Research Projects

VA Funded Research Projects 2006

Bernstein, An Evaluation of a Coordinated Proactive Diabetes Eye Care Program: Completed The objective of this translational research project was to develop and evaluate a targeted system-level intervention, the Progressive Reminder and Scheduling System (PRSS), for improving the optimal timing of photocoagulation in VA diabetic patients. The PRSS requires both clinical data from the VA electronic medical record and data from the automated scheduling system. However, since these are two distinct systems, it was impossible to develop a fully automated proactive scheduling system. The study did provide important information for understanding patients’ risk of developing diabetic eye disease, gaps in follow-up of patients with identified disease, and specific considerations for additional implementation work in the area of proactive scheduling. .

Hinshaw, Acute Post-Operative Pain management Using Massage as Adjuvant Therapy: Completed This RCT, which was completed this past year, examined the use of massage therapy in postoperative pain management for patients who have undergone major thoracic or abdominal surgery. Compared with a control group, patients in the massage group experienced significantly less short term pain intensity, pain unpleasantness, and anxiety. There were no differences in rate of decrease in long term anxiety, length of stay, opiate use, and post-operative complications between the intervention and control group. Massage appears to be an effective and safe adjuvant therapy for the relief of acute post-operative pain in patients undergoing major abdominal and thoracic operations.

Hopp, Evaluation of a Cardiac Nurse Practitioner Palliative Care Program:  New
The objective of this RCT is to evaluate the impact of a cardiac nurse practitioner palliative care program for VA patients with advanced symptoms of Chronic Heart Failure (CHF).  As of 8/17/06: 45 patients have been enrolled (21 in Ann Arbor, 24 in Detroit); 2 patients have died, and 1 After-Death Family Interview has been completed.  10 six-month follow-up surveys have been mailed.  Interventions are needed that encourage the use of palliative care services earlier in the disease process, to provide maximum benefits from palliative-focused psychological support and symptom relief.  This study is intended to direct appropriate end-of-life care to CHF patients, who have not been a traditional focus of palliative care services.

Kerr and Hofer, Addressing Barriers to Translation for Treatment of Hypertension:  Ongoing The ABATE project (Addressing Barriers to Translation for Treatment of Hypertension) is examining clinician, organizational and patient factors that contribute to clinical inertia in the treatment of hypertension.  The project has enrolled 1175 diabetic patients of 92 primary care providers in nine Midwest VA facilities.  All 92 providers and 1068 patients completed baseline surveys.  Additionally, providers completed a brief post-visit survey for the majority of these patients.  Findings from the patient surveys showed that diabetic patients' willingness to accept new blood pressure (BP) medications appears to be primarily related to (a) their concern about medication side effects, (b) their difficulty managing their current medication regime, and (c) how much they perceive their health as dependent on BP medications. By contrast, measures of BP prioritization and self-efficacy showed little predictive power.  These results suggest that improving patients' ability to manage their current medications and their side-effects may increase patients' willingness to accept new treatment recommendations and potentially to improve downstream outcomes such as BP control.  Other preliminary findings identify reasons for lack of BP medication intensification by providers.  The next phase of data collection consists of obtaining medical record and secondary dataset data. 

Krein and Saint, Translating Infection Prevention Evidence to Enhance Patient Safety:  Ongoing The TRIP study (Translating Infection Prevention Evidence to Enhance Patient Safety) is working on identifying factors that facilitate and impede the adoption and implementation of evidence-based infection prevention practices in VA medical centers.  Results from a written survey of 119 VA Medical Centers and 678 non-VA hospitals have shown the following factors to be associated with adoption:  number of ICU beds, infection control practitioner certification, residency training, and hospital safety culture.  In addition, 38 phone interviews have been conducted at 14 sites, and the next step is to conduct on-site interviews at 3 to 6 sites.

Lowery, Evaluation of a Nurse Case Management Model for Chronic Heart Failure:  Ongoing This study is evaluating the impact of a nurse practitioner case management model compared with usual care in patients with congestive heart failure (CHF) using a quasi-experimental design.  A total of 970 patients were enrolled, including 459 in the intervention group (VAMCs with nurse case management in the northern part of VISN 11) and 511 in the control group (VAMCs without nurse case management in the southern part of VISN 11).  The last of the two-year follow-up surveys was received in May 2006.  Data analysis is underway.

Piette and Heisler, Improving Insulin Therapy with Enhanced Care Management and Peer Support:  New This new study is a randomized trial that will evaluate an intervention using a low-cost interactive voice response (IVR) exchange system to promote peer-to-peer communication among diabetes patients initiating or increasing insulin therapy under medical guidance.  This low-cost peer support system may improve VA diabetes patients’ self-care and treatment outcomes.  Because the intervention addresses barriers to effective disease management that are common among chronically-ill patients, the study may have broader impact on management practices for patients with other illnesses, such as depression, chronic pain, or heart failure.

Valenstein, Improving Antipsychotic Adherence Among Patients with Schizophrenia:  Completed This RCT was completed this past year, with some significant findings.  The purpose of the study was to implement and evaluate a practical, pharmacy-based intervention designed to improve antipsychotic adherence among patients with serious mental illness.  In logistic regression analyses, patients enrolled in the intervention group had an OR of 4.5 for meeting criteria for “good adherence” (medication possession ratios > 0.8) compared to patients in the control group.  This practical, low complexity intervention appears to be effective. 

Valenstein, Suicide Among Veterans: Using the VA Depression Registry to Inform Care:  New The objective of this study, which began in the latter part of FY ’05, is to inform VA policy makers and clinicians about the current suicide rates within depressed VA patients, risk factors for suicide that are germaneto thispopulation, and the impact of treatment practices on risks.  Analyses conducted this past year show that depressed VA patients have high rates of suicide.  They have frequent antidepressant starts and dose changes during their treatment and they are at greater risk for suicide following these events.  Extending the FDA specified criterion for close monitoring to this vulnerable population would require substantial increases in visits and health system expenditures.  Research is urgently needed to assess the effectiveness of increased monitoring in preventing suicide.  Data management and analysis of VA, Medicare, and National Death Index data continue.