COIN Investigators & Staff
COIN Investigators
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Chelsea Leonard, PhD
- Title: Core Investigator; Co-Director, Qualitative Core (Denver)
Assistant Professor, University of Colorado School of Medicine - Contact: Chelsea.Leonard@va.gov
- Location: Denver
Research Interests
I am an Anthropologist who is interested in understanding how patients and providers experience healthcare. I am specifically interested in experiences of patients with limb loss.
I hope to make a meaningful impact on the lives of Veterans through gaining insight into their experiences receiving care in the VA and how those experiences can be improved.
I hope that my work will lead to the development of tools or interventions to improve Veteran experience in the VA.
See Chelsea Leonard's Dimensions profile that includes: publications, grants, datasets, patents and clinical trials
Grants/Funding
Designing for Dissemination and Implementation Training Hub
Role: Co-I; PI: Cathy Battaglia
The Designing for Dissemination and Implementation (D4D&I) Training Hub aims to train Veterans Health Administration (VA) researchers, practitioners, and operational leaders/staff in the D4D&I implementation strategy.
The D4D&I strategy targets program adoption, implementation, sustainment, and scale-up and spread. The four multicomponent D4D&I implementation strategy bundles of the D4D&I strategy are:
1) Pre-implementation assessment for planning and evaluation of multi-level context using the Practical, Robust Implementation and Sustainability Model (PRISM) to ensure program success and sustainability,
2) Multi-level stakeholder engagement to learn what is important to end-users and garner program buy-in,
3) Implementation and adaptations guided by the pre-implementation assessment and stakeholders while retaining fidelity to care coordination program core components, and
4) Program evaluation using RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) to define program outcomes.
Funder: Veterans Administration
NIH website
Publications of note:
Designing for Dissemination and Implementation Training Hub
FLOW3 Partnered Evaluation
Role: PI
VA provides care for more than 50,000 Veterans with major limb loss, including those with amputations secondary to combat. Across the VA healthcare system, the prosthetic limb care process is labor and time intensive, inconsistent across facilities, and challenging to coordinate among frontline staff (e.g., clinical, administrative, logistics, and acquisition).
To address these challenges, clinicians with the FLOW3: Diffusion of Excellence Gold Status Practice – Enterprise-Wide Diffusion have developed a computerized management system to optimize the prosthetic limb process.
Dr. Leonard leads in the evaluation of this program.
Funder: Veterans Administration, Quality Enhancement Research Initiative (QUERI)
QUERI website
Effectiveness of telehealth to adequately manage ACSC such as admission for congestive heart failure (CHF)
Role: Co-PI with David E Winchester, MD MS BS, North Florida/South Georgia Veterans Health System, Gainesville, FL
The COVID-19 pandemic has forced VHA Facilities to rapidly adopt and deploy telehealth alternatives to provide continuity of care to Veterans while minimizing physical contact, leading to widespread cancellation of face-to-face clinics, elective procedures, and noninvasive testing.
VHA has generated transparent reports on the quality of care, known as Strategic Analytics for Improvement and Learning (SAIL) reports. The SAIL reports include ambulatory care-sensitive conditions (ACSC) and hospital readmissions.
Questions remain about telehealth's effectiveness in managing ACSC adequately, such as admission for congestive heart failure (CHF). This proposal addresses how VHA can better prepare for future infectious disease outbreaks by comparing qualitative and quantitative outcomes between facilities with existing telehealth use and those forced to adopt telehealth in response to COVID-19.
Funder: Veterans Administration
QUERI website
Rural Transitions Nurse Program Expansion
Role: Project Lead
Funder: Veterans Administration, Office of Rural Health
Improving Care Coordination using Home Pulse Oximeters for COVID-19 Patients
Role: PI
Funder: Veterans Administration, Office of Connected Care
Mobile Prosthetics and Orthotics Evaluation
Role: Project Lead
Funder: Veterans Administration, Office of Rural Health
Megabus Amputation Survey
Role: PI
Funder: Veterans Administration, Office of Rehabilitation and Prosthetic Services and VA QUERI
Telediabetes Evaluation
Role: Project Lead
Funder: Veterans Administration, Office of Rural Health
Recent Publications
2024
Gilmartin HM, Connelly B, Daus M, Hess E, Leonard C, Morgan B, Nolan JP Jr, Perry P, Sjoberg H, Subramaniam S, Anderson ML 3rd. Implementation of the Acute Inpatient Medicine-High Reliability, Learning Environment, and Workforce Development Initiative (AIM-HI) in rural Veterans Health Administration hospitals: A mixed methods evaluation protocol. J Hosp Med. 2024 Aug 16. doi: 10.1002/jhm.13474. Epub ahead of print.
PMID: 39149834.
Hess PL, Langner P, Heidenreich PA, Essien U, Leonard C, Swat SA, Polsinelli V, Orlando ST, Grunwald GK, Ho PM. National Trends in Hospital Performance in Guideline-Recommended Pharmacologic Treatment for Heart Failure at Discharge. JACC Heart Fail. 2024 Mar 23:S2213-1779(24)00178-1. doi: 10.1016/j.jchf.2024.02.014. Epub ahead of print.
PMID: 38573268.
Gilmartin H, Jones C, Nunnery M, Leonard C, Connelly B, Wills A, Kelley L, Rabin B, Burke RE. An implementation strategy postmortem method developed in the VA rural Transitions Nurse Program to inform spread and scale-up. PLoS One. 2024 Mar 8;19(3):e0298552. doi: 10.1371/journal.pone.0298552. PMCID: PMC10923440.
PMID: 38457367.
Leonard C, Carey E, Holstein A, Ho PM, Heckman JT. Cluster-randomized implementation trial of two facilitation strategies to implement a novel information and communications technology at the Veterans Health Administration. Implement Sci. 2024 Jan 2;19(1):1. doi: 10.1186/s13012-023-01329-5. PMCID: PMC10759444.
PMID: 38166974
2023
Leonard C, Sayre G, Williams S, Henderson A, Norvell D, Turner AP, Czerniecki J. Perceived shared decision-making among patients undergoing lower-limb amputation and their care teams: A qualitative study. Prosthet Orthot Int. 2023 Apr 17. doi: 10.1097/PXR.0000000000000234. Epub ahead of print. PMID: 37079358
Kelley L, Broadfoot K, McCreight M, Wills A, Leonard C, Connelly B, Gilmartin H, Burke RE. Implementation and Evaluation of a Training Curriculum for Experienced Nurses in Care Coordination: The VA Rural Transitions Nurse Training Program. J Nurs Care Qual. 2023 Feb 27. doi: 10.1097/NCQ.0000000000000698. Epub ahead of print.
PMID: 36857291.
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Leonard C, Liu W, Holstein A, Alliance S, Nunnery M, Rohs C, Sloan M, Winchester DE. Informing Use of Telehealth for Managing Chronic Conditions: Mixed-Methods Evaluation of Telehealth Use to Manage Heart Failure During COVID-19. J Am Heart Assoc. 2023 Feb 21;12(4):e027362. doi: 10.1161/JAHA.122.027362. Epub 2023 Feb 8. PMID: 36752228
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Henderson AW, Turner AP, Leonard C, Sayre G, Suckow B, Williams SL, Norvell DC, Czerniecki JM. Mortality conversations between male Veterans and their providers prior to dysvascular lower extremity amputation. Ann Vasc Surg. 2023 Feb 4:S0890-5096(23)00056-0. doi: 10.1016/j.avsg.2023.01.042. Epub ahead of print. PMID: 36746270
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2022
Williams PH, Gilmartin HM, Leonard C, McCarthy MS, Kelley L, Grunwald GK, Jones CD, Whittington MD. The Influence of the Rural Transitions Nurse Program for Veterans on Healthcare Utilization Costs. J Gen Intern Med. 2022 Aug 30. doi: 10.1007/s11606-022-07401-y. Epub ahead of print. PMID: . PMID: 36042072
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Leonard C, Connelly B, Kwan B, Albright K, Gilmartin H. Addressing leadership communication, parenting demands and mental health challenges: a mixed-methods case study of clinical and translational scientists during COVID-19BMJ Leader Published Online First: 21 July 2022. doi: 10.1136/leader-2021-000523
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Leonard C, Sayre G, Williams S, Henderson A, Norvell D, Turner AP, Czerniecki J. Understanding the experience of veterans who require lower limb amputation in the veterans health administration. PLoS One. 2022 Mar 18;17(3):e0265620. doi: 10.1371/journal.pone.0265620. PMCID: PMC8932557. PMID: 35303030
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Gilmartin, HM, Warsavage, T, Hines, A, Leonard, C, Kelley, L, Wills, A, Gaskin, D, Ujano-De Motta, L, Connelly, B, Plomondon, M, Yang, F, Kaboli, P, Burke, RE, Jones, CD. Effectiveness of the rural transitions nurse program for veterans: A multicenter implementation study. J Hosp Med. 2022; 17: 149- 157. doi:10.1002/jhm.12802
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Nunnery MA, Gilmartin H, McCarthy M, Motta LU, Wills A, Kelley L, Jones CD, Leonard C. Sustainment stories: a qualitative analysis of barriers to sustainment of the National Rural Transitions of Care Nurse Program. BMC Health Serv Res. 2022 Jan 28;22(1):119. doi: 10.1186/s12913-021-07420-1. PMID: 35090448
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Leonard C, Kenney RR, Lee M, Greene P, Whittington M, Kirsh S, Ho PM, Sayre G, Simonetti J. Common Ground: Primary Care and Specialty Clinicians' Perceptions of E-Consults in the Veterans Health Administration. Fed Pract. 2022 Jan;39(1):42-47b. doi: 10.12788/fp.0214. Epub 2022 Jan 12. PMCID: PMC8849031. PMID: 35185320
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2021
Leonard C, Connelly B, Albright K, Gilmartin H. "This is an opportunity for leadership to lead, but leadership has disappeared": A qualitative case study of clinical and translational scientists during COVID-19. Res Sq [Preprint]. 2021 Mar 16:rs.3.rs-310774. doi: 10.21203/rs.3.rs-310774/v1. PMCID: PMC7987101. PMID: 33758832
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Connelly B, Leonard C, Gaskin D, Warsavage T, Gilmartin H. Increasing enrolment in a national VA transitions of care programme: a pre-post evaluation of a data dashboard and nudge-based intervention. BMJ Health Care Inform. 2021 Nov;28(1):e100416. doi: 10.1136/bmjhci-2021-100416. PMCID: PMC8587340. PMID: 34764197
McCarthy MS, Ujano-De Motta LL, Nunnery MA, Gilmartin H, Kelley L, Wills A, Leonard C, Jones CD, Rabin BA. Understanding adaptations in the Veteran Health Administration's Transitions Nurse Program: refining methodology and pragmatic implications for scale-up. Implement Sci. 2021 Jul 13;16(1):71. doi: 10.1186/s13012-021-01126-y. PMCID: PMC8276503. PMID: 34256763
Leonard C, Gilmartin H, McCreight M, Kelley L, Mayberry A, Burke RE. Training registered nurses to conduct pre-implementation assessment to inform program scale-up: an example from the rural Transitions Nurse Program. Implement Sci Commun. 2021 Mar 8;2(1):28. doi: 10.1186/s43058-021-00127-8. PMCID: PMC7938579. PMID: 33685521
Valverde PA, Ayele R, Leonard C, Cumbler E, Allyn R, Burke RE. Gaps in Hospital and Skilled Nursing Facility Responsibilities During Transitions of Care: a Comparison of Hospital and SNF Clinicians' Perspectives. J Gen Intern Med. 2021 Feb 2. doi: 10.1007/s11606-020-06511-9. Epub ahead of print. PMID: 33532965
2020
Leonard C, Ayele R, Ladebue A, McCreight M, Nolan C, Sandbrink F, Frank JW. Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study. Pain Med. 2020 Sep 24:pnaa312. doi: 10.1093/pm/pnaa312. Online ahead of print. PMID: 32974662
Manges KA, Ayele R, Leonard C, Lee M, Galenbeck E, Burke RE. Differences in transitional care processes among high-performing and low-performing hospital-SNF pairs: a rapid ethnographic approach. BMJ Qual Saf. 2020 Sep 21:bmjqs-2020-011204. doi: 10.1136/bmjqs-2020-011204. Online ahead of print. PMID: 32958550
Ayele R, Manges KA, Leonard C, Lee M, Galenbeck E, Molla M, Levy C, Burke RE. How Context Influences Hospital Readmissions from Skilled Nursing Facilities: A Rapid Ethnographic Study. J Am Med Dir Assoc. 2020 Sep 14:S1525-8610(20)30665-4. doi: 10.1016/j.jamda.2020.08.001. Online ahead of print. PMID: 32943342
Connelly B, Ujano-De Motta LL, Leonard C, Mayberry A, Kelley L, Gaskin D, Gilmartin HM. Mapping the reach of a rural Transitions Nurse Program for veterans with geographic information systems. Implement Sci Commun. 2020 Mar 19;1:36. doi: 10.1186/s43058-020-00026-4. eCollection 2020. PMID: 32885193
2019
Burke RE, Leonard C, Lee M, Ayele R, Cumbler E, Allyn R, Greysen SR. Cognitive Biases Influence Decision-Making Regarding Postacute Care in a Skilled Nursing Facility. J Hosp Med. 2020 Jan 1;15(1):22-27. doi: 10.12788/jhm.3273. Epub 2019 Aug 16. PMCID: PMC6932595. PMID: 31433771
McCreight MS, Rabin BA, Glasgow RE, Ayele RA, Leonard CA, Gilmartin HM, Frank JW, Hess PL, Burke RE, Battaglia CT. Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs. Transl Behav Med. 2019 Nov 25;9(6):1002-1011. doi: 10.1093/tbm/ibz085. PMID: 31170296
McCreight MS, Gilmartin HM, Leonard CA, Mayberry AL, Kelley LR, Lippmann BK, Coy AS, Radcliff TA, Côté MJ, Burke RE. Practical Use of Process Mapping to Guide Implementation of a Care Coordination Program for Rural Veterans. J Gen Intern Med. 2019 May;34(Suppl 1):67-74. doi: 10.1007/s11606-019-04968-x. PMID: 31098974
Ayele R, Jones J, Ladebue A, Lawrence E, Valverde P, Leonard C, Cumbler E, Allyn R, Burke RE. Perceived Costs of Care Influence Post-Acute Care Choices by Clinicians, Patients, and Caregivers. J Am Geriatr Soc. 2019 Apr;67(4):703-710. doi: 10.1111/jgs.15768. Epub 2019 Feb 1. PMID: 30707766
Media (Video, Podcast, Other)
Phenomenological Research and Health Services: Understanding the Lived Experience of Veterans with Lower Limb Amputations
8 June 2023
by Chelsea Leonard, PhD; George Sayre, PsyD
The Arranged Marriage between Innovation and Research: Lessons Learned from the FLOW3/VACE Partnership
18 May 2020
by Evan Carey, PhD ; Jeffrey Heckman, DO ; Chelsea Leonard, PhD
Description: FLOW3 is a VA developed innovation that leverages VA EMR infrastructure to incorporate and streamline the step-wise process for prosthetic limb care. The purpose of FLOW3 is to 1) improve accuracy, efficiency, consistency, and timeliness of the provision of artificial limbs to Veterans with limb loss, 2) improve data systems that manage and report on artificial limb provision, 3) improve employee satisfaction, and 4) improve the Veteran patient experience. To understand and evaluate implementation and impacts of FLOW3 on prosthetic limb care as it spread enterprise-wide, the FLOW3 operations team partnered with an evaluation team. Our partnership has resulted in a nuanced understanding of how a research-operational partnership can contribute to the use of data in a Learning Healthcare System, including identification of data sources to evaluate various aspects of an operations or clinical initiative and describing a standardized process for using and validating electronic health record data. Further, we have developed insight into the synergy of research-operational partnership; both research and operations are enhanced by understanding perspectives and methods of the other.
Objectives:
-Present experiential learning of the FLOW3 operations team in development and implementation of a novel program at VA.
-Describe impact of incorporating RE-AIM framework for understanding and development of high value data metrics
-Discuss lessons learned from operationalizing a dashboard using VA data and information systems to monitor and facilitate implementation.
Caring for Veterans reporting Chronic pain: Provider experiences and trends in the prevalence of chronic pain
by Evan Carey, PhD ; Chelsea Leonard, PhD
Seminar date: 4/3/2018
