VA Eastern Colorado REAP to Improve Care Coordination (CRICC)
Evelyn Hutt, MD, Director

Research Focus: VA Eastern Colorado Health Care System’s (VA-ECHCS) REAP to Improve Care Coordination for Veterans (CRICC) provides VA HSR&D with a center devoted to researching the critical problem of poor care coordination. At least 200,000 veterans currently require support from VA beyond acute hospitalization and outpatient clinic visits; this segment of the veteran population is expanding rapidly. Poor coordination among care provider disciplines and across multiple sites of care is dangerous, frequently causing medication errors, conflicting care recommendations, patient/caregiver confusion or distress, early rehospitalization and higher costs. CRICC increases HSR&D capacity by expanding the multidisciplinary core of investigators at ECHCS who conduct successful research in this understudied area.

Key Issues: CRICC works on projects in four domains within the care coordination rubric: (1) quality of life and care for veterans entitled to long-term care (LTC); (2) using telemedicine to coordinate chronic disease management across the continuum of care; (3) deploying electronic medical record and patient-centered methods to improve coordination; (4) improving pain management and palliative care across the care continuum.

Leadership: Evelyn Hutt, MD directs CRICC. She is Associate Professor in the Divisions of Health Care Policy & Research (HCPR) and Geriatrics, University of Colorado Denver (UCD) and Principal Investigator on an AHRQ-funded RO-1 to implement guidelines for treating nursing home acquired pneumonia. She has built HSR&D capacity at ECHCS from two investigators and support staff in 2002 to its current capacity of seven core investigators and ten research assistants by recruiting a full-time Health Services Research Scientist and capitalizing on strong collaborative relationships with VA-ECHCS colleagues, and the leadership of UCD’s Division of HCPR, Health Outcomes Program, and Nursing School.

Core Investigators: John Rumsfeld, MD, PhD, Director of the Ischemic Heart Disease QUERI Clinical Coordinating Center, helped launch two HSR&D funded projects, IHI 02-062 as Co-PI and IIR 02-089 as Site PI. He is Clinical Director for the VA’s national cardiac catheterization laboratory database. Tiffany Radcliff, PhD was awarded HSR&D funding to study Hip Fracture Repair and Outcomes: a National Cohort Study of Veterans, beginning in January 2007. Allan Prochazka, MD, is Co-PI on an HSR&D study entitled Effects of a Computer-Based Informed Consent Program for Surgery. Dr. Prochazka is also funded from the VA’s Clinical Research R&D to study smoking cessation interventions. Michael Ho, MD, PhD is a Career Development Awardee under Dr. Rumsfeld’s mentorship, He studies ways to improve blood pressure control using interactive voice technology. Cari Levy, MD, also a Career Development Awardee, focuses on palliative care for veterans who live in nursing homes, under Dr. Hutt’s mentorship. Core investigators authored 50 first-author publications over the last 3 years; an additional 16 are in press.

Affiliate Investigators: Liron Caplan, MD is Co-Investigator on a recently awarded HSR&D Merit Review, “Using VA Databases to Identify Drug AEs and Their Health & Cost Impact. Under the co-mentorship of Seth Eisen, MD and Dr Hutt, he is studying treatment of glucocorticoid induced osteoporosis using the PBM and Austin Data Center databases and plans a Career Development Application for June 2007. Ryan McGhan, MD, an affiliate investigator, is being co-mentored by Dr. Radcliff to study COPD exacerbations and prescribing patterns in the VA using Austin Data Center data.

Added Value: CRICC’s multidisciplinary core investigators have joined forces to conduct research on ameliorating poor care coordination for the rapidly expanding segment of the veteran population who needs complex, multi-site, chronic care. Support for this nidus of researchers, who have successfully mentored junior faculty and led projects on multiple facets of care coordination, permits us to develop and test interventions to assure high quality, safe coordination of care for diverse veteran populations: the elderly, those with multiple chronic medical and psychiatric problems, and those returning from OEF/OIF.