May 20, 2013

Improving Veteran care through research

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VAQS nursing s1The U.S. Department of Veterans Affairs celebrated National VA Research Week May 13-17, 2013 and the Birmingham VA Medical Center conducted poster presentations and provided lay information highlighting clinical, basic, rehabilitation and outcomes research in collaboration with UAB faculty.

“VA research is a national asset that benefits Veteran patients and the entire nation by moving medical science forward,” said Louis Dellitalia, the medical center’s associate chief of staff for research. “VA investigators play key roles in drug testing, developing devices and techniques, and research in patient-care quality measures that continue to revolutionize our changing health care environment. Through these national research programs, VA is a leader in many areas of research, such as AIDS, mental health, genomics, heart disease, cancer, diabetes, infectious diseases, and spinal cord injury.”

“The VA provides vital research funding to UAB School of Medicine researchers,” said Anupam Agarwal, M.D., interim senior vice president for Medicine and dean of the School of Medicine. Agarwal is also a VA investigator and VA staff physician. “Likewise, UAB physicians and scientists are honored to contribute to the care of VA patients and to the advancement of science within the VA system. The VA hospital and VA research is integral to UAB.”

Research at the BVAMC is conducted by UAB faculty; 43 have primary appointments in the School of Medicine, nine in the School of Nursing. In return, grants funded through the VA support faculty and staff effort on research projects.

Research projects include a “Program Project Award,” one of very few in the country. The $2.5 million, four-year grant brings together four investigators with appointments at UAB and the BVAMC to work on three different projects and to share a core facility. “The idea is to synergize the research so the outcome is greater than each individual’s contribution,” said Paul Sanders, M.D., a professor of Nephrology in UAB’s Department of Medicine.

Sanders works with Agarwal and Edgar Jaimes, M.D., who also are professors of Nephrology, and Yabing Chen, Ph.D., an associate professor in the Department of Pathology. The group is applying their respective expertise to study the mechanisms leading to arteriosclerosis, or a stiffening of the smooth muscle in arteries. Aging and chronic kidney disease increase arteriosclerosis and a high-salt diet is another suspected culprit. Agarwal is studying iron metabolism, Chen is studying a specific molecule and its role in salt and potassium intake, and Sanders is looking at salt and the aging process. The long-term goal is to translate their findings into better cardiovascular outcomes in aging and chronic kidney disease.

Another important research collaboration is the Birmingham-Atlanta Geriatric Research, Education and Clinical Center, a collaboration between UAB and Emory University. Richard Allman, M.D., director of the GRECC and director of the Comprehensive Center for Healthy Aging at UAB, says the VA provides funding crucial to recruiting and retaining faculty at UAB. In return, scientific members of the GRECC provide education, clinical care, basic and clinical research and rehabilitation to Veterans, focusing on incontinence and related disorders, mobility and palliative care.

“The VA’s support provides infrastructure that allows me and other members of the GRECC to perform work that leads to grants from other funding agencies, including the National Institutes of Health,” Allman said. “Other grants have provided start-up funds for programs, such as UAB’s Center for Exercise Science.”

Mary Hawn, M.D., professor of Surgery at UAB and director of the program in gastrointestinal surgery, is studying quality and outcomes measures through the VA. Hawn has merged VA and CMS databases to study the risk of post-operative adverse cardiac events in patients with prior coronary stenting undergoing non-cardiac surgery.  This study will influence guidelines on how to most safely manage these patients peri-operatively.

The School of Medicine also collaborates on a one-year position on a medical resident, called the VA Chief Medical Resident in Quality and Safety, which integrates quality and safety concepts into the residency program.

The School of Medicine and the School of Nursing collaborate with the VA to provide a quality-focused advanced educational program. This two-year position, called the VA Quality Scholars Fellowship, is a post-residency fellowship for physicians and pre-doctoral or post-doctoral fellowship for nurses. Pat Patrician, Ph.D., a retired Army colonel and the Donna Brown Banton Endowed Professor at the UAB School of Nursing, and Carlos Estrada, M.D., director of the division of General Internal Medicine in the UAB School of Medicine, serve as senior scholars in Birmingham, directing the program for each school. The fellowship promotes leader­ship in quality improvement research. Participants develop and apply quality improvement initiatives for the ongoing advancement of healthcare services for VA and the nation.

“The UAB School of Nursing and the Birmingham VA Medical Center have a long-standing academic partnership through faculty practice, nursing research and clinical education,” said UAB Dean of Nursing Doreen C. Harper, Ph.D., RN. “Our research partnerships, especially, enable us to enhance the quality of care our Veterans and their families receive though the development and implementation of evidence-based studies in the VA Medical Center setting. Our partner hospitals are our laboratories for research so that we can explore ways to improve the quality of patient care and there is no greater research mission than that of delivering the highest quality care nurses can provide to our nation’s Veterans.”