The mission of our COIN is to advance scientific discovery, incubate novel interventions, promote research collaboration and engage operational partners. We pursue this mission by creating an environment within VA where informatics is tightly integrated with health services research and other disciplines. We have established success in building VA informatics research capacity, developing novel tools to derive meaning from data and enhancing our understanding of the distributed information space. Through these successes, we are leading research to transform measurement of quality, understanding of sociotechnical complexity, surveillance of adverse events and management of population health. Our plan is to apply methodological innovations in informatics, epidemiology and cognitive science to address high-priority health problems for Veterans. Our underlying conceptual framework posits that innovation and implementation are two synergistic components of effective system change. Needs and gaps in healthcare delivery arise and are addressed through active engagement with partners through the entire span of the research process, ranging from observation, brainstorming, implementation, evaluation and dissemination. As a result of our close relationship with clinical processes, our research enterprise produces innovative tools that are effective and practical for Veterans, clinicians and managers. Central to our research portfolio is the quest to enhance effective use of VA data. Our COIN draws heavily from our experience with the HSR&D informatics initiatives, Veterans Informatics and Computing Infrastructure (VINCI) and Consortium for Healthcare Informatics Research (CHIR). Indeed, the establishment of a secure national data and computational environment is a notable achievement of partnership-based research. Our COIN will build on this accomplishment to move to new levels of integration between research and operations that will both benefit the VA health services research community and the quality of care delivered to Veterans. Our focused areas of research reflect the clinical emphases of our investigators and partners, coupled with our methodological strengths in information visualization, natural language processing, decision- support system design, mathematical models and pharmacoepidemiology. The first thematic focus, the topic associated with our CREATE, is cognitive support for therapeutic decision-making. A second focus is the set of problems related to healthcare-associated infection, antibiotic resistance and inappropriate use of antibiotics. A third focus is post-deployment health in vulnerable Veterans, including problems of homelessness and limb loss. Finally, an emerging area of research for our COIN is rural health. For each of these areas, we have exceptionally strong partnerships providing an open path for implementation and dissemination. Our mentoring and career development program will provide structure and sufficient time for us to help develop the next generation of health services researchers.
Our Coin will transform measurement of quality, evaluation of outcomes and management of Veterans' health. The first of four research areas is therapeutic decision-making leading to development and implementation of decision support tools, leveraging informatics and developing methods to extract meaning from VA data. Next, addressing hospital acquired infection and antimicrobial resistance, we will develop and implement new strategies to reduce and infections. Third, in our research on post-deployment health in vulnerable veterans, we will target problems of homelessness, community reintegration, limb loss and war related syndromes. Finally we will test ways to improve rural health through coordination of care encompassing VA and community contract providers. Operational partners will be involved in the research and will implement the findings. In conducting this research we will mentor the next generation of health services researchers.
