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https://www.readbyqxmd.com/read/29350512/electronic-health-record-problem-lists-accurate-enough-for-risk-adjustment
#1
Timothy J Daskivich, Garen Abedi, Sherrie H Kaplan, Douglas Skarecky, Thomas Ahlering, Brennan Spiegel, Mark S Litwin, Sheldon Greenfield
OBJECTIVES: To determine whether comorbidity information derived from electronic health record (EHR) problem lists is accurate. STUDY DESIGN: Retrospective cohort study of 1596 men diagnosed with prostate cancer between 1998 and 2004 at 2 Southern California Veterans Affairs Medical Centers with long-term follow-up. METHODS: We compared EHR problem list-based comorbidity assessment with manual review of EHR free-text notes in terms of sensitivity and specificity for identification of major comorbidities and Charlson Comorbidity Index (CCI) scores...
January 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29346587/are-root-cause-analyses-recommendations-effective-and-sustainable-an-observational-study
#2
Peter D Hibbert, Matthew J W Thomas, Anita Deakin, William B Runciman, Jeffrey Braithwaite, Stephanie Lomax, Jonathan Prescott, Glenda Gorrie, Amy Szczygielski, Tanja Surwald, Catherine Fraser
Objective: To assess the strength of root cause analysis (RCA) recommendations and their perceived levels of effectiveness and sustainability. Design: All RCAs related to sentinel events (SEs) undertaken between the years 2010 and 2015 in the public health system in Victoria, Australia were analysed. The type and strength of each recommendation in the RCA reports were coded by an expert patient safety classifier using the US Department of Veteran Affairs type and strength criteria...
January 16, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29345997/trends-in-health-insurance-and-type-among-military-veterans-united-states-2000-2016
#3
Carla E Zelaya, Colleen N Nugent
OBJECTIVES: To describe long-term national trends in health insurance coverage among US veterans from 2000 to 2016 in the context of recent health care reform. METHODS: We used 2000 to 2016 National Health Interview Survey data on veterans aged 18 to 64 years to examine trends in insurance coverage and uninsurance by year, income, and state Medicaid expansion status. We also explored the current proportions of veterans with each type of insurance by age group. RESULTS: The percentage of veterans with private insurance decreased from 70...
January 18, 2018: American Journal of Public Health
https://www.readbyqxmd.com/read/29345407/hepatitis-c-eradication-with-daa-and-risk-of-liver-cancer-recurrence-the-debate-unrests
#4
Massimo Colombo, Vincenzo Boccaccio
The advent of user friendly and highly successful oral regimens based on direct antiviral agents (DAA), has made a cure of hepatitis C possible in more than 95% of treated patients, including those who were considered difficult to cure with interferon, a vast category including patients with advanced liver disease and those who had a hepatocellular carcinoma (HCC) successfully eradicated by resection or local ablation1 . Despite low rates of treatment uptake and response to therapy with interferon, such hard to treat patients were able to gain significant health benefits, like halting of progression towards liver failure and prevention of second primary tumours, once replication of the hepatitis C virus (HCV) was permanently shut down2,3 ...
January 18, 2018: Journal of Viral Hepatitis
https://www.readbyqxmd.com/read/29344631/a-brief-exposure-based-treatment-vs-cognitive-processing-therapy-for-posttraumatic-stress-disorder-a-randomized-noninferiority-clinical-trial
#5
Denise M Sloan, Brian P Marx, Daniel J Lee, Patricia A Resick
Importance: Written exposure therapy (WET), a 5-session intervention, has been shown to efficaciously treat posttraumatic stress disorder (PTSD). However, this treatment has not yet been directly compared with a first-line PTSD treatment such as cognitive processing therapy (CPT). Objective: To determine if WET is noninferior to CPT in patients with PTSD. Design, Setting, and Participants: In this randomized clinical trial conducted at a Veterans Affairs medical facility between February 28, 2013, and November 6, 2016, 126 veteran and nonveteran adults were randomized to either WET or CPT...
January 17, 2018: JAMA Psychiatry
https://www.readbyqxmd.com/read/29342320/association-of-pre-esrd-serum-calcium-with-post-esrd-mortality-among-incident-esrd-patients-a-cohort-study
#6
Yoshitsugu Obi, Christina Park, Melissa Soohoo, Keiichi Sumida, Takayuki Hamano, Connie M Rhee, Csaba P Kovesdy, Kamyar Kalantar-Zadeh, Elani Streja
Albumin-corrected serum calcium (cSCa) decline at late stages of chronic kidney disease and rise after dialysis initiation. While hypercalcemia is associated with higher mortality in end-stage renal disease (ESRD), there are scarce data on the impact of pre-ESRD cSCa on post-ESRD mortality. Therefore, we used a large national cohort of 21,826 US veterans with incident ESRD who transitioned to dialysis in all US Department of Veterans Affairs healthcare facilities over 2009-2014 to examine the associations with all-cause and cause-specific post-ESRD mortality of (1) cSCa concentrations averaged over the last six months and (2) its rate of decline during the last 12 months before dialysis initiation...
January 17, 2018: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
https://www.readbyqxmd.com/read/29339013/the-use-of-telemental-health-to-meet-the-mental-health-needs-of-women-using-department-of-veterans-affairs-services
#7
Jessica L Moreau, Kristina M Cordasco, Alexander S Young, Sabine M Oishi, Danielle E Rose, Ismelda Canelo, Elizabeth M Yano, Sally G Haskell, Alison B Hamilton
BACKGROUND: Women veterans are a growing segment of Department of Veterans Affairs (VA) users with distinct mental health needs and well-documented barriers to care. Telemental health holds much promise for reducing barriers to mental health care. We assessed VA stakeholders' perceptions of telemental health's appropriateness and potential to address the mental health needs of women veteran VA users. METHODS: We conducted semistructured qualitative interviews with 40 key leadership and clinical stakeholders at VA medical centers and associated outpatient clinics...
January 12, 2018: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/29337486/improving-risk-stratification-among-veterans-diagnosed-with-prostate-cancer-impact-of-the-17-gene-prostate-score-assay
#8
Julie A Lynch, Megan P Rothney, Raoul R Salup, Cesar E Ercole, Sharad C Mathur, David A Duchene, Joseph W Basler, Javier Hernandez, Michael A Liss, Michael P Porter, Jonathan L Wright, Michael C Risk, Mark Garzotto, Olga Efimova, Laurie Barrett, Brygida Berse, Michael J Kemeter, Phillip G Febbo, Atreya Dash
BACKGROUND: Active surveillance (AS) has been widely implemented within Veterans Affairs' medical centers (VAMCs) as a standard of care for low-risk prostate cancer (PCa). Patient characteristics such as age, race, and Agent Orange (AO) exposure may influence advisability of AS in veterans. The 17-gene assay may improve risk stratification and management selection. OBJECTIVES: To compare management strategies for PCa at 6 VAMCs before and after introduction of the Oncotype DX Genomic Prostate Score (GPS) assay...
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29336277/evaluation-of-hypoglycemia-and-potential-risk-factors-in-a-veterans-affairs-community-living-center
#9
Marissa L Ostroff, Kristin Aloi, William Bryan, Jason Moss, Lindsay Garris, Richard Sloane, Jennie Hewitt, Carrie Thomas, Janine Bailey
OBJECTIVES: To describe hypoglycemic events in a Veterans Affairs (VA) community living center (CLC) population and to determine predictive risk factors associated with hypoglycemia. DESIGN: Retrospective, exploratory, observational chart review. SETTING: Tertiary-care VA Healthcare System CLC. PATIENTS: Residents residing in a VA CLC with at least one active order for insulin between June 1, 2009, and June 30, 2013, were evaluated over a 90-day study period...
January 1, 2018: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/29335238/automating-quality-measures-for-heart-failure-using-natural-language-processing-a-descriptive-study-in-the-department-of-veterans-affairs
#10
Jennifer Hornung Garvin, Youngjun Kim, Glenn Temple Gobbel, Michael E Matheny, Andrew Redd, Bruce E Bray, Paul Heidenreich, Dan Bolton, Julia Heavirland, Natalie Kelly, Ruth Reeves, Megha Kalsy, Mary Kane Goldstein, Stephane M Meystre
BACKGROUND: We developed an accurate, stakeholder-informed, automated, natural language processing (NLP) system to measure the quality of heart failure (HF) inpatient care, and explored the potential for adoption of this system within an integrated health care system. OBJECTIVE: To accurately automate a United States Department of Veterans Affairs (VA) quality measure for inpatients with HF. METHODS: We automated the HF quality measure Congestive Heart Failure Inpatient Measure 19 (CHI19) that identifies whether a given patient has left ventricular ejection fraction (LVEF) <40%, and if so, whether an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker was prescribed at discharge if there were no contraindications...
January 15, 2018: JMIR Medical Informatics
https://www.readbyqxmd.com/read/29334874/a-comparison-of-collaborative-care-outcomes-in-two-health-care-systems-va-clinics-and-federally-qualified-health-centers
#11
Kathleen M Grubbs, John C Fortney, Jeffrey Pyne, Dinesh Mittal, John Ray, Teresa J Hudson
OBJECTIVE: Collaborative care for depression results in symptom reduction when compared with usual care. No studies have systematically compared collaborative care outcomes between veterans treated at Veterans Affairs (VA) clinics and civilians treated at publicly funded federally qualified health centers (FQHCs) after controlling for demographic and clinical characteristics. METHODS: Data from two randomized controlled trials that used a similar collaborative care intervention for depression were combined to conduct post hoc analyses (N=759)...
January 16, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/29332503/-they-said-on-the-death-certificate%C3%A2-but-really-what-i-think-happened-characterizing-cause-of-death-in-va-medical-centers
#12
Beverly Rosa Williams, F Amos Bailey, Patricia S Goode, Kathryn L Burgio
Cause of death information is a vital resource for family and public health, yet significant issues persist regarding its determination, documentation and communication. In this study, we aim to characterize cause of death attribution process from the perspective of next-of-kin of Veterans who died in Veterans Affairs (VA) Medical Centers. Using a semi-structured guide, we explored next-of-kin's experiences of the Veteran's terminal hospitalization and conducted a content analysis of interview texts. In over two-third of cases next-of-kin's understanding was not consistent with their recollection of physicians' determination of cause of death...
January 1, 2018: Journal of Palliative Care
https://www.readbyqxmd.com/read/29331475/end-of-life-care-for-patients-with-advanced-kidney-disease-in-the-us-veterans-affairs-health-care-system-2000-2011
#13
Susan P Y Wong, Margaret K Yu, Pamela K Green, Chuan-Fen Liu, Paul L Hebert, Ann M O'Hare
BACKGROUND: Little is known about patterns of end-of-life care for patients with advanced kidney disease not treated with maintenance dialysis. STUDY DESIGN: Case series. SETTING & PARTICIPANTS: A sample of 14,071 patients with sustained estimated glomerular filtration rates < 15mL/min/1.73m2 treated in the US Veterans Affairs health care system who died during 2000 to 2011. Before death, 12,756 of these patients had been treated with dialysis, 503 had been discussing and/or preparing for dialysis therapy, and for 812, there had been a decision not to pursue dialysis therapy...
January 10, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29330260/race-and-socioeconomic-status-independently-affect-risk-of-major-amputation-in-peripheral-artery-disease
#14
Shipra Arya, Zachary Binney, Anjali Khakharia, Luke P Brewster, Phil Goodney, Rachel Patzer, Jason Hockenberry, Peter W F Wilson
BACKGROUND: Black race has been shown to be a risk factor for amputation in peripheral artery disease (PAD); however, race has been argued to be a marker for socioeconomic status (SES) rather than true disparity. The aim of this study is to study the impact of race and SES on amputation risk in PAD patients. METHODS AND RESULTS: Patients with incident PAD in the national Veterans Affairs Corporate Data Warehouse were identified from 2003 to 2014 (N=155 647). The exposures were race and SES (measured by median income in residential ZIP codes)...
January 12, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29330243/task-delegation-and-burnout-trade-offs-among-primary-care-providers-and-nurses-in-veterans-affairs-patient-aligned-care-teams-va-pacts
#15
Samuel T Edwards, Christian D Helfrich, David Grembowski, Elizabeth Hulen, Walter L Clinton, Gordon B Wood, Linda Kim, Danielle E Rose, Greg Stewart
PURPOSE: Appropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown. METHODS: We performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative...
January 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29330238/changing-patterns-of-mental-health-care-use-the-role-of-integrated-mental-health-services-in-veteran-affairs-primary-care
#16
Lucinda B Leung, Jean Yoon, Lisa V Rubenstein, Edward P Post, Maureen E Metzger, Kenneth B Wells, Catherine A Sugar, José J Escarce
OBJECTIVE: Aiming to foster timely, high-quality mental health care for Veterans, VA's Primary Care-Mental Health Integration (PC-MHI) embeds mental health specialists in primary care and promotes care management for depression. PC-MHI and patient-centered medical home providers work together to provide the bulk of mental health care for primary care patients with low-to-moderate-complexity mental health conditions. This study examines whether increasing primary care clinic engagement in PC-MHI services is associated with changes in patient health care utilization and costs...
January 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29330214/statins-have-a-dose-dependent-effect-on-amputation-and-survival-in-peripheral-artery-disease-patients
#17
Shipra Arya, Anjali Khakharia, Zachary O Binney, Randall R DeMartino, Luke P Brewster, Philip P Goodney, Peter W F Wilson
Background -Statin dose guidelines for Peripheral Artery Disease (PAD) patients are largely based on coronary artery disease and stroke data. The aim of this study is to determine the effect of statin intensity on PAD outcomes of amputation and mortality. Methods -Using an observational cohort study design and a validated algorithm we identified incident PAD patients (2003-2014) in the national Veterans Affairs data. Highest statin intensity exposure [high intensity vs low- moderate intensity vs antiplatelet therapy but no statin use (AP only)] was determined within one year of diagnosis of PAD...
January 12, 2018: Circulation
https://www.readbyqxmd.com/read/29325440/case-mix-adjustment-of-the-bereaved-family-survey
#18
Ann Kutney-Lee, Joan Carpenter, Dawn Smith, Joshua Thorpe, Alina Tudose, Mary Ersek
Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29325162/an-analysis-of-adverse-events-in-the-rehabilitation-department-using-the-veterans-affairs-root-cause-analysis-system
#19
Gregory W Hagley, Peter D Mills, Brian Shiner, Robin R Hemphill
Background: Root cause analyses (RCA) are often completed in health care settings to determine causes of adverse events (AEs). RCAs result in action plans designed to mitigate future patient harm. National reviews of RCA reports have assessed the safety of numerous health care settings and suggested opportunities for improvement. However, few studies have assessed the safety of receiving care from physical therapists, occupational therapists, or speech and language pathology pathologists...
January 9, 2018: Physical Therapy
https://www.readbyqxmd.com/read/29320139/reimbursement-for-emergency-treatment-interim-final-rule
#20
(no author information available yet)
The Department of Veterans Affairs (VA) revises its regulations concerning payment or reimbursement for emergency treatment for non-service-connected conditions at non-VA facilities to implement the requirements of a recent court decision. Specifically, this rulemaking expands eligibility for payment or reimbursement to include veterans who receive partial payment from a health-plan contract for non-VA emergency treatment and establishes a corresponding reimbursement methodology. This rulemaking also expands the eligibility criteria for veterans to receive payment or reimbursement for emergency transportation associated with the emergency treatment, in order to ensure that veterans are adequately covered when emergency transportation is a necessary part of their non-VA emergency treatment...
January 9, 2018: Federal Register
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