Charleston Health Equity and Rural Outreach Innovation Center (HEROIC)

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DESCRIPTION (provided by applicant): The mission of the Charleston Health Equity and Rural Outreach Innovation Center (HEROIC) is to improve access and equity in health care for all Veterans by eliminating geographic, racial/ethnic, and gender-based disparities. Our strong, growing and talented group of VA health services researchers has been continuously funded by the VHA HSR&D Program for more than 8 years, as a TREP (2004-2008) and as a REAP (2008-current) under the leadership of Dr. Leonard Egede. Over the past 8 years, the Charleston TREP and REAP have achieved many major milestones, including (a) assembling a multidisciplinary MD and PhD faculty (19 core investigators and 15 affiliate investigators) who have effectively used both quantitative and qualitative research methodology to advance VA health services research and develop Veteran-centric interventions; (b) engaging clinical and operations partners, such as the VA Office of Rural Health, the VA Center for Minority Veterans, the VA Office of Health Equity and the VA Office of Informatics and Analytics; (c) obtaining funding for over 20 investigator-initiated Meri, QUERI and CDA proposals; (d) disseminating research findings via over 60 publications and 25 presentations, the majority of which were directly in line with the mission of HSR&D; (e) fostering an increase in VA HSR&D funding between 2004 and 2012; and (f) providing extensive mentorship opportunities to undergraduate and graduate research students, general internal medicine fellows, interns, and post-doctoral fellows. Our multi-disciplinary team has demonstrated scientific leadership in health services research; has led development and rigorous testing of innovative interventions for Veterans; has led implementation research as well as systems-oriented research; and has been consistently dedicated to research on health equity and access for rural and minority Veterans. We are smaller than many other programs, but our consistency in research focus, multidisciplinary make-up, and scientific leadership have enabled us to achieve national and international recognition in the areas of equity and access in a relatively short period of time. The three focused areas of research for the proposed COIN fall directly in line with our areas of expertise and HSR&D priorities: health equity, access, and rural health. The VHA is an "equal access" healthcare system for over 5 million U.S. Veterans. Yet, disparities in health continue to be significant despite success in addressing many barriers to care. Recent reviews continue to document disparities across all clinical content areas and our investigative team also has documented racial/ethnic, gender, and geographic disparities in health outcomes among Veterans. Our COIN, consistent with over 8 years of research, will develop and test interventions to eliminate health disparities in clinical outcomes for Veterans and improve access for rural Veterans. We define health disparities as racial/ethnic, gender, and geographic (urban-rural) differences in health outcomes for chronic medical and mental illnesses among Veterans. The CREATE for our COIN was conceptualized in collaboration with our partners: the VA Office of Rural Health, VA Office of Health Equity, VA Center for Minority Veterans, and VA Office of Informatics and Analytics and includes 5 closely linked CREATE projects that will advance the field in our focused area of research. Our CREATE is entitled, "Access to Evidence-Based Interventions for Rural and Minority Veterans." The CREATE projects will be conducted in partnership with investigators from CHERP, VISN 7, and National Center for PTSD/Pacific Islands VA. In addition to support from our host medical center, we have very strong institutional support for the COIN from our academic affiliate, the Medical University of South Carolina (MUSC), which has made a commitment of faculty FTEs, space and institutional resources to ensure the success of the COIN.