Note: This table dons NOT include most of the "contract nursing home patients" that are paid for by the DVA but reside in Community Nursing Home f At the time this was created, the contractor did not know that (most of) the contract patients are not listed in FTF.} Health Research Abstract Conducting health research has been one of the fundamental missions of VA during the past 30 years. Official recognition of VA's research program occurred with the passage of Public Law 85-857 in 1958, which formalized medical and prosthetic research. In his guidance to VHSERA for the fiscal year 1991 budget preparation, Secretary Derwinski proposed creating an Advisory Committee on Health Research Policy to review VA's research program. The panel's review would be fourfold: the balance of VA's research areas, the appropriateness of the research in providing medical and other health care services to veterans, the appropriateness of research in regard to other federal research initiatives and the quality of the research. At the first meeting of the committee in February 1990, he asked the committee to recommend a research budget for fiscal year 1992. The committee found VA's research to be of high quality, appropriate to the patient care mission of VA, occupying a proper niche in the federal government research efforts and almost suitably balanced. However, the committee concluded that more funding is needed for research and that additional emphasis should be placed on rehabilitation and mental health research. It found that VA's research program is beneficial to the nation and the world. Introduction The authorization for the conduct of health research is found in Title 38, which governs most VA operations. Section 4101 (c) (1) states, "In order to carry out more effectively the primary function of the Department of Medicine and Surgery and in order to contribute to the Nation's knowledge about disease and disability, the Administrator shall, in connection with the provision of medical care and treatment to veterans, carry out a program of medical research (including biomedical, prosthetic, and health care services research, and stressing research into spinal cord injuries and diseases that lead to paralysis of the lower extremities)." The section continues with some requirements for the conduct of the research program and provides additional emphasis for research in geriatrics and gerontology. The Secretary of Veterans Affairs, in his guidance to VHS & RA for the fiscal 1991 budget submission, proposed creating a blue ribbon panel to review the VA's research program. In response, a federal advisory committee--the Advisory Committee on Health Research Policy--was created. Committee objectives, as spelled out in its charter, were to prepare a comprehensive review and analysis of research in VHS&RA and advise the Secretary whether the research currently being conducted is properly balanced between health research subject areas, fits the role of VA in providing medical and other health care services to veterans, and is appropriate visa-vis the role of other federal agencies performing health research. The committee was also to provide an evaluation of the quality of the research conducted and make any being recommendations to the Secretary it deemed appropriate. After the committee was established, the Secretary asked it to develop a proposed research budget for fiscal year 1992. The committee (members are listed in Appendix A) met three times between February and November 1990 and formed task groups, which met at other times and visited or interviewed by telephone personnel at VA medical centers. A report was issued in February 1991. Background The research program in VA is made up of three, administratively distinct services: Medical Research Service, Rehabilitation Research and Development Service, and Health Services Research and Development Service (HSR&D). Each plays a different role in VA medical centers and an explanation of the history and mission of each is useful in getting a perspective on VA's research efforts. VA's research program was developed as part of the post-World War II effort to upgrade patient care in the VA system by having VA hospitals affiliate with medical schools. This strategy was developed by Drs. Paul Hawley (Chief Medical Director 1945-1947) and Paul Magnuson (Chief of Research and Education, 1946-1948). Affiliated VA hospitals adopted the academic medical model in which physicians care for patients, teach medical students and residents, and engage in their own research. In short, VA medical centers that are affiliated with medical schools recruit clinicians who are appointed members of a medical school faculty. The role of the VA's medical research program in the VA/medical school partnership is to provide a special opportunity for research support to VA staff. VA's medical research program is an investment in recruitment and retention of academically oriented clinicians in VA. Its other main function is to advance the diagnosis and treatment of health problems prevalent among veterans. The union of recruitment with research opportunity enhances VA's ability to obtain the human resources needed to provide modern, quality care to veterans. of The Medical Research Service supports the research approximately 2,500 VA scientists, 75 percent of whom are physicians, with a budget of approximately $180,000,000. Research areas include medical, dental and psychiatric problems that are specific to the veteran population and general health problems that are particularly prevalent among veterans. Research projects of special interest to the health of veteran patients are conducted in such areas as schizophrenia, post-traumatic stress disorder, alcoholism, agent orange, aging, spinal cord injury and AIDS. The Rehabilitation Research and Development Service was developed after WWII, a direct response to the demands of disabled war veterans who sought improved prosthetic and orthotic devices and services. In fact, the rehabilitation research program was the first official VA research service, established in 1948. The current mission of VA rehabilitation research emphasizes efforts to improve the quality of life for disabled veterans in need of prosthetic devices, sensory aids and mobility assistance. The Health Services Research and Development Service is the newest VA research effort, formally established as a service in 1973. This program investigates factors relating to the existing organization, delivery, costs and outcomes of VA health care programs by supporting peer-reviewed research on issues related to the improvement of the quality, efficiency and cost-effectiveness of health care provided by VA. Its creation reflects the need for a VA research program to support the department's efforts to manage and deliver health care to veterans in the most cost-effective manner. This service has carried out projects for the Commission on Future Structure of Veterans Health Care, including the development of a comparative profile of users of the VA health care system and users of private sector health care. Examples of accomplishments cited in the committee report include showing the costeffectiveness of geriatric evaluation units in the care of elderly patients and a recent study demonstrating that many alcoholic patients requiring detoxification can be most cost-effectively treated as outpatients. HSR&D can provide VHS&RA with much information it needs to make policy decisions. The total appropriated research budget for fiscal year 1990 was approximately $212 million, more than 90% of which was expended in medical research. The chart below depicts the appropriated budget for each of the three services over the past 10 years. The research budget is supplemented by nonappropriated funds from a variety of sources, primarily grants, but also including contracts and donations. To receive appropriated dollars, an investigator or researcher must work at least 5/8 of the time at VA. This restriction does not apply to nonappropriated funds. Outside funding may be awarded to any VA investigator or researchers at affiliated universities who work with VA in some type of collaborative effort. The quality of VA's research program is shown by the significant amount of funding it is able to attract from outside sources. The source and amounts proportion of these funds to appropriations are shown in figures 2 and 3 below. Non-Appropriated VA Medical Research $'s |