Veterans Affairs Research Research Articles

Experiences and lessons learned from a patient-engagement service established by a national research consortium in the U.S. Veterans Health Administration.

Meaningful engagement of patients in the research process has increased over the past 20 years. Few accounts are available of engagement infrastructure and processes used by large research organizations. The Pain/Opioid Consortium of Research (Consortium) is a U.S. Department of Veterans Affairs (VA) research network that provides infrastructure to accelerate health research and implementation of evidence-based health care. The Consortium's key activities include facilitating Veteran-engaged research and building community between Veterans and VA researchers. This report sought to describe experiences and lessons learned from the first 3 years of a national research engagement service, featuring a Veteran Engagement (VE) Panel, established by the Consortium. We gathered authors' experiences to describe development and operation of the Consortium's VE Panel. Engagement staff collected program evaluation data about partners (Veterans and researchers), projects about which the VE Panel consulted, and meeting attendance during operation of the engagement service. We created a 12-member VE Panel; all of whom had lived experience with chronic pain, prescription opioid medication use, or opioid use disorder. Engagement staff and VE Panel members implemented an engagement service operational model designed to continuously learn and adapt. The panel consulted on 48 projects spanning the research process. Seventy-eight percent of panel members, on average, attended each monthly meeting. VE Panel members and participating researchers reported high satisfaction with the quality, ease, and outcomes of their engagement service experiences. This work provides an illustrative example of how a national research consortium facilitated Veteran-engaged research and built community between Veterans and VA researchers by developing and operating an ongoing engagement consulting service, featuring a VE Panel. The service, designed as a learning community, relied on skilled engagement staff to cultivate high quality experiences and outcomes for all partners.

Evaluating the impact of translational research enrollment on the patient care experience of Veterans with prostate cancer who receive care through the Veterans Affairs (VA) healthcare system.

e23210 Background: Veterans with cancer represent a unique subset of patients with distinct exposure histories and cancer epidemiology. Translational research studies that incorporate Veteran-derived biospecimens are therefore critical to advance our understanding of Veteran cancer biology and improve treatment options for Veterans with cancer. Biospecimen-based translational studies also offer an opportunity to enhance the Veteran care experience by enabling Veterans to directly contribute to cancer research efforts. While the biologic benefits of biospecimen research have been well established, the benefit of translational research on the Veteran care experience has yet to be defined. In this study, we evaluated: 1. Whether Veteran enrollment in a biospecimen-based prostate cancer research study improved their VA patient care experience and satisfaction and 2. Whether a VA-based data analyst tool could be used to optimize patient enrollment in translational research studies. Methods: Beginning in January, 2022, Veterans with a diagnosis of prostate cancer receiving care at the William S. Middleton VA were enrolled in a translational research study that collected blood and tissue biospecimens for subsequent investigation and analysis. After at least 30 days of enrollment, subjects were sent an anonymous survey inquiring about how participation in the translational research study impacted their VA care experience and healthcare satisfaction. To optimize enrollment in the study, an ICD-9 code search function was employed within the medical record database to readily identify eligible VA clinic patients based on an active prostate cancer diagnosis. Descriptive analyses were performed using Prism statistical software. Results: Nearly all Veterans who responded to the questionnaire agreed that participation in translational research was a meaningful experience that increased their satisfaction with their VA medical care. In addition, a vast majority of Veterans surveyed felt that their research participation could help improve care for other Veterans, and most expressed willingness to participate in future VA research opportunities. In a secondary analysis, our ICD-9 search function accurately identified eligible VA clinic patients with a prostate cancer diagnosis, and implementation of this tool has saved approximately 30 minutes of weekly physician and research coordinator work compared to manual chart review. Conclusions: Veteran enrollment in translational research studies provides a meaningful experience for Veterans that can lead to increased satisfaction with the VA healthcare system. Future VA initiatives to improve the Veteran care experience should focus on expanding translational research opportunities for Veterans as well as addressing potential barriers to enrollment.

Estrogen Signaling Modulation Prevents and Even Reverses Skeletal Muscle Fibrosis

Background: Skeletal muscle fibrosis represents accumulation of extracellular matrix (ECM), often leading to muscle weakness and atrophy. Notably, lower abdominal muscle (LAM) fibrosis and atrophy cause inguinal herniation—a prevalent condition lacking pharmacological treatment. We developed a herniation mouse model, Aromhum, characterized by spontaneous scrotal hernias due to local estradiol (E2) production within LAM as well as hernia-associated fibroblasts (HAFs) that express platelet-derived growth factor alpha (PDGFRA) and estrogen receptor alpha (ESR1). Objectives & Hypothesis: Our objective was to investigate the mechanism of ESR1 signaling on LAM HAFs and subsequent development of hernias. Methods: We manipulated estrogen signaling in two ways: first, we generated fibroblast-specific estrogen receptor alpha knockout mice (fEsr1−/−-Aromhum) capable of local E2 production but incapable of signaling through ESR1 (n = 5-10 mice/group). Second, we blocked E2 signaling pharmacologically using the potent ESR1 antagonist fulvestrant (0.15mg/kg, 90 days, n=10-15 mice/group). We conducted in vitro experiments on primary LAM HAFs exposed to 10nM E2 ± 100nM Fulvestrant (24-48h). These cells underwent analysis via ESR1 ChIP, ATAC, and RNA-seq in 3 technical replicates (3-5 mice each). Additionally, to demonstrate clinical relevance, we probed human herniated LAM tissues from patients (n=25 samples, 21-76 years). Results: All Aromhum mice develop scrotal hernias by 6 weeks. However, fEsr1−/−-Aromhum mice did not develop hernias, while littermate controls exhibited hernias. Thus, HAF ESR1 depletion mitigated LAM fibrosis and atrophy. Similarly, administering fulvestrant prior to hernia onset prevented hernia development. Remarkably, fulvestrant treatment in mice that had developed large scrotal hernias (>200mm2) led to complete hernia regression with reversed muscle fibrosis and fiber atrophy (collagen levels comparable to wild-type mice). In vitro HAF culturing and subsequent multiomic analyses unveiled a core set of 58 genes directly influenced by E2/ESR1, including crucial ECM genes like fibulins ( Fbln5, Fbln7), metalloproteases ( Adamts3, Adamts6), and signaling molecules ( Ltbp1, Ncam1, Piezo2). Pathways such as TGFβ, WNT, and N-Glycan biosynthesis were significantly upregulated by E2. Human herniated LAM tissues exhibited substantial fibrosis, along with stromal HAF markers PDGFRA and ESR1. We also validated expression of the core E2-modulated genes in human LAM tissues ( NCAM1, LTBP1, ADAMTS6, PIEZO2). Collectively, these findings provide compelling evidence of ESR1 pathway activation and downstream gene involvement in both Aromhum scrotal hernias and human inguinal hernias. Conclusion: Our research underscores the central role of E2 in skeletal muscle fibrosis. Notably, we demonstrated that fibrosis can be entirely reversed by modulation of ESR1 signaling. Our study offers valuable insights into downstream genes and pathways that may serve as therapeutic targets for inguinal hernias and other fibrotic disorders. Funding: NIH: R01DK121529, Department of Veterans Affairs Research Career Scientist Award: IK6 RX003351. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

VA Big Data Science: A Model for Improved National Pandemic Response Present and Future.

The US Department of Veterans Affairs (VA) enterprise approach to research (VA Research) has built a data-sharing framework available to all research teams within VA. Combined with robust analytic systems and tools available for investigators, VA Research has produced actionable results during the COVID-19 pandemic. Big data science techniques applied to VA's health care data demonstrate that medical research can be performed quickly and judiciously during nationwide health care emergencies. We envision a common framework of data collection, management, and surveillance implemented in partnership with other health care agencies that would capture even broader, actionable, and timely observational data on populations, while providing opportunities for enhanced collaborative research across agencies. This model should be continued and expanded through the current COVID-19 and future pandemics. Extending the achievements of VA Research in the COVID-19 pandemic to date, we advocate national goals of open science by working toward a synergistic national framework of anonymized, synchronized, shared health data that would provide researchers with potent tools to combat future public health crises.

The VA Research Enterprise: A Platform for National Partnerships Toward Evidence Building and Scientific Innovation.

Within a year of the start of the COVID-19 pandemic, the US Department of Veterans Affairs (VA) was managing about 300 COVID-19-related research projects across roughly 100 facilities, which has since grown to more than 900 projects. This robust set of activities arose from an existing enterprise strategy and aimed at identifying needs for supporting the clinical care mission, more rapidly leveraging resources, and coordinating research across the VA. The VA's efforts to implement an enterprise strategy before March 2020 positioned its research community to dynamically partner with other federal agencies, academic institutions, and industry in addressing a national public health emergency. The VA research enterprise involves a broad range of functions, scientific and clinical leaders, and organizational resources to enhance the health and care of veterans and the nation. The scope of research activities enables it to support its priorities while also partnering with others who share in mutual commitments to veteran health. Moving toward being the nation's learning health care system, the VA's leadership support, staff, patient volunteers, and partners were key contributors to a national response to COVID-19. Swift action and consistent communication helped address the complexities of the pandemic and strengthened the VA's ability to prepare and mobilize for emergencies and other potential disease outbreaks. Documenting strategies and practices can enhance future opportunities aimed at addressing the most challenging health care needs while also focusing on the primary mission to serve veterans. The COVID-19 pandemic contributed to critical knowledge and lessons that enabled the VA to advance enterprise goals, particularly in the context of its health care system. Sharing these unique processes and experiences will inform current and future partnerships among research, clinical, and public health communities oriented to serve veterans and the nation through scientific innovation.

A Clinician's Roadmap to the Research and Data Acquisition Process Within the Veterans Health System.

Objective Identify and address potential obstacles to initiation of older population-related research within the NF/SG VHS through the provision of a concise flowchart. Setting North Florida/South Georgia Veterans Health System (NF/SG VHS). Practice Description The Department of Veterans Affairs (VA) Research Service with connection to the University of Florida facilitates research that contributes to improving the delivery of inpatient/outpatient care to veterans and their families. Practice Innovation A compendium of a senior care pharmacist's experiences will be compiled and reviewed by other specialists within the field while attempting to submit research protocols for publication within the VHS through the use of data platforms such as VINCI (VA Informatics and Computing Infrastructure) and the Corporate Data Warehouse. Main Outcome Measurements Impact of navigating research websites affiliated with and directly pertaining to the NF/SG VHS upon clinicians attempting to begin research processes within the institution. Results It was determined that for the most expeditious publication experience to result the following six steps had to be pursued sequentially: VA Institutional Review Board (IRB) Net documentation/ submission, local myIRB submission, Data Access Request Tracker/VINCI access request, setup of VINCI workspace, drafting of VINCI cohort specification, data analysis and tracking, statistical methods, abstract, and manuscript production. Conclusion This study outlines a consistent/clear method from first-hand experiences on how to navigate, more efficiently, complex research processes to produce successful future impacts on patient care.

A clinician/researcher partnership to understand patterns and predictors of trauma-focused psychotherapy and nontrauma-focused psychotherapy use among veterans with PTSD.

Post-traumatic stress disorder (PTSD) is common in veterans, and trauma-focused evidence-based psychotherapies (TF-EBP) have the strongest evidence for reducing PTSD and improving functioning. However, most veterans with PTSD do not receive TF-EBP. Extensive research focuses on why this gap between scientific recommendations and clinician practice exists. This study adds an unique perspective by reporting on a program evaluation that was jointly designed and implemented by Veterans Affairs researchers and PTSD Clinic providers to increase shared understanding about patterns and predictors of TF-EBP and non-TF-EBP use and interpret results in light of clinic contextual factors. The evaluation describes the psychotherapy utilization patterns of 242 veterans' who were referred to the PTSD clinic and investigates what patient characteristics predict psychotherapy use over the next year. Most veterans (87%) received psychotherapy: 27% received at least one session of TF-EBP and 14% received an adequate dose of TF-EBP. Veterans who started TF-EBP were significantly more likely to receive eight sessions compared to veterans getting non-TF-EBP. Core PTSD symptoms predicted more psychotherapy use, while negative beliefs about oneself/the world predicted less psychotherapy use. Clinicians were more likely to recommend TF-EBP when veterans endorsed feeling guilt/shame in reaction to their emotions. Referral from integrated primary care-mental health providers rather than specialty mental health providers predicted more overall psychotherapy sessions. Clinicians interpret results in line with contextual factors that promote delivery of non-TF-EBP. More clinician engagement in the research process can improve the clinical relevance of research and help bridge the gap between scientific and practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

VA Research and Operations Uniting to Combat COVID-19 Inequities.

As novel coronavirus 2019 disease (COVID-19) began to spread across the United States in early 2020, health care systems faced extreme demands on resources. As the country's largest single-payer health care system, the U.S. Department of Veterans Affairs (VA) was uniquely positioned to study how the virus impacted different communities and work to improve care provided to all. Early on, a literature review of prior epidemics revealed that occupational exposures and an inability to socially distance could impact some groups more than others. The VA's Office of Health Equity leveraged a general sense of community to create a collaborative research space and a dedicated analytic space to inform pandemic operations. VA researchers and operations staff were able to quickly share information and respond to updates to produce accurate and reliable publications for medical professionals and the general public. Partnerships with VA Medical Centers and Veteran Service Organizations helped to increase communication across the nation and determine the most critical needs. Although COVID-19 was dynamic in nature, VA's intentional examination of social and structural factors was crucial in informing a more equitable approach. Moving forward, these inequities must be intentionally addressed in future pandemic responses.

Validation of algorithms to select patients with multiple myeloma and patients initiating myeloma treatment in the national Veterans Affairs Healthcare System.

We aimed to evaluate and compare the performance of multiple myeloma (MM) selection algorithms for use in Veterans Affairs (VA) research. Using the VA Corporate Data Warehouse (CDW), the VA Cancer Registry (VACR), and VA pharmacy data, we randomly selected 500 patients from 01/01/1999 to 06/01/2021 who had (1) either one MM diagnostic code OR were listed in the VACR as having MM AND (2) at least one MM treatment code. A team reviewed oncology notes for each veteran to annotate details regarding MM diagnosis and initial treatment within VA. We evaluated inter-annotator agreement and compared the performance of four published algorithms (two developed and validated external to VA data and two used in VA data). A total of 859 patients were reviewed to obtain 500 patients who were annotated as having MM and initiating MM treatment in VA. Agreement was high among annotators for all variables: MM diagnosis (98.3% agreement, Kappa=0.93); initial treatment in VA (91.8% agreement; Kappa=0.77); and initial treatment classification (87.6% agreement; Kappa=0.86). VA Algorithms were more specific and had higher PPVs than non-VA algorithms for both MM diagnosis and initial treatment in VA. We developed the "VA Recommended Algorithm," which had the highest PPV among all algorithms in identifying patients diagnosed with MM (PPV=0.98, 95% CI=0.95-0.99) and in identifying patients who initiated their MM treatment in VA (PPV=0.93, 95% CI=0.90-0.96). Our VA Recommended Algorithm optimizes sensitivity and PPV for cohort selection and treatment classification.

How the VA is training the Next-Generation workforce for learning health systems.

ObjectivesThe U.S. Department of Veterans Affairs (VA) has been a national leader in Learning Health System (LHS) implementation due to its combined mission of research, education, clinical care, and emergency preparedness. We describe the current VA LHS training ecosystem within the Veterans Health Administration's Office of Academic Affiliations (OAA), Office of Research and Development (ORD), ORD's Health Services Research and Development (HSR&D) program, and Innovation Ecosystem (IE), including lessons learned regarding their sustainment.MethodsThe VA LHS training ecosystem is based on the Learning Loop and HSR&D Quality Enhancement Research Initiative (QUERI) Roadmap, which describes VA learning opportunities, underlying infrastructures, and core competencies.ResultsVA‐focused LHS educational programs include data‐to‐knowledge initiatives in health sciences and analytics, for example, OAA/HSR&D health services and informatics research fellowships; knowledge‐to‐performance opportunities in implementation and quality improvement, for example, QUERI Learning Hubs and IEs' Diffusion of Excellence Initiative; and performance‐to‐data embedded opportunities, for example, IE's entrepreneur fellowship programs and QUERI's Advancing Diversity in Implementation Leadership. These training programs are supported by combined VA research and clinical operations investments in funding, informatics, governance, and processes. Lessons learned include ongoing alignment of research funding with operational priorities and capacity, relentless recruitment and retention of implementation, system, and information scientists especially from under‐represented groups, sustainment of data infrastructures suitable for research and quality improvement, and ensuring sustainable funding opportunities for researchers to work on system‐wide health care problems.ConclusionsThere is an urgent need to expand training opportunities in LHSs, especially as health care is increasingly driven by multiple interested parties, impacted by persistent health disparities exacerbated by emerging public health threats, and rapid technology growth. With ongoing alignment of research and clinical goals, foundational support through research funding, underlying clinical operations infrastructures, and active engagement interested parties, VA's LHS training ecosystem promotes a more LHS‐savvy, 21st century workforce.

Valuing the Partnership Between the Veterans Health Administration and Academic Medicine.

Valuing the Partnership Between the Veterans Health Administration and Academic Medicine.

Aligning quality improvement efforts and policy goals in a national integrated health system.

To describe the design and impact of a systematic, enterprise-wide process for engaging US Department of Veterans Affairs (VA) leadership in prioritizing scarce implementation and evaluation resources. From 2017 to 2021, the VA Quality Enhancement Research Initiative (QUERI) identified priorities from local, regional, and national leaders through qualitative discussions and a national survey and tracked impacts via reports generated from competitively funded initiatives addressing these priorities. Guided by the Learning Health System framework and QUERI Implementation Roadmap, QUERI engaged stakeholders to nominate and rank-order priorities, peer-reviewed and funded initiatives to scale up and spread evidence-based practices (EBPs) using theory-based implementation strategies, and evaluated the impact of these initiatives using the QUERI Impact Framework. QUERI collected priority nominations through qualitative discussions and a web-based survey, and live voting was used to rank-order priorities. QUERI-funded teams regularly submitted progress reports describing the key activities, findings, and impacts of the quality improvement (QI) initiatives using a standardized form created in the VA Research Electronic Data Capture (REDCap). QUERI launched five QI initiatives to address priorities selected by VA leadership. In partnership with 28 health system leaders, these initiatives are implementing 10 EBPs across 53 sites, supporting 1055 VA employees in delivering evidence-based care. The success of these initiatives led to an expansion of QUERI's process to address 2021 VA leadership priorities: virtual care, health disparities, delayed or suppressed care due to COVID-19, employee burnout, long-term and home care options, and quality and cost of community care. QUERI, a unique program embedded in a national integrated health system, deployed a novel approach to inform policy making and enhance the real-world impact of research through prioritization of limited resources, rigorous peer-review, and assessment of impacts on the health system, employees, and Veterans.

Editorial introductions.

Editorial introductions.

Partnership Forum: The Role of Research in the Transformation of Veterans Affairs Community Care.

Partnership Forum: The Role of Research in the Transformation of Veterans Affairs Community Care.

Learning health systems: Driving real-world impact in mental health and substance use disorder research.

The Veterans Health Administration (VHA), under the U.S. Department of Veterans Affairs (VA), is one of the largest single providers of health care in the U.S. VA supports an embedded research program that addresses VA clinical priorities in close partnership with operations leaders, which is a hallmark of a Learning Health System (LHS). Using the LHS framework, we describe current VA research initiatives in mental health and substance use disorders that rigorously evaluate national programs and policies designed to reduce the risk of suicide and opioid use disorder (data to knowledge); test implementation strategies to improve the spread of effective programs for Veterans at risk of suicide or opioid use disorder (knowledge to performance); and identify novel research directions in suicide prevention and opioid/pain treatments emanating from implementation and quality improvement research (performance to data). Lessons learned are encapsulated into best practices for building and sustaining an LHS within health systems, including the need for early engagement with clinical leaders; pragmatic research questions that focus on continuous improvement; multi‐level, ongoing input from regional and local stakeholders, and business case analyses to inform ongoing investment in sustainable infrastructure to maintain the research‐health system partnership. Essential ingredients for supporting VA as an LHS include data and information sharing capacity, protected time for researchers and leaders, and governance structures to enhance health system ownership of research findings. For researchers, incentives to work with health systems operations (e.g., retainer funding) are vital for LHS research to be recognized and valued by academic promotion committees.

Big Data in the Veterans Health Administration: A Nursing Informatics Perspective.

This article reviews the missions of the U.S. Department of Veterans Affairs (VA) and the evolution of its electronic health record (EHR), the Veterans Health Information Systems and Technology Architecture (VistA). This system, along with its clinical graphical user interface the Computerized Patient Record System, form a key link in VA health care. A Veteran who receives healthcare through the VA can have their EHR accessed by clinicians at any VA healthcare facility across the United States and its territories. Data aggregated daily at a corporate data warehouse supports VA quality improvement and research. Serving over 9 million Veterans, the VA is one of the largest integrated healthcare systems in the United States. It has been a leader in the development and use of healthcare informatics, EHR, and big data analytics for over 30 years. Nurses engaged in major roles in the evolution of these developments. With over 500 nurses as members, the Office of Nursing Informatics' Field Alliance demonstrates the VA's continuing commitment to fostering nursing informatics. The commitment includes investment by the VA to develop nursing informaticists from among its own staff. Exemplars of the impact of nursing informatics are shared. Future directions include an EHR that begins during military service and follows the Veteran into VA health care.

Enhancing Health Care in the Veteran Community Through Synergistic Research Funding.

The veteran population faces myriad health burdens, particularly regarding mental health. As veterans age, combined genetic, environmental, and biochemical factors with natural biological processes may increase their susceptibility to mental health disorders as well as neuropsychiatric and dementia-related disorders that present as persistent cognitive impairment. Multi-organizational, multidisciplinary research partnerships help explore relevant evidence-based methodologies and create a two-way continuum between basic science and clinical application to address veterans', often complex, health care needs. The Congressionally Directed Medical Research Programs (CDMRP), a global funding organization located within the U.S. Army Medical Research and Development Command (USAMRDC), fosters novel approaches to biomedical research in response to the expressed needs of stakeholders and, as directed by Congress, many CDMRP programs focus on topics that are relevant to the health care of veterans. The CDMRP's foundation as a research management organization includes a two-tier review process and fully integrates consumer advocates. The CDMRP complements the U.S. Department of Veterans Affairs (VA) research through collaborative partnerships and synergistic award mechanisms tailored to areas of greatest need. Continued partnerships between the VA and CDMRP can facilitate translation of basic research to clinical application and enhance health care in the veteran community. This perspective highlights the need for research to address mental health issues affecting the veteran community, describes how the CDMRP integrates veterans into its processes, and discusses how the CDMRP's processes and collaborations with the VA have the capacity to improve mental health care for veterans.

The Precision Oncology Program for Cancer of the Prostate (POPCaP) Network: A Veterans Affairs/Prostate Cancer Foundation Collaboration.

The promise of precision oncology only can be realized when genetic alterations are identified that can be lever-aged to improve response and minimize toxicity. Identifying those alterations as efficiently as possible and then giving patients access to targeted therapy and clinical study requires a comprehensive strategy across health care systems. The US Department of Veterans Affairs (VA) and Prostate Cancer Foundation have established a network of VA centers to help develop best practices for precision oncology for the treatment of veterans with advanced prostate cancer. This article describes the genesis and structure of this network and its potential for contributing to care and research in the VA and the health care system as a whole. The Precision Oncology Program for Cancer of the Prostate network and its partnership with VA clinical and research efforts is anticipated to provide important insights into barriers and solutions to the implementation of precision oncology for prostate cancer across the VA.

Racial disparities in positive airway pressure therapy adherence among veterans with obstructive sleep apnea.

Black individuals are disproportionately affected by diabetes, cardiovascular disease, obesity, and OSA. Adherence to PAP therapy has been reported to be lower among black individuals. This study seeks to examine associations between black race and PAP adherence among veterans with OSA. This was a retrospective study. Veterans newly diagnosed with OSA at a single Department of Veterans Affairs sleep center who were prescribed a modem-enabled PAP device between January 2015 and November 2017 were enrolled. PAP adherence was defined as ≥ 4 hours nightly usage for at least 70% of nights measured at 30 days from PAP setup. We examined the relationship between race and adherence, controlling for sex, marital status, age, socioeconomic status, residual apnea-hypopnea index), and mask leak. Of 3013 patients identified with OSA, 2571 (85%) were newly started on PAP therapy (95% male, aged 59 years ± 14 years, 45% married, 8% with neighborhood socioeconomic disadvantage). Twenty-five percent of participants were black, and 57% were white. PAP adherence at 30 days was 50% overall (42% among blacks, 53% among nonblacks). Black race was associated with reduced 30-day PAP adherence in unadjusted (P < .001) and adjusted logistic regression models (odds ratio = 0.64; 95% CI, 0.53 - 0.78; P < .001). Among veterans with OSA, black race was associated with reduced PAP adherence. These findings suggest health inequality among black individuals in the treatment of OSA.

Research translation for military and veteran health: research, practice, policy.

Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National Institutes of Health, and affiliated universities. Key themes and recommendations for research translation are outlined in areas of: (a) stakeholder engagement and collaboration; (b) implementation science methods; and (c) funding along the translation continuum. Overall, the ability to rapidly translate research into clinical practice and policy for positive health outcomes requires collaborative relationships among many stakeholders. This includes servicemembers, veterans, and their families along with researchers, health care clinicians, and administrators, as well as policymakers and the broader population.