The Center for Healthcare Organization and Implementation Research (CHOIR) is an HSR&D Center of Innovation (COIN) dedicated to improving Veterans' health outcomes by developing, studying, and applying evidence-based practices that will be widely implemented and sustained. CHOIR builds on two long-standing and highly successful HSR&D Centers of Excellence based at the Bedford VA Hospital and the VA Boston Healthcare System. In partnership with key VA stakeholders, including VA New England Healthcare System (VISN 1), the Office of Patient Care Services-Mental Health Services, the National Center on Homelessness Among Veterans, Pharmacy Benefits Management Service, and the Office of Public Health, we propose to focus our research on three critical areas: 1. Enhancing Recovery-Oriented Care for Behaviorally Vulnerable Populations. We intend to enhance the transformation of VA to a recovery-oriented healthcare system, and to improve recovery-oriented outcomes for behaviorally vulnerable Veterans. Our strategy involves investigators working to address a knowledge gap in operational definitions, build a scientific basis for implementing high-priority program rollouts, and adapt existing interventional evidence for use with this behaviorally vulnerable population. 2. Medication Optimization Program. Providing optimal medication treatment to Veteran patients encompasses many VA priorities regarding safer, more effective, more patient-centered, and more cost-efficient prescriptive practices. Existing tools allow some ability to ensure medication optimization for patients. However, important gaps remain. We will address these gaps by examining how and why medication therapy is prescribed, estimating beneficial and harmful outcomes of medication therapy, and developing and evaluating implementation strategies to promote higher-quality use of medication therapies. 3. Public Health Communication (PHC). Traditional and emerging media and messaging may be used to deliver and exchange information about VA system-wide public health priorities to Veterans both inside and outside of VA care. These priorities include large-scale adverse events, deployment environmental health risks, and health behavior change. An important gap remains regarding best practices in communicating information that maximizes Veterans' trust in VA care, minimizes perceptions of potential harm, and encourages Veterans' self-management. We will work to provide an evidence base and tools for communicating about a range of public health issues, utilizing optimal communication channels such as social media and mobile health platforms, to create effective messaging that empowers Veterans to prioritize their health. CHOIR research will be performed in other areas including organization science, implementation science, long-term care, patient safety, health services genomics and patient-centered communication. We are also fully committed to training a new generation of health services researchers, emphasizing capabilities in developing and conducting research with operational partners, and collaborating with other investigators throughout VA. Through these activities, we intend to move science into practice and to facilitate organizational adaptation to sustain science-based gains for Veterans throughout all levels of the VA healthcare system.
Healthcare in the Department of Veterans Affairs (VA) has undergone a fundamental shift in the last decade, with a goal of transparent, comprehensive, coordinated, patient- and family-centered care across primary, specialty, extended and mental health care. VA health services research is also transforming to now involve a wide range of stakeholders from the outset-Veterans, their families, providers, organizational teams, and operational partners. The goals of such research are to identify and conduct meaningful studies that will generate new knowledge, leading to the development of sustainable interventions to improve Veterans' lives. Through our proposed Center for Healthcare Organization and Implementation Research (CHOIR), we will conduct such research that will have a measurable impact in three distinct areas: Enhancing Recovery- Oriented Care for Behaviorally Vulnerable Populations; Medication Optimization; and Public Health Communication.
