Minneapolis VA Health Care System
New Name Comes with a Renewed Purpose and Approach
What does the film "The Magnificent Seven" have to do with research at the Minneapolis VA?
At first blush, an old West movie about seven gunfighters hired to protect a village from bandits seems to have very little to do with the pursuit of clinical knowledge.
But if you stretch the metaphor, you can see the similarities.
It was in 1998, when seven Minneapolis internal medicine staffers banded together to create a center for the study of outcomes of chronic disease treatments. Consider those diseases the "bandits" of health.
"Magnificent" may not be the right adjective to describe humble clinicians, but its synonym "skillful" was certainly applicable because all had exemplary clinical skills and superior intellect: Dr. Hanna Bloomfield, Dr. Tim Wilt, Dr. Kris Ensrud, Dr. Maureen Murdoch, Dr. Kristin Nichol, Dr. Anne Joseph and Dr. Frank Lederle.
Originally known as the Center for Chronic Disease Outcomes Research (CCDOR), it was recently renamed the Center for Care Delivery and Outcomes Research. The acronym still works!
Bloomfield assembled the group and became its first director, serving until 2013 when she became Minneapolis VA’s Associate Chief of Staff for Research.
"I was inspired by the amazing Veteran-centric research ideas that my colleagues in the Section of General Internal Medicine were developing and which I knew would never come to full fruition without the administrative and data analytical support that a Center grant could provide," Bloomfield said. "Plus, I wanted to create a new position for my study coordinator who would be out of a job when my large 8-year study, the VA HDL Intervention Trial, ended in 1999."
Current CCDOR director Dr. Steven Fu, a nationally recognized expert in the study of smoking cessation, said CCDOR’s greatest accomplishment in its 20 years is not a single study or clinical finding.
Fu says the creation of an infrastructure of clinical staff able to access and analyze data may be its most profound achievement.
"CCDOR is a treasure in the VA," says Fu. "We have access to a data base of clinical encounters that is unparalleled. Plus, we have the clinical expertise that allows us to understand what is occurring in patients."
Today, there are 26 Core Investigators and a total staff of 86, including statisticians, epidemiologists, recruitment coordinators and administrators. The investigators are imbedded clinicians, meaning that they see patients in hospital clinics across the street from CCDOR’s offices in Building 9, the four-story red brick building near the Credit Union and the Fisher House.
Fu attributed CCDOR’s success to support from VA leadership in Minneapolis and the commitment of patients who often volunteer for clinical studies based on their military training of always helping your comrade.
"They know that study findings may not help them, but eventually may help other Veterans," said Fu.
Fu said CCDOR focuses on high-impact research projects. It’s not surprising that it has many efforts studying chronic pain and opioid use reduction and trauma recovery, which are common conditions among Veterans.
Because of the prevalence and negative consequences of those conditions, researchers must learn to move at a faster pace.
"The timeline of research has changed," Fu said. "In the past, studies might take eight to 15 years to complete. Today, we must compress the timeline and take some risks to make our work as relevant as possible."
CCDOR research results are regularly published in top tier medical journals such as the New England Journal of Medicine, JAMA and Annals of Internal Medicine.
Asked how CCDOR attracts top-notch staff, many from prestigious academic institutions, Fu offered several reasons.
"Talent attracts talent," he said, noting the stellar reputations of the original CCDOR "Magnificent 7" helped draw good people to the Minneapolis VA. Support from medical center leadership, allowing researchers to maintain clinical practice, is another key to success, Fu said.
And, finally, people choose to join CCDOR because they want to affect the public good.
Maybe the "Magnificent 7" metaphor isn’t a stretch after all!
- A study headed by Erin Krebs, MD, comparing the benefits and harms of opioid therapy vs. non-opioid pain medication therapy among patients with moderate to severe chronic back or hip/knee osteoarthritis pain found no advantage of opioids compared to non-opioid medications.
- A study headed by Melissa Polusny, PhD, demonstrated that Veterans have clinically significant improvement in PTSD symptom severity with mindfulness-based stress reduction and that improvements are sustained 2 months after treatment.
- Investigators developed a tracking tool for incidentally detected pulmonary nodules, lung cancer screening, and post-cancer resection follow-up.
- A systematic review by Hanna Bloomfield, MD, and team showed that a Mediterranean diet may reduce the risk of breast cancer, cardiovascular events and type 2 diabetes mellitus.
- A 19.5-year follow-up of a cohort of 731 men with localized prostate cancer by Tim Wilt, MD, and team, showed that surgery was not associated with significantly lower all-cause or prostate-cancer mortality than observation.
- Research by Elisheva Danan, MD, showed smokers can quit before they are ready.
For more details about these and other CCDOR efforts, see their website: www.ccdor.research.va.gov