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Director's Letter

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Director's Letter

VA Geriatric and Advanced Care Research: Serving as a Model in the Learning Health Care System Era

VA is caring for more aging Veterans than ever before. The number of Veterans ages 85 or older nearly tripled between 2000 and 2010, and the number of Veterans eligible for community nursing home care is expected to double in the next decade.1 The implementation of the Veterans Choice Act and efforts recommended by the Commission on Care to enhance community care provider networks will have a profound impact on care for older Veterans.2

On September 20, 2016 the Secretary of Veterans Affairs spoke at the Coalition to Transform Advanced Care Summit on how VA is serving as a model for private healthcare in terms of geriatric and advanced care planning. Specifically, VA conducts research to better inform care for Veterans based on what the National Academy of Medicine has called the Learning Health Care System. Key goals of a Learning Health Care System include:

  • Aligning scientific pursuit with clinical priority goals (partnerships),
  • Leveraging existing data to deploy and evaluating innovations and best practices ("Big Data"), and
  • Conducting more rapid and efficient studies to inform care improvements (implementing and evaluating in real time).

VA is addressing the challenges of aging and disability through research, implementation, and evaluation. In close collaboration with clinical leaders, VA healthcare researchers have been leading innovative research studies for at least two decades, in particular to determine optimal care models for aging Veterans. Many of these studies have informed non-VA care services such as home-based primary care.3 Strong and ongoing partnerships between researchers and clinical leaders have been further supported through VA's national network of Geriatric Research and Education Clinical Centers (GRECCs), the Geriatrics and Extended Care Data Analysis Center (GECDAC), HSR&D's Centers of Innovation in Long-Term Services and Supports for Vulnerable Veterans and Disability and Rehabilitation Research (CINDRR) - and through VA's Quality Enhancement Research Initiative (QUERI) national program.

HSR&D and QUERI have further enabled VA to become a Learning Health Care System in geriatric care through the application of science to practice and the more rapid implementation and evaluation of national programs and initiatives. This could not have happened without the commitment of the Office of Geriatrics and Extended Care (GEC) working in concert with other national VA partners in ethics, nursing, and mental health, as well as with VA researchers to conduct rigorous evaluation of new programs or policies.

VA QUERI investigators employ Big Data and implementation science to deploy and evaluate new models of care for the aging Veteran. Notably, the QUERI Partnered Evaluation on Disseminating a Dashboard for VA Purchased Community Nursing Homes is leveraging national data from the Centers for Medicare and Medicaid Services (CMS) to compare quality of care across nursing homes and to ultimately inform improvements in care. In addition, the Partnered Evaluation of Geriatric Patient-Aligned Care Team (GeriPACT) Implementation will help determine whether this model effectively provides frail, elderly Veterans and their caregivers with access to the most appropriate care for their healthcare needs.

For advanced care planning, the national QUERI Program on Implementing Goals of Care Conversations with Veterans in VA Long-Term Care (LTC) Settings will determine the best approaches to effectively implementing VA's Life-Sustaining Treatment Decisions Initiative to improve patient-centered care for Veterans with serious illness.

More recently, HSR&D - through the QUERI Partnered Evidence-based Policy Resource Center (PEPReC) - commissioned a randomized evaluation of Veteran-Directed Home and Community Based Services (VD-HCBS) in collaboration with the GEC. VD-HCBS is focused on preserving Veterans' independence and the GEC is planning an expansion of the program to 90 additional VA medical centers over the next three years. This evaluation seeks to evaluate the VD-HCBS expansion by capturing comprehensive information on the impact of VD-HCBS on Veterans' and caregivers' outcomes, as well as identifying how the program was implemented.

Overall, as health and long-term care costs are expected to rise with an aging U.S. population, VA is becoming a national leader in informing best practices in geriatric and advanced care planning. This is accomplished because VA can leverage provider networks, Big Data, and research expertise in a Learning Health Care System to more rapidly implement and evaluate innovative and cost-efficient models of care that will ultimately inform a more effective, personalized, and humane approach for our most vulnerable Veterans.


1. Edes T. Geriatrics and Extended Care Goals and Metrics for FY2015. Internal presentation to U.S. Department of Veterans Affairs, Central Office, Washington DC. (January 13, 2015; cited August 20, 2015).

2. Letter from the President -- Report of the VA Commission on Care:

3. Shay K, Schectman G. Primary care for older Veterans. Generations - Journal of the American Society on Aging. 2010; 34(2):35-42.

Amy Kilbourne, PhD, MPH
Director, Quality Enhancement Research Initiative

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