VA Center for Clinical Management Research

Impacts of CCMR Work - Tools

A preoperative screening tool to estimate risk of postsurgical complications for older patients

• 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.

• Min L, Hall K, Finlayson E, et al. Estimating risk of postsurgical general and geriatric complications using the VESPA preoperative tool. JAMA Surg 2017; 152(12):1126-1133.

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

• Intensive blood pressure treatment can reduce the chance of having a heart attack, stroke, or other major cardiovascular illness, but may increase the chance of experiencing a serious adverse event, such as kidney failure. We developed and validated a clinical decision score to identify patients likely to experience benefits and unlikely to experience harms when undergoing intensive treatment. 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: https://blogs.nejm.org/now/index.php/whats-new-sprint-data-analysis-challenge/2017/03/15/

• Basu S, Sussman JB , Rigdon J, Steimle L, Denton BT, Hayward RA. Benefit and harm of intensive blood pressure treatment: Derivation and validation of risk models using data from the SPRINT and ACCORD trials PLoS medicine 2017;14(10): e1002410.

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. The website can be accessed at https://cansort.med.umich.edu/ under "resources". This has led to a NIH-grant submission to integrate the tool into clinical workflow.

• 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.

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. The tool can be accessed at https://share.lungdecisionprecision.com. The modeling work that informed tool development, as well as tool usability testing, helped lead to the funding of Dr. Tanner Caverly's VA HSR&D Career Development Award. This tool is presently being implemented in eight VA medical centers as part of a PROVE QUERI project.

• 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. This paper also presents a four-step framework that can be used by researchers for leveraging big data for research and quality improvement purposes. We are currently working with the Office of Veterans Access to Care, the Office of Community Care (OCC), and the GI National Program Office to use data from this database to implement measures of colonoscopy quality and overuse in VHA.

• 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.

VA Patient Database

• This is a nation-wide dataset at the patient-day level, which provides data on day-by-day physiology. The paper describing the creation of this dataset is under review. 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:
  • Identifying patterns of, risk factors for, and outcomes of late cardiovascular failure in the hospital
  • Finding patterns of patients at increased risk for recurrent infections
  • Developing improved prognostic scores
  • Finding patients at risk for inappropriate discontinuation of statins and inappropriate continuation of antipsychotics after hospitalization

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. WeCareAdvisor is currently being used as part of a QUERI grant (QUE 15-471 Helfrich PI) in 5 CLCs to support efforts to reduce antipsychotic use. WeCareAdvisor is being tested in a randomized trial funded by DoD to assess acceptability, usability, and immediate impact on caregiver distress with and confidence in managing behavioral symptoms, and secondarily, frequency of behavioral occurrences.

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