VA Center for Clinical Management Research

Impacts of CCMR Work - Tools

Kettles Esophageal and Cardia Adenocarcinoma prediction (K-ECAN) Tool

• K-ECAN is an automated, valid tool predicting incident esophageal adenocarcinoma (EAC) or gastric cardia adenocarcinoma (GCA) using only electronic health records.

The Consolidated Framework for Implementation Research

• The Consolidated Framework for Implementation Research (CFIR) is a practical theory-based guide for systematically assessing potential barriers to and facilitators of implementation of evidence-based practices. It guides tailoring of implementation strategies and adaptations for the innovation being implemented and can help explain outcomes.

• Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science | Implementation Science | Full Text (biomedcentral.com)

• The updated Consolidated Framework for Implementation Research based on user feedback | Implementation Science | Full Text (biomedcentral.com)

Learn. Engage. Act. Process. QI Learning Program (LEAP)

• LEAP is designed to engage frontline teams in quality improvement (QI) within the demands of everyday clinical practice. By the end of the LEAP program, teams complete a project with the support of a coach and with a learning community comprised of other teams.

• LEAP has been chosen to be one of the first 75 innovations featured on the VA Diffusion Marketplace’s new public-facing website. The Marketplace is a centralized repository of novel best and evidence-based practices across VA to help spread innovations more broadly. Diffusion Marketplace: LEAP 

Lung DecisionPrecision lung cancer screening tool

• The web-based Lung DecisionPrecision tool is a provider-facing tool designed to personalize the harm-benefit assessment of lung cancer screening for informing screening decisions.

• Caverly, TJ, Cao P, Hayward RA, Meza R. Identifying patients for whom lung cancer screening is preference-sensitive: A microsimulation study. Ann Intern Med 2018; 169(1):1-9.

VA Colonoscopy Collaborative

• The VA Colonoscopy Collaborative includes creation of the largest, linked, longitudinal national endoscopic database in the United States, which leverages big data to: (1) measure and report colonoscopy quality; and (2) develop and validate a risk prediction model for colorectal cancer and high-risk polyps. Researchers can utilize their four-step framework to leverage big data for research and quality improvement purposes.

• Gupta S, Liu L, Patterson OV, Earles A, Bustamante R, Gawron AJ, et al. A framework for leveraging "big data" to advance epidemiology and improve quality: Design of the VA Colonoscopy Collaborative. eGEMs (Generating Evidence & Methods to improve patient outcomes) 2018;6(1):4

Estimating risk of postsurgical general and geriatric complications using the VESPA preoperative tool. JAMA Surg 2017

• We developed a short geriatric assessment scale (< 10 minutes) that can be administered by surgical, non-physician staff to estimate the risk of postsurgical complications, including traditional postoperative occurrences, as well as novel geriatric outcomes such as delirium and falls. The tool can be used to identify patients in need of close monitoring.

Clinical decision score to maximize benefit and minimize harm from intensive blood pressure treatment

• We developed and validated a clinical decision score to identify patients likely to experience benefits of intensive blood pressure treatment (e.g., less chance of having a heart attack, stroke, etc.) and unlikely to experience harms (e.g., kidney failure). The score was developed from SPRINT trial data and tested using both SPRINT and ACCORD-BP trial data. Code for replication (in R): github.com/sanjaybasu/sprint-challenge. This work was awarded third place in the 2017 SPRINT data analysis challenge from 143 submissions.

iCanDecide website for helping breast cancer patients with treatment decision making

• The iCanDecide web site is an interactive and tailored breast cancer treatment tool, which focuses on knowledge building and values clarification. Our research showed the tool positively affected high quality decisions largely by improving knowledge compared with static online information.

• Hawley ST, Li Y, An LC, Resnicow K, Janz NK, Sabel MS, Ward KC, Fagerlin A, Morrow M, Jagsi R, Hofer TP, Katz SJ. Improving Breast Cancer Surgical Treatment Decision Making: The iCanDecide Randomized Clinical Trial. J Clin Oncol 2018 Mar 1; 36(7): 659-666.

Veterans Affairs patient database (VAPD 2014-2017)

• This is a nation-wide dataset at the patient-day level, which provides data on day-by-day physiology. The statistical code to extract and clean laboratory values in the dataset has been published on Github. https://github.com/CCMRcodes/VAPD. Our VA collaborators in Salt Lake City are already using the Github code in their research. Examples of potential uses of this dataset include: finding patterns of patients at increased risk for recurrent infections, and finding patients at risk for inappropriate discontinuation of statins and anti-psychotics.

WeCareAdvisor web-based tool for supporting caregivers of patients with dementia

• WeCareAdvisor is designed to educate and provide detailed assistance to families based on non- pharmacological behavior methodology. The tool provides information about dementia, daily tips, and treatment plans consisting of management tips tailored to symptom presentation. More information is available at Home | WeCareAdvisor Study

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