VA’s Evidence Synthesis Program – Data to provide effective care for Veterans

VA has built one of America’s most comprehensive clinical evidence review programs with its Evidence Synthesis Program (ESP).

The program has been instrumental in advancing treatment for a range of conditions. It has taken an important role in helping clinicians nationwide better manage COVID-19 care and save lives amidst the pandemic.

Here are a few comments from a recent interview with Evidence Synthesis Program co-founder Dr. Mark Helfand.

“Right now, we’re doing a lot of COVID work. We’re more focused on the long-term effects of COVID related illnesses and the implications that has for chronic disease rehabilitation in VA. It’s impact on mental health is a very big focus for us.”

Feasible and deliverable – not hypothetical

“We use the best evidence available in decision making but  it’s not the only factor we consider. There are other factors including what Veterans say, and what’s feasible and deliverable on a patient basis instead of just in some hypothetical world.

Dr. Mark Helfand

“All of that’s very complicated, and it’s not something that ESP can do by itself. But my view would be, you can’t do it at all unless you have the evidence synthesis component of it. Put all the other components together and you have an effective learning health system. We’re very lucky in VA to have had such a program for 15 years. I think other health systems really haven’t been able to do what VA done in this area so far.

“ESP began in 2007 with the mission of evaluating clinical studies to gain insight as to how to deliver treatment and care for conditions ranging from post-traumatic stress disorder to lung cancer. ESP’s ultimate goal has been to improve long term outcomes for a range of physical and mental health conditions with a particular focus on those commonly experienced by Veterans.

“Since the outbreak of the COVID-19 pandemic, the program has taken a forefront role in evaluating the efficacy of various COVID-19 treatment methods and emergency care practices and have helped share these with the broader American medical community.

“We also have been working with our colleagues across the world. We’re trying to try to get the systematic review community’s response to be more coordinated.”

Began with polytrauma and TBI

“There are steady priorities over the years, mental health being one. But at any particular time, we engage with the most important and difficult problems of that time. Years ago, polytrauma was such an important issue. We had Veterans who had brain injury plus other injuries.

“How do you rehabilitate them in light of their pain and their brain injury? We did a lot of work on traumatic brain injury, Gulf War Illness and the value of various services like geriatrics.

“We all want to do what we can, the best we can, for Veterans. And we want to get the best treatments, the best tests, the best organization of services. Nobody wants to be the last person on the block to adopt something after five or 10 years because that’s when the absolute proof came in.

“VA leadership recognizes that.”