Center for Care Delivery and Outcomes Research
Conducting innovative research which contributes to and benefits Veterans lives.
Determining the Ineffectiveness of Long-Term Opioid therapy for Chronic Pain. Funded by VA HSR&D, the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial compared the benefits and harms of opioid therapy vs. non-opioid pain medication therapy among VA primary care patients with moderate to severe chronic back or hip/knee osteoarthritis pain. This trial, the first to report long-term pain, function, and quality of life outcomes of opioid therapy, found no advantage of opioids compared to non-opioid medications. The main outcomes were published in JAMA, which has been featured on 130+ national and international media outlets. This landmark study is the first trial of long-term opioid therapy and provides evidence in support of recent CDC recommendations that non-opioid therapies are preferred over opioids for chronic pain. https://jamanetwork.com/journals/jama/fullarticle/2673971?format=txt
Implementing Opioid Agonist Treatment (OAT) Toolkit. As part of a previous Substance Use Disorder (SUD) QUERI implementation project, Dr. Hagedorn was instrumental in producing a quality improvement toolkit for VHA opioid agonist treatment programs. Given the current opioid epidemic, there was renewed interest in this toolkit from the National Mental Health Program Director for SUDs, Dr. Drexler. Dr. Drexler invited Dr. Hagedorn to present the toolkit on her monthly national opioid agonist treatment program call and uploaded selected tools to the national SUD resources SharePoint. Dr. Hagedorn was also contacted by the OMHSP Psychotropic Drug Safety Initiative to assist with their FY 2018 campaign to implement pharmacologic treatments for opioid and alcohol use disorders.
Discovering Evidence-Based Treatments for PTSD. Polusny and colleagues conducted a comparative effectiveness trial of mindfulness-based stress reduction (MBSR) therapy versus present-centered group therapy for PTSD among Veterans published in JAMA. This study demonstrated that Veterans have clinically significant improvement in PTSD symptom severity with MBSR and that improvements are sustained 2 months after treatment. Importantly, less than a quarter of Veterans dropped out from MBSR. This is a critical finding because dropout rates for existing evidence-based psychotherapies for PTSD are as high as 44%. Dr. Polusny was invited to brief OMHSP and NCPTSD leadership on these findings, which suggest MBSR shows promise as an effective, tolerable treatment for Veterans with PTSD. Dr. Polusny was also invited to participate in HSR&D’s Complementary & Integrative Health (CIH) Work Group, focused on developing VA’s CIH research agenda and capacity building, which meets VHA's Blueprint for Excellence, Strategy 7J, "Enhance VA Care with Research on Complementary and Alternative Medicine." https://jamanetwork.com/journals/jama/fullarticle/2422542
Developing Tracking Tools for Regional and National VHA Lung Cancer Screening Implementation. The National Lung Cancer Screening Trial demonstrated that annual low-dose computed tomography screening reduced lung-cancer mortality in high-risk smokers. In response, the NCP conducted a demonstration project with the MVAHCS serving as 1 of the 8 participating sites. CCDOR investigators (Fu and Melzer) contributed to MVAHCS’s participation in the demonstration project and evaluated the implementation of lung cancer screening by conducting a survey of more than 1,000 Veterans eligible for lung cancer screening.43 Subsequently, the MVAHCS and CCDOR investigators developed a tracking tool for incidentally detected pulmonary nodules, lung cancer screening, and post-cancer resection follow-up. The tracking tool is integrated with CPRS and helps ensure that the best care is delivered for these complex and longitudinal care processes. At the request of Dr. Kim, Chief Consultant for NCP, the development of this tracking tool was expedited to aid in national lung cancer screening implementation efforts. To date, the nodule tracking portion of the tool has been implemented throughout VISN 23, and 8 sites nationally are in the process of implementing the database for tracking incidental pulmonary nodules and lung cancer screening. Using operational funds provided by NCP, the MVAHCS and CCDOR have been providing technical and implementation support to new sites across the country to improve the efficiency of adoption as part of the VA National Lung Cancer Screening Toolkit. This work has been recognized with an ICare award from NCP and by the VISN-23 Network Star award for innovative clinical processes.