Mission, Vision, and Research Priorities

The VA HSR&D Center on Implementing Evidence-Based Practice (CIEBP) was designated a national VA HSR&D Center of Excellence in June 2004 through an effective partnership between the Roudebush VAMC in Indianapolis, Veterans Integrated Service Network (VISN) 11, the Regenstrief Institute, Inc., IU School of Medicine and our academic affiliates. The mission of the Center is to advance the science of transforming the health care system, both within and outside the VA health care system.  Our vision is to become the leading national research resource for learning about health systems transformation.  Our strategy is to partner with managers, clinicians, patients and other researchers in interdisciplinary teams to innovate, foster system redesign and drive broad scale adoption of changes to improve care delivery.

Within this overall mission and vision, our research priorities are to: 1) Apply models of care that are safe, effective, patient- and relationship-centered, timely, efficient, and equitable; 2) Identify and share effective approaches for organizational change and rapid cycle process improvement; 3) Implement and disseminate systems interventions, considering human, social and organizational factors, to transform care delivery; 4) Implement health information technology into work flow to improve care; and 5) Redesign health care delivery systems.

In pursuit of our mission, we have the following goals:  1) Research.  Conduct health services and implementation research to transform health care delivery; 2) Disseminate. Identify, evaluate, communicate and disseminate best clinical and management practices for systems redesign to further VHA’s transformation; and 3) Build. Develop capacity (human resources, financial resources, and work processes) and achieve excellence in loyalty, worklife and stability for the Center to accelerate change in healthcare organizations and systems.

Collaborating Institutions

• Indiana University School of Medicine, Department of Medicine
• Regenstrief Institute, Inc.
• Regenstrief Center for Healthcare Engineering
• Indiana University-Purdue University-Indianapolis (IUPUI)

Overview of Center Activities

"To bring to the practice of medicine the most modern scientific advances from engineering, business, and the social sciences, and to foster the rapid dissemination into medical practice of the new knowledge created by research."            -- Sam Regenstrief, April 7, 1967

The Indianapolis HSR&D Center on Implementing Evidence-Based Practice is a local and national resource for learning about implementation of health information technology and process improvement methods. Our Center helps leverage VA's investment in healthcare quality improvement, information technology, and care reengineering to ensure high quality, safe and effective routine medical care. In addition, the Center provides postdoctoral training in health services research, medical informatics and patient safety. Our mission is to advance the science of implementing evidence-based practices, both within and outside the VA health care system.

Given the multiple demands driving the increasing complexity and costs of medical care, healthcare systems face increasing pressures to use their own data effectively to drive change and improvement of healthcare processes and operations. The research at our Center shares the common goal of fostering system change and improving care delivery, both within and outside the VA. Within this overall goal, our research priorities are to:

• Apply models of care that are patient-centered, safe, high quality and reliable;
• Identify and share effective approaches for organizational change and rapid cycle process improvement;
• Implement and disseminate systems interventions, considering human, social and organizational factors, to improve care delivery.

These inter-related research priorities capitalize on our recognized strengths in assessing contextual, provider and patient factors important in implementing health care systems change and in developing and testing innovative systems and patient-centered strategies and care models across settings (hospital, clinic and community).

Implementation research is by its nature interdisciplinary, optimally considering the perspectives of patients, providers, managers and multiple scientific and management disciplines needed to effectively change healthcare. Partnering with managers, clinicians, patients and other researchers is an important key to success in implementing system changes to improve healthcare practice. Center investigators work in interdisciplinary research working groups, focused on conducting implementation and systems improvement research. The Center is composed of 11 core and multiple affiliate investigators; 5 statistical and data management staff; 4 post-doctoral fellows, and 10 administrative and support staff.

Our core and affiliate investigators currently participate in 34 research projects from a variety of federal and non-federal sources. Current year funding for research projects totaled $1.7 million; VA specific funding specific funding for the year totaled $1.4 million, for an overall annual funding of $4.4 million. These projects cover a wide variety of implementation related health services research projects. We also have an internal pilot grant program, which funds a series of Locally-Initiated Projects. Two recently funded IIRs (Drs. Bair and Damush) address improvement of chronic pain and stroke care issues for veterans. Additionally, teams of investigators are working closely with the VA Office of Quality & Performance in leading two national Quality Improvement Technical Assistance Projects (QI-TAP) to improve consult completion and missed opportunities in VA. In the past year, our investigators published 53 peer-reviewed journal articles and participated in 24 oral and poster presentations at national research meetings.

Center investigators have received national media attention for their research in multiple areas relevant to the Center’s mission. A number of our Center papers were highly cited, received considerable media attention, or were among the top 20 articles published in J. Gen. Intern. Med. in 2006. Key impacts include research in the areas of 1) information technology to improve care at the bedside; 2) effective hospital patient "handoffs"; 3) effective processes for controlling antibiotic prescribing and resistance; 4) the impact of computers on patient-provider communication; and 5) relationship-centered care.

Center faculty actively partner with VA management and operations in conducting systems improvement implementation, research and development and dissemination. Dr. Eri Kuno led a Center team in a VA-funded QI-TAP in a systems approach to reduce missed appointments. Dr. Peter Woodbridge led a second Center team in a VA funded QI-TAP in improving consultation delays. Drs. Damush and Williams from Stroke QUERI helped plan and lead an innovative stroke risk patient education program, incorporating cartoons drawn by the creator of the "Beetle Bailey" cartoon series, drawing attention from multiple veterans in VISNs 8 and 11. The Center has also received increasing attention from throughout VA for our work in improving operations and efficiency by applying systems engineering and health services research methods to improve care in VA.

The Center is well integrated in providing service to VA HSR&D, VHA/ORD in general, and the nation. Center investigators contribute their expertise and provide input into clinical practice and management issues, policy development, and review of project proposals and research career awards. Investigators also continue to develop successful proposals that have regional and national significance and impact. Center investigators have also played prominent roles in national VA clinical work groups, councils, and committees, including those focused on clinical practice guidelines, clinical reminders, pain management, quality improvement, and deployment health. Center faculty serve on the VA-cosponsored journal Implementation Science Editorial Board, HSR&D’s Scientific Review and Evaluation Board, and lead the clinical and implementation arms of the Stroke QUERI. Within VHA, Center faculty serve on VA’s IMPROVE and Clinical Decision Support Committees, advise VA on the use of evidence-based recovery approaches for the severely mentally ill and homeless veterans nationally, and in the improvement of pain management task forces and committees. National services include service to Technical Expert Panel on Benchmarking, Statistical Methods for Quality Initiatives, Center for Medicare and Medicaid Services; Health Services Research Study Section and Research Dissemination, AHRQ; and leading American Heart Association (AHA)’s Workgroup on Metrics for Measuring Quality of Care in Stroke Centers.

During the past year, our Center carefully reviewed and refined our organizational mission, vision and strategic plan. We have also worked closely with our faculty and staff to develop more effective internal processes, expand our Center’s human and technological infrastructure, and improve the quality, depth, breadth and impact of our research.

The Center is engaging VA in implementation research building upon our urban location in Indianapolis and further establishing partnerships between our center, VA and local community, as well as service and cultural organizations. Our quality improvement and research partnerships with Indianapolis healthcare system leaders include the Indianapolis Coalition for Patient Safety, Indiana State Patient Safety Center, Indianapolis Network for Patient Care, and other regional, state and national organizations and collaborations.

The Center was selected as a partner in one of Agency for Healthcare Research & Quality (AHRQ)’s Accelerating Change and Transformation in Organizations & Networks (ACTION) collaboratives. This positions it to respond to task orders for implementation research projects involving the VA, in partnership with the six health systems in Indianapolis. Through this collaborative, Center investigators received funding from AHRQ to implement and disseminate evidence-based practices, pioneered at the Pittsburgh VAMC, to markedly reduce MRSA infections in hospitalized patients.

Core research development and training opportunities in the Center include our leading the IU NIH K30 Clinical Research Curriculum Award (Clinician Investigator Training Enhancement) program, and four VA postdoctoral fellowships in health services research (physician and associated health), informatics and an interprofessional patient safety fellowship open to multiple health and other disciplines. Training opportunities include new courses we have led or helped develop on patient safety and implementation research methods.