Center for Healthcare Organization & Implementation Research
The Center for Healthcare Organization and Implementation Research (CHOIR) grew out of institutions in Boston and Bedford established during the reorganization of the Veterans Health Administration (VA) in the early 1990s. Both Centers were ahead of their time with an early emphasis on partnerships and the cross-fertilization of ideas between campuses and across the VA. CHOIR evolved from collaborations molded around individual and organizational research and implementation expertise.
CHOIR Bedford began as a Health Services Research & Development (HSR&D) Field Program, a Center of Excellence originally called the Center for the Health Maintenance of the Aging Veteran. Dr. Gene Stollerman, the Associate Chief of Staff for Geriatrics and Extended Care at Edith Nourse Rogers Memorial Veterans Hospital, founded the Center in 1990. Co-Associate Director Dr. Lewis Kazis expanded the Center’s research interests into health outcomes measurement and quality assessment. Staff grew to include more clinicians, statisticians, and anthropologists. In 1995, it was renamed the Center for Health Quality, Outcomes, and Economic Research (CHQOER). Dr. Dan Berlowitz became director in 2004. He worked closely with Drs. Amy Rosen, Nancy Kressin, Sue Eisen, Jack Clark, and others for CHQOER’s successful reapplication as a Center of Excellence in 2006. New investigators spurred new collaborative projects with research centers on campus and throughout the country. For example, Bedford Director Dr. Barbara Bokhour came aboard in 1998 and later partnered with the Office of Patient-Centered Care and Cultural Transformation (OPCC&CT) to direct the Evaluating Patient Centered Care (EPCC-VA) Quality Enhancement Research Initiative (QUERI), while current CHOIR Boston Director Dr. Allen Gifford’s arrival to Bedford in 2006 brought the HIV/Hepatitis QUERI, now the Bridging the Care Continuum QUERI.
CHOIR Boston began with former HSR&D Director Daniel Deykin’s vision to help Centers of Excellence nationwide bridge research and practice (see Dr. Deykin's bio under Daniel Deykin Award for Outstanding Mentor). In 1992, Dr. Deykin recruited Dr. Martin Charns as the founding director of the Management Decision and Research Center (MDRC), which offered resources in organizational and implementation science to bridge health services research and operations. Drs. Gary Young, Carol VanDeusen Lukas, Geraldine McGlynn, and Karen Flynn led programs within the MDRC and helped complete over 100 consultation projects, including an evaluation of the VA health system with recommendations for integration of services and centers. As a direct result, in 1995-6 Undersecretary of Health Kenneth Kizer created the VISN system and integrated 40 medical centers, including the West Roxbury, Brockton, and Jamaica Plain VA medical centers (VAMCs), now the VA Boston Healthcare System. The MDRC also co-founded the All-Employee Survey, sponsored a state-of-the-art conference on data-sharing and documentation of national data sets that inspired the founding of the VA Information Resource Center (VIReC), and laid the foundation for the Center for Information Dissemination and Education Resources (CIDER). Organizational shifts prompted MDRC investigators to deepen research partnerships with 4 VISNs and the National Center for Organization and Development (NCOD). They became a new Center of Excellence in 2004, the Center for Organization, Leadership, and Management Research (COLMR). The Center continued to help on major evaluation projects which use research to change practice, as CHOIR does today. In 2009, Dr. Mark Bauer became COLMR’s Associate Director, bringing mental health expertise with him.
In 2012, HSR&D announced they would refocus the Centers of Excellence. They emphasized partnered research in a call for applications for new Centers of Innovation (COINs). Drs. Charns and Berlowitz knew the power of integration and partnership. Cross-fertilization of ideas and collaboration of investigators between the two Centers was already well-established when VA Bedford and Boston Centers united and successfully applied as a joint COIN. Now the largest COIN in the nation, CHOIR continues to strengthen partnerships and improve healthcare, capitalizing on their campuses’ complementary strengths, bolstering careers of young investigators through mentoring and fellowship programs, and advising on steering committees of other COINs and resource centers throughout the country. When Dr. Charns retired in 2017, Dr. Gifford joined CHOIR Boston as Director, Dr. Bokhour became Director of Bedford, and Dr. Renda Wiener joined the Executive Leadership Team as Associate Director of CHOIR Bedford. In 2020, Dr. Wiener moved to be the CHOIR Boston Associate Director. Dr. Sarah Cutrona became the Associate Director of CHOIR Bedford in 2021. Solid science and camaraderie strengthens the merged Centers through traditions old and new of cross-campus research conferences, annual holiday parties, and summer picnics.
Above: CHOIR staff gather at the 2023 annual CHOIR Picnic.
Acknowledgements: Special thanks to Marie Flaherty (Bedford, 1991-2015), Allen Gifford (Bedford, 2009-2017; Boston 2017-present), and Martin Charns (Boston, 1992-present) for their generosity in time and resources.