Chronic pain is one of the most prevalent and disabling conditions affecting Veterans. One of the Veterans Health Administration’s (VHA’s) most pressing national clinical priorities is to increase access to non- pharmacological pain management and improve the safety of opioid prescribing. The National Pain Management and Opioid Safety Program (PMOP) is implementing virtual interdisciplinary pain management teams, TelePain, to improve access to evidence-based pain care among rural Veterans and those served by smaller VA facilities. The proposed evaluation, developed closely with PMOP, uses a rigorous prospective design to evaluate TelePain’s impact on clinical outcomes for Veterans and costs to VHA, while also evaluating TelePain’s impact on access to care and other implementation outcomes. These findings will provide actionable information to improving ongoing TelePain implementation efforts and inform VHA of the potential sustainability of TelePain as a model of care.
Practice Type: Veterans Health Administration
Patient Readiness for Improvement through Motivation, Engagement, and Decision-making for PTSD (PRIMED-PTSD)
PTSD is one of the most common mental health conditions affecting Veterans and is associated with significant burden. Highly effective treatments exist for PTSD, evidence-based psychotherapies, but very few Veterans receive them. Although VA has trained over 8,500 providers in evidence-based psychotherapies for PTSD over the past 10 years, only 6% of the 650,000 VHA patients with PTSD receive an evidence-based psychotherapy. It is critical that we connect Veterans with our most effective PTSD treatments and that we do so in a way that is Veteran-centered. Shared decision making is a patient-centered approach to choosing healthcare treatment options. It has been shown to increase patients’ motivation for treatment and ability to stay in treatment long enough to get benefit. It has also been shown to help providers align their practice with evidence-based guidelines. This proposal will refine and pilot test a shared decision making intervention for PTSD to be used in VA primary care clinics, where the vast majority of Veterans with PTSD are treated.
Pilot trial of a computerized treatment for mental health symptoms in primary care
This pilot study will leverage Veteran expertise to inform user-centered design improvements and will pilot the effectiveness of a computerized intervention targeting anxiety sensitivity among this patient population.
DVD Lifestyle Intervention (D-ELITE)
This pragmatic trial will study a DVD- and coaching-based weight loss intervention among Veterans, relative to VA usual care.
MOVE!+UP: Testing a tailored weight management program for Veterans with PTSD
This Hybrid Type 1 Trial will test the effectiveness of MOVE!+UP, a behavioral weight management intervention tailored to address PTSD-based weight loss barriers. The trial will compare MOVE!+UP to VA’s standard weight loss program on weight and PTSD symptom changes. The study also will identify implementation barriers and facilitators to help understand effectiveness findings and inform future implementation.
Remote assessment of cognitive aging and mental health in older African Americans during COVID-19
Alzheimer’s disease and related dementias (ADRD) affect more than 10% of adults who are age 65 and older, but the toll of ADRD is most devastating among older African Americans. COVID-19 widened these disparities; in addition to being more susceptible to COVID-19 infection and fatalities, older African Americans are more likely to experience digital and technical inequities. This puts them at risk for the development/worsening of depression, anxiety, cognitive impairment and sleep disturbances.
This project will evaluate several traditional and mobile health tools for remotely monitoring the effects of social isolation on cognition and mental health in older African Americans with baseline cognitive complaints. By testing three different strategies, we will identify the most effective, feasible and subject-preferred approach to collecting cognitive and mental health data which will help address brain health disparities.
Improving access to cognitive rehabilitation treatment following mild traumatic brain injury
More than a million people in the US sustain a mild traumatic brain injury (mTBI) every year, and many report difficulties with attention, memory and other thinking abilities months and even years following their injury. A promising treatment option is cognitive rehabilitation, but the full-length (20 hours), in-person intervention is not feasible for many people due to time and financial constraints.
This study will evaluate a brief (6 hours), virtual cognitive rehabilitation intervention developed for individuals with persisting cognitive difficulties after mTBI. We will evaluate several outcomes related to improving patient care including treatment satisfaction, feasibility of this intervention when using telehealth and preliminary effectiveness. The proposed treatment aims to provide the same clinical impact of traditional cognitive rehabilitation while reducing burden and increasing access.
Impact of medical and recreational marijuana laws on cannabis, opioids and psychiatric medications: national study of VA patients, 2000 – 2024
We will analyze Veterans Health Administration electronic medical record data to determine the effects of medical marijuana laws (MML) and recreational marijuana laws (RML) on cannabis (use and cannabis use disorder); opioids (prescriptions, fatal and non-fatal overdoses, opioid use disorders); and psychotropic medication prescriptions, providing important information on MML and RML effects in VA patients and in others with similar vulnerability factors to researchers, policy makers, health professionals and the public.
Evaluating the Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) Program
The Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) program is a national VA initiative which aims to improve access to treatment medications for opioid use disorder (OUD) in primary care, pain management, and mental health clinics. The Seattle CESATE is conducting ongoing evaluations of SCOUTT to understand providers’ perspectives on the initiative and the outcomes for Veteran participants. Project aims also include to: assess patient retention in and compliance with SCOUTT, assess changes in number of waivered and prescribing providers, retention in and compliance with stepped care, and identify barriers and facilitators to implementing, sustaining and spreading OUD care.
Mapping SUD treatment in VA using administrative data
The Mapping SUD Treatment in VA Using Administrative Data: Identifying Similarities and Differences Between Women and Men Veterans project is using VA administrative data to evaluate the uptake and receipt of SUD-oriented treatment among all Veterans with a chart diagnosis of SUD enrolled in VHA from FY14 to FY18. Location of care, referral patterns, and characteristics of Veterans obtaining SUD care in different treatment settings will be evaluated stratified by gender.
