Program areas at PAVIR
Targeted strategies to accelerate evidence-based psychotherapy (ebp) implementation in military. Principal investigators: craig s. rosen, ph.d. and carmen p. mclean, ph.d. This four-year study, funded by the department of defense, is aimed at increasing use of evidence-based psychotherapies (therapies proven effective in Research) in clinics on military bases. Despite efforts to train military providers in effective psychotherapies for posttraumatic stress disorder (ptsd), only a minority of service members receive these treatments. This trial tests whether a tailored process improvement approach (using a toolkit for matching specific change strategies to local barriers) is more effective than provider training alone in expanding the proportion of patients who receive an ebp. The project, led by investigators at the national center for ptsd and Palo Alto Veterans Institute for Research (Pavir), includes collaborators from five universities and eight military treatment facilities. Objectives: to test in a stepped-wedge randomized trial whether the targeted assessment and context-tailored implementation of change strategies (tactics) increases use of evidence-based psychotherapy more than does provider training alone. Secondary outcomes include effects of tactics on average improvement in ptsd symptoms, and satisfaction with the tactics process. Accomplishments: all staff have been hired, eight military clinics representing all service branches have been recruited, military irb approval has been obtained from our first site (others are in process), and training providers in evidence-based treatment has begun. Implementation of tactics will begin within the next six months.potential impact: if effective, tactics may represent a scalable approach to accelerating the use of behavioral health best practices in military settings.
Participatory system dynamics vs audit and feedback: a cluster randomized trial of mechanisms of implementation change to expand reach of evidence-based addiction and mental health care: principal investigator. Lindsey zimmerman, ph.d.our broad aim is to empower all healthcare stakeholders to provide the highest quality care to all patients. Our specific aims address the complexities and tradeoffs associated with implementing evidence-based practices (ebps) in outpatient addiction and mental health systems. There is scientific consensus about the best evidence-based psychotherapies and pharmacotherapies (ebps) to meet the needs of patients with opioid and alcohol use disorder, ptsd, and depression. However, ebp coordination over time, within and across multidisciplinary teams of providers, is complex and constantly changing. Veterans health administration (va) policy mandates, national training programs, and incentivized quality measures, have been insufficient for reaching more than 3 to 28% of patients with the highest quality treatments. As an alternative, participatory system dynamics (psd) has been used to explain causes of complex problems in business management for 60 years. We use existing enterprise data to tailor model parameters to each care team. Psd models were made accessible via a `modeling to learn' interface and training, during which teams safely evaluated local change scenarios via simulation to find the highest yield options for meeting Veterans' needs. During the second year of our project, concurrent with the onset of the covid19 pandemic, we began our two-arm, 24-site (12 sites/arm) cluster randomized trial to test the effectiveness of psd simulation as compared to more standard team audit and feedback data review. We also made available new free online resources for other Research teams and healthcare systems to use (see https://mtl.how/demo). Our study has the potential to inform a new paradigm, by determining what works to improve health system quality defined as ebp reach, why it works, and under what conditions. If psd is effective, study activities will address a national priority to improve Veterans' addiction and mental health care to prevent chronic symptoms, relapse, suicide, and overdose.
A new framework for understanding the mechanisms of diastolic dysfunction. Principal investigator: daniel ennis, ph.d.dr. Ennis directs the radiological sciences lab at vapahcs, which aims to develop the next generation of radiologic imaging exams and evaluation for a wide range of clinical indications. Our primary focus is on improving the diagnosis of heart and cardiovascular disease. We emphasize technical improvements to mri exams that enable the results to be quantitative. Currently, one project focuses on developing technologies that will enable measuring changes in the stiffness of the heart. The heart may become stiffer because of several diseases, but currently there are limited way to measure heart stiffness. We aim to develop both the mri methods that enable accurate estimates of heart motion and patient-specific computational models that enable the estimation of the underlying heart stiffness. We expect that these technologies will aid in the diagnosis of patients with a specific form of heart failure for which the heart contracts adequately but does not fill adequately. To date we have invented new methods to measure heart motion with mri, developed a validation platform to confirm our ability to measure heart stiffness, and we have an on-going study to evaluate our new approach in patients with heart failure.