IHOPE
Who we are:
The IHOPE (Improving Health Outcomes & Patient Healthcare Experience) Team applies qualitative and quantitative scientific approaches to improve patient-centered outcomes. Our team is part of the Center to Improve Veterans Involvement in Care (CIVIC) at the Portland VA HCS. The main goal of CIVIC is to conduct rigorous and high-quality research with the goal of empowering Veterans to improve their health through engagement in self-care, engagement with VA and non-VA healthcare systems, and engagement in the research process. We collaborate with other CIVIC members, OHSU researchers, and many others. Our research projects include patients from multiple clinical settings including lung cancer screening, head and neck cancer, critical care, toxic exposures, and palliative care.
Overview
The Improving Health Outcomes & Patient Health-Care Experience (IHOPE) is a collaborative of clinical and health services researchers whose aim is to improve the overall quality of healthcare for patients with serious illness including pulmonary diseases, cancer, critical illness, end-of-life care, and toxic military exposure related conditions. We hope to accomplish this aim by using rigorous comparative effectiveness and mixed methods research methodologies to focus on improving patient-centered outcomes, enhancing patient-clinician communication, and identifying novel mechanisms of healthcare delivery for patients.
Mission
We perform research to understand how modifiable mechanisms, such as important domains of patient-centered communication and care delivery processes, influence patient-centered outcomes, such as quality of life and mental health.
We focus on patients who have or are at risk of serious illness such as cancer, pulmonary diseases, critical illness or conditions related to toxic military exposures.
The goal of our work is to identify interventions that can be developed and quickly implemented to improve patient-centered outcomes. We want to be recognized for our commitments to patient-centeredness, collegiality, collaboration, and critical thinking. Importantly, we will continually emphasize the privilege of working with patients and the joys of answering important questions.
Culture
We have a culture of scientific rigor and inclusivity. We want to increase inclusion of underrepresented people in medicine and health services research and help everyone successfully obtain their chosen career goals. We hold ourselves to the highest standards of scientific integrity.
To obtain these goals, we foster collaboration and collegiality. We encourage critical thinking, vigorous scientific debates, and do not tolerate discriminatory actions or words. We support staff and researchers in both their success and tribulations. We aim to accomplish these goals using a light-hearted approach whenever possible that recognizes that rewarding jobs are the only sustainable jobs.
Our home is in the VA Portland Health Care System’s Center to Improve Veteran Involvement in Care (CIVIC). We collaborate with many CIVIC investigators and teams on health services research projects and initiatives. We wholeheartedly endorse CIVIC’s mission to “conduct research that empowers Veterans to improve their health through engagement in self-care, engagement with VA and non-VA healthcare systems, and engagement in the research process”.
IHope Investigators
Sara Golden, PhD is a qualitative methodologist at the Center to Improve Veteran Involvement in Care at the VA Portland Health Care System and a research data analyst in the Division of Pulmonary, Allergy, and Critical Care Medicine at Oregon Health and Science University. Dr. Golden has a strong background in qualitative methods and mixed-methods studies, using these methods with the goal of improving care for patients with, and at risk, of lung cancer. Her research has primarily focused on patient-reported outcomes such as quality of life, patient-clinician communication, smoking cessation, and shared decision-making. You can contact Sara Golden by email at sara.golden1@va.gov
Shannon Nugent, PhD is an investigator at the VA Portland Healthcare System, Center to Improve Veteran Involvement in Care (CIVIC) and an Assistant Professor at Oregon Health and Science University in the Department of Psychiatry. Dr. Nugent is broadly interested in understanding and improving mental health outcomes among individuals with serious medical conditions. Her research interests are in the areas of palliative medicine, psychosocial oncology, chronic pain, evidence synthesis, and improving access to health care for older adults. She is a co-investigator on a VA HSR&D study that aims to qualitatively describe the health experiences of Gulf War Era Veterans. You can contact Shannon Nugent by email at Shannon.Nugent@va.gov
Christopher Slatore, MD, MS is a health services researcher and Professor at Oregon Health & Science University. Dr. Slatore is interested in the prevention, detection, treatment, and healthcare delivery for patients with tobacco-related lung diseases, chiefly lung cancer and chronic obstructive pulmonary disease (COPD). His research has focused on improving patient outcomes and identifying innovative approaches to treatment in these areas. You can contact Christopher Slatore by email at Christopher.Slatore@va.gov.
Donald Sullivan, MD, MA, MCR is an Associate Professor and health services researcher in the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine at Oregon Health and Science University, and affiliate physician-scientist at the Portland VA Medical Center, CIVIC. His primary research focus is on improving the quality of life and value of care among persons with serious respiratory illness integrating high-quality palliative and end-of-life care. This work includes projects developing resources to encourage shared decision-making among persons with lung cancer, their families, and clinicians; determining suicide risks among Veterans with cancer, and examining palliative care and hospice delivery models among persons with dementia. You can contact Donald Sullivan by email at sullivad@ohsu.edu.
Kelly C. Vranas, MD, is an Assistant Professor in the Division of Pulmonary and Critical Care at Oregon Health & Science University, a Staff Physician at the Portland VA Medical Center, and a Core Investigator at CIVIC. She is also a critical care health services researcher at CIVIC focused on improving the quality, efficiency, and value of critical care for Veterans hospitalized with acute respiratory failure through innovations in the care delivery process. Her research is focused on understanding how organizational factors and processes of care influence the outcomes of critically ill patients. You can contact Kelly Vranas by email at vranas@ohsu.edu
Research Staff:
Research Assistant I
Senior Clinical Research Assistant
Research Data Analyst
Senior Clinical Research Assistant
Research Assistant II
Research Assistant
Stephanie Unger, MA Senior Clinical Research Assistant
Biostatistician
Some of Our Research and Studies
Lung Cancer Screening for Veterans Enrolled in Community Care: Modifiable Mechanisms to Improve Patient-Centered Outcomes
PI: Christopher Slatore, MD, MS
Source: Dept. of Veterans Affairs, HSRD
This convergent, nested, mixed-methods study will evaluate how processes that are used by VA lung cancer screening programs and community care programs are associated with patient-centered outcomes, such as adherence, decisional regret, satisfaction, and smoking cessation resource utilization, especially those from rural settings. This project will identify key components that VA and non-VA LCS programs can utilize to improve these outcomes.
Teachable Moment to Opt-Out of Tobacco (TeaM OUT): A Stepped Wedge Cluster Randomized Trial
PI: Christopher Slatore, MD, MS
Source: Dept. of Veterans Affairs, HSRD
This project evaluates a pragmatic, proactive, low-cost solution, that takes advantage of a naturally occurring teachable moment, which has the potential to increase smoking abstinence in Veterans as well as provide generalizable results for patients in multiple settings and situations.
Improving Decision-Making Encounters in Lung Cancer: Development of a Low-literacy Conversation Tool (iDECIDE)
PI: Donald Sullivan, MD
Source: ACS
This stepped wedged, randomized trial focuses on the development and determining the effectiveness of a low-literacy conversation tool to improve patient-centered and decisional outcomes among patients participating in lung cancer treatment-related decisions to engage the clinical team in high-quality shared decision making.
Understanding and Improving Palliative Care Delivery among Persons with Alzheimer’s Disease and Related Dementias (ADRD)
PI: Donald Sullivan, MD
Source: NIH/NIA (Pending)
This proposal investigates the role of hospice and palliative care to improve the quality of end-of-life care by leading to fewer treatments before death likely to cause distress, discomfort, pain, and time away from home and loved ones. This work has the potential to improve the quality of end-of-life care and substantially impact future clinical and policy interventions among those with Alzheimer’s disease and related dementias.
Promoting Advance Care Planning Using a Prognosis and Outcome Information Sheet among Persons with Advanced Dementia in Long Term Services and Support Facilities
PI: Donald Sullivan, MD
Source: NIH/NIA
The goal of this mixed-methods study is to develop, refine, and pilot test an education information sheet to promote advanced care planning (ACP) among families of persons with dementia (PWD).
Temporal Trends & Clinical Factors Associated with Suicide Risk among Veterans with Cancer: A Retrospective Cohort Analysis
PI: Donald Sullivan, MD
Source: Dept of Veterans Affairs
As the first national study of suicide deaths and attempts among Veterans with cancer including pandemic-related associations, this study identifies a high-risk group of Veterans for death by suicide as well as potentially modifiable risk factors leading to the creation of future evidence-based interventions among Veterans with cancer. The goal of this study is to identify temporal trends and a high-risk group of Veterans for death by suicide and suicide attempts as well as potentially modifiable risk factors.
Optimizing Critical Care for Patients with Acute Respiratory Failure: A Mixed-Methods Study
PI: Kelly Vranas, MD
Source: Dept. of Veterans Affairs
The goal of this study is to identify modifiable organizational characteristics and care processes associated with efficient, high-quality critical care. It will also lead to the development and testing of triage strategies for patients with acute respiratory failure that are sensitive to hospital-specific environments and tailored to different risk groups.
Harnessing Active Relationships within VA ICUs to Engage Surrogates and Care Teams (HARVEST)
Co-PI: Kelly Vranas, MD
Source: Dept. of Veterans Affairs
This study uses the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to understand current family-centered care practices across VA ICUs; identify barriers/enablers to routine delivery of family-centered care practices; and prioritize strategies that promote their use based on the values and preferences of key stakeholders. Our central hypothesis is that current practices vary widely and are not tailored to the specific needs of Veterans and their families.
Evaluating Patient-Centered Outcomes Among Veterans with Critical Illness who Undergo Tracheostomy (EPOCH)
PI: Kelly Vranas, MD
Source: Dept of Veterans Affairs
The goal of this study is to describe the clinical characteristics of Veterans who undergo tracheostomy, determine factors associated with its receipt, and evaluate patient-centered outcomes among Veterans who undergo tracheostomy placement.
Survivors of Head and Neck Cancer: Optimizing Pain Management
Co-PI: Shannon Nugent, PhD
Source: ACS
The goal of this study is to use a telehealth pain and symptom management intervention to target improvement of pain-related physical functioning, mood and quality of life in a sample of individuals who have undergone treatment for head and neck cancer.
Assessing Benefits and Harms of Cannabis Use in Patients Treated with Immunotherapy for Cancer: A Prospective Cohort Study
PI: Shannon Nugent, PhD
Source: NIH (NCI)
The purpose of this research is to assess how patients with cancer being treated with Immune Checkpoint Inhibitors (ICI) manage symptoms related to cancer and/or its treatment. Patients use a variety of ways to manage symptoms including traditional and alternative treatments including cannabis, acupuncture, etc. This research will have an important impact on our knowledge of cancer symptom management and ultimately improve patient care and safety.