Substance Abuse State of the Art Conference Greenville Nc

State of the Art (SOTA) Conferences

SOTAs join an invited multidisciplinary group of VA and non-VA experts to:

• Synthesize what we know and what we demand to know about topics critical to the wellness and well-being of veterans;
• Promote implementation of findings that improve quality of care; and
• Contribute to more constructive management and more relevant research.

Papers are commissioned prior to the conference and are provided to the briefing participants, who work to move the knowledge base forward.

A diversity of mail service-briefing products are developed to disseminate the conference findings and recommendations throughout the VA organisation, and frequently to the non-VA health care community.

Contact
Karen Bossi, MA
Portfolio and Special Projects Coordinator
Email: Karen.Bossi@va.gov
Phone: 857-364-5690

Past State of the Art (SOTA) Conferences

• SOTA XVI: Country of the Art Conference on VA Emergency Medicine (Relieve)
• SOTA XV: Constructive Management of Hurting and Addiction: Strategies to Improve Opioid Condom
• SOTA Fourteen: Intendance Coordination
• SOTA XIII: Non-pharmacological Approaches to Chronic Musculoskeletal Hurting Management
• SOTA XII: Weight Management
• SOTA Eleven: Next Generation Clinical Functioning Measures
• SOTA X: Access
• SOTA Nine: Traumatic Brain Injury Research
• SOTA VIII: Managing Complexity in Chronic Care
• SOTA VII: Implementation
• SOTA VI:Long-term Care
• SOTA V: Informed Consent
• SOTA IV: Organizational Transformation
• SOTA Three: Applied science Assessment
• SOTA II: Databases
• SOTA I: Long-Term Intendance

SOTA Sixteen: Country of the Art Conference on VA Emergency Medicine (Relieve)

January - February 2022 (virtual)

Goals

1. To summarize what we know and need to know about evidence-based emergency medicine care, specifically addressing:
• Emergency Intendance for Acute Mental Health Weather (e.thou., suicide prevention, substance employ disorder, access: telehealth, transfer, timely mental health care)
• Emergency Care for Older Veterans (eastward.g., polypharmacy/medication safety, delirium recognition, falls adventure assessment, effective models of geriatric emergency intendance)
• Emergency Intendance Provided in the Customs (e.thousand., quality/costs of customs care, impact of expanded access to community urgent care [MISSION Act] and patterns of use)
2. To identify bear witness-based approaches set up for wider dissemination and implementation, including identification of barriers and approaches for overcoming barriers
3. To place a inquiry agenda that can lead to increasing use of evidence-based approaches in emergency medicine and to make recommendations for policy every bit appropriate
4. To disseminate SOTA findings and recommendations

Outcomes:

The VA Prove Synthesis Program conducted several show reviews to inform discussions at the conference:

Evidence Compendium: Effectiveness of Mental Wellness Interventions in the Emergency Department (intranet - https://vaww.hsrd.research.va.gov/publications/esp/mental-health-interventions-compendium.cfm)

Bear witness Map: Implementation Factors Influencing the Transition from Emergency to Outpatient Care Settings

Show Inventory: Emergency Department-based Geriatric Risk Cess (awaiting)

Show Inventory: Emergency Section-based Telehealth Interventions for Older Adults (pending)

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SOTA Xv: Opioid Condom

September xi-12, 2019

Goals:

1. Reach consensus on policy recommendations to improve management of hurting and addiction and better opioid condom

a. Where is the evidence sufficient to move to implementation?

2. Accomplish consensus on recommendations for research calendar

a. What of import questions exercise not have sufficient evidence to guide practice and clinical policy?

3. Prioritize bug for future consideration

a. What problems or new developments are on the horizon that may need to be considered in research, planning, and policy?

Outcomes:

• The VA Evidence Synthesis Program conducted three evidence reviews to inform discussions at the briefing and three related cyberseminars:
• Barriers and Facilitators to Employ of Medications for Opioid Use Disorder (report)
• Cyberseminar
• Benefits and Harms of Long-term Opioid Dose Reduction or Discontinuation in Patients with Chronic Pain (report)
• Cyberseminar
• Managing Acute Pain in Patients with Opioid Use Disorder on Medication-assisted Treatment (study)
• Cyberseminar
• Workgroup slides:
  • Workgroup 1: Managing Opioid Use Disorder
  • Workgroup 2: Long-term Opioid Therapy and Tapering
  • Workgroup iii: Managing Co-Occurring Chronic Pain and Substance Apply Disorders
• Briefing of conference policy recommendations to Mental Health leadership.
• A special supplement to the Journal of General Internal Medicine was published in Dec 2020.

  Table i Implementation and Policy Recommendations
  From: Implementation and Policy Recommendations from the VHA Country-of-the-Art Conference on Strategies to Better Opioid Safety

  Goal	Specific recommendations
  Managing opioid use disorder
  1. Increase admission to MOUD	Provide aforementioned-day access to MOUD at every VHA facility and support medical management of OUD across clinical settings Ensure that psychosocial treatment is bachelor just non a pre-requisite for medication treatment Analyze regulations around tele-prescribing of MOUD Mandate overdose upshot reporting with the Suicide Behavior and Overdose Written report and require timely follow-upwardly post-obit an overdose
  2. Improve provider noesis and comfort to provide MOUD	Develop national SUD consultation program modeled after existing VHA programs in PTSD and suicide run a risk management Disseminate provider and patient educational resources
  three. Improve fidelity to evidence-based models of MOUD	Standardize monitoring of substance use during OUD handling Supersede authoritative discharges for substance use with evidence-based treatment of co-occurring SUDs
  Long-term opioid therapy and opioid tapering
  i. Support evidence-based, patient-centered approaches to opioid therapy and opioid tapering	Avoid initiation of high-dose long-term opioid therapy for chronic pain Individualize assessment of risks and benefits and individualize implementation of opioid dose reduction Align advice about VHA policy for Veterans, their families/caregivers, healthcare teams and leadership
  2. Provide system-wide access to squad-based care	Offer multidisciplinary care with more frequent follow-upwards during opioid dose reduction
  3. Ensure access to assessment and treatment for OUD	Recommend against abrupt discontinuation of opioid medications due to business concern for OUD without facilitating transition to OUD treatment
  Managing co-occurring pain and substance use disorder
  1. Improve access to evidence-based non-pharmacologic treatments	Disseminate evidence-based combined psychological interventions for co-occurring disorders Disseminate show-based interventions for chronic hurting (e.yard., cognitive behavioral therapy, movement therapies)

  * MOUD, medications for opioid use disorder; OUD, opioid use disorder; PTSD, post-traumatic stress disorder; SUD, substance utilise disorder; VHA, Veterans Health Assistants

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SOTA 14: Intendance Coordination

March 20-21, 2018

Goals:

ane. To summarize what we know and need to know about care coordination specifically addressing:

• Coordination of Care inside VA
• Coordination of Care from VA to not-VA intendance
• Measures, Models, and Definitions

2. To identify approaches ready for wider dissemination and implementation, including identification of barriers and approaches for overcoming barriers

3. To place a research agenda that tin lead to increasing use of evidence-based approaches to coordination of care and to brand recommendations for policy as appropriate

Outcomes:

• The VA Evidence Synthesis Programme conducted a Rapid Show Review of intendance coordination theoretical models and conceptual frameworks to inform the piece of work of the Measures, Models, and Definitions work group.
• Care Coordination Theoretical Models and Frameworks
• A special supplement to the Journal of Full general Internal Medicine was published in May 2019.

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SOTA XIII: Not-pharmacological Approaches to Chronic Musculoskeletal Hurting Management

November iii-iv, 2016

Goals:

To identify the state of the art by clarifying what we know and what we need to know about non-pharmacological approaches to chronic musculoskeletal hurting management specifically,

• psychological/behavioral therapies,
• exercise/motion therapies,
• manual therapies and,
• models for delivery of multi-modal hurting care.

Iv work groups made upward of VA and non-VA bailiwick affair experts addressed the following:

• Where is the evidence sufficient to movement to implementation?
  • Attain consensus on priorities and develop recommendations for policy and strategies to assist VA and the larger health intendance community to better implementation.
• What important questions practise not have sufficient show to guide practise and clinical policy?
  • Attain consensus on recommendations for research and develop a research calendar to address knowledge gaps.
• What problems or new developments are on the horizon that may need to be considered in research, planning, and policy?
  • Prioritize issues for time to come consideration.
• Recommend strategies for dissemination and implementation of SOTA findings.

Outcomes/Products

• The VA Evidence Synthesis Programme conducted a Rapid Evidence Review of Measures to inform the work of the Measurement work grouping. This certificate is available on the intranet but. If you have intranet access, re-create and paste vaww.hsrd.research.va.gov/publications/esp/chronicpain-measures.cfm into your browser.
• An evidence brief was published by the VA Evidence Synthesis Program, titled Effectiveness of Models Used to Deliver Multimodal Care for Chronic Musculoskeletal Hurting, and was used to inform initial give-and-take of the Models of Intendance work grouping during the conference.
• Formed a Measurement piece of work group to develop recommendations for hurting consequence measures to be used in interventional or observational inquiry studies. Kroenke G, Krebs EE, Turk D, et al. Core Issue Measures for Chronic Musculoskeletal Pain Inquiry: Recommendations from a Veterans Health Administration Work Group. Pain Med. 2019 January five. doi: 10.1093/pm/pny279. [Epub ahead of print]
• A webinar was held March 7, 2017 to present the findings of the Non-pharmacologic Approaches to Chronic Musculoskeletal Pain Direction SOTA
• A special supplement to the Journal of General Internal Medicine was published in May 2018.
• Conference to Rehabilitation and Prosthetic Services staff
• The VA Opioid Condom Initiative - how did nosotros become here and what is ahead? (webinar)

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SOTA XII: Weight Direction

March 7-eight, 2016

Goals:

To identify the land of the fine art by clarifying what we know and what we need to know about weight management, specifically, bariatric surgery, behavioral interventions, and pharmacotherapy. For each of these three areas, participants worked to place:

• Where is the evidence sufficient to motility to implementation?
  • Reach consensus on policy recommendations to improve implementation


• What important questions do not accept sufficient evidence to guide practice and clinical policy?
  • Achieve consensus on recommendations for research


• What problems or new developments are on the horizon that may demand to exist considered in research, planning, and policy?
  • Prioritize bug for future consideration

Outcomes:

• SOTA findings and recommendations were presented to VHA leaders in DC on 4/19/sixteen and later to the Healthcare Commitment Committee on six/eight/16
• Established a charter and technical advisory group for a national survey on weight management to be administered by VHA's Healthcare Analysis and Information Group (HAIG). The target appointment for fielding the survey is Feb 2017.
• VA'due south Pharmacy Benefits Management has implemented changes to the criteria for utilize for weight loss drugs that were recommended as a result of the SOTA.
• Research agenda provided to VA Wellness Services Research and Development Service.
• A special supplement to the Periodical of General Internal Medicine on Weight Management in VHA was published on-line in March 2017 and in print in April 2017.

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SOTA XI: Adjacent Generation Clinical Operation Measures:
Patient-Centered, Clinically Meaningful, and Loftier Value

January 21, 2014

Goals:
Regarding side by side-generation clinical functioning measures, identify:

• the current state of the evidence – what practice nosotros know now?,
• the show gaps – what are the important areas to research?, and
• areas that are set up to implement now.

Participants volition develop research calendar and implementation recommendations in iv central areas:

• Making Measures More Personalized and Clinically Meaningful
• Incorporating Patient Preferences into Functioning Measurement
• Measuring Value
• Implementing Measurement Strategies

Outcomes/Products

• SOTA Eleven: Clinical Functioning Measures (February 2014)
• Special consequence of the Periodical of General Internal Medicine (JGIM), in press, expected publication date: February 2016

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SOTA Ten: Access

September 21 - 22, 2010

Goals:

• Identify what we know and what we demand to know nigh the human relationship of admission to individual needs/characteristics, community networks/characteristics, utilization (VA and non-VA), and patient outcomes.
• Define best strategies for outreach programs to better admission including resource, relationships, infrastructure, and policies.

Participants were charged with developing recommendations for a research agenda, equally well as policy change in the areas of:

• Defining access, constructs, and a conceptual framework with focus on measures
• Identifying access issues for special populations
• Impact of admission on utilization, quality, outcomes, and satisfaction
• Touch on of policy and arrangement of intendance on access
• Adoption and implementation of IT

Outcomes/Products

• A special issue of the Journal of General Internal Medicine comprising papers commissioned for the conference, as well as boosted papers featuring empirical research on access was published in Nov 2011.
• Research calendar forwarded to VA Office of Research and Evolution.
• Executive Summary and policy recommendations forwarded to VHA leadership.

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SOTA Nine: Traumatic Brain Injury Research

April 30 - May 2, 2008

Goals: to place what nosotros know and what we need to know almost:

• The bones science of TBI
• Comorbidities and Pain Issues in TBI
• Care Management from Department of Defense through VA
• Rehabilitation and Community Reintegration
• Sensory Deficits in TBI
• Neuro-imaging for TBI

Additionally, participants were charged to develop a enquiry agenda to accost knowledge gaps, methods, models of care, and vehicles for translation.

Materials:

• Foreword (71 KB, PDF)
• Introduction (101 KB, PDF)

Outcomes:

ORD took several actions in response to the SOTA, including:

1. Released a new RFA including many of the research recommendations generated through the SOTA.
2. ORD's Rehabilitation Enquiry and Evolution Service released a solicitation for Centers of Excellence on topics of TBI, regenerative medicine, and social re-integration/vocational rehabilitation.
3. A clinical fellowship in collaboration with the VA Function of Academic Affairs was established that provides for 75% protected research time.
4. VA representation on the Federal Interagency Brain Injury Research Grouping which will coordinate enquiry activities in TBI and disseminate data.
5. Papers deputed for the SOTA were published every bit a special supplement to the Journal of Rehabilitation Research and Development in 2009.

All of these efforts volition yield important insights and results aimed at moving VA and the greater health care community forrad toward a better agreement of balmy to severe traumatic brain injury and how to provide the best care to those who have suffered a traumatic brain injury.

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SOTA Viii: Managing Complexity in Chronic Care

September 13-xv, 2006

Goals: To identify electric current noesis and knowledge gaps about improving the intendance and management of patients with complex chronic care needs.

Key Discussion Topics:

• The spectrum of complexity in caring for patients with complex, challenging, and chronic illnesses and managing complex care
• Defining best practices
• Resources, relationships, infrastructures, and policies that are needed to ensure quality intendance and successful intendance management for complex patients

Products: Published a special issue of the Journal of General Internal Medicine in December 2007 (Vol 22, Supplement 3). In addition, a research agenda for CCC was submitted to Fundamental Office.

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SOTA 7: Implementing the Evidence: Transforming Practices, Systems, and Organizations

Baronial thirty - September 1, 2004

Goals: To identify current knowledge and knowledge gaps about best strategies for implementing evidence into practice to make recommendations for further research, processes, or policies that will help fill the gaps and advance knowledge in this area.

Cardinal Discussion Topics:

• Attributes of an Ideal Integrated Informatics Organisation That Supports Implementation of Evidence
• How Does Evidence Inform What an Organisation and Its Providers Do?
• Incentives for Implementation and Organizational Alter
• How Does the Inquiry Infrastructure Need to Change to Make Implementation Easier?

Products: Publication of special issue of the Journal of Full general Internal Medicine, Feb 2006

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SOTA VI: Leading the Style to Quality Long-Term Intendance: Lessons from the Past, Strategies for the Future

September 15-17, 2003

Goals: 1.) Identify what is currenly known and what we need to know regarding long-term intendance demand, coordination, outcomes, cost-effectiveness, quality, and satisfaction, equally well as long-term intendance resources, relationships, and infrastructures needed to ensure the highest quality long-term care. 2.) Develop recommendations and a inquiry calendar that volition assist VA and the larger health care community in providing the highest quality, near toll-effective long-term care.

Fundamental Word Topics:

• Projecting Long-Term Care Demand and Planning Resources
• Improving Long-Term Care Structures for Patient-Focused Intendance
• Improving Processes to Ensure Coordination of Care
• Innovations and Models in Long-Term Care
• Measuring the Quality of Long-Term Care

Products: Policy recommendations sent to Under Secretarial assistant for Health, planned publication of several conference papers in a special section of The Gerontologist.

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SOTA Five: Making Informed Consent Meaningful

March 7-ix, 2001

Goals: To identify existing knowledge about informed consent in both theory and practice; to identify what the VA and others can practice to amend the practise of informed consent; and to outline a research agenda identifying and filling in the almost important gaps in our current cognition.

Key Word Topics:

• Informing Subjects (content)
• Informing Subjects (process)
• Decision-Making Capacity
• Voluntariness of Consent
• Decision-Making Dynamics
• Impact of Existing and Emerging Technology on Informed Consent
• Informed Consent Problems Across the Wellness Care Continuum

Products:

• Informed Consent Bibliography: Annotated bibliography compiled past Jeremy Sugarman, et al., and published as a Special Supplement to The Hastings Middle Study
• Medical Care September 2002 (special supplement ) - features nine manufactures written every bit background papers for the conference. Papers were revised based on comments from conference participants, as well equally outside reviewers, and were compiled every bit a special supplement.
• Informed Consent for Man Subjects Research: A Primer

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SOTA IV: Leading Organizational Transformation

April eight-10, 1996

Goals: To decide the state of the fine art of integrated delivery systems and its relevance to VA'due south organizational vision; to identify the post-obit: tools and resources for change, information dissemination vehicles, high priority topics for research, and to provide a forum for discussion.

Key Discussion Topics:

• Integrated Delivery Systems
• Designing Strategic Alliances
• Changing Organizational Civilisation and Managing the Human being Side of Change
• Recruiting, Nurturing, and Rewarding Desired Leadership Competencies
• Forging New Relationships within the Customs

Products:

• Special Supplement Issue:The Periodical of the Foundation of the American College of Healthcare Executives Vol 42, No 3, Fall 1997
• Organizational Alter: A Primer (253 KB, PDF)

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SOTA III: Technology Assessment: A Tool for Applied science Management and Improved Patient Outcomes

January 23-25, 1995

Goals: Assess the current land of health intendance technology assessment, identify gaps in current knowledge, identify and prioritize recommendations, identify stategies for implementation.

Key Discussion Topics:

• Developing an Organization'due south Approach to Technology Assessment
• Methodological Aspects of Conducting Technology Cess
• Broadcasting and Implementation of Engineering Assessment Recommendations
• Monitoring and Evaluating the Dissemination of Engineering science Assessment Recommendations

Products: Health Care Engineering science Assessment in VA: A Primer

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SOTA II: Databases: A Resource for Research and Decisionmaking

Nov 8-10, 1993

Goals: To ameliorate the delivery of health care through recommendations for advancements in the design and use of data and information systems supporting policy, management and clinical decisionmaking and health services research.

Key Discussion Topics:

• Needs and Demand
• Access and Utilization
• Outcomes and Effectiveness
• Quality Assessment and Improvement
• Costs
• Resources Allotment
• Ambulatory Intendance Services
• Geriatric and Extended Care Services

Products:

• Databases: A Resources for Research and Decisionmaking (Annotated bibliography)
• Databases: A Resource for Research and Decisionmaking (Recommendations)

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SOTA I: Community-Based Long Term Care: What We Know and Demand to Know

September 23-25, 1992

Goals: Amend the commitment of community-based long term care services to the veteran population by disseminating what is known from the research literature and best practices to managers, clinicians, and policymakers.

Key Discussion Topics:

• Current and future needs and demands for VA community-based long term intendance services
• Outcomes from the provision of customs-based long term care services
• Delivery coordination of community-based long term care services (VA-wide, VAMC, individual patients)
• Characteristics of specific programs and services made available as function of VA community-based long term care

Products:

• Customs-Based Long Term Care Resource Guide, Customs-Based Long Term Care Executive Summary
• Community-Based Long Term Care, VA Programs and Services

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Source: https://www.hsrd.research.va.gov/meetings/sota/

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