This Center of Innovation (COIN) proposal seeks to facilitate the growth of partnered health services research in Long-Term Services and Supports (LTSS) for Vulnerable Veterans. In the next decade, over 700,000 Veterans will be over age 85, the group with the greatest need for LTSS. About 1.2 million Veterans (over one-fifth of all VA users) will be dependent in at least one activity of daily living (ADL), suggesting enormous impending need for LTSS over the next decade. Younger Veterans, including disabled OEF/OIF Veterans, increasingly use LTSS. Improving the access, quality and value of LTSS through a transformation focused on Veteran-centered care is a high-priority area for VHA's Geriatrics and Extended Care service (GEC). This HSR&D COIN will build on the infrastructure developed by the GEC Data & Analysis Center (GEC DAC), HSR&D Research Enhancement Award Program (REAP), our CREATE Transforming the Spectrum of Long-Term Care for America's Veterans, and the proposed Southern New England Geriatric Research, Education and Care Center (GRECC). The COIN on Long-Term Services and Supports for Vulnerable Veterans (LTSS COIN) will provide infrastructure to advance scientific inquiry and research on LTSS programs and policies primarily within the VA, and as they relate to all Veterans. It goals and objectives are as follows 1. The primary goal is to improve access, quality and value of LTSS for vulnerable Veteran populations. Specific objectives in support of the primary goal are: (1) To support partnered and cross-medical center research to improve LTSS programming for vulnerable Veterans across the U.S. To achieve this objective the LTSS COIN will provide infrastructure support to our CREATE and other projects in LTSS. (2) To develop GEC DAC as a resource for research in LTSS. For this objective we will: establish a research arm of GEC DAC; partner with GEC and other VA LTSS researchers to evaluate implementation of new LTSS programs and policies; and incorporate research data into the GEC DAC data architecture that will be available to VA investigators. (3) To facilitate partnered and cross-medical center research to address local and regional LTSS issues in operations and clinical care. This objective will be served by supporting research activities of the proposed Southern New England GRECC in collaboration with West Haven VAMC; and by supporting pilot projects to evaluate local and regional geriatric and LTSS programming. The secondary goal is to advance HSR&D research at the Providence VAMC in areas and populations that are relevant to, but outside of the focused area of LTSS, including Veteran homelessness, service use by Veteran amputees, and Veterans' service use across multiple systems. A tertiary goal is to support mentoring and career development of clinician- and non-clinician-investigators interested in LTSS locally, regionally and across VHA. Finally, a quaternary goal is to promote research collaborations in LTSS across medical center and VISNs by building a national community of VA LTSS researchers; facilitating HSR&D research partnered with GEC; providing expertise and data to researchers in other areas who are interested in LTSS issues; and creating research partnerships between VISN1, its medical centers and the LTSS COIN. Center Director Dr. Peter Friedmann has a proven track record in scientific administration and mentorship, having grown our HSR&D program from its inception as a TREP in 2004. Associate Director Dr. Orna Intrator, Founding Director of GEC DAC, will serve as Scientific Director. The LTSS COIN will leverage administrative and research infrastructure at Providence VAMC, a strong partnership with GEC and VA LTSS collaborators, and long-standing collaborations with long-term care research and training programs at Brown University, to conduct high-quality health services research in LTSS that will benefit both Veteran and civilian populations.
In the next decade, over 700,000 Veterans will be over age 85, the group with the greatest need for Long- Term Services and Supports (LTSS) and over one-fifth of all VA users will be dependent in at least one activity of daily living (ADL), suggesting enormous impending need for LTSS. OEF/OIF Veterans increasingly use LTSS. This proposed Center of Innovation (COIN) will build on our strong partnership with VA's Geriatric and Extended Care (GEC); infrastructure developed by the GEC Data Analysis Center (GEC DAC) and HSR&D Research Enhancement Award Program (REAP); collaborations with VA LTSS researchers nationwide established through our recently-funded Long-Term Care CREATE; and long-standing collaborations with long- term care research and training programs at Brown University to facilitate partnered health services research that improves access, quality and value of LTSS for vulnerable Veterans. The goal is to conduct high-quality, partnered health services research in LTSS that will benefit both Veteran and civilian populations.
