Background/Rationale: The VA Greater Los Angeles COIN, the VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), draws from our 20 year focus on healthcare provider behavior and the resulting theoretical and empirical advances we have made to build new pathways to high- impact research. Our mission is to develop and test innovative care models and health systems interventions which markedly improve the effectiveness and value of VA healthcare. Objectives:
We aim to advance scientific methods for accelerating multi-level adoption, implementation, spread and sustainability of effective health care. Our strategic goals are: #1 (Focused Area): To improve the delivery and performance of primary care practice in the context of VA's patient-centered medical home (PACT) by developing and studying PACT innovations; #2 (Focused Area): To accelerate implementation of and access to high-quality comprehensive care for women Veterans through the Women's Health CREATE and related research; #3 (Focused Area): To conduct research that systematically improves the care of vulnerable populations, including care for serious mental illness, care for older adults, and palliative care; #4: To use research to advance evidence-based practice and policy in emerging areas (e.g., health services genomics, infectious diseases, emergency management, and integrative medicine); #5: To recruit, train and mentor researchers in the COIN's recognized areas of expertise, including cross- cutting methods (e.g., health systems intervention, implementation science, partner-oriented research); and, #6: To promote research collaboration across medical centers and VISNs in the development, conduct, implementation and spread of partnered, systems-oriented research. Methods: This Center is organized to maximize the impacts of our research on health care and education. Aligned with the Veterans Health Administration (VHA) strategic framework, we use research-clinical partnerships to provide Veterans with personalized, proactive and patient-driven health care that is evidence- based and continuously improving. We have a strong continuing commitment to training the next generation of VA health services researchers while providing nationally recognized expertise in advanced methods in our areas of expertise, as well as multi-site and multi-VISN research collaboration in support of partnered, implementation-oriented research. In our research, we leverage our deep understanding of the factors underlying provider and organizational behavior. Our research activities begin, when data are lacking, by characterizing patient, provider and organizational determinants of variations in care. Based on these results, we develop and evaluate new care models and innovations to improve care. When opportunities arise, we move to implementation research that evaluates strategies for implementation and spread of evidence-based practices to improve the impact and value of VA care.
National reform is changing the landscape of U.S. health care, while creating an unprecedented demand for evidence to support transformation into more effective and efficient systems of care. The VHA's position as a quality leader, competing in this new market for high-value care, is by no means secure, requiring an infusion of innovative ideas and approaches that establish a new paradigm of high-quality, patient-centered care that radically changes what Veterans experience as routine care. We view our Center as an integral part of the national VA research/clinical partnership, leveraging investments of HSR&D and our clinical, research and policy partners by developing and applying new knowledge to improve Veterans' care. Our responsibility within the partnership is to anticipate new challenges in care for Veterans, to propose and test relevant interventions, to disseminate methodologically robust approaches for achieving high quality performance, and to implement effective approaches in practice.
