PALO ALTO VETERANS INSTITUTE FOR RESEARCH
3801 MIRANDA AVENUE, PALO ALTO, CA 94304 www.pavir.org

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Organizations Filed Purposes: ADVANCE VETERANS AND PUBLIC HEALTH THROUGH INNOVATIVE RESEARCH

TARGETED STRATEGIES TO ACCELERATE EVIDENCE BASED PSYCHOTHERAPY (EBP) IMPLEMENTATION IN MILITARY. PRINCIPAL INVESTIGATORS: CRAIG S. ROSEN, PH.D AND CARMEN P. MCLEAN, PH.D.THIS FOUR-YEAR STUDY, FUNDED BY THE DEPARTMENT OF DEFENSE, IS AIMED AT INCREASING USE OF EVIDENCE - BASED PSYCHOTHERAPIES (THERAPIES PROVEN EFFECTIVE IN RESEARCH) IN CLINICS ON MILITARY BASES. DESPITE EFFORTS TO TRAIN MILITARY PROVIDERS IN EFFECTIVE PSYCHOTHERAPIES FOR POSTTRAUMATIC STRESS DISORDER (PTSD), ONLY A MINORITY OF SERVICE MEMBERS RECEIVE THESE TREATMENTS. THIS TRIAL TESTS WHETHER A TAILORED PROCESS IMPROVEMENT APPROACH (USING A TOOLKIT FOR MATCHING SPECIFIC CHANGE STRATEGIES TO LOCAL BARRIERS) IS MORE EFFECTIVE THAN PROVIDER TRAINING ALONE IN EXPANDING THE PROPORTION OF PATIENTS WHO RECEIVE AN EBP. THE PROJECT, LED BY INVESTIGATORS AT THE NATIONAL CENTER FOR PTSD AND PALO ALTO VETERANS INSTITUTE FOR RESEARCH (PAVIR), INCLUDES COLLABORATORS FROM FIVE UNIVERSITIES AND EIGHT MILITARY TREATMENT FACILITIES. OBJECTIVES: TO TEST IN A STEPPED-WEDGE RANDOMIZED TRIAL WHETHER THE TARGETED ASSESSMENT AND CONTEXT-TAILORED IMPLEMENTATION OF CHANGE STRATEGIES (TACTICS) INCREASES USE OF EVIDENCE-BASED PSYCHOTHERAPY MORE THAN DOES PROVIDER TRAINING ALONE. SECONDARY OUTCOMES INCLUDE EFFECTS OF TACTICS ON AVERAGE IMPROVEMENT IN PTSD SYMPTOMS, AND SATISFACTION WITH THE TACTICS PROCESS. ACCOMPLISHMENTS: ALL STAFF HAVE BEEN HIRED, EIGHT MILITARY CLINICS REPRESENTING ALL SERVICE BRANCHES HAVE BEEN RECRUITED, MILITARY IRB APPROVAL HAS BEEN OBTAINED FROM OUR FIRST SITE (OTHERS ARE IN PROCESS), AND TRAINING PROVIDERS IN EVIDENCE-BASED TREATMENT HAS BEGUN. IMPLEMENTATION OF TACTICS WILL BEGIN WITHIN THE NEXT SIX MONTHS. POTENTIAL IMPACT: IF EFFECTIVE, TACTICS MAY REPRESENT A SCALABLE APPROACH TO ACCELERATING THE USE OF BEHAVIORAL HEALTH BEST PRACTICES IN MILITARY SETTINGS.

DEFENSE AND VETERANS BRAIN INJURY CENTER (DVBIC). PRINCIPAL INVESTIGATOR: ODETTE HARRIS, M.D., M.P.H. THE DEFENSE AND VETERANS BRAIN INJURY CENTER (DVBIC) AT THE PALO ALTO VETERANS INSTITUTE OF RESEARCH (PAVIR) OPERATES IN AN ENVIRONMENT THAT WORKS IN COLLABORATION WITH THE DEPARTMENT OF REHABILITATION AT THE VA PALO ALTO WHICH IS AN INTEGRATED SERVICE DELIVERY SYSTEM DEVELOPED BY THE VA TO ADEQUATELY PROVIDE FOR THE COMPREHENSIVE MEDICAL, SURGICAL, AND REHABILITATION CARE FOR RETURNING SERVICE MEMBERS AND VETERANS. WE PROVIDE STATE OF THE ART CARE FOR OUR VETERAN AND ACTIVE DUTY PERSONNEL THROUGH THIS INTEGRATION AND OFFER EDUCATION AND ASSISTANCE FOR THEM TO REINTEGRATE INTO SOCIETY. WE ACCESS LONGITUDINAL AND CONTINUOUS EPIDEMIOLOGIC DATA AS PRIMARY TOOLS TO FOCUS ON RELEVANT FUNCTIONAL OUTCOMES THAT HELP VETERANS, MILITARY PERSONNEL AND CIVILIANS REINTEGRATE INTO SOCIETY AFTER ACUTE INJURY. OUR CURRENT PROJECTS INCLUDE BEING A SITE FOR NATIONAL VA AND DOD LONGITUDINAL STUDIES SUCH AS TBI MODEL SYSTEMS AND CLINICAL TRACKING FORM STUDY. USING VARIOUS INNOVATIVE INTERVENTIONS SUCH AS NEUROMODULATION, COMPLIMENTARY ALTERNATIVE MEDICINE AND COGNITIVE REHABILITATION, DVBIC DEVELOPS TREATMENT STRATEGIES FOR HEALTH PROBLEMS FREQUENTLY REPORTED IN THE BRAIN INJURED POPULATIONS. THROUGH OUR LOCAL AND NATIONAL COLLABORATIONS WITHIN THE DVBIC NETWORK AS WELL AS WITH UNIVERSITIES AND HOSPITALS ACROSS THE NATION, WE ARE AMONG THE LEADERS IN ADVANCED NEUROIMAGING, BIOMARKER AND COMPUTERIZED COGNITIVE ASSESSMENTS FOR DIAGNOSIS AND MANAGEMENT OF BRAIN INJURIES AND THEIR RELATED SYMPTOMS. CURRENT PROJECTS IN SUCH POPULATIONS INCLUDE LARGE MULTISITE LONGITUDINAL ASSESSMENT AND NEUROIMAGING AND NEUROMODULATION STUDIES FUNDED BY DOD, VA AND NIH. OUR LEADERSHIP PROVIDES MENTORSHIP TO POSTDOCTORAL FELLOWS FROM THE VA OFFICE OF ACADEMIC AFFAIRS AND RESIDENTS IN PSYCHIATRY, NEUROLOGY AND PHYSICAL MEDICINE AND REHABILITATION DEPARTMENTS AT STANFORD. OUR REGIONAL EDUCATION COORDINATOR ALONG WITH OUR NATIONAL DVBIC EDUCATION DEPARTMENT PROVIDES LOCAL AND REGIONAL TBI AWARENESS AND WE HOST AN ANNUAL TBI FORUM TO PROVIDE UPDATED CLINICAL AND RESEARCH INFORMATION TO PROVIDERS, RESEARCHERS, PATIENTS AND CAREGIVERS. WE UTILIZE OUR ACTIVE CLINICAL PRACTICE AT THE VA PALO ALTO AND STANFORD NEUROSURGERY DEPARTMENT AND OUR DVBIC EDUCATION NETWORK TO TRANSLATE OUR NEUROSCIENCE DRIVEN RESEARCH METHODOLOGIES INTO THESE CLINICAL SETTINGS FOR TARGETED AND ACCURATE MEDICAL CARE.

A PROSPECTIVE INVESTIGATION OF THE RISKS OF MISUSE, ABUSE, AND ADDICTION OF OPIOIDS AMONG PATIENTS TREATED WITH EXTENDED-RELEASE/LONG ACTING (ER/LA) OPIOIDS FOR THE TREATMENT OF CHRONIC PAIN: PRINCIPAL INVESTIGATOR: MUDUMBAI, SESHADRI, M.D. THIS STUDY EXAMINES THE MAGNITUDE OF MISUSE, ABUSE, AND ADDICTION AMONG PATIENTS WHO ARE TREATED WITH OPIOIDS FOR CHRONIC PAIN WHILE HAVING COMORBIDITY OF OPIOID USE DISORDER WITH OTHER SUBSTANCE USE AND PSYCHIATRIC DISORDERS AND ESTIMATES HOW THE RISK OF THESE OUTCOMES VARIES BY THE PRESENCE OF RISK FACTORS AMONG PATIENTS TREATED WITH OPIOIDS LONG-TERM. THE PUBLIC HEALTH CRISIS OF OPIOID MISUSE. ADDICTION AND OVERDOSE IS ONE OF THE MOST CHALLENGING ISSUES FACED BY AMERICAN SOCIETY. THE ISSUE CUTS ACROSS EVERY SOCIOECONOMIC LEVEL AND GEOGRAPHIC BOUNDARY. EVERY COMMUNITY IN AMERICA HAS BEEN TOUCHED BY FRIENDS, FAMILY MEMBERS OR COLLEAGUES SUFFERING FROM OPIOID ADDICTION, AND FAR TOO OFTEN, LOSING THEIR LIVES TO IT. OVER THE PAST FEW YEARS, FDA HAS TAKEN MANY ACTIONS TO HELP REDUCE THE NUMBER OF PEOPLE WHO BECOME ADDICTED, OR ULTIMATELY OVERDOSE FROM PRESCRIPTION OPIOIDS. TO COMBAT THIS EPIDEMIC, THE FDA MANDATED THAT PHARMACEUTICAL COMPANIES HOLDING NEW DRUG APPLICATIONS (NDA) OF EXTENDED-RELEASE/LONG LASTING (ER/LA) OPIOIDS CONDUCT ONE OR MORE STUDIES TO PROVIDE QUANTITATIVE ESTIMATES OF SERIOUS RISKS OF MISUSE, ABUSE, ADDICTION, OVERDOSE, AND DEATH ASSOCIATED WITH LONG-TERM USE OF OPIOIDS FOR MANAGEMENT OF CHRONIC PAIN, AMONG PATIENTS PRESCRIBED ER/LA OPIOID PRODUCTS. ALTHOUGH ABUSE AND MISUSE OF PRESCRIPTION OPIOIDS HAVE INCREASED OVER THE PAST DECADE, THERE IS DEBATE ABOUT THE MAGNITUDE OF MISUSE, ABUSE, AND ADDICTION AMONG PATIENTS WHO ARE TREATED WITH OPIOIDS FOR CHRONIC PAIN. FURTHER, ALTHOUGH THERE APPEARS TO BE COMORBIDITY OF OPIOID USE DISORDER WITH OTHER SUBSTANCE USE AND PSYCHIATRIC DISORDER, THERE IS INSUFFICIENT DATA TO ESTIMATE HOW THE RISK OF THESE OUTCOMES VARIES BY THE PRESENCE OF RISK FACTORS AMONG PATIENTS TREATED WITH OPIOIDS LONG-TERM.

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