Department of Veterans Affairs

The Department of Veterans Affairs (VA) Office of Research and Development supports intramural biomedical, rehabilitation, and health services research. Health services research focuses on conditions that are common among veterans, including cancer (especially prostate and lung). Recent initiatives have addressed factors affecting the delivery of health care such as managed care; the implementation of clinical practice guidelines; ethnic, cultural, and gender issues; continuity of care, and patient-centered care. VA support for cancer-related health services research totaled $9.5 million in fiscal years 1997 and 1998.

Eleven Centers of Excellence have been established to link health services research to patient and administrative needs and to provide technical expertise in certain areas, for example, the measurement of chronic disease outcomes, health economics, and tobacco use and cessation. Studies of cancer treatments, chronic pain, and end-of-life care are being conducted as part of the VA's quality improvement program, the Quality Enhancement Research Initiative (QUERI).

The VA is supporting two clinical trials with health services research components:

  1. PIVOT, a randomized trial comparing radical prostatectomy versus palliative expectant management for the treatment of clinically localized prostate cancer (other sponsors include NCI and AHCPR); and
  2. A VA cooperative trial to assess whether 18-F-Fluorideoxyglucose Positron Emission Tomography (PET) imaging can be used to accurately determine if solitary pulmonary nodules are malignant. The trial will assess the costs and benefits of this technology (e.g., avoidance of unnecessary procedures).

In 1998, the VA's Office of Research and Development began collaborating with the Department of Defense for studies on prostate diseases including prostate cancer.

Other VA intramural health services research is shown in Box 7.10.

BOX 7.10 Intramural Health Services Research Projects, Department of Veterans Affairs

General

  • Assessing pain control in acute and chronically ill patients
  • Implementation of clinical practice guidelines for smoking cessation
  • The use of nurses to improve cancer patient pain outcomes

Prostate Cancer

  • Impact of education on prostate cancer screening decisions
  • Prospective study of patient preferences for prostatic cancer treatment
  • Familial patterns in prostate cancer
  • Effectiveness of screening for prostatic cancer
  • Effects of age and race on prostate cancer outcomes
  • Differences in patterns of care, risk factors, and health-related knowledge and beliefs among African-American and white men


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