# Collaborative Specialty Care for Gulf War Illness

> **NIH VA I01** · VA NEW JERSEY HEALTH CARE SYSTEM · 2022 · —

## Abstract

There is a quality chasm between the care Gulf War Veterans (GWVs) should receive and the care they do
receive. Our data show 70% of GWVs with Gulf War Illness (GWI) do not receive treatment recommendations
for their GWI and 78% are NOT very satisfied with their care. Reducing this quality chasm is essential. The VA
and DoD have invested hundreds of millions of dollars to develop new treatments, including the second largest
clinical trial for GWVs which is finding health coaching and problem-solving treatment both reduce the disability
of GWI. Without effective models of healthcare to implement these treatments, GWVs will not benefit. In the
current model of care, GWVs receive care locally through VA’s primary care patient aligned care teams
(PACTs). The VA War Related Illness and Injury Study Center (WRIISC) supports the current model of care by
increasing local knowledge of the skills and treatments needed to manage GWI through national education
efforts and electronic consultation (e-consultation) on difficult cases. The WRIISC and other stakeholders are
currently questioning whether improving local knowledge of skills and treatments for GWI is enough to address
the quality chasm, or if GWI is too complex to be treated in primary care without additional support from
specialists in GWI. A potentially useful model of care for GWI is collaborative specialty care where specialists
work with PACTs to synergistically treat patients. The local PACT is the lead of the team with the specialist
providing some direct care to the patient (through tele-health) and also consulting with the PACT about other
aspects of care. Collaborative specialty care is effective for other complex conditions (e.g., depression) with
over 40 studies documenting its efficacy. The goal of this proposal is to conduct a hybrid type 1 randomized
effectiveness/implementation trial for GWVs with GWI (n=220). Our primary aim is to determine the
effectiveness of tele-CSC as compared to e-consultation. In tele-CSC, our specialty provider team will deliver
health coaching and problem-solving treatment to GWVs and recommend the PACT make monthly
optimization of analgesics. In e-consultation the specialty provider team will make a onetime recommendation
to the PACT that the GWV locally receive health coaching and problem-solving treatment and analgesic
optimization. Our secondary aim is to understand implementation outcomes. This information will be used to
guide a future randomized (by VISN) multi-site implementation study. Throughout, an advisory committee of
operations partners will be convened to ensure that the results of the study are able to directly and immediately
improve care. Determining the best model of care to translate research into practice for GWVs with GWI is a
key goal of the VA Gulf War Strategic Plan and a specific aim of this Request for Applications.

## Key facts

- **NIH application ID:** 10213137
- **Project number:** 5I01HX002835-02
- **Recipient organization:** VA NEW JERSEY HEALTH CARE SYSTEM
- **Principal Investigator:** Lisa Marie McAndrew
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-06-01 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10213137

## Citation

> US National Institutes of Health, RePORTER application 10213137, Collaborative Specialty Care for Gulf War Illness (5I01HX002835-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10213137. Licensed CC0.

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