Relevance to VA's Mission: The Center to Improve Veterans' Involvement in Care (CIVIC) will directly support the first of VA's Strategic Goals for 2013 - 2018, to Provide Veterans personalized, proactive, patient- driven healthcare. Specific objectives of this Strategic Goal include: 1) partnering with Veterans to create personal, proactive strategies to improve health and well-being, 2) improving communications among stakeholders, 3) optimizing Veterans' access to healthcare information so that they can make informed health decisions and implement personal health plans, 4) ensuring equity, and 5) fostering innovation. Background: VA care providers often utilize a biomedical model of care, which places patients as passive recipients of treatment. This approach has been shown to be inferior for treating chronic medical conditions compared to more participatory models. Despite the recognized importance of optimizing participation of Veterans and their supports in healthcare, relatively little emphasis has been placed on systematically identifying Veterans' personal goals for health and for seeking care from the VA, Veterans' needs and preferences regarding self-management, and Veterans' views on how to optimally collaborate with providers. We know little about the effectiveness of emerging patient-centered care processes and approaches. Goals: CIVIC's mission is to conduct research that empowers Veterans to improve their health by enhancing active participation of Veterans and their supports in healthcare. We will, in particular, focus on patients who have psychological challenges or other vulnerabilities that impact self-management and recovery. CIVIC has two primary, integrated focused areas that build on investigators' expertise: 1) Veteran-Centric Mental Health Care; and 2) Innovative Strategies to Enhance Veteran-Clinician Collaboration. Across these two areas, we will gain knowledge of the goals, needs, and preferences for care among Veterans and their supports, and Veterans' views on facilitators and barriers to health improvement and collaboration with clinicians. We will apply this knowledge to developing and testing interventions and implementation strategies that promote active involvement of Veterans in decision-making, treatment, and recovery. We also seek to identify methods to actively incorporate the voice of Veterans into the health services research process. Additional goals include synthesizing evidence to guide development of effective care approaches of priority to Veterans, enhancing capacity in implementation science and mixed-methods research, supporting investigator career development, and building and strengthening collaborations with operations and research partners. Methods: In Focused area 1, we will assess goals, needs, and preferences for mental health care among Veterans and their supports, and barriers and facilitators to active participation in care. In Focused area 2, we will develop innovative approaches to facilitate productive Veteran-care team collaboration. In both areas, we will utilize mixed-methods approaches to gather and synthesize information from stakeholders, and incorporate participatory research approaches; Veterans will participate on research teams and advise CIVIC investigators on implications of findings and implementation strategies. CIVIC's strategic plan and approaches result from growing collaborations with several partners: VA Office of Patient Centered Care and Cultural Transformation; Office of Mental Health-Operations; Mental Health Services-Suicide Prevention; VISN 20, and Mental Health QUERI. In a partnered, impact-oriented set of projects which seek to enhance Veterans' collaboration in VA mental health care, we will 1) examine benefits and harms of Veterans accessing mental health progress notes through MyHealtheVet, and test if a clinician training program can optimize the benefits, 2) identify facilitators and barriers to outpatient treatment engagement following psychiatric admission among Veterans of Iraq and Afghanistan at risk for suicide; and 2) test the impact of a novel application of collaborative care to care coordination activities occurring between specialty mental health and patient aligned care teams (PACTs).

Public Health Relevance

The first goal in VHA's Strategic plan for 2013-2018 is to provide personalized, proactive, patient-driven healthcare. The Center to Improve Veterans' Involvement in Care (CIVIC) will be a coordinated effort of experienced HSR&D investigators and staff, VA operational partners, and Veterans who are committed to conducting research and service activities in support of VA's efforts to promote and deliver patient-centered care, and to increase active participation of Veterans and their supports in care, recovery, and health. CIVIC activities have the potential to increase the quality, relevance, and impact of VA research; increase the efficiency of healthcare operations; and improve effectiveness and satisfaction with patient-provider interactions. Through quantitative and qualitative research, and including Veterans as active members in the research process, CIVIC will use scientific evidence to help the VA move away from a disease-centered approach to care, to an approach that is more personalized, responsive and culturally sensitive.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (I50)
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Special Emphasis Panel (HCN1)
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Portland VA Medical Center
United States
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Wyse, Jessica J (2018) Older Former Prisoners' Pathways to Sobriety. Alcohol Treat Q 36:32-53
Dobscha, Steven K; Lovejoy, Travis I; Morasco, Benjamin J et al. (2016) Predictors of Improvements in Pain Intensity in a National Cohort of Older Veterans With Chronic Pain. J Pain 17:824-35