In brief
A VA Center of Innovation (THRIVE) mission document describing research to improve long-term services and supports, equity, and independence for aging Veterans through a Learning Health System model; it states goals and priorities rather than study results.
What this article is about
Quick Answer
A VA Center of Innovation (THRIVE) mission document describing research to improve long-term services and supports, equity, and independence for aging Veterans through a Learning Health System model; it states goals and priorities rather than study results.
Student takeaways
Key Takeaways
- This document describes a VA Center of Innovation's mission and priorities (THRIVE), not a single study; it presents goals and plans rather than appraisable study results.
- THRIVE focuses on long-term services and supports (LTSS) for aging Veterans, which are usually home-based but also include nursing home and palliative care.
- The center uses a Learning Health System model, linking care and research across VA medical center, regional, and national levels with the Geriatrics and Extended Care program.
- Its two impact goals are to improve LTSS quality, safety, and value using a research lifecycle, and to build and implement practices that reduce disparities in equity and access.
- Additional priorities include mental health and suicide prevention for older Veterans, a research training pathway, and an emerging pharmacology focus (PILL, Pharmacologic Intervention in Later Life).
Student summary
Why This Research Matters
This document describes the mission and plans of a research center rather than a single study, so it is best read as a statement of goals and priorities rather than a set of findings. The center is called THRIVE, short for Transforming Health Systems Research to Improve Veteran Equity and Independence, and it is a VA Center of Innovation (formerly known as LTSS-COIN). Its work centers on long-term services and supports (LTSS), the range of help that Veterans need when disability, disease, or aging affects their ability to function day to day. The document explains that LTSS are usually provided in a person's home but also include nursing home care and palliative care.
THRIVE's stated mission is to honor Veterans' preferences for health, independence, and well-being by advancing expertise, programs, and partnerships that improve what it calls the quintuple aim. Its vision is for research to guide LTSS so that these services are distributed fairly and all Veterans are safely and effectively supported in the living environment they prefer. The background makes the case for why this matters: the Veteran population is aging and living with more coexisting health conditions, which contributes to disability and functional decline.
A central idea in the document is the Learning Health System (LHS) model. In a Learning Health System, care and research are closely linked so that everyday practice generates knowledge, and that knowledge continuously improves care. THRIVE describes working across several levels of the VA, from individual medical centers up to regional and national offices, in partnership with the VA's Geriatrics and Extended Care program. The document also lists areas where the center reports it has already had an impact, including the COVID-19 pandemic in nursing homes, access and equity in LTSS, understanding Veteran vulnerability related to social needs or homelessness, and toxic exposures. Students should treat these as the center's described areas of contribution rather than as measured results reported in this summary.
THRIVE lays out two main impact goals. The first is to improve the quality, safety, and value of LTSS programs using a structured research lifecycle. The second is to build and put into practice effective approaches that reduce disparities in equity and access, because the availability of VA long-term care varies widely between medical centers. Beyond these goals, the document names additional areas: a research area focused on mental health and suicide prevention for older Veterans in long-term care, an innovation area built around a training pathway that develops scientists from the undergraduate level to junior faculty, and an emerging area called PILL (Pharmacologic Intervention in Later Life), which addresses medication safety and effectiveness as drugs, guidelines, and vaccines change. The center also describes close partnerships with many VA offices, including those focused on health equity, social work, homelessness, pharmacy, and mental health and suicide prevention.
For nursing students, THRIVE offers a useful, big-picture view of how health-systems research is organized to improve care for an aging population. It introduces important concepts: long-term services and supports, the Learning Health System, health equity, and the goal of helping people remain independent in the setting they prefer. It also shows that mental health and suicide prevention are recognized priorities for older adults, a group whose emotional health can be overlooked.
A few cautions are important. Because this is a description of a center's mission and plans, it does not present study data, effect sizes, or outcomes that can be appraised here; claims of impact are the center's own descriptions. Suicide prevention is named as a priority, which is a sensitive topic: anyone concerned about an older adult's safety should connect them to qualified crisis and mental-health resources, and nurses should follow their local suicide-risk assessment and referral protocols rather than acting alone. Read this way, the document is valuable for understanding how research infrastructure, equity, and independence come together in caring for aging Veterans.
Source abstract
Study Overview
Background: Long term services and supports (LTSS) assist Veterans with functional deficits from disability, disease or aging. While LTSS are typically provided in-home, they include nursing home (NH) and palliative care. The Transforming Health Systems Research to Improve Veteran Equity and Independence (THRIVE) Center of Innovation (COIN) (formerly LTSS-COIN) mission is to honor Veterans' preferences for health, independence and well-being by advancing expertise, programs, and partnerships that improve the quintuple aim. Our vision is for THRIVE research to guide LTSS development to help ensure LTSS is distributed equitably and all Veterans are safely and effectively supported in their preferred living environments. Significance: The Veteran population is aging and accumulating comorbidity; contributing to disability and functional decline. THRIVE actively engages with the VA's Geriatrics and Extended Care (GEC) to foster a Learning Health System (LHS) model with novel projects at the VAMC, VISN, and VACO levels. THRIVE has impacted the COVID-19 pandemic in NHs; access and equity of LTSS; the understanding of Veteran vulnerability with social needs or homelessness; and toxic exposures. The THRIVE LHS Model uses continuous improvement to propose, conduct, and disseminate research that serves Veterans by improving the LTSS system. We perform cutting-edge science that informs treatments, programs, and policies for Veterans and their providers further advances VA as a national LHS. Impact Goals and Priorities: Impact Goal 1: Improve quality, safety, and value of LTSS programs using the HSR LHS Lifecycle. The VA LTSS system encompasses a dozen programs that would benefit from continual improvement to measure quality and safety. The LTSS value equation is incomplete without these measures and thus LTSS expansion remains challenged. By using the LHS lifecycles, THRIVE will propose research with the intention of LTSS delivery system implementation. Impact Goal 2: Build and implement effective practices to address disparities in equity and access within LTSS programs. While VA LTSS are robust, there is tremendous variability in the programs and availability at VA medical centers resulting in access disparities. Our work will focus on building, testing, and implementing practices that reduce disparities and result in a more equitable distribution of LTSS. Additional Research, Innovation and Emerging Areas: Research Area: Our VA investigators and partners lead mental health and suicide prevention research focused on older Veterans/LTSS. This focus is critically needed in moving the needle on VA suicide prevention efforts, while building collaborations with HSR researchers from multiple disciplines. Innovation Area: GEC urged THRIVE to use its training pathway (undergraduate to junior faculty) to increase prepared scientists focusing on LTSS Veterans for the Performance to Data LHS phase. Emerging Area: Pharmacologic Intervention in Later Life (PILL). PILL will address drug efficacy and improve care affected by rapidly changing medications, indications, guidelines and vaccines. Partnerships and Support for Research Enterprise: THRIVE closely partners with GEC and other offices aligned with the independence of older Veterans including the Office of Health Equity (OHE), the Office of Social Work (OSW), National Center for Veterans affected by Homelessness (NCVAH), Pharmacy Benefits Management (PBM), and the Office of Mental Health and Suicide Prevention (OMHSP). THRIVE also works closely with VISN 1 and the Providence VA (VAPHS) where we are engaged in evaluations across impact goals and additional research, innovation and emerging areas.
Evidence appraisal
Main Findings
- This document describes a VA Center of Innovation's mission and priorities (THRIVE), not a single study; it presents goals and plans rather than appraisable study results.
- THRIVE focuses on long-term services and supports (LTSS) for aging Veterans, which are usually home-based but also include nursing home and palliative care.
- The center uses a Learning Health System model, linking care and research across VA medical center, regional, and national levels with the Geriatrics and Extended Care program.
- Its two impact goals are to improve LTSS quality, safety, and value using a research lifecycle, and to build and implement practices that reduce disparities in equity and access.
- Additional priorities include mental health and suicide prevention for older Veterans, a research training pathway, and an emerging pharmacology focus (PILL, Pharmacologic Intervention in Later Life).
Practice transfer
Clinical Relevance
- Nurses can support aging patients' independence by helping coordinate long-term services and supports across home, nursing home, and palliative care settings.
- Attention to equity and access reminds nurses to consider social needs, homelessness, and variability in service availability when planning care.
- Mental health and suicide prevention are priorities for older adults, so routine, compassionate screening and referral matter in this population.
- Medication safety in later life is an ongoing concern as drugs, guidelines, and vaccines change, supporting careful medication review for older patients.
- Because this is a mission statement rather than study evidence, nurses should look to the center's specific studies for appraisable data before changing practice.
Faculty notes
Educational Relevance
This is a Center of Innovation mission-and-priorities document, not a primary study, which makes it an excellent teaching artifact for health-systems thinking and for distinguishing organizational aims from evidence. THRIVE (Transforming Health Systems Research to Improve Veteran Equity and Independence, formerly LTSS-COIN) organizes research around long-term services and supports (LTSS) for aging Veterans, spanning home-based care, nursing homes, and palliative care. Core concepts to teach include the Learning Health System model (linking care and research for continuous improvement), the quintuple aim, and health equity. The center states two impact goals: improving LTSS quality, safety, and value via a research lifecycle; and reducing disparities in equity and access given wide variability in program availability. Additional areas include mental health and suicide prevention for older Veterans, a training pathway from undergraduate to junior faculty, and an emerging pharmacology focus (PILL). Emphasize to students that described impacts (COVID-19 in nursing homes, equity, homelessness, toxic exposures) are organizational claims, not appraisable outcomes in this summary. The suicide-prevention priority is a prompt to reinforce that risk assessment and referral must follow local protocols. Use this to discuss how infrastructure, partnerships, and equity shape care for vulnerable, aging populations.
Critical appraisal
Limitations
- This is a description of a research center's mission and plans, so it contains no study data, effect sizes, or outcomes that can be independently appraised here.
- Claims that the center has 'impacted' areas such as COVID-19 in nursing homes or homelessness are organizational descriptions, not measured results presented in this summary.
- The available metadata is an abstract-style overview, so specific projects, methods, and findings cannot be verified from it.
Classroom use
Discussion Questions
- What are long-term services and supports (LTSS), and why are they central to caring for an aging population?
- How does a Learning Health System link everyday care with research, and why is that valuable?
- Why might there be disparities in the availability of VA long-term care between different medical centers?
- How can nurses help patients remain safely independent in the living environment they prefer?
- Why are mental health and suicide prevention important priorities for older adults specifically?
- What is the difference between a center's stated impact and appraisable research evidence?
- Why does medication safety (the PILL area) become more complex in later life?
- How do partnerships with offices focused on equity, social work, and homelessness strengthen long-term care research?
- What does 'equity' mean in the context of distributing health services, and how would you recognize inequity?
- How should a nurse respond if they are concerned about an older adult's risk of suicide?
Search-ready answers
Frequently asked questions
Is this a research study I can appraise for results?
No. It describes a research center's mission and priorities, so it has no study data or outcomes to appraise here; look to the center's specific projects for evidence.
What is THRIVE?
A VA Center of Innovation working on health-systems research to improve equity and independence for aging Veterans in long-term care.
What are long-term services and supports?
The help people need for daily functioning due to disability, disease, or aging, usually at home but also in nursing homes and palliative care.
What is a Learning Health System?
A system where care and research are linked so that practice continuously improves through the knowledge it generates.
What are the center's main goals?
To improve LTSS quality, safety, and value, and to reduce disparities in equity and access.
Why is mental health part of this work?
The center prioritizes mental health and suicide prevention for older Veterans, a group whose emotional health can be overlooked.
What is the PILL area?
Pharmacologic Intervention in Later Life, focused on safe, effective medication use as drugs, guidelines, and vaccines change.
Does this apply outside the VA?
The concepts of LTSS, equity, and Learning Health Systems are broadly useful, but the specific structures center on the VA and Veterans.
How can nurses use these ideas?
By coordinating long-term supports, considering equity and social needs, screening older adults for mental-health concerns, and reviewing medications carefully.
What is the key safety message about suicide risk?
Take any concern seriously and follow local risk-assessment and referral protocols to connect the person with qualified mental-health and crisis resources.