Center for Health Optimization & Implementation Research

A group photo taken at the CHOIR Annual Picnic ~2008 in Bedford featuring Amy Rosen in the center, wearing blue

Sometimes the most meaningful impacts are the ones you have to fight for, and according to VA Senior Research Career Scientist Dr. Amy Rosen, the best strategy may be found somewhere at the intersection of data and creativity. Dr. Rosen’s VA research journey has been marked by tenacity, collaboration, an enduring pursuit of questions that drive her curiosity, and a pragmatic vision for better quality of care in VA and beyond. As she prepares for retirement after more than three decades of federal service, Dr. Rosen’s career offers valuable lessons about following one’s passions and leveraging the things researchers do best to push for progress.

In the early days of her career, the reality of motherhood with no available childcare led her to work out a sort of prototypical remote work arrangement, working part-time at multiple institutions. “I was, you know, home… I did quite a bit of work doing analysis actually over my computer, using a modem of all things. I dabbled, you know, and I got some publications out, but I was never full time, so I missed all those benefits… [When I finally got to work full time], I was very motivated.”

Her initial work at the Bedford VAMC over 30 years ago was an assignment focused on nursing home quality and functional decline among residents. With graduate training in gerontology and sociology, Dr. Rosen recognized how this work could bridge to her broader questions about quality of care.

She marvels at the early days in VA research, when opportunities for international travel were more readily available. For her: Budapest, then Hungary. She presented work in England on episodes of care and risk adjustment. Paris. England again. “When I think back that I could do that, it’s amazing,” Dr. Rosen says. “And it’s so important. I’ve had a Research Career Scientist Award since 2006, and when you get to my level, you need to have an international reputation. I’ve reviewed papers on patient safety from all over the world.”

Her pioneering work on Patient Safety Indicators, or PSIs, is among her proudest achievements. When the Agency for Healthcare Research and Quality (AHRQ) first introduced these metrics—standardized tools that track potentially preventable events that occur in in-patient settings—Dr. Rosen and her team were early champions of testing their application within the VA system. “It was a great project. It evolved into several projects, really. Kept us busy for many, many years.”

Yet support for her work on PSIs did not always come easily. She recalls initial resistance to the use of administrative data, so much so that she was at one point encouraged to stop. “There's a funny story where I was giving a talk on the Patient Safety Indicators, or we call PSIs, down in Florida. [Another presenter] was talking about how terrible the Patient Safety Indicators were, and I was literally the next speaker. So, I kind of made a joke about it and I said, well, just forget everything the previous speaker said, because I'm gonna show you how they can lead to quality improvement.” She presented her data showing the impact of the PSIs. “So that was it… It had a real national impact in the VA.”

Dr. Rosen and her colleagues eventually developed collegial relationships with AHRQ leadership and went on to work with them to improve the initial PSIs. Her team was able to advocate for funding from the VA National Patient Safety Center for a Patient Safety Center of Inquiry (PSCI), which she directed for about eight years, she estimates, during which time researchers visited VA facilities to show them how they could improve quality of care and patient safety. “It all turned out quite well.”

As she approaches retirement, Rosen looks back with gratitude, especially for the support of colleagues and her family, and expresses hopes for the future of VA research. “I'm really glad that I've worked in the VA and helped support veteran care. So that's really been important to me… I think the exciting part of research for me is coming up with an idea and carrying it through. I like to be creative in my work, and that's been the cornerstone for me… I wish everyone the best of luck because I think things are changing and it's important to speak up, and it does take a village.”

She encourages the next generation of investigators to nurture creativity, defend the importance of curiosity-driven but scientifically-based research, and speak up for the data and the researchers putting it to use. She describes her career as a testament to teamwork and notes that support from her professional network and her family made her long career possible. Retirement will bring new adventures, more travel, time with grandchildren, and volunteer work. As she retires, Amy Rosen’s career reminds us that it is often the hardest-won achievements, forged through persistence and collaboration, that prove most consequential.

In addition to being an Investigator at the VA Center for Health Optimization and Implementation Research (CHOIR), Dr. Rosen is a Professor of Surgery at Boston University Chobanian and Avedisian School of Medicine and Adjunct Professor, University of Massachusetts Medical School. She directed the National Patient Safety Center of Inquiry (PSCI) on Measurement to Advance Patient Safety. Read some of her recent work in JAMA Health Forum about disparities in access to Primary Care for Veterans following the MISSION Act.