwork to specifically help the health needs of women veterans, and study how to best treat veterans with mental disorders.
The “Evidence-Based Therapies for PTSD” project includes developing an innovative web-based tool to deliver an online version of “Community Reinforcement and Family Training” (VA-CRAFT) to enable veterans and their caregivers to become more involved in the veteran’s care for PTSD.
The VA has adopted a patient-centered care model called the “Patient Aligned Care Team” (PACT). The goal is to develop and implement point-of-care interventions into PACT. Several point-of-care projects are ongoing to improve care coordination, automate point-of-care surveillance for outpatient delays in diagnosing cancer, and automate heart failure data for patients at the point-of-care.
One of the specific goals is to leverage health information technology to provide more effective pain care for veterans. The projects in this program will help to better diagnose the population of veterans with musculoskeletal issues. This will enable the veterans to deal with pain issues for their long term care and also provide for better screening for pain.
One of the projects in pain care research includes studying, testing, and using a telehealth-based self management training system to promote improved care for veterans receiving chronic opioid therapy. This project incorporates self management support with delivery system design.
Another area being studied includes looking at veterans and their substance use disorders. One objective is to administer a multi-site randomized clinical trial of a self administered web-based brief alcohol intervention to reduce alcohol consumption in veterans with hepatitis C virus.
Another planned clinical trial will use telemonitoring to improve substance use disorder treatment after detoxification. This multi-site randomized clinical trial will look at telephonic monitoring and support to improve care transitions and outcomes among veterans.
Researchers are studying specific problems related to women veterans in terms of implementing VA women’s Health Patient Aligned Care Teams (WH-PACT).This study will test evidence-based quality improvement approaches to adapting PACT features to women veterans and their needs.
The project directed towards women will look at the care for women veterans at CBOCs where primary care providers often have limited access to specialists in women’s health issues. This project will be the first to examine the effectiveness of using technology to provide virtual education and consultations with women’s health specialists.
Another VA project to improve outcomes in veterans experiencing suicidal tendencies along with schizophrenia is to bring together a team with expertise in schizophrenia, telehealth interventions, and health services implementation research.
The VA is studying veterans with schizophrenia in combination with a panel of academic and consumer leaders to see if telehealth can be effective. The panel members have expertise in attempted suicides and recovery, substance use disorders, and are knowledgeable on the early warning signs of relapse.
The plan is to test the telehealth system in ten veterans for three months. The veterans will answer questions and their comments will be audio taped and analyzed. If a veteran is admitted for suicidal behavior, then the individual will receive the Health Buddy unit upon discharge.
The veterans will answer questions each day, and nurses from the VA will read the responses every 4 hours 24/7. If there are issues or concerns, research clinicians will be contacted. At that point, a decision will be made as to whether to provide further treatment. At the end of the three month intervention, all of the participants will be asked questions about their impressions of the treatment and these responses will be analyzed.
For more information on CREATE, go to www.hsrd.research.va.gov/create.