Resources needed to enhance and develop health services research to improve the oral health status of the aging veteran in the Department of Veterans Affairs System.

Abstract

Health services research (HSR) in the Department of Veterans Affairs (VA) is one way in which to study the oral health care delivered to aging veterans and to ensure the most effective and efficient methods of meeting their oral health needs. This article details the current resources and infrastructure within VA dentistry that could be used to support a dental HSR agenda, followed by recommendations for improvements. The Department of Veterans Affairs' current situation regarding dental HSR is as follows: Dental health services research within VA needs expansion. Staff dentists have neither the training nor the incentives to conduct dental HSR. Dental clinic administrators are discouraged from being supportive of research due to the high clinical work-load requirements present at most dental services. Dental service affiliations with universities are not structured to support HSR. The HSR personnel outside of the dental services do not have the time nor the inclination to engage in dental HSR. Few recruitment and training initiatives are used to increase the number of VA dental health services researchers. Although funding sources exist that could be used to support dental HSR, the lack of trained and interested research personnel prevents full use. The Department of Veterans Affairs data collection in dentistry are inadequate to support dental HSR. If the required changes occur, VA is uniquely situated to be the largest contributor to dental HSR in the United States and to act as a catalyst for improving dental HSR throughout the nation. Recommendations for improvement of VA dental HSR are as follows: Restructure the Dental Activity System to include detailed diagnostic and treatment data as part of an integrated computerized patient record. Develop and implement a strategic plan with a detailed timeline for increasing dental HSR in VA. Recruit staff dentists with formal research training and provide them protected research time and resources to conduct meaningful research. Develop academic affiliations with centers of excellence in dental HSR. Develop full-time equivalent employee positions dedicated to research at the proposed Veterans Service Areas level. Develop incentives to increase collaboration with non-VA health services researchers in addressing VA issues. Develop dental HSR training programs modeled after the Career Development Program, Dental-Geriatric Fellowship, and Dentist-Scientist Programs that will permit VA to become a leader in dental HSR training. Develop mechanisms to ensure adequate and sustained funding for dental HSR projects. Ensure that dissemination techniques are effective and result in improvements in operational effectiveness and quality of care.