Topics and Projects


A VA-funded RCT of an intervention aimed to improve patient engagement and lower risk for diabetes complications, through technology-enhanced coaching of patients along with supportive family members. The study toolkit contains information and tools that can be used by healthcare professionals, family members, or patients who are interested in helping patients’ family or friends get more involved with patients’ healthcare.

Click here to learn more about the CO-IMPACT toolkit.


An NIH-funded randomized comparative effectiveness trial examining the impacts of the Family Action for Health (FAM-ACT) program, in partnership with the CHASS Center in Detroit, MI. In FAM-ACT, Community Health Workers train family members of adults with diabetes in effective support techniques, with the goal of making successful diabetes management easier for patients to achieve and sustain.

VA High Risk Investigator Network and Analytic Core

The High Risk Investigator Network and Analytic Core (the ‘High Risk Core’) within the VA Primary Care Analytic Team (PCAT) supports the VA Office of Primary Care (OPC) in building capacity for complex, high risk patient care evaluation and application development by 1) connecting a network of complex care scientific experts; 2) generating informational and methodological resources to support the conduct of complex care relevant evaluations; and 3) providing scientific and analytic expertise to national evaluation studies with potential to impact high risk patient care.

Click here to learn more about the VA High Risk Investigator Network and access High Risk Care Investigator Resources.

High Risk Patient Comorbidity Subgroups: Analyses and Applications

Our team, supported by VA operations partners, develops and implements innovative segmentation and machine learning methods to identify clinically-relevant subgroups of high risk patients using real-time health system data. Our findings have recently been implemented into a panel management tool available to VA clinicians that uses real-time health system data to support effective primary care management for high risk patients.

Click here to read about VA High Risk Comorbidity Subgroups Analyses.

Click here to watch our Segmenting Methods and Applications Cyberseminar.


High-RIsk VETerans (RIVET) QUERI Program aims to advance VHA primary care ability to provide comprehensive, evidence-based care for complex, high-risk patients. RIVET will support VHA as a learning organization through data-driven priority-setting, leveraging virtual care to enhance mental and whole health, and standardizing care to reduce inefficiency and variations in care quality for high-risk patients.

Click here to read more about RIVET QUERI.

PACE Study

More information coming soon.