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VA Health Care: Efforts to Prioritize and Translate Research into Clinical Practice

GAO-20-211 Published: Jan 23, 2020. Publicly Released: Jan 23, 2020.
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Fast Facts

VA provides health care to over 9 million veterans each year. It also funds research on veterans’ health conditions—including chronic conditions, like diabetes, and illnesses and injuries resulting from military service, like traumatic brain injury.

We reviewed, among other things, how VA works to help translate research findings into clinical practice to improve care. For example, VA researchers are studying the delivery of psychotherapy for PTSD via video to veterans in rural areas. VA is also studying the use of exoskeletons to help veterans with spinal cord injury.

VA research participant with a spinal cord injury uses an exoskeleton—motorized prosthesis worn outside a person’s clothes—to walk.

A man using an exoskeleton to walk out of a spinal cord injury research center

A man using an exoskeleton to walk out of a spinal cord injury research center

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What GAO Found

The Department of Veterans Affairs (VA) uses stakeholder input and other information to set priorities for funding research projects. VA's Office of Research and Development (ORD) manages VA's intramural research program—that is, research funded by and conducted within VA, by VA researchers. To set priorities, ORD considers input from VA and non-VA stakeholders (such as agency leaders and a federal research advisory council, respectively) and data on veterans' health conditions. ORD encourages VA researchers to study—and collaborate with other VA researchers on—priority topics, such as post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).

Examples of Veterans Affairs (VA) Intramural Research Projects on Priority Topics

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ORD's Quality Enhancement Research Initiative (QUERI) and other VA entities facilitate translating research findings into clinical practice to improve care for veterans. QUERI is VA's central point of focus for research translation and provides a link between ORD, VA program offices, and providers. For example, one QUERI program is studying delivery of an evidence-based treatment for PTSD using telemedicine, specifically, by providing psychotherapy via video to veterans in rural areas. Another program recently adopted a new research translation strategy by establishing a requirement that research proposals for large, multi-center clinical trials include an implementation plan. VA officials said the goal of the new requirement is to encourage researchers to think about research translation from the beginning of a study—and how their work might be translated into practice.

VA officials from both ORD and the national program offices GAO spoke with described a variety of efforts coordinating on research. Such coordination can help inform research priorities and help program offices incorporate evidence-based practices in developing and rolling out national policies. For example, ORD officials said that VA researchers were serving as subject matter experts to the national program office developing a protocol and clinical guidelines for a new treatment for certain veterans with depression that is resistant to existing treatments.

Why GAO Did This Study

In addition to providing health care services, VA funds research on veterans' health conditions, including chronic conditions (such as diabetes) as well as illnesses and injuries resulting from military service (such as TBI). VA's ORD manages the agency's research program, including its intramural research. In fiscal year 2018, VA resources for its intramural research program included an appropriation of $722 million.

GAO was asked to review aspects of VA's research program. In this report, which focuses on VA's intramural research, GAO describes 1) how VA sets priorities for funding research, 2) VA efforts to facilitate translation of research into clinical practice, and 3) coordination between VA's research program and other VA entities.

To perform this work, GAO reviewed VA policies, reports, and other documents about VA research efforts. GAO also interviewed officials from ORD, three VA national clinical program offices, and two VA offices that focus on implementing evidence-based practices. In addition, GAO conducted site visits with four VA medical centers. GAO selected those locations because they house VA-funded research centers that focus on a range of topics and ORD programs that focus on disseminating and translating research. At each location, GAO interviewed medical center officials and VA researchers. GAO also reviewed VA summary data on research projects and funding for fiscal year 2018.

VA provided technical comments on a draft of this report, which GAO incorporated as appropriate.

For more information, contact Jessica Farb at (202) 512-7114 or

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Chronic diseasesChronically illClinical trialsEvidence-based practicesHealth careHealth care servicesPatient carePost-traumatic stress disordersQuality of careResearch and developmentSuicide preventionTelemedicineTraumatic brain injuryVeteransVeterans affairsVeterans health careVeterans researchMental healthChronic illnessesVeterans medical centers