Advancing veterans’ healthcare using electronic data Lessons learned from researchers in the field.docx

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1、Elizabeth Tarlov, RN, PhD; Kevin T.Stroupe, PhDGuestEditorialAdvancing veterans5 healthcare using electronic data:Lessons learned from researchers in the fieldThe Department of V eterans Affirs (VA) provides na tionwide access,lifetime coverage, and an integrated care structure to its enrollees. Tho

2、se keyaspects of VA healthcaretogether with data contained in VAs electronicinfbation systems supporting over eight million veterans-provideunique opportunities to study proces ses, outcomes, and costs of care.Recently, for example, VA data have been used to study outcomes associatedwith acute posto

3、perative inpatient re habilitation and care in specializedrehabilitation bed units after lowe r-limb amputation 12, medicationadherence and relapse amon g patients discharged from a VA posttraumaticstress disorder (P TSD) treatment progr am 3, the provision and costs ofassistive technology devices t

4、o veterans after stroke 4, and use of mentalhealth services by veterans disabled by auditory disorders 5.UNDERPINNINGS OF SINGLE-TOPIC ISSUE ON DATA QUALITYIn 1998, the V A Health Services Research & Development Servicefunded the VA Information Resource Center (VIRcC) to facilitate the use ofVA admi

5、nistrative data for research. Since that time, VIReC has developedand disseminated research-relevant information about V A databases andinformation systems. Knowledge-build ing activities include data qualityinvestigations conducted within VIReC. This si ngle-topic issue recognizesthe vast stores of

6、 inform ation about VA data that VA investigators generatenationwide, in the normal course of th eir data analysis activities, and seeksto leverage that information to advance clcctronic-data-bascd research.A call for abstracts was issued in the spring of 2009 for investigations ofthe quality and re

7、search utility of electronic data used in research to advancethe care of veterans- V A invest igators respondedmany more worthyabstracts were submitted than could be included in one JRRD issue. Reflect-ing strong research-community support for VA research, 54 scholars readilyaccepted invitations to

8、peer review a nd almost 100 individuals participatedas authors, reviewers, or editors.VA researchers have long been major contributors to the methodologicalliterature in the area of administrative data use 6-17. This issue advancesthat literature by focusing specifically on the quality and research

9、utility ofdatabases used in veterans researc h. We view data quality-roughly , thecompleteness and accuracy of the data collected and entered-as a necessarybut not sufficient feature of a “research-useful” data set 18. The re searchVIIixJRRD, Volume 47, Number 8, 2010utility of a data set entails ad

10、ditional factors such ascoverage of the population of interest and degree ofvalidity achievable when specific data elements areused as proxies for impor tant but absent infbrma -tion. Research utility questi ons5 therefore, relate tothe inevitable challenges involved in the use of sec-ondary dataie,

11、 data that were collected for a dif-ferent purpose-rather than a deficiency in the dataper seVITAL VETERANS RESEARCH AND VAHEALTH INFORMATION SYSTEMSThe questions of data quality and research utilityaddressed in the included articles were encounteredduring research tackling key issues in the care an

12、drehabilitation of wounded war veterans. Promotinghigh-quality care and providing the tools forindependent living to veterans with spinal cordinjury (SCI) 19, polyt rauma 20, P TSD, sub -stance-use disorder and ot her mental health condi -tions 21-23 and to others needing rehabilitativeand assistive

13、 services 24-25 are high VA priorities.Investigating obesity and chronic kidney diseaseand its antecedents are im portant because these areamong the most common chronic conditions afflict-ing veterans seeking care in the VA 26-27. Under-standing the healthcare needs and ensuringaccessible care for w

14、ome n and oth er vulnerablepopulations 23,28-30 are among the V As topresearch priorities. Id entifying cost-ef fctiveapproaches to veterans? healthcare 25,29,31 is crit-ical to long-term viability of the VA healthcare sys-tem. S tudies included in this issue were derivedfrom research inv estigating

15、 these issues using datafrom sources inside and outside the VA.The included articles also spotlight the greatvalue that VAs health information systems have forresearch. Chief among the data sources mined forresearch is the electronic medical record (EMR),portions of which are extr acted to create the V ANational Patient C are Database, providing clinicaland health services utilization information. Condition-based registries maintained for clinical and adminis-trative purposes and other case-reporting systemsprovide additional clinical and treatment detail andso are also ric