Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

Science.gov (United States)

Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

2016-01-01

The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

77 FR 14600 - Public Availability of the Department of Veterans Affairs Fiscal Year (FY) 2011 Service Contract...

Science.gov (United States)

2012-03-12

... DEPARTMENT OF VETERANS AFFAIRS Public Availability of the Department of Veterans Affairs Fiscal Year (FY) 2011 Service Contract Inventory AGENCY: Department of Veterans Affairs. ACTION: Notice of... Affairs (VA) is publishing this notice to advise the public of the availability of the FY 2011 Service...

Erectile Dysfunction Medication Use in Veterans Eligible for Medicare Part D.

Science.gov (United States)

Spencer, Samantha H; Suda, Katie J; Smith, Bridget M; Huo, Zhiping; Bailey, Lauren; Stroupe, Kevin T

2016-07-01

Erectile dysfunction (ED) medications are therapeutically effective and associated with satisfaction. Medicare Part D included ED medications on the formulary during 2006 and inadvertently in 2007-2008. To characterize phosphodiesterase-5 inhibitor (PDE-5) medication use among veterans who were dually eligible for Veterans Affairs (VA) and Medicare Part D benefits. Veterans aged > 66 years who received PDE-5 inhibitors between 2005 and 2009 were included. Veterans were categorized by PDE-5 inhibitor claims: VA-only, Part D-only, or dual users of VA and Part D-reimbursed pharmacies. T-tests and chi-square tests were applied as appropriate. From 2005 to 2009, the majority (85.2%) of veterans used VA benefits exclusively for their PDE-5 inhibitors; 11.4% used Medicare Part D exclusively; and 3.4% were dual users. The Part D-only group was older, more frequently not black, had a VA copay, and had a higher income (P filling prescriptions for PDE-5 inhibitors (-68%) and total number of PDE-5 inhibitor 30-day equivalents dispensed (-86.7%) from the VA decreased. Part D prescriptions increased through 2006 (full coverage period) and 2007 (accidental partial coverage) and decreased in 2008. While Part D accounted for only 10% of PDE-5 inhibitor 30-day equivalents, it equaled 29.2% of dispensed tablets. In October 2007, VA PDE-5 inhibitor use returned to 2005 levels. Implementation of Medicare Part D reduced VA PDE-5 inhibitor acquisition. However, after removal of PDE-5 inhibitors from the Part D formulary, use of VA pharmacies for PDE-5 inhibitors resumed. Medication policies outside the VA can affect medication use. Veterans with access to non-VA health care may obtain medications from the private sector because of VA restrictions. This may be especially true for nonformulary and lifestyle medications. The authors received funding support for this research project from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and

Interagency partnership to deliver Veteran-Directed Home and Community-Based Services: Interviews with Aging and Disability Network agency personnel regarding their experience with partner Department of Veterans Affairs medical centers.

Science.gov (United States)

Thomas, Kali S; Allen, Susan M

2016-01-01

Veteran-Directed Home and Community-Based Services (VD-HCBS) is a consumer-directed program that began in 2009 and is jointly administered in a partnership between the Veterans Health Administration and the Administration for Community Living. The objective of this article is to describe the Aging and Disability Network agency (ADNA) personnel's perceptions of the implementation of the VD-HCBS program with partner Department of Veterans Affairs medical centers (VAMCs). Qualitative interviews with 26 ADNA VD-HCBS personnel across the country were transcribed, coded, and analyzed. Results suggest that the majority of ADNA personnel interviewed perceive the collaboration experience to be positive. Interviewees reported several key mechanisms for facilitating a successful partnership, including frequent communication, training in VAMC billing procedures, having a designated VAMC staff person for the program, and active involvement of the VAMC from the onset of VD-HCBS program development. Findings have implications for other interagency partnerships formed to deliver services to vulnerable Veterans.

Military Construction, Military Quality of Life and Veterans Affairs: FY2007 Appropriations

National Research Council Canada - National Science Library

Else, Daniel H; Scott, Christine; Panangala, Sidath V

2007-01-01

... construction, military housing allowances, military installation maintenance and operation, the Department of Veterans Affairs, and other veteran-related agencies, rested in the House Committee...

32 CFR Appendix D to Part 45 - State Directors of Veterans Affairs

Science.gov (United States)

2010-07-01

... 55155. Mississippi President, State Veterans Affairs Board, 120 North State Street, War Memorial..., Trenton, NJ 08608. New Mexico Director, Veterans Service Commission, P.O. Box 2324, Santa Fe, NM 87503...

Accessibility and acceptability of the Department of Veteran Affairs health care: diverse veterans' perspectives.

Science.gov (United States)

Damron-Rodriguez, JoAnn; White-Kazemipour, Whitney; Washington, Donna; Villa, Valentine M; Dhanani, Shawkat; Harada, Nancy D

2004-03-01

Diverse veteran's perspectives on the accessibility and acceptability of the Department of Veteran Affairs (VA) health services are presented. The qualitative methodology uses 16 focus groups (N = 178) stratified by war cohort (World War II and Korean Conflict versus Vietnam War and Persian Gulf War) and four ethnic/racial categories (African American, Asian American, European American, Hispanic American). Five themes emerged regarding veterans' health care expectations: (1) better information regarding available services, (2) sense of deserved benefits, (3) concern about welfare stigma, (4) importance of physician attentiveness, and (5) staff respect for patients as veterans. Although veterans' ethnic/racial backgrounds differentiated their military experiences, it was the informants' veteran identity that framed what they expected of VA health services. Accessibility and acceptability of VA health care is related to veterans' perspectives of the nature of their entitlement to service. Provider education and customer service strategies should consider the identified factors to increase access to VA as well as improve veterans' acceptance of the care.

PTSD Treatment Programs in the U.S. Department of Veterans Affairs

Science.gov (United States)

... Programs in the U.S. Department of Veterans Affairs PTSD: National Center for PTSD Menu Menu PTSD PTSD Home For the Public ... Enter ZIP code here Enter ZIP code here PTSD Treatment Programs in the U.S. Department of Veterans ...

77 FR 54367 - Sharing Information Between the Department of Veterans Affairs and the Department of Defense

Science.gov (United States)

2012-09-05

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 1 RIN 2900-AN95 Sharing Information Between the...) regulatory restriction on the sharing of certain medical information with the Department of Defense (DoD... economy of $100 million or more or adversely affect in a material way the economy, a sector of the economy...

Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center.

Science.gov (United States)

Eisenberg, Dan; Lohnberg, Jessica A; Kubat, Eric P; Bates, Cheryl C; Greenberg, Lauren M; Frayne, Susan M

2017-04-01

Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m 2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts. Published by

Facilitators and Barriers to Preparedness Partnerships: A Veterans Affairs Medical Center Perspective.

Science.gov (United States)

Schmitz, Susan; Wyte-Lake, Tamar; Dobalian, Aram

2017-09-13

This study sought to understand facilitators and barriers faced by local US Department of Veterans Affairs Medical Center (VAMC) emergency managers (EMs) when collaborating with non-VA entities. Twelve EMs participated in semi-structured interviews lasting 60 to 90 minutes discussing their collaboration with non-VAMC organizations. Sections of the interview transcripts concerning facilitators and barriers to collaboration were coded and analyzed. Common themes were organized into 2 categories: (1) internal (ie, factors affecting collaboration from within VAMCs or by VA policy) and (2) external (ie, interagency or interpersonal factors). Respondents reported a range of facilitators and barriers to collaboration with community-based agencies. Internal factors facilitating collaboration included items such as leadership support. An internal barrier example included lack of clarity surrounding the VAMC's role in community disaster response. External factors noted as facilitators included a shared goal across organizations while a noted barrier was a perception that potential partners viewed a VAMC partnership with skepticism. Federal institutions are important partners for the success of community disaster preparedness and response. Understanding the barriers that VAMCs confront, as well as potential facilitators to collaboration, should enhance the development of VAMC-community partnerships and improve community health resilience. (Disaster Med Public Health Preparedness. 2017; page 1 of 6).

38 CFR 2.8 - Delegation of authority to authorize allowances for Department of Veterans Affairs employees who...

Science.gov (United States)

2010-07-01

... AUTHORITY § 2.8 Delegation of authority to authorize allowances for Department of Veterans Affairs employees... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Delegation of authority to authorize allowances for Department of Veterans Affairs employees who are notaries public. 2.8...

AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for Department of Veterans Affairs. James J. Peters VA Medical Center, Bronx, NY

Energy Technology Data Exchange (ETDEWEB)

Schey, Stephen [Intertek Testing Services, North America, Phoenix, AZ (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2014-10-01

This report focuses on the Department of Veterans Affairs, James J. Peters VA Medical Center (VA - Bronx) fleet to identify daily operational characteristics of select vehicles and report findings on vehicle and mission characterizations to support the successful introduction of PEVs into the agencies’ fleets. Individual observations of these selected vehicles provide the basis for recommendations related to electric vehicle adoption and whether a battery electric vehicle or plug-in hybrid electric vehicle (collectively referred to as PEVs) can fulfill the mission requirements.

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

Science.gov (United States)

Hussey, Peter S.; Ringel, Jeanne S.; Ahluwalia, Sangeeta; Price, Rebecca Anhang; Buttorff, Christine; Concannon, Thomas W.; Lovejoy, Susan L.; Martsolf, Grant R.; Rudin, Robert S.; Schultz, Dana; Sloss, Elizabeth M.; Watkins, Katherine E.; Waxman, Daniel; Bauman, Melissa; Briscombe, Brian; Broyles, James R.; Burns, Rachel M.; Chen, Emily K.; DeSantis, Amy Soo Jin; Ecola, Liisa; Fischer, Shira H.; Friedberg, Mark W.; Gidengil, Courtney A.; Ginsburg, Paul B.; Gulden, Timothy; Gutierrez, Carlos Ignacio; Hirshman, Samuel; Huang, Christina Y.; Kandrack, Ryan; Kress, Amii; Leuschner, Kristin J.; MacCarthy, Sarah; Maksabedian, Ervant J.; Mann, Sean; Matthews, Luke Joseph; May, Linnea Warren; Mishra, Nishtha; Miyashiro, Lisa; Muchow, Ashley N.; Nelson, Jason; Naranjo, Diana; O'Hanlon, Claire E.; Pillemer, Francesca; Predmore, Zachary; Ross, Rachel; Ruder, Teague; Rutter, Carolyn M.; Uscher-Pines, Lori; Vaiana, Mary E.; Vesely, Joseph V.; Hosek, Susan D.; Farmer, Carrie M.

2016-01-01

Abstract The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans' demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth. PMID:28083424

38 CFR 3.201 - Exchange of evidence; Social Security and Department of Veterans Affairs.

Science.gov (United States)

2010-07-01

... Compensation Evidence Requirements § 3.201 Exchange of evidence; Social Security and Department of Veterans... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Exchange of evidence; Social Security and Department of Veterans Affairs. 3.201 Section 3.201 Pensions, Bonuses, and Veterans...

Preventing Hospitalization with Veterans Affairs Home-Based Primary Care: Which Individuals Benefit Most?

Science.gov (United States)

Edwards, Samuel T; Saha, Somnath; Prentice, Julia C; Pizer, Steven D

2017-08-01

To examine how medical complexity modifies the relationship between enrollment in Department of Veterans Affairs (VA) home-based primary care (HBPC) and hospitalization for ambulatory care-sensitive conditions (ACSC) for veterans with diabetes mellitus and whether the effect of HBPC on hospitalizations varies according to clinical condition. Retrospective cohort study. VA and non-VA hospitals. VA beneficiaries aged 67 and older with diabetes mellitus and enrolled in Medicare (N = 364,972). Instrumental variables regression models were used to estimate the effect of HBPC enrollment on hospitalization for ACSCs (defined according to the Agency for Healthcare Research and Quality Prevention Quality Indicators) overall and in subgroups stratified according to medical complexity. Models were also estimated for each ACSC to determine which conditions were most sensitive to HBPC. Distance from the veteran's residence to the nearest HBPC site was used as the instrumental variable. HBPC was associated with fewer ACSC hospitalizations (odds ratio (OR) = 0.35 per person-month, 95% confidence interval (CI) = 0.30-0.42). For veterans in the highest quartile of medical complexity, HBPC enrollment was associated with fewer ACSC hospitalizations (OR = 0.43, 95% CI = 0.19-0.93), whereas for those in the lowest quartile, HBPC was associated with more ACSC hospitalizations (OR = 33.2, 95% CI = 4.6-240.1). HBPC enrollment was associated with fewer hospitalizations for a range of ACSCs. HBPC enrollment was associated with fewer hospitalizations for a range of ACSCs in veterans with diabetes mellitus but only in the most medically complex individuals. This demonstrates the importance of appropriate targeting and suggests that the effect of HBPC is attributable to its comprehensive approach rather than condition-specific interventions. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Assessment of diabetic teleretinal imaging program at the Portland Department of Veterans Affairs Medical Center.

Science.gov (United States)

Tsan, Grace L; Hoban, Keely L; Jun, Weon; Riedel, Kevin J; Pedersen, Amy L; Hayes, John

2015-01-01

We conducted a retrospective chart review of 200 diabetic patients who had teleretinal imaging performed between January 1, 2010, and January 1, 2011, at Portland Department of Veterans Affairs (VA) Medical Center outpatient clinics to assess the effectiveness of the diabetic teleretinal imaging program. Twenty patients (10%) had diabetic retinopathy. Ninety percent of the available teleretinal imaging studies were of adequate quality for interpretation. In accordance with local VA policy at that time, all teleretinal imaging patients should have been referred for a dilated retinal examination the following year. Image readers referred 97.5% of the patients to eye clinics for subsequent eye examinations, but the imagers scheduled appointments for only 80% of these patients. The redundancy rate, i.e., patients who had an eye examination within the past 6 mo, was 11%; the duplicate recall rate, i.e., patients who had a second teleretinal imaging performed within 1 yr of the eye examination, was 37%. Rates of timely diabetic eye examinations at clinics with teleretinal imaging programs, particularly when teleretinal imaging and eye clinics were colocated at the same community-based outpatient clinic, were higher than those without a teleretinal imaging program. We concluded that the Portland VA Medical Center's teleretinal imaging program was successful in increasing the screening rate for diabetic retinopathy.

Veterans Affairs Geographic Distribution of Expenditures FY09 by Congressional District

Data.gov (United States)

Department of Veterans Affairs — The Geographic Distribution of VA Expenditures (GDX) is an annual report that shows estimated VA expenditures for major programmatic areas by geographic area (state,...

Veterans Affairs Geographic Distribution of Expenditures FY08 by Congressional District

Data.gov (United States)

Department of Veterans Affairs — The Geographic Distribution of VA Expenditures (GDX) is an annual report that shows estimated VA expenditures for major programmatic areas by geographic area (state,...

2 CFR 801.930 - Debarring official (Department of Veterans Affairs supplement to government-wide definition at 2...

Science.gov (United States)

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Debarring official (Department of Veterans Affairs supplement to government-wide definition at 2 CFR 180.930). 801.930 Section 801.930 Grants and... DEBARMENT AND SUSPENSION Definitions § 801.930 Debarring official (Department of Veterans Affairs supplement...

2 CFR 801.1010 - Suspending official (Department of Veterans Affairs supplement to government-wide definition at 2...

Science.gov (United States)

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Suspending official (Department of Veterans Affairs supplement to government-wide definition at 2 CFR 180.1010). 801.1010 Section 801.1010 Grants and... DEBARMENT AND SUSPENSION Definitions § 801.1010 Suspending official (Department of Veterans Affairs...

76 FR 72046 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

Science.gov (United States)

2011-11-21

... DEPARTMENT OF VETERANS AFFAIRS Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development of Space for Community Services and Parking in Memphis, TN AGENCY... property is located. This project meets this requirement. Approved: November 14, 2011. Eric K. Shinseki...

76 FR 72048 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

Science.gov (United States)

2011-11-21

... DEPARTMENT OF VETERANS AFFAIRS Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development of Permanent Housing in Grand Island, NE AGENCY: Department of... property is located. This project meets this requirement. Approved: November 14, 2011. Eric K. Shinseki...

Impact of presumed service-connected diagnosis on the Department of Veterans Affairs healthcare utilization patterns of Vietnam-Theater Veterans

Science.gov (United States)

Fried, Dennis A.; Rajan, Mangala; Tseng, Chin-lin; Helmer, Drew

2018-01-01

Abstract During the Vietnam War, the US military sprayed almost 20 million gallons of Agent Orange (AO), an herbicide contaminated with dioxin, over Vietnam. Approximately, 2.7 million US military personnel may have been exposed to AO during their deployment. Ordinarily, veterans who can demonstrate a nexus between a diagnosed condition and military service are eligible for Department of Veterans Affairs (VA) service-connected disability compensation. Vietnam Veterans have had difficulty, however, establishing a nexus between AO exposure and certain medical conditions that developed many years after the war. In response, VA has designated certain conditions as “presumed service connected” for Vietnam Veterans who were present and possibly exposed. Veterans with any of these designated conditions do not have to document AO exposure, making it easier for them to access the VA disability system. The extent to which VA healthcare utilization patterns reflect easier access afforded those with diagnosed presumptive conditions remains unknown. In this cross-sectional study, we hypothesized that Vietnam Veterans with diagnosed presumptive conditions would be heavier users of the VA healthcare system than those without these conditions. In our analysis of 85,699 Vietnam Veterans, we used binary and cumulative logit multivariable regression to assess associations between diagnosed presumptive conditions and VA healthcare utilization in 2013. We found that diagnosed presumptive conditions were associated with higher odds of 5+ VHA primary care visits (OR = 2.01, 95% CI: 1.93–2.07), 5+ specialty care visits (OR = 2.11, 95% CI: 2.04–2.18), emergency department use (OR = 1.22, 95% CI: 1.11–1.34), and hospitalization (OR = 1.23, 95% CI: 1.17–1.29). Consistent with legislative intent, presumptive policies appear to facilitate greater VA system utilization for Vietnam Veterans who may have been exposed to AO. PMID:29742706

Veterans Affairs Geographic Distribution of Expenditures FY07 by State and County

Data.gov (United States)

Department of Veterans Affairs — The Geographic Distribution of VA Expenditures (GDX) is an annual report that shows estimated VA expenditures for major programmatic areas by geographic area (state,...

Veterans Affairs Geographic Distribution of Expenditures FY08 by State and County

Data.gov (United States)

Department of Veterans Affairs — The Geographic Distribution of VA Expenditures (GDX) is an annual report that shows estimated VA expenditures for major programmatic areas by geographic area (state,...

Zeroing in on methicillin-resistant Staphylococcus aureus: US Department of Veterans Affairs' MRSA Prevention Initiative.

Science.gov (United States)

Kralovic, Stephen M; Evans, Martin E; Simbartl, Loretta A; Ambrose, Meredith; Jain, Rajiv; Roselle, Gary A

2013-05-01

Implementation of a methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative within US Department of Veterans Affairs medical facilities was associated with a significant reduction in MRSA health care-associated infection (HAI) rates nationwide. The first 36 months of data from the Initiative were analyzed to determine how many facilities reported zero MRSA HAIs each month. From October 2007 through September 2010, there was a 37.6% increase nationwide in the number of facilities achieving zero MRSA HAIs each month. Published by Mosby, Inc.

The Veterans Affairs's Corporate Data Warehouse: Uses and Implications for Nursing Research and Practice.

Science.gov (United States)

Price, Lauren E; Shea, Kimberly; Gephart, Sheila

2015-01-01

The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one of the largest integrated health care information systems in the United States. The VHA's Corporate Data Warehouse (CDW) was developed in 2006 to accommodate the massive amounts of data being generated from more than 20 years of use and to streamline the process of knowledge discovery to application. This article describes the developments in research associated with the VHA's transition into the world of Big Data analytics through CDW utilization. The majority of studies utilizing the CDW also use at least one other data source. The most commonly occurring topics are pharmacy/medications, systems issues, and weight management/obesity. Despite the potential benefit of data mining techniques to improve patient care and services, the CDW and alternative analytical approaches are underutilized by researchers and clinicians.

Determinants of Contraceptive Availability at Medical Facilities in the Department of Veterans Affairs

Science.gov (United States)

Cope, Jacqueline R; Yano, Elizabeth M; Lee, Martin L; Washington, Donna L

2006-01-01

OBJECTIVE To describe the variation in provision of hormonal and intrauterine contraception among Veterans Affairs (VA) facilities. DESIGN Key informant, cross-sectional survey of 166 VA medical facilities. Data from public use data sets and VA administrative databases were linked to facility data to further characterize their contextual environments. PARTICIPANTS All VA hospital-based and affiliated community-based outpatient clinics delivering services to at least 400 unique women during fiscal year 2000. MEASUREMENTS Onsite availability of hormonal contraceptive prescription and intrauterine device (IUD) placement. RESULTS Ninety-seven percent of facilities offered onsite prescription and management of hormonal contraception whereas 63% offered placement of IUDs. After adjusting for facility caseload of reproductive-aged women, 3 organizational factors were independently associated with onsite IUD placement: (1) onsite gynecologist (adjusted odds ratio [OR], 20.35; 95% confidence interval [CI], 7.02 to 58.74; Pwomen's health training to other clinicians (adjusted OR, 3.40; 95% CI 1.19 to 9.76; P=.02). CONCLUSIONS VA's provision of hormonal and intrauterine contraception is in accordance with community standards, although onsite availability is not universal. Although contraception is a crucial component of a woman's health maintenance, her ability to obtain certain contraceptives from the facility where she obtains her primary care is largely influenced by the availability of a gynecologist. Further research is needed to determine how fragmentation of women's care into reproductive and nonreproductive services impacts access to contraception and the incidence of unintended pregnancy. PMID:16637943

Redesigning a joint replacement program using Lean Six Sigma in a Veterans Affairs hospital.

Science.gov (United States)

Gayed, Benjamin; Black, Stephen; Daggy, Joanne; Munshi, Imtiaz A

2013-11-01

In April 2009, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, revealed that total hip and knee replacements incurred $1.4 million in non-Veterans Affairs (VA) care costs with an average length of stay of 6.1 days during fiscal year 2008. The Joint Replacement Program system redesign project was initiated following the Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain (VA-TAMMCS) model to increase efficiency, decrease length of stay, and reduce non-VA care costs. To determine the effectiveness of Lean Six Sigma process improvement methods applied in a VA hospital. Perioperative processes for patients undergoing total joint replacement were redesigned following the VA-TAMMCS model--the VA's official, branded method of Lean Six Sigma process improvement. A multidisciplinary team including the orthopedic surgeons, frontline staff, and executive management identified waste in the current processes and initiated changes to reduce waste and increase efficiency. Data collection included a 1-year baseline period and a 20-month sustainment period. The primary endpoint was length of stay; a secondary analysis considered non-VA care cost reductions. Length of stay decreased 36% overall, decreasing from 5.3 days during the preproject period to 3.4 days during the 20-month sustainment period (P Lean and Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in length of stay and completely eliminating non-VA care for total hip and knee replacements while increasing total joint replacement volume at this medical center.

Adherence to clinical practice guidelines for the treatment of candidemia at a Veterans Affairs Medical Center

Science.gov (United States)

Ashong, Chester N.; Hunter, Andrew S.; Mansouri, M. David; Cadle, Richard M.; Hamill, Richard J.; Musher, Daniel M.

2017-01-01

Objectives: The primary objective of this study was to examine the appropriateness of candidemia management at a Veterans Affairs Medical Center as recommended by the 2009 Infectious Diseases Society of America (IDSA) guidelines for treatment of Candida infections. Methods: A retrospective analysis of 94 adult patients with blood cultures positive for Candida spp. was performed. Patients were stratified by severity of disease into two groups: non-neutropenic, mild-moderate disease (Group 1, n = 54, 56%) and non-neutropenic, moderate-severe disease (Group 2, n = 40, 42%). Results: Adherence to the IDSA recommendations for recommended antifungal drug, dose, and duration of therapy was low in both groups (16.7% in Group 1 and 17.5% in Group 2). Although adherence was not associated with higher clinical resolution of infection (P = 0.111), it was associated with a significantly lower mortality rate (P = 0.001) when compared to variance from the guidelines at 6 weeks. Conclusion: Although adherence to published guidelines for treating patients with candidemia was suboptimal at our institution, patients that were managed based on the guidelines had a statistically lower mortality rate. PMID:28936146

Exploring Rural Disparities in Medical Diagnoses Among Veterans With Transgender-related Diagnoses Utilizing Veterans Health Administration Care.

Science.gov (United States)

Bukowski, Leigh A; Blosnich, John; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Gordon, Adam J

2017-09-01

Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.

Department of Veterans Affairs - Monthly Report to Congress of Data Incidents (April 2014)

Data.gov (United States)

Department of Veterans Affairs — This is a monthly report that the VA Office of Information Technology provides to congress about data incidents that took place during the month (April 2014). The...

Veterans’s Medical Care: FY2014 Appropriations

Science.gov (United States)

2013-08-14

to veterans’ benefits, including claims for service connection, increased disability ratings, pension, insurance benefits, educational benefits...accompanying the budget request provides few details regarding the data and assumptions that were modified in the updated actuarial model projection...Affairs (VA) provides benefits to veterans who meet certain eligibility criteria. Benefits to veterans range from disability compensation and pensions

Gulf War veterans' health: medical evaluation of a U.S. cohort.

Science.gov (United States)

Eisen, Seth A; Kang, Han K; Murphy, Frances M; Blanchard, Melvin S; Reda, Domenic J; Henderson, William G; Toomey, Rosemary; Jackson, Leila W; Alpern, Renee; Parks, Becky J; Klimas, Nancy; Hall, Coleen; Pak, Hon S; Hunter, Joyce; Karlinsky, Joel; Battistone, Michael J; Lyons, Michael J

2005-06-07

United States military personnel reported various symptoms after deployment to the Persian Gulf during the 1991 Gulf War. However, the symptoms' long-term prevalence and association with deployment remain controversial. To assess and compare the prevalence of selected medical conditions in a national cohort of deployed and nondeployed Gulf War veterans who were evaluated by direct medical and teledermatologic examinations. A cross-sectional prevalence study performed 10 years after the 1991 Gulf War. Veterans were examined at 1 of 16 Veterans Affairs medical centers. Deployed (n = 1061) and nondeployed (n = 1128) veterans of the 1991 Gulf War. Primary outcome measures included fibromyalgia, the chronic fatigue syndrome, dermatologic conditions, dyspepsia, physical health-related quality of life (Short Form-36 [SF-36]), hypertension, obstructive lung disease, arthralgias, and peripheral neuropathy. Of 12 conditions, only 4 conditions were more prevalent among deployed than nondeployed veterans: fibromyalgia (deployed, 2.0%; nondeployed, 1.2%; odds ratio, 2.32 [95% CI, 1.02 to 5.27]); the chronic fatigue syndrome (deployed, 1.6%; nondeployed 0.1%; odds ratio, 40.6 [CI, 10.2 to 161]); dermatologic conditions (deployed, 34.6%; nondeployed, 26.8%; odds ratio, 1.38 [CI, 1.06 to 1.80]), and dyspepsia (deployed, 9.1%; nondeployed, 6.0%; odds ratio, 1.87 [CI, 1.16 to 2.99]). The mean physical component summary score of the SF-36 for deployed and nondeployed veterans was 49.3 and 50.8, respectively. Relatively low participation rates introduce potential participation bias, and deployment-related illnesses that resolved before the research examination could not, by design, be detected. Ten years after the Gulf War, the physical health of deployed and nondeployed veterans is similar. However, Gulf War deployment is associated with an increased risk for fibromyalgia, the chronic fatigue syndrome, skin conditions, dyspepsia, and a clinically insignificant decrease in the SF-36

Financial incentives and accountability for integrated medical care in Department of Veterans Affairs mental health programs.

Science.gov (United States)

Kilbourne, Amy M; Greenwald, Devra E; Hermann, Richard C; Charns, Martin P; McCarthy, John F; Yano, Elizabeth M

2010-01-01

This study assessed the extent to which mental health leaders perceive their programs as being primarily accountable for monitoring general medical conditions among patients with serious mental illness, and it assessed associations with modifiable health system factors. As part of the Department of Veterans Affairs (VA) 2007 national Mental Health Program Survey, 108 mental health program directors were queried regarding program characteristics. Perceived accountability was defined as whether their providers, as opposed to external general medical providers, were primarily responsible for specific clinical tasks related to serious mental illness treatment or high-risk behaviors. Multivariable logistic regression was used to determine whether financial incentives or other system factors were associated with accountability. Thirty-six percent of programs reported primary accountability for monitoring diabetes and cardiovascular risk after prescription of second-generation antipsychotics, 10% for hepatitis C screening, and 17% for obesity screening and weight management. In addition, 18% and 27% of program leaders, respectively, received financial bonuses for high performance for screening for risk of diabetes and cardiovascular disease and for alcohol misuse. Financial bonuses for diabetes and cardiovascular screening were associated with primary accountability for such screening (odds ratio=5.01, pFinancial incentives to improve quality performance may promote accountability in monitoring diabetes and cardiovascular risk assessment within mental health programs. Integrated care strategies (co-location) might be needed to promote management of high-risk behaviors among patients with serious mental illness.

Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries.

Science.gov (United States)

McDonald, Scott D; Mickens, Melody N; Goldberg-Looney, Lisa D; Mutchler, Brian J; Ellwood, Michael S; Castillo, Teodoro A

2017-03-13

Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction. Cross-sectional. A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center. Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and clinician-determined mental disorder diagnoses were attained. Overall, 40% of patients received at least one mental disorder diagnosis, most commonly depressive disorders (19%), posttraumatic stress disorder (12%), and substance or alcohol use disorders (11%). Several patient characteristics predicted mental disorders, including age, racial minority identity, non-traumatic SCI etiology, and incomplete (i.e. AIS D) vs. complete injury. Mental disorders were associated with greater impairment from health and mental health-related problems and less satisfaction with life. Mental disorders are common among outpatients receiving VA specialty care for SCI. These findings highlight the importance of having adequate and effective available mental health services available for Veterans with SCI.

Perioperative management of obstructive sleep apnea: a survey of Veterans Affairs health care providers.

Science.gov (United States)

Dhanda Patil, Reena; Patil, Yash J

2012-01-01

(1) To determine the presence of Veterans Affairs (VA) institutional guidelines for the perioperative management of obstructive sleep apnea (OSA); (2) to examine current use of preoperative screening tools for OSA in the VA; and (3) to understand current VA practice patterns regarding postoperative disposition of patients with OSA. Survey study. Veterans Affairs hospitals with surgical services; sample size 102 facilities. Veterans Affairs health care providers. The authors surveyed health care providers at VA hospitals using a survey tool developed by the authors. The response rate was 80%. A variety of preoperative screening tools for OSA were used by respondents, most commonly American Society of Anesthesiologists guidelines (53%). A policy for postoperative disposition of known and presumed OSA was present in 26% and 19% of responses, respectively. Of those respondents reporting a formal postoperative care policy, 48% and 30% admitted patients to a monitored ward bed and surgical intensive care unit, respectively. Of the 74% of respondents unaware of an institutional policy, Anesthesia and Surgery worked together to dictate postoperative disposition of patients with known OSA 73% of the time. The degree of OSA was ranked as the most important factor (58%) influencing postoperative disposition. Ten percent of respondents reported a major perioperative complication attributable to OSA in the past year. This survey study elucidates the heterogeneity of preoperative screening for and postoperative care of veterans with OSA. Future investigators may use these data to formalize institutional policies with regard to patients with OSA, with potentially significant impacts on patient care and usage of financial resources.

Adaptation of Lean Six Sigma Methodologies for the Evaluation of Veterans Choice Program at 3 Urban Veterans Affairs Medical Centers.

Science.gov (United States)

Ball, Sherry L; Stevenson, Lauren D; Ladebue, Amy C; McCreight, Marina S; Lawrence, Emily C; Oestreich, Taryn; Lambert-Kerzner, Anne C

2017-07-01

The Veterans Health Administration (VHA) is adapting to meet the changing needs of our Veterans. VHA leaders are promoting quality improvement strategies including Lean Six Sigma (LSS). This study used LSS tools to evaluate the Veterans Choice Program (VCP), a program that aims to improve access to health care services for eligible Veterans by expanding health care options to non-VHA providers. LSS was utilized to assess the current process and efficiency patterns of the VCP at 3 VHA Medical Centers. LSS techniques were used to assess data obtained through semistructured interviews with Veterans, staff, and providers to describe and evaluate the VCP process by identifying wastes and defects. The LSS methodology facilitated the process of targeting priorities for improvement and constructing suggestions to close identified gaps and inefficiencies. Identified key process wastes included inefficient exchange of clinical information between stakeholders in and outside of the VHA; poor dissemination of VCP programmatic information; shortages of VCP-participating providers; duplication of appointments; declines in care coordination; and lack of program adaptability to local processes. Recommendations for improvement were formulated using LSS. This evaluation illustrates how LSS can be utilized to assess a nationally mandated health care program. By focusing on stakeholder, staff, and Veteran perspectives, process defects in the VCP were identified and improvement recommendations were made. However, the current LSS language used is not intuitive in health care and similar applications of LSS may consider using new language and goals adapted specifically for health care.

77 FR 49865 - Notice of Availability of an Environmental Impact Statement (EIS) for the San Francisco Veterans...

Science.gov (United States)

2012-08-17

... National Environmental Policy Act (NEPA) of 1969, as amended, (42 U.S.C. 4331 et seq.), the Council on...) for the San Francisco Veterans Affairs Medical Center (SFVAMC) Long Range Development Plan (LRDP... Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121 or by telephone...

Design and Implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital.

Science.gov (United States)

Walters, Tessa L; Howard, Steven K; Kou, Alex; Bertaccini, Edward J; Harrison, T Kyle; Kim, T Edward; Shafer, Audrey; Brun, Carlos; Funck, Natasha; Siegel, Lawrence C; Stary, Erica; Mariano, Edward R

2016-06-01

The innovative Perioperative Surgical Home model aims to optimize the outcomes of surgical patients by leveraging the expertise and leadership of physician anesthesiologists, but there is a paucity of practical examples to follow. Veterans Affairs health care, the largest integrated system in the United States, may be the ideal environment in which to explore this model. We present our experience implementing Perioperative Surgical Home at one tertiary care university-affiliated Veterans Affairs hospital. This process involved initiating consistent postoperative patient follow-up beyond the postanesthesia care unit, a focus on improving in-hospital acute pain management, creation of an accessible database to track outcomes, developing new clinical pathways, and recruiting additional staff. Today, our Perioperative Surgical Home facilitates communication between various services involved in the care of surgical patients, monitoring of patient outcomes, and continuous process improvement. © The Author(s) 2015.

Impact of presumed service-connected diagnosis on the Department of Veterans Affairs healthcare utilization patterns of Vietnam-Theater Veterans: A cross-sectional study.

Science.gov (United States)

Fried, Dennis A; Rajan, Mangala; Tseng, Chin-Lin; Helmer, Drew

2018-05-01

During the Vietnam War, the US military sprayed almost 20 million gallons of Agent Orange (AO), an herbicide contaminated with dioxin, over Vietnam. Approximately, 2.7 million US military personnel may have been exposed to AO during their deployment. Ordinarily, veterans who can demonstrate a nexus between a diagnosed condition and military service are eligible for Department of Veterans Affairs (VA) service-connected disability compensation. Vietnam Veterans have had difficulty, however, establishing a nexus between AO exposure and certain medical conditions that developed many years after the war. In response, VA has designated certain conditions as "presumed service connected" for Vietnam Veterans who were present and possibly exposed. Veterans with any of these designated conditions do not have to document AO exposure, making it easier for them to access the VA disability system. The extent to which VA healthcare utilization patterns reflect easier access afforded those with diagnosed presumptive conditions remains unknown. In this cross-sectional study, we hypothesized that Vietnam Veterans with diagnosed presumptive conditions would be heavier users of the VA healthcare system than those without these conditions. In our analysis of 85,699 Vietnam Veterans, we used binary and cumulative logit multivariable regression to assess associations between diagnosed presumptive conditions and VA healthcare utilization in 2013. We found that diagnosed presumptive conditions were associated with higher odds of 5+ VHA primary care visits (OR = 2.01, 95% CI: 1.93-2.07), 5+ specialty care visits (OR = 2.11, 95% CI: 2.04-2.18), emergency department use (OR = 1.22, 95% CI: 1.11-1.34), and hospitalization (OR = 1.23, 95% CI: 1.17-1.29). Consistent with legislative intent, presumptive policies appear to facilitate greater VA system utilization for Vietnam Veterans who may have been exposed to AO.

75 FR 7648 - Privacy Act of 1974, as Amended; Computer Matching Program (SSA/Department of Veterans Affairs...

Science.gov (United States)

2010-02-22

... Computer Matching and Privacy Protection Act of 1988 (Public Law (Pub. L.) 100-503), amended the Privacy... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA 2010-0006] Privacy Act of 1974, as Amended; Computer Matching Program (SSA/ Department of Veterans Affairs/Veterans Benefits Administration (VA/ VBA...

Barriers to the use of Veterans Affairs health care services among female veterans who served in Iraq and Afghanistan.

Science.gov (United States)

Newins, Amie R; Wilson, Sarah M; Hopkins, Tiffany A; Straits-Troster, Kristy; Kudler, Harold; Calhoun, Patrick S

2018-02-08

The study investigated barriers to the utilization of Veterans Affairs (VA) health care services among female veterans who served in served in Iraq and Afghanistan, including reasons for not choosing VA health care, reasons for not seeking mental health treatment, and types of desired VA services. Female respondents to a survey assessing Operation Enduring Freedom/Operation Iraqi Freedom veterans' needs and health (N = 186) completed measures of military history, posttraumatic stress disorder, depression, barriers to VA health care, and preferences for services. Barriers to use of VA health care endorsed by female veterans included receiving care elsewhere and logistical issues. Barriers to utilization of mental health services among female veterans who screened positive for depression or posttraumatic stress disorder included negative treatment biases and concerns about stigma, privacy, and cost. Female veterans endorsed preferences for services related to eligibility education, nonprimary care physical health services, vocational assistance, and a few behavioral/mental health services. Findings highlight the need for ongoing outreach and education regarding eligibility and types of resources for physical and mental health problems experienced by female veterans who served in Iraq and Afghanistan, as well as inform types of VA programming and services desired by female veterans. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Brief report: Comparison of methods to identify Iraq and Afghanistan war veterans using Department of Veterans Affairs administrative data.

Science.gov (United States)

Bangerter, Ann; Gravely, Amy; Cutting, Andrea; Clothier, Barb; Spoont, Michele; Sayer, Nina

2010-01-01

The Department of Veterans Affairs (VA) has made treatment and care of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans a priority. Researchers face challenges identifying the OIF/OEF population because until fiscal year 2008, no indicator of OIF/OEF service was present in the Veterans Health Administration (VHA) administrative databases typically used for research. In this article, we compare an algorithm we developed to identify OIF/OEF veterans using the Austin Information Technology Center administrative data with the VHA Support Service Center OIF/OEF Roster and veterans' self-report of military service. We drew data from two different institutional review board-approved funded studies. The positive predictive value of our algorithm compared with the VHA Support Service Center OIF/OEF Roster and self-report was 92% and 98%, respectively. However, this method of identifying OIF/OEF veterans failed to identify a large proportion of OIF/OEF veterans listed in the VHA Support Service Center OIF/OEF Roster. Demographic, diagnostic, and VA service use differences were found between veterans identified using our method and those we failed to identify but who were in the VHA Support Service Center OIF/OEF Roster. Therefore, depending on the research objective, this method may not be a viable alternative to the VHA Support Service Center OIF/OEF Roster for identifying OIF/OEF veterans.

75 FR 54028 - Technical Revisions To Conform With the Veterans' Mental Health Care Act of 2008 and Other Laws

Science.gov (United States)

2010-09-03

...,'' authorizing VA to exercise discretion to provide certain mental health services, counseling, and training for... Health and Medical Program of the Department of Veterans Affairs, which provides health benefits for... the Veterans' Mental Health Care Act of 2008 and Other Laws AGENCY: Department of Veterans Affairs...

Veteran family reintegration, primary care needs, and the benefit of the patient-centered medical home model.

Science.gov (United States)

Hinojosa, Ramon; Hinojosa, Melanie Sberna; Nelson, Karen; Nelson, David

2010-01-01

Men and women returning from the wars in Afghanistan and Iraq face a multitude of difficulties while integrating back into civilian life, but the importance of their veteran status is often overlooked in primary care settings. Family physicians have the potential to be the first line of defense to ensure the well-being of veterans and their families because many will turn to nonmilitary and non-Veterans Affairs providers for health care needs. An awareness of the unique challenges faced by this population is critical to providing care. A patient-centered medical home orientation can help the family physician provide veterans and their families the care they need. Specific recommendations for family physicians include screening their patient population; providing timely care; treating the whole family; and integrating care from multiple disciplines and specialties, providing veterans and families with "one-stop shopping" care. An awareness of the unique challenges faced by veterans and their families translates into better overall outcomes for this population.

Electronic Medical Record Documentation of Driving Safety for Veterans with Diagnosed Dementia.

Science.gov (United States)

Vair, Christina L; King, Paul R; Gass, Julie; Eaker, April; Kusche, Anna; Wray, Laura O

2018-01-01

Many older adults continue to drive following dementia diagnosis, with medical providers increasingly likely to be involved in addressing such safety concerns. This study examined electronic medical record (EMR) documentation of driving safety for veterans with dementia (N = 118) seen in Veterans Affairs primary care and interdisciplinary geriatrics clinics in one geographic region over a 10-year period. Qualitative directed content analysis of retrospective EMR data. Assessment of known risk factors or subjective concerns for unsafe driving were documented in fewer than half of observed cases; specific recommendations for driving safety were evident for a minority of patients, with formal driving evaluation the most frequently documented recommendation by providers. Utilizing data from actual clinical encounters provides a unique snapshot of how driving risk and safety concerns are addressed for veterans with dementia. This information provides a meaningful frame of reference for understanding potential strengths and possible gaps in how this important topic area is being addressed in the course of clinical care. The EMR is an important forum for interprofessional communication, with documentation of driving risk and safety concerns an essential element for continuity of care and ensuring consistency of information delivered to patients and caregivers.

New to Care: Demands on a Health System When Homeless Veterans Are Enrolled in a Medical Home Model

Science.gov (United States)

Bourgault, Claire; Johnson, Erin E.; Redihan, Stephen G.; Borgia, Matthew; Aiello, Riccardo; Kane, Vincent

2013-01-01

Objectives. We compared service use among homeless and nonhomeless veterans newly enrolled in a medical home model and identified patterns of use among homeless veterans associated with reductions in emergency department (ED) use. Methods. We used case–control matching with a nested cohort analysis to measure 6-month health services use, new diagnoses, and care use patterns in veterans at the Providence, Rhode Island, Veterans Affairs Medical Center from 2008 to 2011. Results. We followed 127 homeless and 106 nonhomeless veterans. Both groups had similar rates of chronic medical and mental health diagnoses; 25.4% of the homeless and 18.1% of the nonhomeless group reported active substance abuse. Homeless veterans used significantly more primary, mental health, substance abuse, and ED care during the first 6 months. Homeless veterans who accessed primary care at higher rates (relative risk ratio [RRR] = 1.46; 95% confidence interval [CI] = 1.11, 1.92) or who used specialty and primary care (RRR = 10.95; 95% CI = 1.58, 75.78) had reduced ED usage. Homeless veterans in transitional housing or doubled-up at baseline (RRR = 3.41; 95% CI = 1.24, 9.42) had similar reductions in ED usage. Conclusions. Homeless adults had substantial health needs when presenting for care. High-intensity primary care and access to specialty care services could reduce ED use. PMID:24148042

Examination of Veterans Affairs disability compensation as a disincentive for employment in a population-based sample of Veterans under age 65.

Science.gov (United States)

Tsai, Jack; Rosenheck, Robert A

2013-12-01

Concerns that disability benefits may create disincentives for employment may be especially relevant for young American military veterans, particularly veterans of the recent wars in Iraq and Afghanistan who are facing a current economic recession and turning in large numbers to the Department of Veterans Affairs (VA) for disability compensation. This study describes the rate of employment and VA disability compensation among a nationally representative sample of veterans under the age of 65 and examines the association between levels of VA disability compensation and employment, adjusting for sociodemographics and health status. Data on a total of 4,787 veterans from the 2010 National Survey of Veterans were analyzed using multinomial logistic regressions to compare employed veterans with two groups that were not employed. Two-thirds of veterans under the age of 65 were employed, although only 36 % of veterans with a VA service-connected disability rating of 50 % or higher were employed. Veterans who received no VA disability compensation or who were service-connected 50 % or more were more likely to be unemployed and not looking for employment than veterans who were not service-connected or were service-connected less than 50 %, suggesting high but not all levels of VA disability compensation create disincentives for employment. Results were similar when analyses were limited to veterans who served in Iraq and Afghanistan. Education and vocational rehabilitation interventions, as well as economic work incentives, may be needed to maximize employment among veterans with disabilities.

Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities.

Science.gov (United States)

Seal, Karen H; Bertenthal, Daniel; Miner, Christian R; Sen, Saunak; Marmar, Charles

2007-03-12

Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) have endured high combat stress and are eligible for 2 years of free military service-related health care through the Department of Veterans Affairs (VA) health care system, yet little is known about the burden and clinical circumstances of mental health diagnoses among OEF/OIF veterans seen at VA facilities. US veterans separated from OEF/OIF military service and first seen at VA health care facilities between September 30, 2001 (US invasion of Afghanistan), and September 30, 2005, were included. Mental health diagnoses and psychosocial problems were assessed using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The prevalence and clinical circumstances of and subgroups at greatest risk for mental health disorders are described herein. Of 103 788 OEF/OIF veterans seen at VA health care facilities, 25 658 (25%) received mental health diagnosis(es); 56% of whom had 2 or more distinct mental health diagnoses. Overall, 32 010 (31%) received mental health and/or psychosocial diagnoses. Mental health diagnoses were detected soon after the first VA clinic visit (median of 13 days), and most initial mental health diagnoses (60%) were made in nonmental health clinics, mostly primary care settings. The youngest group of OEF/OIF veterans (age, 18-24 years) were at greatest risk for receiving mental health or posttraumatic stress disorder diagnoses compared with veterans 40 years or older. Co-occurring mental health diagnoses and psychosocial problems were detected early and in primary care medical settings in a substantial proportion of OEF/OIF veterans seen at VA facilities. Targeted early detection and intervention beginning in primary care settings are needed to prevent chronic mental illness and disability.

The effect of pre-existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center

International Nuclear Information System (INIS)

Wadia, Roxanne J; Yao, Xiaopan; Deng, Yanhong; Li, Jia; Maron, Steven; Connery, Donna; Gunduz-Bruce, Handan; Rose, Michal G

2015-01-01

There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15–20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care

Diffusion of innovation in women's health care delivery: the Department of Veterans Affairs' adoption of women's health clinics.

Science.gov (United States)

Yano, Elizabeth M; Goldzweig, Caroline; Canelo, Ismelda; Washington, Donna L

2006-01-01

In response to concerns about the availability and quality of women's health services in Department of Veterans Affairs (VA) medical centers in the early 1990s, Congress approved landmark legislation earmarking funds to enhance women's health services. A portion of the appropriation was used to launch Comprehensive Women's Health Centers as exemplars for the development of VA women's health care throughout the system. We report on the diffusion and characteristics of VA women's health clinics (WHCs) 10 years later. In 2001, we surveyed the senior women's health clinician at each VA medical center serving > or =400 women veterans (83% response rate) regarding their internal organizational characteristics in relation to factors associated with organizational innovation (centralization, complexity, formalization, interconnectedness, organizational slack, size). We evaluated the comparability of WHCs (n = 66) with characteristics of the original comprehensive women's health centers (CWHCs; n = 8). Gender-specific service availability in WHCs was comparable to that of CWHCs with important exceptions in mental health, mammography and osteoporosis management. WHCs were less likely to have same-gender providers (p business case for managers faced with small female patient caseloads.

Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

OpenAIRE

Eibner, Christine; Krull, Heather; Brown, Kristine M.; Cefalu, Matthew; Mulcahy, Andrew W.; Pollard, Michael; Shetty, Kanaka; Adamson, David M.; Amaral, Ernesto F. L.; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii

2016-01-01

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next...

Veterans Affairs methicillin-resistant Staphylococcus aureus prevention initiative associated with a sustained reduction in transmissions and health care-associated infections.

Science.gov (United States)

Evans, Martin E; Kralovic, Stephen M; Simbartl, Loretta A; Freyberg, Ron W; Obrosky, D Scott; Roselle, Gary A; Jain, Rajiv

2013-11-01

Implementation of a methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative was associated with significant declines in MRSA transmission and MRSA health care-associated infection rates in Veterans Affairs acute care facilities nationwide in the 33-month period from October 2007 through June 2010. Here, we show continuing declines in MRSA transmissions (P = .004 for trend, Poisson regression) and MRSA health care-associated infections (P < .001) from July 2010 through June 2012. The Veterans Affairs Initiative was associated with these effects, sustained over 57 months, in a large national health care system. Published by Mosby, Inc.

Time required for institutional review board review at one Veterans Affairs medical center.

Science.gov (United States)

Hall, Daniel E; Hanusa, Barbara H; Stone, Roslyn A; Ling, Bruce S; Arnold, Robert M

2015-02-01

Despite growing concern that institutional review boards (IRBs) impose burdensome delays on research, little is known about the time required for IRB review across different types of research. To measure the overall and incremental process times for IRB review as a process of quality improvement. After developing a detailed process flowchart of the IRB review process, 2 analysts abstracted temporal data from the records pertaining to all 103 protocols newly submitted to the IRB at a large urban Veterans Affairs medical center from June 1, 2009, through May 31, 2011. Disagreements were reviewed with the principal investigator to reach consensus. We then compared the review times across review types using analysis of variance and post hoc Scheffé tests after achieving normally distributed data through logarithmic transformation. Calendar days from initial submission to final approval of research protocols. Initial IRB review took 2 to 4 months, with expedited and exempt reviews requiring less time (median [range], 85 [23-631] and 82 [16-437] days, respectively) than full board reviews (median [range], 131 [64-296] days; P = .008). The median time required for credentialing of investigators was 1 day (range, 0-74 days), and review by the research and development committee took a median of 15 days (range, 0-184 days). There were no significant differences in credentialing or research and development times across review types (exempt, expedited, or full board). Of the extreme delays in IRB review, 80.0% were due to investigators' slow responses to requested changes. There were no systematic delays attributable to the information security officer, privacy officer, or IRB chair. Measuring and analyzing review times is a critical first step in establishing a culture and process of continuous quality improvement among IRBs that govern research programs. The review times observed at this IRB are substantially longer than the 60-day target recommended by expert panels

The U.S. Department of Veterans' Affairs depleted uranium exposed cohort at 25 Years: Longitudinal surveillance results

Energy Technology Data Exchange (ETDEWEB)

McDiarmid, Melissa A.; Gaitens, Joanna M.; Hines, Stella [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Department of Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201 (United States); Condon, Marian, E-mail: mcondon@medicine.umaryland.edu [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Roth, Tracy; Oliver, Marc; Gucer, Patricia [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Department of Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201 (United States); Brown, Lawrence [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Department of Pathology, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201 (United States); Centeno, Jose A. [US Food and Drug Administration, Center for Devices and Radiological Health Office of Science and Engineering Laboratories, Silver Spring, MD 20993 (United States); Dux, Moira [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Squibb, Katherine S. [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Department of Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201 (United States)

2017-01-15

Background: A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly-fire incidents have been monitored for health changes in a clinical surveillance program at the Veterans Affairs Medical Center, Baltimore since 1994. Methods: During the spring of 2015, an in-patient clinical surveillance protocol was performed on 36 members of the cohort, including exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes. Results: On-going mobilization of U from embedded fragments is evidenced by elevated urine U concentrations. The DU isotopic signature is observed principally in participants possessing embedded fragments. Those with only an inhalation exposure have lower urine U concentration and a natural isotopic signature. Conclusions: At 25 years since first exposure to DU, an aging cohort of military veterans continues to show no U-related health effects in known target organs of U toxicity. As U body burden continues to accrue from in-situ mobilization from metal fragment depots, and increases with exposure duration, critical tissue-specific U concentration thresholds may be reached, thus recommending on-going surveillance of this veteran cohort. - Highlights: • Gulf War I veterans wounded with depleted uranium are monitored for health changes. • In 2015 in-patient clinical surveillance was performed on 36 members of the cohort. • Mobilization of U from embedded fragments is evidenced by elevated U in urine. • This cohort of continues to show no U-related health effects.

The U.S. Department of Veterans' Affairs depleted uranium exposed cohort at 25 Years: Longitudinal surveillance results

International Nuclear Information System (INIS)

McDiarmid, Melissa A.; Gaitens, Joanna M.; Hines, Stella; Condon, Marian; Roth, Tracy; Oliver, Marc; Gucer, Patricia; Brown, Lawrence; Centeno, Jose A.; Dux, Moira; Squibb, Katherine S.

2017-01-01

Background: A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly-fire incidents have been monitored for health changes in a clinical surveillance program at the Veterans Affairs Medical Center, Baltimore since 1994. Methods: During the spring of 2015, an in-patient clinical surveillance protocol was performed on 36 members of the cohort, including exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes. Results: On-going mobilization of U from embedded fragments is evidenced by elevated urine U concentrations. The DU isotopic signature is observed principally in participants possessing embedded fragments. Those with only an inhalation exposure have lower urine U concentration and a natural isotopic signature. Conclusions: At 25 years since first exposure to DU, an aging cohort of military veterans continues to show no U-related health effects in known target organs of U toxicity. As U body burden continues to accrue from in-situ mobilization from metal fragment depots, and increases with exposure duration, critical tissue-specific U concentration thresholds may be reached, thus recommending on-going surveillance of this veteran cohort. - Highlights: • Gulf War I veterans wounded with depleted uranium are monitored for health changes. • In 2015 in-patient clinical surveillance was performed on 36 members of the cohort. • Mobilization of U from embedded fragments is evidenced by elevated U in urine. • This cohort of continues to show no U-related health effects.

75 FR 62348 - Reimbursement Offsets for Medical Care or Services

Science.gov (United States)

2010-10-08

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN55 Reimbursement Offsets for Medical Care... Veterans Affairs (VA) proposes to amend its regulations concerning the reimbursement of medical care and... situations where third-party payers are required to reimburse VA for costs related to care provided by VA to...

VA Veterans Health Administration Access Data

Data.gov (United States)

Department of Veterans Affairs — At the Department of Veterans Affairs (VA), our most important mission is to provide the high quality health care and benefits Veterans have earned and deserve —...

Perceived Stigma, Discrimination, and Disclosure of Sexual Orientation Among a Sample of Lesbian Veterans Receiving Care in the Department of Veterans Affairs.

Science.gov (United States)

Mattocks, Kristin M; Sullivan, J Cherry; Bertrand, Christina; Kinney, Rebecca L; Sherman, Michelle D; Gustason, Carolyn

2015-06-01

Many lesbian women experience stigma and discrimination from their healthcare providers as a result of their sexual orientation. Additionally, others avoid disclosure of their sexual orientation to their providers for fear of mistreatment. With the increasing number of lesbian, gay, bisexual, and transgender (LGBT) veterans seeking care from the Veterans Health Administration (VHA), it is important to understand lesbian veterans' experiences with stigma, discrimination, and disclosure of sexual orientation. This article examines lesbian veterans' experiences with perceived stigma and discrimination in VHA healthcare, their perspectives on disclosure of sexual orientation to VHA providers, and their recommendations for improvements in VHA healthcare to create a welcoming environment for lesbian veterans. This is a mixed methods study of twenty lesbian veterans at four VHA facilities. The women veterans participated in a one-hour interview and then completed an anonymous survey. Ten percent of lesbian veterans had experienced mistreatment from VHA staff or providers, but nearly 50% feared that their Veterans Affairs (VA) providers would mistreat them if they knew about their sexual orientation. A majority of lesbian veterans (70%) believed that VHA providers should never ask about sexual orientation or should only ask if the veteran wanted to discuss it. A majority (80%) believed the VHA had taken steps to create a welcoming environment for LBGT veterans. Though many lesbian veterans have fears of stigma and discrimination in the context of VHA care, few have experienced this. Most lesbian veterans believed the VHA was trying to create a welcoming environment for its LGBT veterans. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.

Women Veteran Report

Data.gov (United States)

Department of Veterans Affairs — This report summarizes the history of women Veterans in the military and as Veterans. It profiles the characteristics of women Veterans in 2015, and illustrates how...

Improving trends in gender disparities in the Department of Veterans Affairs: 2008-2013.

Science.gov (United States)

Whitehead, Alison M; Czarnogorski, Maggie; Wright, Steve M; Hayes, Patricia M; Haskell, Sally G

2014-09-01

Increasing numbers of women veterans using Department of Veterans Affairs (VA) services has contributed to the need for equitable, high-quality care for women. The VA has evaluated performance measure data by gender since 2006. In 2008, the VA launched a 5-year women's health redesign, and, in 2011, gender disparity improvement was included on leadership performance plans. We examined data from VA Office of Analytics and Business Intelligence quarterly gender reports for trends in gender disparities in gender-neutral performance measures from 2008 to 2013. Through reporting of data by gender, leadership involvement, electronic reminders, and population management dashboards, VA has seen a decreasing trend in gender inequities on most Health Effectiveness Data and Information Set performance measures.

Lung and colorectal cancer treatment and outcomes in the Veterans Affairs health care system

International Nuclear Information System (INIS)

Zullig, Leah L; Williams, Christina D; Fortune-Britt, Alice G

2015-01-01

Lung cancer (LC) and colorectal cancer (CRC) are the second- and third-most commonly diagnosed cancers in the Veterans Affairs (VA) health care system. While many studies have evaluated the treatment quality and outcomes of various aspects of VA LC and CRC care, there are no known reviews synthesizing this information across studies. The purpose of this literature review was to describe LC and CRC treatment (ie, surgical and nonsurgical) and outcomes (eg, mortality, psychosocial, and other) in the VA health care system as reported in the existing peer-reviewed scientific literature. We identified potential articles through a search of published literature using the PubMed electronic database. Our search strategy identified articles containing Medical Subject Headings terms and keywords addressing veterans or veterans’ health and LC and/or CRC. We limited articles to those published in the previous 11 years (January 1, 2003 through December 31, 2013). A total of 230 articles were retrieved through the search. After applying the selection criteria, we included 74 studies (34 LC, 47 CRC, and seven both LC and CRC). VA provides a full array of treatments, often with better outcomes than other health care systems. More work is needed to assess patient-reported outcomes

Effectiveness of an Evidence-Based Quality Improvement Approach to Cultural Competence Training: The Veterans Affairs' "Caring for Women Veterans" Program.

Science.gov (United States)

Fox, Annie B; Hamilton, Alison B; Frayne, Susan M; Wiltsey-Stirman, Shannon; Bean-Mayberry, Bevanne; Carney, Diane; Di Leone, Brooke A L; Gierisch, Jennifer M; Goldstein, Karen M; Romodan, Yasmin; Sadler, Anne G; Yano, Elizabeth M; Yee, Ellen F; Vogt, Dawne

2016-01-01

Although providing culturally sensitive health care is vitally important, there is little consensus regarding the most effective strategy for implementing cultural competence trainings in the health care setting. Evidence-based quality improvement (EBQI), which involves adapting evidence-based practices to meet local needs, may improve uptake and effectiveness of a variety of health care innovations. Yet, to our knowledge, EBQI has not yet been applied to cultural competence training. To evaluate whether EBQI could enhance the impact of an evidence-based training intended to improve veterans affairs health care staff gender sensitivity and knowledge (Caring for Women Veterans; CWV), we compared the reach and effectiveness of EBQI delivery versus standard web-based implementation strategies of CWV and assessed barriers and facilitators to EBQI implementation. Workgroups at four diverse veterans affairs health care sites were randomized to either an EBQI or standard web-based implementation condition (SI). All EBQI sites selected a group-based implementation strategy. Employees (N = 84) completed pretraining and posttraining assessments of gender sensitivity and knowledge, and focus groups/interviews were conducted with leadership and staff before and after implementation. Reach of CWV was greater in the EBQI condition versus the SI condition. Whereas both gender sensitivity and knowledge improved in the EBQI condition, only gender sensitivity improved in the SI condition. Qualitative analyses revealed that the EBQI approach was well received, although a number of barriers were identified. Findings suggest that EBQI can enhance the uptake and effectiveness of employee trainings. However, the decision to pursue EBQI must be informed by a consideration of available resources.

The Use of Telemental Health to Meet the Mental Health Needs of Women Using Department of Veterans Affairs Services.

Science.gov (United States)

Moreau, Jessica L; Cordasco, Kristina M; Young, Alexander S; Oishi, Sabine M; Rose, Danielle E; Canelo, Ismelda; Yano, Elizabeth M; Haskell, Sally G; Hamilton, Alison B

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. We conducted semistructured qualitative interviews with 40 key leadership and clinical stakeholders at VA medical centers and associated outpatient clinics. Transcripts were summarized in a template of key domains developed based on the interview guide, and coded for topics relevant to women's mental health needs and telehealth services. Telemental health was perceived to increase access to mental health care, including same-gender care and access to providers with specialized training, especially for rural women and those with other limiting circumstances. Respondents saw women veterans as being particularly poised to benefit from telemental health, owing to responsibilities associated with childcare, spousal care, and elder caregiving. Interviewees expressed enthusiasm for telemental health's potential and were eager to expand services, including women-only mental health groups. Implementation challenges were also noted. Overall, our stakeholders saw telemental health as a good fit for helping to address the perceived needs of women veterans, especially in addressing the geographical barriers experienced by rural women and those with a limited ability to travel. These findings can help to inform gender-tailored expansion of telemental health within and outside of the VA. Published by Elsevier Inc.

Comparative Evaluation of Serotonin Toxicity among Veterans Affairs Patients Receiving Linezolid and Vancomycin

Science.gov (United States)

Patel, N.; Rivera, A.; Tristani, L.; Lazariu, V.; Vandewall, H.; McNutt, L. A.

2013-01-01

Despite the theoretical risk of serotonin toxicity (ST) with linezolid, “real-world” clinical evaluations of the risk of ST in patients receiving linezolid have been limited to case reports and noncomparator studies. An observational, matched-cohort study was conducted to evaluate the risk of ST among hospitalized patients who received linezolid or vancomycin at the Upstate New York Veterans Affairs Healthcare Network (Veterans Integrated Service Network 2 [VISN-2]). Matching criteria included VISN-2 hospital, hospital ward, prior hospital length of stay, age, and baseline platelet counts. The patients' electronic medical records were evaluated for symptoms consistent with ST and the Hunter serotonin toxicity criteria (HSTC) using an intensive, natural word search algorithm. The study included 251 matched pairs. Demographics and comorbidities were similar between groups. Over half of the study population received at least one concurrent medication with serotonergic activity. Receipt of agents with serotonergic activity was more pronounced in the vancomycin group, and the higher frequency was due to concomitant antihistamine and antiemetic use. Antidepressant use, including selective serotonin reuptake inhibitors (SSRIs), was similar between groups. No patients in either group were found to meet the criteria using the word search algorithm for ST. Fewer linezolid patients than vancomycin patients met the HSTC overall (3.2% versus 8.8%) and when stratified by receipt of a concurrent serotonergic agent (4.3% versus 12.4%). Of the patients meeting the HSTC, most had past or present comorbidities that may have contributed to or overlapped the HSTC. This study of hospitalized patients revealed comparably low frequencies of adverse events potentially related to ST among patients who received linezolid or vancomycin. PMID:24041888

Prescription headache medication in OEF/OIF veterans: results from the Women Veterans Cohort Study.

Science.gov (United States)

Seng, Elizabeth K; Driscoll, Mary A; Brandt, Cynthia A; Bathulapalli, Harini; Goulet, Joseph; Silliker, Norman; Kerns, Robert D; Haskell, Sally G

2013-09-01

To examine differences in male and female veterans of Operations Enduring Freedom/Iraqi Freedom (OEF/OIF) period of service in taking prescription headache medication, and associations between taking prescription headache medication and mental health status, psychiatric symptoms, and rates of traumatic events. Headaches are common among active service members and are associated with impairment in quality of life. Little is known about headaches in OEF/OIF veterans. Veterans participating in the Women Veterans Cohort Study responded to a cross-sectional survey to assess taking prescription headache medication, mental health status (Post Deployment Health Assessment), psychiatric symptoms (portions of the Brief Patient Health Questionnaire and the Posttraumatic Stress Disorder Checklist), and traumatic events (the Traumatic Life Events Questionnaire and queries regarding military trauma). Gender differences among taking prescription headache medication, health status, psychiatric symptoms, and traumatic events were examined. Regression analyses were used to examine the influence of gender on the associations between taking prescription headache medication and health status, psychiatric symptoms, and traumatic events. 139/551 (25.2%) participants reported taking prescription headache medication in the past year. A higher proportion of women veterans (29.1%) reported taking prescription medication for headache in the last year compared with men (19.7%). Taking prescription headache medication was associated with poorer perceived mental health status, higher anxiety and posttraumatic stress disorder symptoms, and higher rates of traumatic events. The association between prescription headache medication use and perceived mental health status, and with the association between prescription headache medication use and posttraumatic stress disorder symptoms, was stronger for men than for women. Among OEF/OIF veterans, the prevalence of clinically relevant headache is high

Veterans Crisis Line

Data.gov (United States)

Department of Veterans Affairs — The caring responders at the Veterans Crisis Line are specially trained and experienced in helping Veterans of all ages and circumstances. Some of the responders are...

Outcomes of cataract surgery with residents as primary surgeons in the Veterans Affairs Healthcare System.

Science.gov (United States)

Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Chen, Xi; Cakiner-Egilmez, Tulay; Chomsky, Amy; Baze, Elizabeth; Vollman, David; Lawrence, Mary G; Daly, Mary K

2016-03-01

To explore visual outcomes, functional visual improvement, and events in resident-operated cataract surgery cases. Veterans Affairs Ophthalmic Surgery Outcomes Database Project across 5 Veterans Affairs Medical Centers. Retrospective data analysis of deidentified data. Cataract surgery cases with residents as primary surgeons were analyzed for logMAR corrected distance visual acuity (CDVA) and vision-related quality of life (VRQL) measured by the modified National Eye Institute Vision Function Questionnaire and 30 intraoperative and postoperative events. In some analyses, cases without events (Group A) were compared with cases with events (Group B). The study included 4221 cataract surgery cases. Preoperative to postoperative CDVA improved significantly in both groups (P < .0001), although the level of improvement was less in Group B (P = .03). A CDVA of 20/40 or better was achieved in 96.64% in Group A and 88.25% in Group B (P < .0001); however, Group B had a higher prevalence of preoperative ocular comorbidities (P < .0001). Cases with 1 or more events were associated with a higher likelihood of a postoperative CDVA worse than 20/40 (odds ratio, 3.82; 95% confidence interval, 2.92-5.05; P < .0001) than those who did not experience an event. Both groups had a significant increase in VRQL from preoperative levels (both P < .0001); however, the level of preoperative to postoperative VRQL improvement was significantly less in Group B (P < .0001). Resident-operated cases with and without events had an overall significant improvement in visual acuity and visual function compared with preoperatively, although this improvement was less marked in those that had an event. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Multidisciplinary HIS DICOM interfaces at the Department of Veterans Affairs

Science.gov (United States)

Kuzmak, Peter M.; Dayhoff, Ruth E.

2000-05-01

The U.S. Department of Veterans Affairs (VA) is using the Digital Imaging and Communications in Medicine (DICOM) standard to integrate image data objects from multiple systems for use across the healthcare enterprise. DICOM uses a structured representation of image data and a communication mechanism that allows the VA to easily acquire images from multiple sources and store them directly into the online patient record. The VA can obtain both radiology and non- radiology images using DICOM, and can display them on low-cost clinician's color workstations throughout the medical center. High-resolution gray-scale diagnostic quality multi-monitor workstations with specialized viewing software can be used for reading radiology images. The VA's DICOM capabilities can interface six different commercial Picture Archiving and Communication Systems (PACS) and over twenty different image acquisition modalities. The VA is advancing its use of DICOM beyond radiology. New color imaging applications for Gastrointestinal Endoscopy and Ophthalmology using DICOM are under development. These are the first DICOM offerings for the vendors, who are planning to support the recently passed DICOM Visible Light and Structured Reporting service classes. Implementing these in VistA is a challenge because of the different workflow and software support for these disciplines within the VA HIS environment.

The Evolution of Veteran Affairs Healthcare - Is It High Time for Cannabis Treatment

Science.gov (United States)

2015-10-01

Neuropathic Pain in HIV, was later published with the National Center for Biotechnology Information and concluded that pain relief was greater with...www.nlm.nih.gov/medlineplus/ magazine /issues/winter09/articles/winter09pg10-14.html, (accessed September 2015). 56 U.S. Department of Veteran Affairs...Medline Plus, PTSD: A Growing Epidemic, https://www.nlm.nih.gov/medlineplus/ magazine /issues/winter09/articles/winter09pg10- 14.html, (accessed

Chronic disease management perspectives of colorectal cancer survivors using the Veterans Affairs healthcare system: a qualitative analysis.

Science.gov (United States)

Zullig, Leah L; Goldstein, Karen M; Bosworth, Hayden B; Andrews, Sara M; Danus, Susanne; Jackson, George L; Provenzale, Dawn; Weinberger, Morris; Kelley, Michael J; Voils, Corrine I

2018-03-09

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the US. CRC survivors may have complex healthcare needs requiring care from both specialists and primary care. Our objective was to understand how CRC survivors perceive their survivorship care, especially management of their cardiovascular-related chronic diseases. We identified patients diagnosed with non-metastatic CRC between 10/1/2007 and 12/31/2015 at Veterans Affairs Medical Centers in North Carolina or Virginia. In 2016, we conducted telephone-based, semi-structured interviews to assess survivors' experiences with cancer survivorship and changes in health priorities. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed, and coded. The 25 participants were, on average, 64 years old and approximately 4 years post-CRC diagnosis at the time of interview; most were white (60%), male (92%), and diagnosed with colon cancer (64%) as opposed to rectal cancer. CRC survivors reported: (1) a shift in focus from surviving cancer to reducing cardiovascular disease risk (e.g., by managing weight); (2) challenges with taking medications for CVD-related conditions; (3) new recognition of the importance of engaging with primary care providers. Experiences with cancer shapes how survivors view their health. Management of cardiovascular-related chronic disease is important to veteran CRC survivors. There is a need to deliver cardiovascular disease risk reduction programs tailored for CRC survivors.

Evaluating user experiences of the secure messaging tool on the Veterans Affairs' patient portal system.

Science.gov (United States)

Haun, Jolie N; Lind, Jason D; Shimada, Stephanie L; Martin, Tracey L; Gosline, Robert M; Antinori, Nicole; Stewart, Max; Simon, Steven R

2014-03-06

The United States Department of Veterans Affairs has implemented an electronic asynchronous "Secure Messaging" tool within a Web-based patient portal (ie, My HealtheVet) to support patient-provider communication. This electronic resource promotes continuous and coordinated patient-centered care, but to date little research has evaluated patients' experiences and preferences for using Secure Messaging. The objectives of this mixed-methods study were to (1) characterize veterans' experiences using Secure Messaging in the My HealtheVet portal over a 3-month period, including system usability, (2) identify barriers to and facilitators of use, and (3) describe strategies to support veterans' use of Secure Messaging. We recruited 33 veterans who had access to and had previously used the portal's Secure Messaging tool. We used a combination of in-depth interviews, face-to-face user-testing, review of transmitted secure messages between veterans and staff, and telephone interviews three months following initial contact. We assessed participants' computer and health literacy during initial and follow-up interviews. We used a content-analysis approach to identify dominant themes in the qualitative data. We compared inferences from each of the data sources (interviews, user-testing, and message review) to identify convergent and divergent data trends. The majority of veterans (27/33, 82%) reported being satisfied with Secure Messaging at initial interview; satisfaction ratings increased to 97% (31/32, 1 missing) during follow-up interviews. Veterans noted Secure Messaging to be useful for communicating with their primary care team to manage health care needs (eg, health-related questions, test requests and results, medication refills and questions, managing appointments). Four domains emerged from interviews: (1) perceived benefits of using Secure Messaging, (2) barriers to using Secure Messaging, (3) facilitators for using Secure Messaging, and (4) suggestions for improving

76 FR 65321 - Gulf War Veterans' Illnesses Task Force

Science.gov (United States)

2011-10-20

... DEPARTMENT OF VETERANS AFFAIRS Gulf War Veterans' Illnesses Task Force AGENCY: Department of... Veterans Affairs (VA) established the Gulf War Veterans' Illnesses Task Force (GWVI-TF) in August 2009 to conduct a comprehensive review of VA's approach to and programs addressing 1990-1991 Gulf War Veterans...

78 FR 28292 - Gulf War Veterans' Illnesses Task Force

Science.gov (United States)

2013-05-14

... DEPARTMENT OF VETERANS AFFAIRS Gulf War Veterans' Illnesses Task Force AGENCY: Department of... Veterans Affairs (VA) established the Gulf War Veterans' Illnesses Task Force (GWVI-TF) in August 2009 to conduct a comprehensive review of VA's approach to and programs addressing 1990-1991 Gulf War Veterans...

75 FR 16577 - Gulf War Veterans' Illnesses Task Force

Science.gov (United States)

2010-04-01

... DEPARTMENT OF VETERANS AFFAIRS Gulf War Veterans' Illnesses Task Force AGENCY: Department of... Veterans Affairs (VA) established the Gulf War Veterans' Illnesses Task Force (GWVI-TF) in August 2009 to conduct a comprehensive review of VA's approach to and programs addressing 1990-1991 Gulf War Veterans...

House Committee on Veterans' Affairs

Science.gov (United States)

... the beaches of Normandy, from t... [...] Read Article House Doubles Down on Commitment to Veterans 08 Nov ... R-Tenn.) released the following statement after the House of Representatives passed nine veterans bills Tuesday and ...

Risk of amphetamine use disorder and mortality among incident users of prescribed stimulant medications in the Veterans Administration.

Science.gov (United States)

Westover, Arthur N; Nakonezny, Paul A; Halm, Ethan A; Adinoff, Bryon

2018-05-01

Non-medical use of prescribed stimulant medications is a growing concern. This study's aims were to ascertain the demographics of stimulant medication users compared with non-users, examine temporal trends of stimulant medication use and estimate risk factors for development of amphetamine use disorder (AUD) and mortality among new users of stimulant medications. Cox proportional hazards regression in a retrospective cohort adjusted by baseline covariates. United States, national administrative database of the Veterans Affairs (VA) health-care system. Adult incident users of stimulant medications (n = 78 829) from fiscal years (FY) 2001 to 2012. Primary outcomes were time-to-event: (1) occurrence of AUD diagnosis and (2) death. Baseline covariates included demographic information, Food and Drug Administration (FDA)-approved indications for stimulant use, substance use disorders (SUD) and depression. Stimulant users compared with non-users were younger, more likely to be non-Hispanic white and female. Incident stimulant medication users increased threefold from FY2001-FY2012 and eightfold among adults aged 18-44 years. Nearly one in 10 incident users in FY2012 had a comorbid baseline SUD. Off-label use was common-nearly three of every five incident users in FY2012. Comorbid SUDs among incident stimulant medication users were risk factors for occurrence of AUD during follow-up, with adjusted hazard ratio (AHR) estimates ranging from 1.54 to 2.83 (Ps users in the Veterans Affairs health-care system, measured from fiscal years 2001 to 2012, comorbid substance use disorders were common and were risk factors for development of an amphetamine use disorder (AUD). Increased mortality risk among incident users of stimulant medications was observed among both those who developed an AUD later and those whose use was defined as off-label. © 2017 Society for the Study of Addiction.

Improving Trends in Gender Disparities in the Department of Veterans Affairs: 2008–2013

Science.gov (United States)

Czarnogorski, Maggie; Wright, Steve M.; Hayes, Patricia M.; Haskell, Sally G.

2014-01-01

Increasing numbers of women veterans using Department of Veterans Affairs (VA) services has contributed to the need for equitable, high-quality care for women. The VA has evaluated performance measure data by gender since 2006. In 2008, the VA launched a 5-year women’s health redesign, and, in 2011, gender disparity improvement was included on leadership performance plans. We examined data from VA Office of Analytics and Business Intelligence quarterly gender reports for trends in gender disparities in gender-neutral performance measures from 2008 to 2013. Through reporting of data by gender, leadership involvement, electronic reminders, and population management dashboards, VA has seen a decreasing trend in gender inequities on most Health Effectiveness Data and Information Set performance measures. PMID:25100416

Stigma Predicts Treatment Preferences and Care Engagement among Veterans Affairs Primary Care Patients with Depression

Science.gov (United States)

Campbell, Duncan G.; Bonner, Laura M.; Bolkan, Cory R.; Lanto, Andrew B.; Zivin, Kara; Waltz, Thomas J.; Klap, Ruth; Rubenstein, Lisa V.; Chaney, Edmund F.

2016-01-01

Background Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed. Purpose To test whether stigma, defined as depression label avoidance, predicted patients' preferences for depression treatment providers, patients' prospective engagement in depression care, and care quality. Methods We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression. Results Relative to low stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care. Conclusions High stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement. PMID:26935310

Department of Veterans Affairs, Gulf War Veterans’ Illnesses Task Force to the Secretary of Veterans Affairs

Science.gov (United States)

2010-09-29

National Health and Nutrition Examination Survey (NHANES); and the National Health Interview Survey ( NHIS ). As of July 1, 2010, VA has submitted to...NHANES and NHIS staff specific questions that if answered positively, will identify Veteran study subjects beginning in 2011 in both these National...several discussions with investigators on the NHANES and NHIS . Staffs from both surveys are willing to include Veteran-specific questions and to plan

The effect of race on postsurgical ambulatory medical follow-up among United States Veterans.

Science.gov (United States)

Schonberger, Robert B; Dai, Feng; Brandt, Cynthia; Burg, Matthew M

2017-08-01

To investigate the association between self-identified black or African American race and the presence of ambulatory internal medicine follow-up in the year after surgery. Our hypothesis was that among US Veterans who presented for surgery, black or African American race would be associated with a decreased likelihood to receive ambulatory internal medicine follow-up in the year after surgery. Retrospective observational. All US Veterans Affairs hospitals. A total of 236,200 Veterans undergoing surgery between 2006 and 2011 who were discharged within 10 days of surgery and survived the full 1-year exposure period. None. Attendance at an internal medicine follow-up appointment within 1 year after surgery. After controlling for year of surgery, age, age ≥65 years, sex, Hispanic ethnicity, and number of inpatient days, black or African American patients were 11% more likely to lack internal medicine follow-up after surgery (adjusted odds ratio, 1.11; 95% confidence interval, 1.06-1.16). When accounting for geographic region, this difference remained significant at the Bonferoni-corrected P < .007 level only in the Midwest United States where black or African American patients were 28% more likely to lack medical follow-up in the year after surgery (odds ratio, 1.28; 95% confidence interval, 1.16-1.42; P < .0001). The disparity in ambulatory medical follow-up following surgery among black or African American vs nonblack or non-African American Veterans in the Midwest region deserves further study and may lead to important quality improvement initiatives aimed specifically at this population. Copyright © 2016 Elsevier Inc. All rights reserved.

Accuracy and completeness of mortality data in the Department of Veterans Affairs

Directory of Open Access Journals (Sweden)

Maynard Charles

2006-04-01

Full Text Available Abstract Background One of the national mortality databases in the U.S. is the Beneficiary Identification and Record Locator Subsystem (BIRLS Death File that contains death dates of those who have received any benefits from the Department of Veterans Affairs (VA. The completeness of this database was shown to vary widely from cohort to cohort in previous studies. Three other sources of death dates are available in the VA that can complement the BIRLS Death File. The objective of this study is to evaluate the completeness and accuracy of death dates in the four sources available in the VA and to examine whether these four sources can be combined into a database with improved completeness and accuracy. Methods A random sample of 3,000 was drawn from 8.3 million veterans who received benefits from the VA between 1997 and 1999 and were alive on January 1, 1999 according to at least one source. Death dates found in BIRLS Death File, Medical SAS Inpatient Datasets, Medicare Vital Status, and Social Security Administration (SSA Death Master File were compared with dates obtained from the National Death Index. A combined dataset from these sources was also compared with National Death Index dates. Results Compared with the National Death Index, sensitivity (or the percentage of death dates correctly recorded in a source was 77.4% for BIRLS Death File, 12.0% for Medical SAS Inpatient Datasets, 83.2% for Medicare Vital Status, and 92.1% for SSA Death Master File. Over 95% of death dates in these sources agreed exactly with dates from the National Death Index. Death dates in the combined dataset demonstrated 98.3% sensitivity and 97.6% exact agreement with dates from the National Death Index. Conclusion The BIRLS Death File is not an adequate source of mortality data for the VA population due to incompleteness. When the four sources of mortality data are carefully combined, the resulting dataset can provide more timely data for death ascertainment than the

Honoring our Nation's Veterans

Directory of Open Access Journals (Sweden)

Robbins RA

2015-11-01

Full Text Available No abstract available. Article truncated at 150 words. Today is Armistice Day, renamed Veterans Day in 1954, to honor our Nation's Veterans. In Washington the rhetoric from both the political right and left supports our Veterans. My cynical side reminds me that this might have something to do with Veterans voting in a higher percentage than the population as a whole, but let me give the politicians this one. Serving our Country in the military is something that deserves to be honored. I was proud to serve our Veterans over 30 years at the four Department of Veterans Affairs (VA hospitals. However, the VA has had a very bad year. First, in Washington there were the resignations of the Secretary of Veterans Affairs, Eric Shinseki; the undersecretary for the Veterans Health Administration, Robert Petzel; and the undersecretary for the Veterans Benefits Administration, Allison Hickey. Locally, in the light of the VA wait scandal there were the firing of ...

Minority Veteran Report

Data.gov (United States)

Department of Veterans Affairs — This report is the first comprehensive report that chronicles the history of racial and ethnic minorities in the military and as Veterans, profiles characteristics...

2007 Veterans Employability Research Survey

Data.gov (United States)

Department of Veterans Affairs — The 2007 Veterans Employability Research Survey (VERS) was conducted to determine the factors that impact veterans' employability resulting from participation in the...

Comparison of Accessibility, Cost, and Quality of Elective Coronary Revascularization Between Veterans Affairs and Community Care Hospitals.

Science.gov (United States)

Barnett, Paul G; Hong, Juliette S; Carey, Evan; Grunwald, Gary K; Joynt Maddox, Karen; Maddox, Thomas M

2018-02-01

The Veterans Affairs (VA) Community Care (CC) Program supplements VA care with community-based medical services. However, access gains and value provided by CC have not been well described. To compare the access, cost, and quality of elective coronary revascularization procedures between VA and CC hospitals and to evaluate if procedural volume or publicly reported quality data can be used to identify high-value care. Observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization, controlling for differences in risk factors using propensity adjustment. The setting was VA and CC hospitals. Participants were veterans undergoing elective percutaneous coronary intervention (PCI) and veterans undergoing coronary artery bypass graft (CABG) procedures between October 1, 2008, and September 30, 2011. The analysis was conducted between July 2014 and July 2017. Receipt of an elective coronary revascularization at a VA vs CC facility. Access to care as measured by travel distance, 30-day mortality, and costs. In the 3 years ending on September 30, 2011, a total of 13 237 elective PCIs (79.1% at the VA) and 5818 elective CABG procedures (83.6% at the VA) were performed in VA or CC hospitals among veterans meeting study inclusion criteria. On average, use of CC was associated with reduced net travel by 53.6 miles for PCI and by 73.3 miles for CABG surgery compared with VA-only care. Adjusted 30-day mortality after PCI was higher in CC compared with VA (1.54% for CC vs 0.65% for VA, P publicly reported mortality data identified hospitals that provided higher-value care with the exception that CABG mortality was lower in small-volume CC hospitals. In this veteran cohort, PCIs performed in CC hospitals were associated with shorter travel distance but with higher mortality, higher costs, and minimal travel savings compared with VA hospitals. The CABG procedures performed in CC hospitals were associated with shorter travel distance

The relationship between local area labor market conditions and the use of Veterans Affairs health services.

Science.gov (United States)

Wong, Edwin S; Liu, Chuan-Fen

2013-03-13

In the U.S., economic conditions are intertwined with labor market decisions, access to health care, health care utilization and health outcomes. The Veterans Affairs (VA) health care system has served as a safety net provider by supplying free or reduced cost care to qualifying veterans. This study examines whether local area labor market conditions, measured using county-level unemployment rates, influence whether veterans obtain health care from the VA. We used survey data from the Behavioral Risk Factor Surveillance System in years 2000, 2003 and 2004 to construct a random sample of 73,964 respondents self-identified as veterans. VA health service utilization was defined as whether veterans received all, some or no care from the VA. Hierarchical ordered logistic regression was used to address unobserved state and county random effects while adjusting for individual characteristics. Local area labor market conditions were defined as the average 12-month unemployment rate in veterans' county of residence. The mean unemployment rate for veterans receiving all, some and no care was 5.56%, 5.37% and 5.24%, respectively. After covariate adjustment, a one percentage point increase in the unemployment rate in a veteran's county of residence was associated with an increase in the probability of receiving all care (0.34%, p-value = 0.056) or some care (0.29%, p-value = 0.023) from the VA. Our findings suggest that the important role of the VA in providing health care services to veterans is magnified in locations with high unemployment.

76 FR 67022 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for a Mixed-Use...

Science.gov (United States)

2011-10-28

... the entire Knoxville campus of the VA Central Iowa Healthcare System. The selected lessee will finance... that includes integrated residential, commercial, agricultural and technology components. The... Management (044), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 461...

Veterans and Homelessness

National Research Council Canada - National Science Library

Perl, Libby

2007-01-01

.... The Department of Veterans Affairs (VA) estimates that it has served approximately 300 returning veterans in its homeless programs and has identified over 1,000 more as being at risk of homelessness...

VA Student Financial Aid. Opportunity To Reduce Overlap in Approving Education and Training Programs. Report to the Committee on Veterans' Affairs, U.S. Senate.

Science.gov (United States)

General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

The Department of Veterans Affairs (VA) contracts with state approving agencies (SAAs) to assess whether schools and training programs offer education of sufficient quality for veterans to receive VA education assistance benefits when attending them. The General Accounting Office examined the gatekeeping activities of the VA and the Department of…

78 FR 77204 - Proposed Information Collection (VA National Veterans Sports Programs and Special Event Surveys...

Science.gov (United States)

2013-12-20

... AGENCY: Office of Public & Intergovernmental Affairs, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Office of Public Affairs (OPA), Department of Veterans Affairs (VA), is announcing an... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-NEW] Proposed Information Collection (VA...

National Structural Survey of Veterans Affairs Home-Based Primary Care Programs.

Science.gov (United States)

Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas

2017-12-01

To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Posttraumatic Stress Disorder's Frequency and Intensity Ratings Are Associated with Factor Structure Differences in Military Veterans

Science.gov (United States)

Elhai, Jon D.; Palmieri, Patrick A.; Biehn, Tracey L.; Frueh, B. Christopher; Magruder, Kathryn M.

2010-01-01

We examined possible differences in the factor structure of posttraumatic stress disorder (PTSD) on the basis of whether frequency or intensity symptom response formats were used to assess PTSD. Participants included 669 veterans recruited from an epidemiological study of four Veterans Affairs Medical Centers' primary care clinics in the…

Joint Patient Tracking Application/Veterans Tracking Application: A Joint Platform for Interdepartmental Data Exchange

National Research Council Canada - National Science Library

Fravell, Michael D

2007-01-01

...) makes it difficult to share clinical information within the DoD and, limited interoperability with Department of Veterans Affairs electronic medical record system prevents much of this critical data...

38 CFR 14.605 - Suits against Department of Veterans Affairs employees arising out of a wrongful act or omission...

Science.gov (United States)

2010-07-01

... MISCELLANEOUS CLAIMS Federal Tort Claims § 14.605 Suits against Department of Veterans Affairs employees arising... damage, personal injury, or death allegedly occurring as a result of malpractice or negligence committed... Health Administration. Accordingly, a malpractice or negligence suit for property damage, personal injury...

Korean War Veterans by State

Data.gov (United States)

Department of Veterans Affairs — The spreadsheet of Korean War Veterans by State includes the total Korean War Veteran population for each state and broken out by age and gender. It also includes...

Fluoroquinolone-Resistant Escherichia coli Infections after Transrectal Biopsy of the Prostate in the Veterans Affairs Healthcare System

Directory of Open Access Journals (Sweden)

Elie Antoun Saade

2016-09-01

Full Text Available Background: Recent reports suggest that infections due to fluoroquinolone-resistant Escherichia coli (E. coli are an increasingly common complication of transrectal biopsy of the prostate (TBP in the United States. A better understanding of the magnitude and scope of these infections is needed to guide prevention efforts. Our objective is to determine whether the incidence of infections due to fluoroquinolone-resistant E. coli after TBP has increased nationwide in the Veterans Affairs Health Care System and to identify risk factors for infection. Methods: We performed a retrospective, observational cohort study and a nested case-control study within the US Deparment of Veterans Affairs Healthcare System. The primary outcomes were the incidence of urinary tract infection (UTI and bacteremia with E. coli and with fluoroquinolone-resistant E. coli strains within 30 days after TBP. Secondary endpoints focused on the correlation between fluoroquinolone-resistance in all urinary E. coli isolates and post-TBP infection and risk factors for infection due to fluoroquinolone-resistant E. coli infection. Results: 245 618 patients undergoing 302 168 TBP procedures from 2000 through 2013 were included in the cohort study, and 59 469 patients undergoing TBP from 2011 through 2013 were included in the nested case-control study. Between 2000 and 2013, there was a 5-fold increase in the incidence of E. coli UTI (0.18%–0.93% and a 4-fold increase in the incidence of E. coli bacteremia (0.04%–0.18% after TBP that was attributable to an increase in the incidence of fluoroquinolone-resistant E. coli UTI (0.03%–0.75% and bacteremia (0.01%–0.14%. The increasing incidence of fluoroquinolone-resistant E. coli infections after TBP occurred in parallel with increasing rates of fluoroquinolone-resistance in all urinary E. coli isolates. By multivariable logistic regression analysis, independent risk factors for fluoroquinolone

78 FR 58264 - Servicemembers' Group Life Insurance and Veterans' Group Life Insurance Information Access

Science.gov (United States)

2013-09-23

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 9 RIN 2900-AO42 Servicemembers' Group Life Insurance and Veterans' Group Life Insurance Information Access AGENCY: Department of Veterans Affairs. ACTION: Proposed rule. SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its regulations governing...

Safety risks with investigational drugs: Pharmacy practices and perceptions in the veterans affairs health system.

Science.gov (United States)

Cruz, Jennifer L; Brown, Jamie N

2015-06-01

Rigorous practices for safe dispensing of investigational drugs are not standardized. This investigation sought to identify error-prevention processes utilized in the provision of investigational drug services (IDS) and to characterize pharmacists' perceptions about safety risks posed by investigational drugs. An electronic questionnaire was distributed to an audience of IDS pharmacists within the Veteran Affairs Health System. Multiple facets were examined including demographics, perceptions of medication safety, and standard processes used to support investigational drug protocols. Twenty-one respondents (32.8% response rate) from the Northeast, Midwest, South, West, and Non-contiguous United States participated. The mean number of pharmacist full-time equivalents (FTEs) dedicated to the IDS was 0.77 per site with 0.2 technician FTEs. The mean number of active protocols was 22. Seventeen respondents (81%) indicated some level of concern for safety risks. Concerns related to the packaging of medications were expressed, most notably lack of product differentiation, expiration dating, barcodes, and choice of font size or color. Regarding medication safety practices, the majority of sites had specific procedures in place for storing and securing drug supply, temperature monitoring, and prescription labeling. Repackaging bulk items and proactive error-identification strategies were less common. Sixty-seven percent of respondents reported that an independent double check was not routinely performed. Medication safety concerns exist among pharmacists in an investigational drug service; however, a variety of measures have been employed to improve medication safety practices. Best practices for the safe dispensing of investigational medications should be developed in order to standardize these error-prevention strategies.

Minority Veteran Report 2014

Data.gov (United States)

Department of Veterans Affairs — This report is the first comprehensive report that chronicles the history of racial and ethnic minorities in the military and as Veterans, profiles characteristics...

78 FR 27882 - VA Veteran-Owned Small Business (VOSB) Verification Guidelines

Science.gov (United States)

2013-05-13

... Verification Self-Assessment Tool that walks the veteran through the regulation and how it applies to the...) Verification Guidelines AGENCY: Department of Veterans Affairs. ACTION: Advanced notice of proposed rulemaking... regulations governing the Department of Veterans Affairs (VA) Veteran-Owned Small Business (VOSB) Verification...

Job satisfaction of Department of Veterans Affairs peer mental health providers.

Science.gov (United States)

Chang, Bei-Hung; Mueller, Lisa; Resnick, Sandra G; Osatuke, Katerine; Eisen, Susan V

2016-03-01

Department of Veterans Affairs (VA) peer specialists and vocational rehabilitation specialists are Veterans employed in mental health services to help other Veterans with similar histories and experiences. Study objectives were to (a) examine job satisfaction among these employees, (b) compare them to other VA mental health workers, and (c) identify factors associated with job satisfaction across the 3 cohorts. The study sample included 152 VA-employed peer specialists and 222 vocational rehabilitation specialists. A comparison group included 460 VA employees from the same job categories. All participants completed the Job Satisfaction Index (11 aspects and overall satisfaction ratings). Linear regression was used to compare job satisfaction and identify its predictors among the 3 cohorts. Job satisfaction was fairly high, averaging "somewhat satisfied" to "very satisfied" in 6 (peer specialists) and 9 (vocational rehabilitation specialists) of the 11 aspects and overall job ratings. Adjusting for length of employment, age and gender resulted in no significant group differences with 2 exceptions: White peer specialists were less satisfied with pay and promotion opportunities than vocational rehabilitation specialists and comparison-group employees. Across all cohorts, shorter length of time employed in the job was associated with higher job satisfaction. The high job satisfaction levels among the 2 peer cohorts suggest support for the policy of hiring peer specialists in the VA. Furthermore, the results are consistent with those of the nonveteran samples, indicating that integrating peer providers into mental health care is possible in VA and non-VA settings. (c) 2016 APA, all rights reserved).

Adoption of PACS by the Department of Veterans Affairs: the past, the present, and future plans

Science.gov (United States)

Siegel, Eliot L.; Reiner, Bruce I.; Kuzmak, Peter M.

2000-05-01

The diffusion of PACS technology within the Department of Veterans Affairs has followed the 'S' curve transition originally described by Ryan and Gross in 1943. They described a paradigm that describes the diffusion of a new technology into the community. However the rate of adoption of filmless radiology by the VA has been much higher than that of the general healthcare system. This is likely due to the fact that the VA and Department of Defense medical systems are somewhat isolated and independent from other health care systems and are subject to a different rate of diffusion of technology. The early introduction and success of PACS in the VA undoubtedly accelerated its acceptance throughout the system. An additional impetus to the growth of PACS in the VA has been the development of an image management system that has been incorporated into the electronic medical record. The universal use of the VISTA HIS and RIS system throughout the VA and the fact that it was developed 'in-house' as well as its extensive support for DICOM functionality have also played a major role in facilitating the acceptance of Picture Archival and Communication Systems throughout the VA.

Report of VA Medical Training Programs

Data.gov (United States)

Department of Veterans Affairs — The Report of VA Medical Training Programs Database is used to track medical center health services trainees and VA physicians serving as faculty. The database also...

77 FR 60304 - Servicemembers' Group Life Insurance and Veterans' Group Life Insurance-Slayer's Rule Exclusion

Science.gov (United States)

2012-10-03

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 9 RIN 2900-AN40 Servicemembers' Group Life Insurance and Veterans' Group Life Insurance--Slayer's Rule Exclusion AGENCY: Department of Veterans Affairs. ACTION: Final rule. SUMMARY: The Department of Veterans Affairs (VA) is amending its regulations...

Chaplaincy and mental health in the department of Veterans affairs and department of defense.

Science.gov (United States)

Nieuwsma, Jason A; Rhodes, Jeffrey E; Jackson, George L; Cantrell, William C; Lane, Marian E; Bates, Mark J; Dekraai, Mark B; Bulling, Denise J; Ethridge, Keith; Drescher, Kent D; Fitchett, George; Tenhula, Wendy N; Milstein, Glen; Bray, Robert M; Meador, Keith G

2013-01-01

Chaplains play important roles in caring for Veterans and Service members with mental health problems. As part of the Department of Veterans Affairs (VA) and Department of Defense (DoD) Integrated Mental Health Strategy, we used a sequential approach to examining intersections between chaplaincy and mental health by gathering and building upon: 1) input from key subject matter experts; 2) quantitative data from the VA / DoD Chaplain Survey (N = 2,163; response rate of 75% in VA and 60% in DoD); and 3) qualitative data from site visits to 33 VA and DoD facilities. Findings indicate that chaplains are extensively involved in caring for individuals with mental health problems, yet integration between mental health and chaplaincy is frequently limited due to difficulties between the disciplines in establishing familiarity and trust. We present recommendations for improving integration of services, and we suggest key domains for future research.

Dengue surveillance in Veterans Affairs healthcare facilities, 2007-2010.

Directory of Open Access Journals (Sweden)

Patricia L Schirmer

Full Text Available BACKGROUND: Although dengue is endemic in Puerto Rico (PR, 2007 and 2010 were recognized as epidemic years. In the continental United States (US, outside of the Texas-Mexico border, there had not been a dengue outbreak since 1946 until dengue re-emerged in Key West, Florida (FL, in 2009-2010. The objective of this study was to use electronic and manual surveillance systems to identify dengue cases in Veterans Affairs (VA healthcare facilities and then to clinically compare dengue cases in Veterans presenting for care in PR and in FL. METHODOLOGY: Outpatient encounters from 1/2007-12/2010 and inpatient admissions (only available from 10/2009-12/2010 with dengue diagnostic codes at all VA facilities were identified using VA's Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE. Additional case sources included VA data from Centers for Disease Control and Prevention BioSense and VA infection preventionists. Case reviews were performed. Categorical data was compared using Mantel-Haenszel or Fisher Exact tests and continuous variables using t-tests. Dengue case residence was mapped. FINDINGS: Two hundred eighty-eight and 21 PR and FL dengue cases respectively were identified. Of 21 FL cases, 12 were exposed in Key West and 9 were imported. During epidemic years, FL cases had significantly increased dengue testing and intensive care admissions, but lower hospitalization rates and headache or eye pain symptoms compared to PR cases. There were no significant differences in clinical symptoms, laboratory abnormalities or outcomes between epidemic and non-epidemic year cases in FL and PR. Confirmed/probable cases were significantly more likely to be hospitalized and have thrombocytopenia or leukopenia compared to suspected cases. CONCLUSIONS: Dengue re-introduction in the continental US warrants increased dengue surveillance and education in VA. Throughout VA, under-testing of suspected cases highlights the need to

Strategic alliances in healthcare: opportunities for the Veterans Affairs healthcare system.

Science.gov (United States)

Halverson, P K; Kaluzny, A D; Young, G J

1997-01-01

Strategic alliances are proving to be effective strategies for responding and adapting to changing environments, and as such they offer the U.S. Department of Veterans Affairs (VA) healthcare system valuable opportunities for accomplishing the goals of its major reorganization effort. This article begins with an examination of basic strategic-alliance structures that are employed across many different types of industries. Next, consideration is given to the ways in which these basic alliance structures may be adapted to the unique organizations and individuals that serve as providers, purchasers, and consumers of health services. Finally, this article explores how models of strategic alliance in healthcare can be tailored to the specific needs and constraints of the VA healthcare system through an examination of existing and potential alliance opportunities.

38 CFR 10.37 - Claim of widow not living with veteran at time of veteran's death.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Claim of widow not living with veteran at time of veteran's death. 10.37 Section 10.37 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUSTED COMPENSATION Adjusted Compensation; General § 10.37 Claim of widow not living with veteran at time of...

Profile of Vietnam War Veterans (2015).

Data.gov (United States)

Department of Veterans Affairs — The Profile of Vietnam War Veterans uses the 2015 ACS to provide a view into the demographic characteristics and socioeconomic conditions of the Vietnam War Veteran...

38 CFR 17.96 - Medication prescribed by non-VA physicians.

Science.gov (United States)

2010-07-01

... AFFAIRS MEDICAL Outpatient Treatment § 17.96 Medication prescribed by non-VA physicians. Any prescription... and medicines ordered by a private or non-Department of Veterans Affairs doctor of medicine or doctor of osteopathy duly licensed to practice in the jurisdiction where the prescription is written, shall...

Master Veteran Index (MVI)

Data.gov (United States)

Department of Veterans Affairs — As of June 28, 2010, the Master Veteran Index (MVI) database based on the enhanced Master Patient Index (MPI) is the authoritative identity service within the VA,...

Posttraumatic Stress Disorder, Traumatic Brain Injury, and Suicide Attempt History among Veterans Receiving Mental Health Services

Science.gov (United States)

Brenner, Lisa A.; Betthauser, Lisa M.; Homaifar, Beeta Y.; Villarreal, Edgar; Harwood, Jeri E. F.; Staves, Pamela J.; Huggins, Joseph A.

2011-01-01

History of posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) has been found to increase risk of suicidal behavior. The association between suicide attempt history among veterans with PTSD and/or TBI was explored. Cases (N = 81) and 2:1 matched controls (N = 160) were randomly selected from a Veterans Affairs Medical Center…

Homeland security and public health: role of the Department of Veterans Affairs, the US Department of Homeland Security, and implications for the public health community.

Science.gov (United States)

Koenig, Kristi L

2003-01-01

The terrorist attacks of 11 September 2001 led to the largest US Government transformation since the formation of the Department of Defense following World War II. More than 22 different agencies, in whole or in part, and >170,000 employees were reorganized to form a new Cabinet-level Department of Homeland Security (DHS), with the primary mission to protect the American homeland. Legislation enacted in November 2002 transferred the entire Federal Emergency Management Agency and several Department of Health and Human Services (HHS) assets to DHS, including the Office of Emergency Response, and oversight for the National Disaster Medical System, Strategic National Stockpile, and Metropolitan Medical Response System. This created a potential separation of "health" and "medical" assets between the DHS and HHS. A subsequent presidential directive mandated the development of a National Incident Management System and an all-hazard National Response Plan. While no Department of Veterans Affairs (VA) assets were targeted for transfer, the VA remains the largest integrated healthcare system in the nation with important support roles in homeland security that complement its primary mission to provide care to veterans. The Emergency Management Strategic Healthcare Group (EMSHG) within the VA's medical component, the Veteran Health Administration (VHA), is the executive agent for the VA's Fourth Mission, emergency management. In addition to providing comprehensive emergency management services to the VA, the EMSHG coordinates medical back-up to the Department of Defense, and assists the public via the National Disaster Medical System and the National Response Plan. This article describes the VA's role in homeland security and disasters, and provides an overview of the ongoing organizational and operational changes introduced by the formation of the new DHS. Challenges and opportunities for public health are highlighted.

Medical Care Cost Recovery National Database (MCCR NDB)

Data.gov (United States)

Department of Veterans Affairs — The Medical Care Cost Recovery National Database (MCCR NDB) provides a repository of summary Medical Care Collections Fund (MCCF) billing and collection information...

Veterans Integrated Services Networks (VISN), Markets, Submarkets, Sectors and Counties by Geographic Location

Data.gov (United States)

Department of Veterans Affairs — The Department of Veterans Affairs (VA) provides healthcare services to its veterans across the USA including territories and possessions. Healthcare services are...

Self-reported infertility among male and female veterans serving during Operation Enduring Freedom/Operation Iraqi Freedom.

Science.gov (United States)

Katon, Jodie; Cypel, Yasmin; Raza, Mubashra; Zephyrin, Laurie; Reiber, Gayle; Yano, Elizabeth M; Barth, Shannon; Schneiderman, Aaron

2014-02-01

Infertility is associated with psychosocial distress and is a growing public health concern. Our objective was to report the prevalence of lifetime history of infertility among men and women Veterans. We used data from the U.S. Department of Veterans Affairs National Health Study for a New Generation of U.S. Veterans, a nationally representative survey of Veterans serving during Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). The primary dependent variables were self-reported lifetime history of infertility among Veterans and their partners, defined as trying unsuccessfully to become pregnant for at least 12 months, and seeking medical help for infertility. Multiple logistic regression was used to determine whether gender was associated with lifetime history of infertility or seeking medical help for infertility, after adjusting for sociodemographic and military characteristics. All analyses were weighted to account for the complex survey design and nonresponse. Among the 20,370 Veterans (16,056 men; 4,314 women) in our final analytic sample, the prevalence of lifetime history of infertility was 15.8% for women and 13.8% for men. After adjusting for age, ever married, education, race/ethnicity, component, branch of service, and deployment to OEF/OIF, compared with men, women Veterans had similar odds of lifetime history of infertility (odds ratio [OR] 1.07; 95% confidence interval [CI] 0.94, 1.20), but increased odds of seeking medical help for infertility (OR 1.35; 95% CI 1.06, 1.72). Women Veterans are more likely than their male counterparts to seek care for infertility, and given their increasing numbers, the demand for infertility evaluation and care within Veterans' Affairs may increase.

Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs.

Science.gov (United States)

Eibner, Christine; Krull, Heather; Brown, Kristine M; Cefalu, Matthew; Mulcahy, Andrew W; Pollard, Michael; Shetty, Kanaka; Adamson, David M; Amaral, Ernesto F L; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii; Mendelsohn, Joshua; Ross, Rachel; Rutter, Carolyn M; Weinick, Robin M; Woods, Dulani; Hosek, Susan D; Farmer, Carrie M

2016-05-09

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade.

Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

Science.gov (United States)

Eibner, Christine; Krull, Heather; Brown, Kristine M.; Cefalu, Matthew; Mulcahy, Andrew W.; Pollard, Michael; Shetty, Kanaka; Adamson, David M.; Amaral, Ernesto F. L.; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii; Mendelsohn, Joshua; Ross, Rachel; Rutter, Carolyn M.; Weinick, Robin M.; Woods, Dulani; Hosek, Susan D.; Farmer, Carrie M.

2016-01-01

Abstract The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade. PMID:28083423

38 CFR 3.454 - Veterans disability pension.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Veterans disability pension. 3.454 Section 3.454 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Pension, Compensation, and Dependency and Indemnity Compensation Apportionments § 3.454 Veterans...

Rural Veterans by State (2015)

Data.gov (United States)

Department of Veterans Affairs — This spreadsheet contains data from the 2015 American Community Survey and shows the demographic and socioeconomic characteristics of Veterans who live in rural and...

Rural Veterans by State (2014)

Data.gov (United States)

Department of Veterans Affairs — This speadsheet contains data from the 2014 American Community Survey and shows the demographic and socioeconomic characteristics of Veterans who live in rural and...

Dysthymia and depression increase risk of dementia and mortality among older veterans

OpenAIRE

Byers, AL; Covinsky, KE; Barnes, DE; Yaffe, K

2012-01-01

OBJECTIVE: To determine whether less severe depression spectrum diagnoses such as dysthymia, as well as depression, are associated with risk of developing dementia and mortality in a "real-world" setting. DESIGN: Retrospective cohort study conducted using the Department of Veterans Affairs (VA) National Patient Care Database (1997-2007). SETTING: VA medical centers in the United States. PARTICIPANTS: A total of 281,540 veterans aged 55 years and older without dementia at study baseline (1997-...

77 FR 37839 - Veterans' Group Life Insurance (VGLI) No-Health Period Extension

Science.gov (United States)

2012-06-25

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 9 RIN 2900-AO24 Veterans' Group Life Insurance (VGLI) No-Health Period Extension AGENCY: Department of Veterans Affairs. ACTION: Proposed rule. SUMMARY... Veterans' Group Life Insurance (VGLI) to extend to 240 days the current 120-day ``no-health'' period during...

78 FR 50145 - Advisory Committee on Women Veterans, Notice of Meeting

Science.gov (United States)

2013-08-16

... will include overview briefings from the Atlanta VA Medical Center leadership and the VA Southeast... Clairmont Road, Decatur, Georgia, to receive briefings on RO business lines and services for women Veterans. A briefing from local Memorial Affairs leadership will also be presented. On August 23, the...

76 FR 24087 - Advisory Committee on Homeless Veterans; Notice of Meeting

Science.gov (United States)

2011-04-29

... DEPARTMENT OF VETERANS AFFAIRS Advisory Committee on Homeless Veterans; Notice of Meeting The Department of Veterans Affairs (VA) gives notice under Public Law 92-463 (Federal Advisory Committee Act... Harbor View Room at the Best Western Bay Harbor Hotel, 7700 Courtney Campbell Causeway, Tampa, Florida...

Effectiveness of off-the-shelf footwear in reducing foot pain in Australian Department of Veterans' Affairs recipients not eligible for medical grade footwear: study protocol for a randomized controlled trial.

Science.gov (United States)

Menz, Hylton B; Frescos, Nicoletta; Munteanu, Shannon E

2013-04-23

Foot pain is highly prevalent in older people, and in many cases is associated with wearing inadequate footwear. In Australia, the Department of Veterans' Affairs (DVA) covers the costs of medical grade footwear for veterans who have severe foot deformity. However, there is a high demand for footwear by veterans with foot pain who do not meet this eligibility criterion. Therefore, this article describes the design of a randomized controlled trial to evaluate the effectiveness of low cost, off-the-shelf footwear in reducing foot pain in DVA recipients who are currently not eligible for medical grade footwear. One hundred and twenty DVA clients with disabling foot pain residing in Melbourne, Australia, who are not eligible for medical grade footwear will be recruited from the DVA database, and will be randomly allocated to an intervention group or a 'usual care' control group. The intervention group will continue to receive their usual DVA-subsidized podiatry care in addition to being provided with low-cost, supportive footwear (Dr Comfort®, Vasyli Medical, Labrador, Queensland, Australia). The control group will also continue to receive DVA-subsidized podiatry care, but will not be provided with the footwear until the completion of the study. The primary outcome measure will be pain subscale on the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8, 12 and 16 weeks. Secondary outcome measures measured at baseline and 16 weeks will include the function subscale of the FHSQ, the Manchester Foot Pain and Disability Index, the number of DVA podiatry treatments required during the study period, general health-related quality of life (using the Short Form 12® Version 2.0), the number of falls experienced during the follow-up period, the Timed Up and Go test, the presence of hyperkeratotic lesions (corns and calluses), the number of participants using co-interventions to relieve foot pain, and participants' perception of overall treatment effect. Data

Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey.

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Chou, Ann F; Graber, Christopher J; Jones, Makoto; Zhang, Yue; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew; Kelly, Allison; Glassman, Peter A

2016-06-01

BACKGROUND Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage. DESIGN A web-based survey regarding stewardship activities was administered to each facility's designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined. SETTING Total of 130 Veterans Affairs facilities with inpatient services. RESULTS Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03). CONCLUSIONS ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices. Infect Control Hosp Epidemiol 2016;37:647-654.

75 FR 4453 - Advisory Committee on Homeless Veterans; Notice of Meeting

Science.gov (United States)

2010-01-27

... DEPARTMENT OF VETERANS AFFAIRS Advisory Committee on Homeless Veterans; Notice of Meeting The Department of Veterans Affairs (VA) gives notice under Public Law 92-463 (Federal Advisory Committee Act... Lafayette Park Room at the Hamilton Crowne Plaza Hotel, 1001 14th Street, NW., Washington, DC. On February...

Veteran Religious Affiliation by State

Data.gov (United States)

Department of Veterans Affairs — This dataset provide a count of Veteran by their religious affiliation and state of residence. The dataset set covers all 50 states, District of Columbia and other...

The impact of the Department of Veterans Affairs Health Care Personnel Enhancement Act of 2004 on VA physicians' salaries and retention.

Science.gov (United States)

Weeks, William B; Wallace, Tanner A; Wallace, Amy E

2009-01-01

To determine whether the Department of Veterans Affairs Health Care Personnel Enhancement Act (the Act), which was designed to achieve VA physician salary parity with American Academy of Medical Colleges (AAMC) Associate Professors and enacted in 2006, had achieved its goal. Using VA human resources datasets and data from the AAMC, we calculated mean VA physician salaries, with 95 percent confidence intervals, for 15 different medical specialties. For each specialty, we compared VA salaries to the median, 25th, and 75th percentile of AAMC Associate Professors' incomes. The Act's passage resulted in a $20,000 annual increase in VA physicians' salaries. VA primary care physicians, medical subspecialists, and psychiatrists had salaries that were comparable to their AAMC counterparts prior to and after enactment of the Act. However, VA surgical specialists', anesthesiologists', and radiologists' salaries lagged their AAMC counterparts both before and after the Act's enactment. Income increases were negatively correlated with full-time workforce changes. VA does not appear to provide comparable salaries for physicians necessary for surgical care. In certain cases, VA should consider outsourcing surgical services.

Department of Veterans Affairs Quarterly Notice to Congress on Data Breaches First Quarter of Fiscal Year 2014 October 1, 2013 through December 31, 2013

Data.gov (United States)

Department of Veterans Affairs — This is a quarterly notice to congress containing statistics on data breeches for fiscal year 2014 for the first quarter (2014 October 1, 2013 through December 31,...

2 CFR 801.137 - Who in the Department of Veterans Affairs may grant an exception to allow an excluded person to...

Science.gov (United States)

2010-01-01

... may grant an exception to allow an excluded person to participate in a covered transaction? 801.137 Section 801.137 Grants and Agreements Federal Agency Regulations for Grants and Agreements DEPARTMENT OF VETERANS AFFAIRS NONPROCUREMENT DEBARMENT AND SUSPENSION General § 801.137 Who in the Department of...

Evaluation of US Veterans Nutrition Education for Diabetes Prevention.

Science.gov (United States)

Erickson, Megan; Braun, Katie; List, Riesa; Utech, Anne; Moore, Carolyn; White, Donna L; Garcia, Jose M

2016-09-01

Evaluate the effectiveness of nutrition education interventions for diabetes prevention. Retrospective cohort design. Tertiary-care US Veterans' Hospital, July 2007 to July 2012, using pre-existing database. Prediabetic, adult veterans (n = 372), mostly men (94.4%, n = 351). Visits with existing nutrition education classes were collected. diabetes status; predictors: visits/encounters, age, body mass index, weight change, and hemoglobin A1c. Cox proportional hazards method, χ(2) test, and logistic regression. In this sample, prediabetic veterans who received nutrition education were less likely to develop diabetes when compared with prediabetic veterans who did not receive nutrition education (hazard ratio, 0.71; 95% confidence interval, 0.55-0.92; P Nutrition education was significantly associated with preventing the progression from prediabetes to diabetes in US Veterans participating in a nutrition education intervention at the Michael E. DeBakey Veterans Affairs Medical Center. Copyright © 2016 Society for Nutrition Education and Behavior. All rights reserved.

The Veteran Population Projection 2014

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Department of Veterans Affairs — VetPop2014 is an actuarial projection model developed by the Office of the Actuary (OACT) for Veteran population projection from Fiscal Year FY2014 to FY2043. Using...

38 CFR 1.575 - Social security numbers in veterans' benefits matters.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Social security numbers... Affairs Records § 1.575 Social security numbers in veterans' benefits matters. (a) Except as provided in... because of refusal to disclose to the Department of Veterans Affairs a social security number. (b) VA...

76 FR 37896 - Advisory Committee on Women Veterans; Notice of Meeting

Science.gov (United States)

2011-06-28

... DEPARTMENT OF VETERANS AFFAIRS Advisory Committee on Women Veterans; Notice of Meeting The Department of Veterans Affairs (VA) gives notice under Public Law 92-463 (Federal Advisory Committee Act... Liaison Capitol Hill Hotel, 415 New Jersey Avenue, NW., Washington, DC, from 8:30 a.m. until 4:30 p.m. The...

Development and initial evaluation of Transdiagnostic Behavior Therapy (TBT) for veterans with affective disorders.

Science.gov (United States)

Gros, Daniel F

2014-12-15

Considerable attention has focused on the growing need for evidence-based psychotherapy for veterans with affective disorders within the Department of Veteran Affairs. Despite, and possibly due to, the large number of evidence-based protocols available, several obstacles remain in their widespread delivery within Veterans Affairs Medical Centers. In part as an effort to address these concerns, newer transdiagnostic approaches to psychotherapy have been developed to provide a single treatment that is capable of addressing several, related disorders. The goal of the present investigation was to develop and evaluate a transdiagnostic psychotherapy, Transdiagnostic Behavior Therapy (TBT), in veterans with affective disorders. Study 1 provided initial support for transdiagnostic presentation of evidence-based psychotherapy components in veterans with principal diagnoses of affective disorders (n=15). These findings were used to inform the development of the TBT protocol. In Study 2, an initial evaluation of TBT was completed in a second sample of veterans with principal diagnoses of affective disorders (n=29). The findings of Study 2 demonstrated significant improvements in symptoms of depression, anxiety, stress, posttraumatic stress, and related impairment across participants with various principal diagnoses. Together, the investigation provided preliminary support for effectiveness of TBT in veterans with affective disorders. Published by Elsevier Ireland Ltd.

Identification of methicillin-resistant Staphylococcus aureus within the Nation’s Veterans Affairs Medical Centers using natural language processing

Directory of Open Access Journals (Sweden)

Jones Makoto

2012-07-01

Full Text Available Abstract Background Accurate information is needed to direct healthcare systems’ efforts to control methicillin-resistant Staphylococcus aureus (MRSA. Assembling complete and correct microbiology data is vital to understanding and addressing the multiple drug-resistant organisms in our hospitals. Methods Herein, we describe a system that securely gathers microbiology data from the Department of Veterans Affairs (VA network of databases. Using natural language processing methods, we applied an information extraction process to extract organisms and susceptibilities from the free-text data. We then validated the extraction against independently derived electronic data and expert annotation. Results We estimate that the collected microbiology data are 98.5% complete and that methicillin-resistant Staphylococcus aureus was extracted accurately 99.7% of the time. Conclusions Applying natural language processing methods to microbiology records appears to be a promising way to extract accurate and useful nosocomial pathogen surveillance data. Both scientific inquiry and the data’s reliability will be dependent on the surveillance system’s capability to compare from multiple sources and circumvent systematic error. The dataset constructed and methods used for this investigation could contribute to a comprehensive infectious disease surveillance system or other pressing needs.

76 FR 17752 - Notice of Intent To Prepare an Environmental Impact Statement for the San Francisco Veterans...

Science.gov (United States)

2011-03-30

... Environmental Policy Act (NEPA) of 1969, as amended, (42 U.S.C. 4331 et seq.), the Council on Environmental... the San Francisco Veterans Affairs Medical Center (SFVAMC) Institutional Master Plan AGENCY...: Comments should be addressed to John Pechman, Facility Planner, San Francisco VA Medical Center (001), 4150...

Employment of Veterans in the Federal Executive Branch

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Department of Veterans Affairs — These quick facts use data from the 2011 Employment of Veterans in the Federal Executive Branch to compare Veteran employment in the Federal Government by agency,...

DefenseLink Special: Veterans Day 2005

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our country, and for making a proud history. God bless you all. And God bless our wonderful country a special Veterans Day observance. Story * Command Sgt. Major Praises Women's Service Woman Vet Veterans Affairs * Center of Military History * White House: Honoring Our Veterans * Library of Congress

75 FR 77956 - Agency Information Collection (Annual Certification of Veteran Status and Veteran-Relatives...

Science.gov (United States)

2010-12-14

... Administration (VBA), Department of Veterans Affairs, will submit the collection of information abstracted below... Review: Extension of a currently approved collection. Abstract: VBA employees, non-VBA employees in VBA space and Veteran Service Organization employees who have access to VA's benefit records complete VA...

The association between in-service sexual harassment and post-traumatic stress disorder among Department of Veterans Affairs disability applicants.

Science.gov (United States)

Murdoch, Maureen; Polusny, Melissa A; Hodges, James; Cowper, Diane

2006-02-01

The goal was to describe the association between post-traumatic stress disorder (PTSD) and in-service sexual harassment in a nationally representative sample of Department of Veterans Affairs PTSD disability applicants. The study was a cross-sectional survey. Of 4,918 eligible veterans, 3,337 (68%) returned surveys. Nonresponse bias appeared to be minimal. After adjustment for other reported traumas, women's reported in-service sexual harassment severity was significantly associated with PTSD symptom severity (p men and for in-service sexual assault among the women. Men showed no association between in-service sexual harassment and PTSD (p = 0.33), although power was low for this test. Sexual harassment significantly contributed to female veterans' PTSD symptoms; its contribution to men's symptoms was unclear. We discuss mechanisms through which sexual harassment might affect PTSD symptom severity, including the possibility that sexual harassment sometimes meets the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, definition of a criterion A stressor.

Racial and Ethnic Differences in Total Knee Arthroplasty in the Veterans Affairs Health Care System, 2001-2013.

Science.gov (United States)

Hausmann, Leslie R M; Brandt, Cynthia A; Carroll, Constance M; Fenton, Brenda T; Ibrahim, Said A; Becker, William C; Burgess, Diana J; Wandner, Laura D; Bair, Matthew J; Goulet, Joseph L

2017-08-01

To examine black-white and Hispanic-white differences in total knee arthroplasty from 2001 to 2013 in a large cohort of patients diagnosed with osteoarthritis (OA) in the Veterans Affairs (VA) health care system. Data were from the VA Musculoskeletal Disorders cohort, which includes data from electronic health records of more than 5.4 million veterans with musculoskeletal disorders diagnoses. We included white (non-Hispanic), black (non-Hispanic), and Hispanic (any race) veterans, age ≥50 years, with an OA diagnosis from 2001-2011 (n = 539,841). Veterans were followed from their first OA diagnosis until September 30, 2013. As a proxy for increased clinical severity, analyses were also conducted for a subsample restricted to those who saw an orthopedic or rheumatology specialist (n = 148,844). We used Cox proportional hazards regression to examine racial and ethnic differences in total knee arthroplasty by year of OA diagnosis, adjusting for age, sex, body mass index, physical and mental diagnoses, and pain intensity scores. We identified 12,087 total knee arthroplasty procedures in a sample of 473,170 white, 50,172 black, and 16,499 Hispanic veterans. In adjusted models examining black-white and Hispanic-white differences by year of OA diagnosis, total knee arthroplasty rates were lower for black than for white veterans diagnosed in all but 2 years. There were no Hispanic-white differences regardless of when diagnosis occurred. These patterns held in the specialty clinic subsample. Black-white differences in total knee arthroplasty appear to be persistent in the VA, even after controlling for potential clinical confounders. © 2016, American College of Rheumatology.

PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War.

Science.gov (United States)

Schlenger, William E; Mulvaney-Day, Norah; Williams, Christianna S; Kulka, Richard A; Corry, Nida H; Mauch, Danna; Nagler, Caryn F; Ho, Chia-Lin; Marmar, Charles R

2016-05-01

The primary goal of this analysis was to assess whether recent use of outpatient services for general medical concerns by Vietnam veterans varies according to level of posttraumatic stress disorder (PTSD) symptomatology over time. Another goal was to determine whether PTSD symptomatology was associated with veterans' reports of discussing behavioral health issues as part of a general medical visit. Self-reported service use data and measures of PTSD were from a nationally representative sample of 848 male and female Vietnam theater veterans (individuals who were deployed to the Vietnam theater of operations) who participated in the National Vietnam Veterans Longitudinal Study, a 25-year follow-up of a cohort of veterans originally interviewed from 1984-1988 as part of the National Vietnam Veterans Readjustment Study. Four categories of PTSD symptomatology course over 25 years were defined, and logistic regression models were used to assess their relationship with recent use of outpatient general medical services. Male and female theater veterans with high or increasing PTSD symptomatology over the period were more likely than those with low symptomatology to report recent VA outpatient visits. Males in the increasing and high categories were also more likely to discuss behavioral health issues at general medical visits. Vietnam veterans with high and increasing PTSD symptomatology over time were likely to use VA outpatient general health services. Attention to stressors of the aging process and to persistence of PTSD symptoms is important for Vietnam veterans, as is addressing PTSD with other psychiatric and medical comorbidities within the context of outpatient general medical care.

Assessments of the Veteran Medication Allergy Knowledge Gap and Potential Safety Improvements with the Veteran Health Information Exchange (VHIE).

Science.gov (United States)

Pan, Eric; Botts, Nathan; Jordan, Harmon; Olinger, Lois; Donahue, Margaret; Hsing, Nelson

2016-01-01

The U.S. Department of Veterans Affairs (VA) Veteran Health Information Exchange (VHIE, formerly Virtual Lifetime Electronic Record, or VLER) had been deployed at all VA sites and used to exchange clinical information with private sector healthcare partners nationally. This paper examined VHIE's effect on allergy documentation. Review of all inbound VHIE transactions in FY14 showed that VHIE use was associated with a nearly eight-fold increase in allergy documentation rate. Preliminary manual document review further showed that VA and partners had shared knowledge of only 38% ofpatient allergies, while VA had exclusive knowledge of another 58% ofpatient allergies, and partners had exclusive knowledge of the last 5% of patient allergies. To our knowledge, this is the first study that examined the effect of HIE on allergy documentation.

Veterans Affairs facility performance on Washington Circle indicators and casemix-adjusted effectiveness.

Science.gov (United States)

Harris, Alex H S; Humphreys, Keith; Finney, John W

2007-12-01

Self-administered Addiction Severity Index (ASI) data were collected on 5,723 patients who received substance abuse treatment in 1 of 110 programs located at 73 Veterans Affairs facilities. The associations between each of three Washington Circle (WC) performance indicator scores (identification, initiation, and engagement) and their casemix-adjusted facility-level improvement in ASI drug and alcohol composites 7 months after intake were estimated. Higher initiation rates were not associated with facility-level improvement in ASI alcohol composite scores but were modestly associated with greater improvements in ASI drug composite scores. Identification and engagement rates were unrelated to 7-month outcomes. WC indicators focused on the early stages of treatment may tap necessary but insufficient processes for patients with substance use disorder to achieve good posttreatment outcomes. Ideally, the WC indicators would be supplemented with other measures of treatment quality.

Basic fibroblast growth factor predicts cardiovascular disease occurrence in participants from the Veterans Affairs Diabetes Trial

Directory of Open Access Journals (Sweden)

Mark B Zimering

2013-11-01

Full Text Available Aim: Cardiovascular disease is a leading cause of morbidity and mortality in adults with type 2 diabetes mellitus. The aim of the present study was to test whether plasma basic fibroblast growth factor (bFGF levels predict future cardiovascular disease (CVD occurrence in adults from the Veterans Affairs Diabetes Trial. Methods: Nearly four- hundred veterans, 40 years of age or older, having a mean baseline diabetes duration of 11.4 years were recruited from outpatient clinics at six geographically distributed sites in the Veterans Affairs Diabetes Trial (VADT. Within the VADT, they were randomly assigned to intensive or standard glycemic treatment, with follow-up as much as seven and one-half years. Cardiovascular disease occurrence was examined at baseline in the patient population and during randomized treatment. Plasma bFGF was determined with a sensitive, specific two-site enzyme-linked immunoassay at the baseline study visit in all 399 subjects. Results: One hundred-five first cardiovascular events occurred in these 399 subjects. The best fit model of risk factors associated with the time to first cardiovascular disease occurrence (in the study over a seven and one-half year period had as significant predictors: prior cardiovascular event, (hazard ratio [HR] 3.378; 95% confidence intervals [CI] 3.079- 3.807; P < .0001, baseline plasma bFGF (HR 1.008; 95% CI 1.002-1.014; P =.01, age, (HR 1.027; 95% CI 1.004-1.051; P =.019, baseline plasma triglycerides, (HR 1.001; 95% CI 1.000-1.002; P =.02 and diabetes duration-treatment interaction (P =.03. Intensive glucose-lowering was associated with significantly decreased hazard ratios for CVD occurrence (0.38-0.63 in patients with known diabetes duration of 0-10 years, and non-significantly increased hazard ratios for CVD occurrence (0.82-1.78 in patients with longer diabetes duration. Conclusion: High level ofplasma basic fibroblast growth factor is a predictive biomarker of future cardiovascular

Medical team training: applying crew resource management in the Veterans Health Administration.

Science.gov (United States)

Dunn, Edward J; Mills, Peter D; Neily, Julia; Crittenden, Michael D; Carmack, Amy L; Bagian, James P

2007-06-01

Communication failure, a leading source of adverse events in health care, was involved in approximately 75% of more than 7,000 root cause analysis reports to the Department of Veterans Affairs (VA) National Center for Patient Safety (NCPS). The VA NCPS Medical Team Training (MTT) program, which is based on aviation principles of crew resource management (CRM), is intended to improve outcomes of patient care by enhancing communication between health care professionals. Unique features of MTT include a full-day interactive learning session (facilitated entirely by clinical peers in a health care context), administration of pre-and postintervention safety attitudes questionnaires, and follow-up semistructured interviews with reports of program activities and lessons learned. Examples of projects in these facilities include intensive care unit (ICU) teams' patient-centered multidisciplinary rounds, surgical teams' preoperative briefings and debriefings, an entire operating room (OR) unit's adoption of "Rules of Conduct" for expected staff behavior, and an ICU team's use of the model for daily administrative briefings. An MTT program based on applied CRM principles was successfully developed and implemented in 43 VA medical centers from September 2003 to May 2007.

Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital.

Science.gov (United States)

Konger, Raymond L; Ndekwe, Paul; Jones, Genea; Schmidt, Ronald P; Trey, Marty; Baty, Eric J; Wilhite, Denise; Munshi, Imtiaz A; Sutter, Bradley M; Rao, Maddamsetti; Bashir, Chowdry M

2016-03-01

To implement an electronic laboratory utilization management system (laboratory expert system [LES]) to provide safe and effective reductions in unnecessary clinical laboratory testing. The LES is a set of frequency filter subroutines within the Veterans Affairs hospital and laboratory information system that was formulated by an interdisciplinary medical team. Since implementing the LES, total test volume has decreased by a mean of 11.18% per year compared with our pre-LES test volume. This change was not attributable to fluctuations in outpatient visits or inpatient days of care. Laboratory cost savings were estimated at $151,184 and $163,751 for 2012 and 2013, respectively. A significant portion of these cost savings was attributable to reductions in high-volume, large panel testing. No adverse effects on patient care were reported, and mean length of stay for patients remained unchanged. Electronic laboratory utilization systems can effectively reduce unnecessary laboratory testing without compromising patient care. Published by Oxford University Press on behalf of the American Society for Clinical Pathology, 2016. This work is written by US Government employees and is in the public domain in the US.

Perspectives of family and veterans on family programs to support reintegration of returning veterans with posttraumatic stress disorder.

Science.gov (United States)

Fischer, Ellen P; Sherman, Michelle D; McSweeney, Jean C; Pyne, Jeffrey M; Owen, Richard R; Dixon, Lisa B

2015-08-01

Combat deployment and reintegration are challenging for service members and their families. Although family involvement in mental health care is increasing in the U.S. Department of Veterans Affairs (VA) system, little is known about family members' preferences for services. This study elicited the perspectives of returning Afghanistan and Iraq war veterans with posttraumatic stress disorder and their families regarding family involvement in veterans' mental health care. Semistructured qualitative interviews were conducted with 47 veterans receiving care for posttraumatic stress disorder at the Central Arkansas Veterans Healthcare System or Oklahoma City VA Medical Center and 36 veteran-designated family members. Interviews addressed perceived needs related to veterans' readjustment to civilian life, interest in family involvement in joint veteran/family programs, and desired family program content. Interview data were analyzed using content analysis and constant comparison. Both groups strongly supported inclusion of family members in programs to facilitate veterans' postdeployment readjustment and reintegration into civilian life. Both desired program content focused on information, practical skills, support, and gaining perspective on the other's experience. Although family and veteran perspectives were similar, family members placed greater emphasis on parenting-related issues and the kinds of support they and their children needed during and after deployment. To our knowledge, this is the first published report on preferences regarding VA postdeployment reintegration support that incorporates the perspectives of returning male and female veterans and those of their families. Findings will help VA and community providers working with returning veterans tailor services to the needs and preferences of this important-to-engage population. (c) 2015 APA, all rights reserved).

75 FR 61860 - Advisory Committee on Women Veterans; Notice of Meeting

Science.gov (United States)

2010-10-06

... on mental health, prosthetic services for women Veterans, readjustment counseling, women Veterans' legislative issues, special health initiatives, women Veterans' research, rural health, and homeless... Veterans Affairs regarding the needs of women Veterans with respect to health care, rehabilitation...

76 FR 50540 - Pilot Program of Enhanced Contract Care Authority for Veterans in Highly Rural Areas

Science.gov (United States)

2011-08-15

... contracts in order to arrange for the provision of care through the pilot program. See Public Law 110- 387... DEPARTMENT OF VETERANS AFFAIRS Pilot Program of Enhanced Contract Care Authority for Veterans in... Veterans Affairs (VA) is implementing Sec. 403 of Public Law (Pub. L.) 110-387, ``Veterans' Mental Health...

76 FR 20823 - Agency Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...

Science.gov (United States)

2011-04-13

... AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: In... to VA's OMB Desk Officer, OMB Human Resources and Housing Branch, New Executive Office Building, Room... benefit claim within 30 days prior to the fielding period. The sample will be stratified as follows: (1...

77 FR 69551 - Advisory Committee on Women Veterans; Notice of Meeting

Science.gov (United States)

2012-11-19

... Administration; and briefings on health care for women Veterans, mental health, women Veterans' legislative... regarding the needs of women Veterans with respect to health care, rehabilitation, compensation, outreach... DEPARTMENT OF VETERANS AFFAIRS Advisory Committee on Women Veterans; Notice of Meeting The...

The value from investments in health information technology at the U.S. Department of Veterans Affairs.

Science.gov (United States)

Byrne, Colene M; Mercincavage, Lauren M; Pan, Eric C; Vincent, Adam G; Johnston, Douglas S; Middleton, Blackford

2010-04-01

We compare health information technology (IT) in the Department of Veterans Affairs (VA) to norms in the private sector, and we estimate the costs and benefits of selected VA health IT systems. The VA spent proportionately more on IT than the private health care sector spent, but it achieved higher levels of IT adoption and quality of care. The potential value of the VA's health IT investments is estimated at $3.09 billion in cumulative benefits net of investment costs. This study serves as a framework to inform efforts to measure and calculate the benefits of federal health IT stimulus programs.

Sexual self-esteem and psychosocial functioning in military veterans after cancer.

Science.gov (United States)

Syme, Maggie L; Delaney, Eileen; Wachen, Jennifer Schuster; Gosian, Jeffrey; Moye, Jennifer

2013-01-01

Little is known about the sexual well-being of male Veteran cancer survivors, or the relationship of sexual concerns to psychosocial adaptation postcancer. This study examined the association between sexual self-esteem and psychosocial concerns in male Veteran cancer survivors. Forty-one male survivors were recruited from a Veterans Affairs (VA) hospital to participate in a pilot study addressing cancer survivorship care for Veterans. Sixty- to 90-minute interviews were conducted, assessing sociodemographic, medical, stress/burden (cancer-related posttraumatic stress disorder [PTSD], depression), and resource (social support, post-traumatic growth) variables. Twenty-one (51.2%) Veteran cancer survivors reported lowered sexual self-esteem as a result of cancer, which corresponded to significantly higher levels of depression and cancer-related PTSD. The lowered sexual self-esteem group also indicated significantly lower social support. Veteran cancer survivors with lowered sexual self-esteem tend to have higher levels of stress and lower levels of resources, putting them at risk for lowered quality of life. This increased risk highlights the importance of addressing sexual well-being in the survivorship care of Veterans.

Does comorbid chronic pain affect posttraumatic stress disorder diagnosis and treatment? Outcomes of posttraumatic stress disorder screening in Department of Veterans Affairs primary care.

Science.gov (United States)

Outcalt, Samantha D; Hoen, Helena Maria; Yu, Zhangsheng; Franks, Tenesha Marie; Krebs, Erin E

2016-01-01

Because posttraumatic stress disorder (PTSD) is both prevalent and underrecognized, routine primary care-based screening for PTSD has been implemented across the Veterans Health Administration. PTSD is frequently complicated by the presence of comorbid chronic pain, and patients with both conditions have increased symptom severity and poorer prognosis. Our objective was to determine whether the presence of pain affects diagnosis and treatment of PTSD among Department of Veterans Affairs (VA) patients who have a positive PTSD screening test. This retrospective cohort study used clinical and administrative data from six Midwestern VA medical centers. We identified 4,244 VA primary care patients with a positive PTSD screen and compared outcomes for those with and without a coexisting pain diagnosis. Outcomes were three clinically appropriate responses to positive PTSD screening: (1) mental health visit, (2) PTSD diagnosis, and (3) new selective serotonin reuptake inhibitor (SSRI) prescription. We found that patients with coexisting pain had a lower rate of mental health visits than those without pain (hazard ratio: 0.889, 95% confidence interval: 0.821-0.962). There were no significant differences in the rate of PTSD diagnosis or new SSRI prescription between patients with and without coexisting pain.

Factors influencing readiness to deploy in disaster response: findings from a cross-sectional survey of the Department of Veterans Affairs Disaster Emergency Medical Personnel System.

Science.gov (United States)

Zagelbaum, Nicole K; Heslin, Kevin C; Stein, Judith A; Ruzek, Josef; Smith, Robert E; Nyugen, Tam; Dobalian, Aram

2014-07-19

The Disaster Emergency Medical Personnel System (DEMPS) program provides a system of volunteers whereby active or retired Department of Veterans Affairs (VA) personnel can register to be deployed to support other VA facilities or the nation during national emergencies or disasters. Both early and ongoing volunteer training is required to participate. This study aims to identify factors that impact willingness to deploy in the event of an emergency. This analysis was based on responses from 2,385 survey respondents (response rate, 29%). Latent variable path models were developed and tested using the EQS structural equations modeling program. Background demographic variables of education, age, minority ethnicity, and female gender were used as predictors of intervening latent variables of DEMPS Volunteer Experience, Positive Attitude about Training, and Stress. The model had acceptable fit statistics, and all three intermediate latent variables significantly predicted the outcome latent variable Readiness to Deploy. DEMPS Volunteer Experience and a Positive Attitude about Training were associated with Readiness to Deploy. Stress was associated with decreased Readiness to Deploy. Female gender was negatively correlated with Readiness to Deploy; however, there was an indirect relationship between female gender and Readiness to Deploy through Positive Attitude about Training. These findings suggest that volunteer emergency management response programs such as DEMPS should consider how best to address the factors that may make women less ready to deploy than men in order to ensure adequate gender representation among emergency responders. The findings underscore the importance of training opportunities to ensure that gender-sensitive support is a strong component of emergency response, and may apply to other emergency response programs such as the Medical Reserve Corps and the American Red Cross.

Evaluation of Cholesterol as a Biomarker for Suicidality in a Veteran Sample.

Science.gov (United States)

Reuter, Chuck; Caldwell, Barbara; Basehore, Heather

2017-08-01

A reduction in total cholesterol may alter the microviscosity of the brain-cell-membrane, reducing serotonin receptor exposure. The resulting imbalance between serotonin and dopamine may lead to an increased risk for suicidality. The objective of this research was to evaluate total cholesterol as a biological marker for suicidality in a sample of US military veterans. The study population consisted of veterans who received care at the Coatesville Veterans Affairs Medical Center (VAMC) and were included in the Suicide Prevention Coordinator's database for having suicidal ideation with evidence of escalating intent, a documented suicide attempt, or committed suicide between 2009 and 2015. The veterans' medical data were obtained from the facility's computerized patient record system. The final sample was 188 observations from 128 unique veterans. Veterans with total cholesterol levels below 168 mg/dl appeared to have a higher suicide risk than those with higher levels. The cholesterol levels of veterans reporting suicidal ideation or attempt were significantly lower than the group reporting neither [F(2, 185) = 30.19, p cholesterol levels from an earlier visit in which they did not report suicidality. A latent class analysis revealed that among other differences, suicidal veterans were younger, leaner, and had more anxiety, sleep problems, and higher education than those being seen for an issue unrelated to suicidality. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Can the Theory of Planned Behavior predict dietary intention and future dieting in an ethnically diverse sample of overweight and obese veterans attending medical clinics?

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Lash, Denise N; Smith, Jane Ellen; Rinehart, Jenny K

2016-04-01

Obesity has become a world-wide epidemic; in the United States (U.S.) approximately two-thirds of adults are classified as overweight or obese. Military veterans' numbers are even higher, with 77% of retired or discharged U.S. veterans falling in these weight categories. One of the most common methods of changing one's weight is through dieting, yet little is known regarding the factors that facilitate successful dieting behavior. The current investigation tested the Theory of Planned Behavior's (TPB) ability to predict dietary intention and future dieting in a sample of 84 overweight and obese patients attending medical clinics at a Veterans Affairs Hospital in the southwestern part of the U.S. Participants primarily were male (92%) and ethnic/racial minorities (58%). Perceived need and anticipated regret were added to the standard TPB model. While the TPB predicted dietary intention, it did not significantly account for improved dietary behaviors. Anticipated regret significantly enhanced the basic TPB's ability to predict intention to diet, while perceived need did not. These findings highlight the difficulty in predicting sustained change in a complex behavior such as dieting to lose weight. The need for more work with older, overweight/obese medical patients attending veterans' facilities is stressed, as is the need for such work with male patients and ethnic minorities in particular. Copyright © 2016 Elsevier Ltd. All rights reserved.

Veterans Choice Program

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Department of Veterans Affairs — If you are already enrolled in VA health care, the Choice Program allows you to receive health care within your community. Using this program does NOT impact your...

America's Women Veterans: Military Service History and VA Benefit Utilization Statistics

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Department of Veterans Affairs — This comprehensive report chronicles the history of women in the military and as Veterans, profiles the characteristics of women Veterans in 2009, illustrates how...

Optimizing strategies to improve interprofessional practice for veterans, part 1

Directory of Open Access Journals (Sweden)

Bhattacharya SB

2014-04-01

Full Text Available Shelley B Bhattacharya,1–3 Michelle I Rossi,1,2 Jennifer M Mentz11Geriatric Research Education and Clinical Center (GRECC, Veteran's Affairs Pittsburgh Healthcare System, 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 3Albert Schweitzer Fellowship Program, Pittsburgh, PA, USAIntroduction: Interprofessional patient care is a well-recognized path that health care systems are striving toward. The Veteran's Affairs (VA system initiated interprofessional practice (IPP models with their Geriatric Evaluation and Management (GEM programs. GEM programs incorporate a range of specialties, including but not limited to, medicine, nursing, social work, physical therapy and pharmacy, to collaboratively evaluate veterans. Despite being a valuable resource, they are now faced with significant cut-backs, including closures. The primary goal of this project was to assess how the GEM model could be optimized at the Pittsburgh, Pennsylvania VA to allow for the sustainability of this important IPP assessment. Part 1 of the study evaluated the IPP process using program, patient, and family surveys. Part 2 examined how well the geriatrician matched patients to specialists in the GEM model. This paper describes Part 1 of our study.Methods: Three strategies were used: 1 a national GEM program survey; 2 a veteran/family satisfaction survey; and 3 an absentee assessment.Results: Twenty-six of 92 programs responded to the GEM IPP survey. Six strategies were shared to optimize IPP models throughout the country. Of the 34 satisfaction surveys, 80% stated the GEM clinic was beneficial, 79% stated their concerns were addressed, and 100% would recommend GEM to their friends. Of the 24 absentee assessments, the top three reasons for missing the appointments were transportation, medical illnesses, and not knowing/remembering about the appointment. Absentee rate diminished from 41% to 19% after instituting a reminder phone call policy.Discussion: Maintaining the

Associations Between the Department of Veterans Affairs' Suicide Prevention Campaign and Calls to Related Crisis Lines

Science.gov (United States)

Bossarte, Robert M.; Lu, Naiji; Tu, Xin; Stephens, Brady; Draper, John; Kemp, Janet E.

2014-01-01

Objective The Transit Authority Suicide Prevention (TASP) campaign was launched by the Department of Veterans Affairs (VA) in a limited number of U.S. cities to promote the use of crisis lines among veterans of military service. Methods We obtained the daily number of calls to the VCL and National Suicide Prevention Lifeline (NSPL) for six implementation cities (where the campaign was active) and four control cities (where there was no TASP campaign messaging) for a 14-month period. To identify changes in call volume associated with campaign implementation, VCL and NSPL daily call counts for three time periods of equal length (pre-campaign, during campaign, and post-campaign) were modeled using a Poisson log-linear regression with inference based on the generalized estimating equations. Results Statistically significant increases in calls to both the VCL and the NSPL were reported during the TASP campaign in implementation cities, but were not reported in control cities during or following the campaign. Secondary outcome measures were also reported for the VCL and included the percentage of callers who are veterans, and calls resulting in a rescue during the study period. Conclusions Results from this study reveal some promise for suicide prevention messaging to promote the use of telephone crisis services and contribute to an emerging area of research examining the effects of campaigns on help seeking. PMID:25364053

Health Status of Gulf War and Era Veterans Serving in the US Military in 2000.

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Porter, Ben; Long, Kyna; Rull, Rudolph P; Dursa, Erin K

2018-05-01

This research describes Gulf War and era veterans enrolled in the Millennium Cohort Study, who were sampled from US military personnel serving in 2000, and compares health characteristics of this sample to a Department of Veterans Affairs study sampled from the complete population. Demographics characteristics of this sample were described. Self-reported health characteristics were compared between the two studies. Gulf War and era veterans in the Millennium Cohort were generally healthier than in the VA study; they had fewer medical conditions and mental health disorders and better self-reported health. In both studies, Gulf War veterans had poorer health outcomes than era veterans. The Millennium Cohort Study is a unique resource for examining the long-term health effects of Gulf War deployment, particularly comparing deployed and nondeployed personnel and examining illnesses with long latencies.

77 FR 65056 - Advisory Committee on Minority Veterans, Notice of Meeting

Science.gov (United States)

2012-10-24

..., Office of Health Equity, and a special panel discussion with Center for Women Veterans, Center for Faith... (VBA), Center for Minority Veterans, Office of Public and Intergovernmental Affairs, Veterans Health...

Use of Psychotherapy by Rural and Urban Veterans

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Cully, Jeffrey A.; Jameson, John P.; Phillips, Laura L.; Kunik, Mark E.; Fortney, John C.

2010-01-01

Purpose: To examine whether differences exist between rural and urban veterans in terms of initiation of psychotherapy, delay in time from diagnosis to treatment, and dose of psychotherapy sessions. Methods: Using a longitudinal cohort of veterans obtained from national Veterans Affairs databases (October 2003 through September 2004), we extracted…

Veterans Health Administration

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... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

Veterans affairs disability compensation: a case study in countertherapeutic jurisprudence.

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Mossman, D

1996-01-01

This article examines the disability compensation programs and health care system of the Department of Veterans Affairs (VA) from the perspective of therapeutic jurisprudence scholarship. VA psychiatric patients have unambiguous financial incentives to endlessly litigate disability claims, to seek lengthy hospitalization rather than outpatient treatment, and to be ill, disabled, and unemployed. These countertherapeutic incentives reward incapacitation, encourage perceiving one-self as sick, diminish personal responsibility, taint treatment relationships, and lead to disparaging perceptions of VA patients. In addition, such perceptions produce moral dilemmas that arise from mutual distrust and frustration when patients and caregivers have antagonistic goals for the clinical encounter. Changes in disability determination procedures, compensation levels, and patterns of payment for treatment could give VA patients and caregivers a "healthier" health care system that encourages personal responsibility and promotes respectful attitudes toward patients. In the absence of such changes, an awareness of countertherapeutic financial incentives can help clinicians distinguish between psychopathological behavior and the pursuit of a rational income strategy, and can help practitioners recognize that apparently deceitful or litigious behavior represents a reasonable response to the economic contingencies that VA patients face.

National Survey of Veterans, Active Duty Service Members, Demobilized National Guard and Reserve Members, Family Members, and Surviving Spouses

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Department of Veterans Affairs — The 2010 National Survey of Veterans (NSV) is the sixth in a series of comprehensive nationwide surveys designed to help the Department of Veterans Affairs (VA) plan...

Positive correlation of employment and psychological well-being for veterans with major abdominal surgery.

Science.gov (United States)

Horner, David J; Wendel, Christopher S; Skeps, Raymond; Rawl, Susan M; Grant, Marcia; Schmidt, C Max; Ko, Clifford Y; Krouse, Robert S

2010-11-01

Intestinal stomas (ostomies) have been associated negatively with multiple aspects of health-related quality of life. This article examines the relationship between employment status and psychological well-being (PWB) in veterans who underwent major bowel procedures with or without ostomy. Veterans from 3 Veterans Affairs (VA) medical centers were surveyed using the City of Hope ostomy-specific questionnaire and the Short Form 36 item Veteran's version (SF-36V). Response rate was 48% (511 of 1,063). Employment and PWB relationship was assessed using multiple regression with age, income, SF-36V physical component summary (PCS), and employment status as independent variables. Employed veterans reported higher PWB compared with unemployed veterans (P = .003). Full-time workers also reported higher PWB than part-time or unemployed workers (P = .001). Ostomy was not an independent predictor of PWB. Employment among veterans after major abdominal surgery may have intrinsic value for PWB. Patients should be encouraged to return to work, or do volunteer work after recovery. Published by Elsevier Inc.

77 FR 18307 - Gulf War Veterans' Illnesses Task Force Report

Science.gov (United States)

2012-03-27

... DEPARTMENT OF VETERANS AFFAIRS Gulf War Veterans' Illnesses Task Force Report AGENCY: Department...) established the Gulf War Veterans' Illnesses Task Force (GWVI-TF) in August 2009 to conduct a comprehensive review of VA policies and programs addressing 1990-1991 Gulf War Veterans' illnesses. The GWVI-TF...

Foot care education and self management behaviors in diverse veterans with diabetes

Directory of Open Access Journals (Sweden)

Jonathan M Olson

2009-01-01

Full Text Available Jonathan M Olson1, Molly T Hogan2, Leonard M Pogach3, Mangala Rajan3, Gregory J Raugi4, Gayle E Reiber51University of Washington School of Medicine, Seattle, WA, USA; 2Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA; 3Department of Veterans Affairs, New Jersey Healthcare System, Center for Healthcare Knowledge Management, East Orange, NJ, USA; 4Division of Dermatology, VA Puget Sound Healthcare System, Department of Veterans Affairs, Seattle, WA, USA; 5Research and Development, VA Puget Sound Healthcare System, Department of Veterans Affairs, Seattle, WA, USAAbstract: The objective of this study was to examine differences in self-reported diabetes foot care education, self management behaviors, and barriers to good foot care among veterans with diabetes by race and ethnicity. Data was collected using the Veterans Health Administration Footcare Survey, a validated tool that assessed demographic, general health, diabetes and foot self-care information, barriers to foot self-care, receipt of professional foot care, and satisfaction with current care. We mailed surveys to a random sample of patients with diabetes from eight VA medical centers. Study participants were 81% White; 13% African American; 4% Asian, and 2% American Indian and Pacific Islanders. The majority of respondents felt that they did not know enough about foot self-care. There were large gaps between self-reported knowledge and actual foot care practices, even among those who reported “knowing enough” on a given topic. There were significant differences in self-reported foot care behaviors and education by race and ethnicity. These findings document the need for culturally-specific self-management education to address unique cultural preferences and barriers to care.Keywords: diabetes mellitus, diabetic foot, patient self-management, ethnic groups, education

A national clinical quality program for Veterans Affairs catheterization laboratories (from the Veterans Affairs clinical assessment, reporting, and tracking program).

Science.gov (United States)

Maddox, Thomas M; Plomondon, Mary E; Petrich, Megan; Tsai, Thomas T; Gethoffer, Hans; Noonan, Gregory; Gillespie, Brian; Box, Tamara; Fihn, Stephen D; Jesse, Robert L; Rumsfeld, John S

2014-12-01

A "learning health care system", as outlined in a recent Institute of Medicine report, harnesses real-time clinical data to continuously measure and improve clinical care. However, most current efforts to understand and improve the quality of care rely on retrospective chart abstractions complied long after the provision of clinical care. To align more closely with the goals of a learning health care system, we present the novel design and initial results of the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program-a national clinical quality program for VA cardiac catheterization laboratories that harnesses real-time clinical data to support clinical care and quality-monitoring efforts. Integrated within the VA electronic health record, the CART program uses a specialized software platform to collect real-time patient and procedural data for all VA patients undergoing coronary procedures in VA catheterization laboratories. The program began in 2005 and currently contains data on 434,967 catheterization laboratory procedures, including 272,097 coronary angiograms and 86,481 percutaneous coronary interventions, performed by 801 clinicians on 246,967 patients. We present the initial data from the CART program and describe 3 quality-monitoring programs that use its unique characteristics-procedural and complications feedback to individual labs, coronary device surveillance, and major adverse event peer review. The VA CART program is a novel approach to electronic health record design that supports clinical care, quality, and safety in VA catheterization laboratories. Its approach holds promise in achieving the goals of a learning health care system. Published by Elsevier Inc.

78 FR 48789 - Veterans' Advisory Committee on Education, Notice of Meeting

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2013-08-09

... DEPARTMENT OF VETERANS AFFAIRS Veterans' Advisory Committee on Education, Notice of Meeting The..., that the Veterans' Advisory Committee on Education will meet on August 13-14, 2013, in the First Floor... on the administration of education and training programs for Veterans, Servicepersons, Reservists...

77 FR 7244 - Advisory Committee on Women Veterans, Notice of Meeting

Science.gov (United States)

2012-02-10

..., and the Women Veterans Health Strategic Health Care Group; and briefings on mental health, women... regarding the needs of women Veterans with respect to health care, rehabilitation, compensation, outreach... DEPARTMENT OF VETERANS AFFAIRS Advisory Committee on Women Veterans, Notice of Meeting The...

Veterans Affairs general surgery service: the last bastion of integrated specialty care.

Science.gov (United States)

Poteet, Stephen; Tarpley, Margaret; Tarpley, John L; Pearson, A Scott

2011-11-01

In a time of increasing specialization, academic training institutions provide a compartmentalized learning environment that often does not reflect the broad clinical experience of general surgery practice. This study aimed to evaluate the contribution of the Veterans Affairs (VA) general surgery surgical experience to both index Accreditation Council for Graduate Medical Education (ACGME) requirements and as a unique integrated model in which residents provide concurrent care of multiple specialty patients. Institutional review board approval was obtained for retrospective analysis of electronic medical records involving all surgical cases performed by the general surgery service from 2005 to 2009 at the Nashville VA. Over a 5-year span general surgery residents spent an average of 5 months on the VA general surgery service, which includes a postgraduate year (PGY)-5, PGY-3, and 2 PGY-1 residents. Surgeries involved the following specialties: surgical oncology, endocrine, colorectal, hepatobiliary, transplant, gastrointestinal laparoscopy, and elective and emergency general surgery. The surgeries were categorized according to ACGME index requirements. A total of 2,956 surgeries were performed during the 5-year period from 2005 through 2009. Residents participated in an average of 246 surgeries during their experience at the VA; approximately 50 cases are completed during the chief year. On the VA surgery service alone, 100% of the ACGME requirement was met for the following categories: endocrine (8 cases); skin, soft tissue, and breast (33 cases); alimentary tract (78 cases); and abdominal (88 cases). Approximately 50% of the ACGME requirement was met for liver, pancreas, and basic laparoscopic categories. The VA hospital provides an authentic, broad-based, general surgery training experience that integrates complex surgical patients simultaneously. Opportunities for this level of comprehensive care are decreasing or absent in many general surgery training

AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for Department of Veterans Affairs – VA Manhattan Campus

Energy Technology Data Exchange (ETDEWEB)

Stephen Schey; Jim Francfort

2014-10-01

This report focuses on the Department of Veterans Affairs, VA Manhattan Campus (VA- Manhattan) fleet to identify the daily operational characteristics of select vehicles and report findings on vehicle and mission characterizations to support successful introduction of plug-in electric vehicles (PEVs) into the agency’s fleet. Individual observations of these selected vehicles provide the basis for recommendations related to electric vehicle adoption and whether a battery electric vehicle or plug-in hybrid electric vehicle (collectively called PEVs) can fulfill the mission requirements.

VeteranOtherInformationService

Data.gov (United States)

Department of Veterans Affairs — This service is used to create, read, delete and update additional information captured during the EVSS Disability Compensation interview in an effort to align with...

Systematic review of women veterans' mental health.

Science.gov (United States)

Runnals, Jennifer J; Garovoy, Natara; McCutcheon, Susan J; Robbins, Allison T; Mann-Wrobel, Monica C; Elliott, Alyssa

2014-01-01

Given recent, rapid growth in the field of women veterans' mental health, the goal of this review was to update the status of women veterans' mental health research and to identify current themes in this literature. The scope of this review included women veterans' unique mental health needs, as well as gender differences in veterans' mental health needs. Database searches were conducted for relevant articles published between January 2008 and July 2011. Searches were supplemented with bibliographic reviews and consultation with subject matter experts. The database search yielded 375 titles; 32 met inclusion/exclusion criteria. The women veterans' mental health literature crosses over several domains, including prevalence, risk factors, health care utilization, treatment preferences, and access barriers. Studies were generally cross-sectional, descriptive, mixed-gender, and examined Department of Veterans Affairs (VA) health care users from all service eras. Results indicate higher rates of specific disorders (e.g., depression) and comorbidities, with differing risk factors and associated medical and functional impairment for female compared with male veterans. Although satisfaction with VA health care is generally high, unique barriers to care and indices of treatment satisfaction exist for women. There is a breadth of descriptive knowledge in many content areas of women veterans' mental health; however, the research base examining interventional and longitudinal designs is less developed. Understudied content areas and targets for future research and development include certain psychiatric disorders (e.g., schizophrenia), the effects of deployment on woman veterans' families, and strategies to address treatment access, attrition, and provision of gender-sensitive care. Published by Elsevier Inc.

Examining Burnout, Depression, and Self-Compassion in Veterans Affairs Mental Health Staff.

Science.gov (United States)

Atkinson, David M; Rodman, John L; Thuras, Paul D; Shiroma, Paulo R; Lim, Kelvin O

2017-07-01

Burnout, a state of emotional exhaustion associated with negative personal and occupational outcomes, is prevalent among healthcare providers. A better understanding of the psychological factors that may be associated with resilience to burnout is essential to develop effective interventions. Self-compassion, which includes kindness toward oneself, recognition of suffering as part of shared human experience, mindfulness, and nonjudgment toward inadequacies and failures, may be one such factor. The purpose of this study was to examine the relationships between burnout, depression, and self-compassion in Veterans Affairs (VA) mental health staff. Cross-sectional study. VA medical center and affiliated community-based clinics. VA mental health staff. The 19-item Copenhagen Burnout Inventory, the 26-item Self-Compassion Scale, and the Patient Health Questionnaire 2-item depression screen. Demographic information included age, sex, years worked in current position, and number of staff supervised. One hundred and twenty-eight of a potential 379 individuals (33.8%) responded. Clerical support, nursing, social work, psychology, and psychiatry were the major professions represented. Self-compassion was inversely correlated with burnout (r = -0.41, p burnout remained significant even after accounting for depressive symptoms and demographic variables in a multiple linear regression model. Of all the variables examined, self-compassion was the strongest predictor of burnout. The results of this study support the hypothesis that self-compassion may be associated with resilience to burnout. Alternatively, decreased self-compassion may be a downstream effect of increased burnout. Prospective, longitudinal studies are needed to determine the directional relationship between these factors, and whether interventions that cultivate self-compassion may decrease burnout and/or protect against its negative personal and professional outcomes.

Veterans Health Administration (VHA)

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Social Security Administration — The purpose of this agreement is for SSA to verify SSNs and other identifying information for the Department of Veterans Affairs, VHA. DVA will use the information...

SCI Hospital in Home Program: Bringing Hospital Care Home for Veterans With Spinal Cord Injury.

Science.gov (United States)

Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson

2016-01-01

The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction.

Role of HIS/RIS DICOM interfaces in the integration of imaging into the Department of Veterans Affairs healthcare enterprise

Science.gov (United States)

Kuzmak, Peter M.; Dayhoff, Ruth E.

1998-07-01

The U.S. Department of Veterans Affairs is integrating imaging into the healthcare enterprise using the Digital Imaging and Communication in Medicine (DICOM) standard protocols. Image management is directly integrated into the VistA Hospital Information System (HIS) software and clinical database. Radiology images are acquired via DICOM, and are stored directly in the HIS database. Images can be displayed on low- cost clinician's workstations throughout the medical center. High-resolution diagnostic quality multi-monitor VistA workstations with specialized viewing software can be used for reading radiology images. DICOM has played critical roles in the ability to integrate imaging functionality into the Healthcare Enterprise. Because of its openness, it allows the integration of system components from commercial and non- commercial sources to work together to provide functional cost-effective solutions (see Figure 1). Two approaches are used to acquire and handle images within the radiology department. At some VA Medical Centers, DICOM is used to interface a commercial Picture Archiving and Communications System (PACS) to the VistA HIS. At other medical centers, DICOM is used to interface the image producing modalities directly to the image acquisition and display capabilities of VistA itself. Both of these approaches use a small set of DICOM services that has been implemented by VistA to allow patient and study text data to be transmitted to image producing modalities and the commercial PACS, and to enable images and study data to be transferred back.

78 FR 14288 - Privacy Act of 1974; System of Records

Science.gov (United States)

2013-03-05

... OMB Circular No. A-130, ``Federal Agency Responsibilities for Maintaining Records About Individuals... evaluation board findings; medical reports from Department of Veterans Affairs and civilian medical..., civilian, and Department of Veteran's Affairs); Department of Veterans Affairs Rating Boards; Department of...

38 CFR 17.142 - Authority to approve sharing agreements, contracts for scarce medical specialist services and...

Science.gov (United States)

2010-07-01

... sharing agreements, contracts for scarce medical specialist services and contracts for other medical... medical specialist services and contracts for other medical services. The Under Secretary for Health is... specialist services at Department of Veterans Affairs health care facilities (including, but not limited to...

Do Veterans With Posttraumatic Stress Disorder Receive First-Line Pharmacotherapy? Results From the Longitudinal Veterans Health Survey

Science.gov (United States)

Greenbaum, Mark A.; Rosen, Craig S.

2012-01-01

Objective: Guidelines addressing the treatment of veterans with posttraumatic stress disorder (PTSD) strongly recommend a therapeutic trial of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). This study examined veteran characteristics associated with receiving such first-line pharmacotherapy, as well as how being a veteran of the recent conflicts in Afghanistan and Iraq impact receipt of pharmacotherapy for PTSD. Method: This was a national study of 482 Veterans Affairs (VA) outpatients between the ages of 18 and 69 years who had been newly diagnosed with PTSD (DSM-IV criteria: 309.81) during a VA outpatient visit between May 31, 2006, and December 7, 2007. Participants completed a mailed survey between August 11, 2006, and April 6, 2008. Veterans from the Afghanistan and Iraq conflicts and female veterans were intentionally oversampled. Logistic regression models were developed to predict 2 dependent variables: odds of initiating an SSRI/SNRI and, among veterans who initiated an SSRI/SNRI, odds of receiving an adequate therapeutic trial. Each dependent variable was regressed on a variety of sociodemographic and survey characteristics. Results: Of the 377 veterans prescribed a psychotropic medication, 73% (n = 276) received an SSRI/SNRI, of whom 61% (n = 168) received a therapeutic trial. Afghanistan and Iraq veterans were less likely to receive a therapeutic trial (odds ratio [OR] = 0.45; 95% CI, 0.27–0.75; P < .01), with presence of a comorbid depression diagnosis in the year after the index episode moderating this relationship, which further decreased the odds of completing a therapeutic trial (OR = 0.29; 95% CI, 0.09–0.95; P < .05). Conclusions: Reduced levels of receipt of first-line pharmacotherapy among recent veteran returnees parallel previous findings of less mental health treatment utilization in this population and warrant investigation. PMID:22943028

Evaluating the Use of Medicare Part D in the Veteran Population With Spinal Cord Injury/Disorder.

Science.gov (United States)

Hatch, Maya N; Raad, Jason; Suda, Katie; Stroupe, Kevin T; Hon, Alice J; Smith, Bridget M

2018-02-06

To examine the different sources of medications, the most common drug classes filled, and the characteristics associated with Medicare Part D pharmacy use in veterans with spinal cord injury/disorder (SCI/D). Retrospective, cross-sectional, observational study. Outpatient clinics and pharmacies. Veterans (N=13,442) with SCI/D using Medicare or Veteran Affairs pharmacy benefits. Not applicable. Characteristics and top 10 most common drug classes were examined in veterans who (1) used VA pharmacies only; (2) used both VA and Medicare Part D pharmacies; or (3) used Part D pharmacies only. Chi-square tests and multinomial logistic regression analyses were used to determine associations between various patient variables and source of medications. Patient level frequencies were used to determine the most common drug classes. A total of 13,442 veterans with SCI/D were analyzed in this study: 11,788 (87.7%) used VA pharmacies only, 1281 (9.5%) used both VA and Part D pharmacies, and 373 (2.8%) used Part D pharmacies only. Veterans older than 50 years were more likely to use Part D pharmacies, whereas those with traumatic injury, or secondary conditions, were less associated with the use of Part D pharmacies. Opioids were the most frequently filled drug class across all groups. Other frequently used drug classes included skeletal muscle relaxants, gastric medications, antidepressants (other category), anticonvulsants, and antilipemics. Approximately 12% of veterans with SCI/D are receiving medication outside the VA system. Polypharmacy in this population of veterans is relatively high, emphasizing the importance of health information exchange between systems for improved care for this medically complex population. Published by Elsevier Inc.

Medical Student Psychiatry Examination Performance at VA and Non-VA Clerkship Sites

Science.gov (United States)

Tucker, Phebe; von Schlageter, Margo Shultes; Park, EunMi; Rosenberg, Emily; Benjamin, Ashley B.; Nawar, Ola

2009-01-01

Objective: The authors examined the effects of medical student assignment to U.S. Department of Veterans Affairs (VA) Medical Center inpatient and outpatient psychiatry clerkship sites versus other university and community sites on the performance outcome measure of National Board of Medical Examiners (NBME) subject examination scores. Methods:…

Patient perspectives on an opioid overdose education and naloxone distribution program in the U.S. Department of Veterans Affairs.

Science.gov (United States)

Oliva, Elizabeth M; Nevedal, Andrea; Lewis, Eleanor T; McCaa, Matthew D; Cochran, Michael F; Konicki, P Eric; Davis, Corey S; Wilder, Christine

2016-01-01

In an effort to prevent opioid overdose mortality among Veterans, Department of Veterans Affairs (VA) facilities began implementing opioid overdose education and naloxone distribution (OEND) in 2013 and a national program began in 2014. VA is the first national health care system to implement OEND. The goal of this study is to examine patient perceptions of OEND training and naloxone kits. Four focus groups were conducted between December 2014 and February 2015 with 21 patients trained in OEND. Participants were recruited from a VA residential facility in California with a substance use disorder treatment program (mandatory OEND training) and a homeless program (optional OEND training). Data were analyzed using matrices and open and closed coding approaches to identify participants' perspectives on OEND training including benefits, concerns, differing opinions, and suggestions for improvement. Veterans thought OEND training was interesting, novel, and empowering, and that naloxone kits will save lives. Some veterans expressed concern about using syringes in the kits. A few patients who never used opioids were not interested in receiving kits. Veterans had differing opinions about legal and liability issues, whether naloxone kits might contribute to relapse, and whether and how to involve family in training. Some veterans expressed uncertainty about the effects of naloxone. Suggested improvements included active learning approaches, enhanced training materials, and increased advertisement. OEND training was generally well received among study participants, including those with no indication for a naloxone kit. Patients described a need for OEND and believed it could save lives. Patient feedback on OEND training benefits, concerns, opinions, and suggestions provides important insights to inform future OEND training programs both within VA and in other health care settings. Training is critical to maximizing the potential for OEND to save lives, and this study

Health Programs for Veterans

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... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

38 CFR 3.453 - Veterans compensation or service pension or retirement pay.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Veterans compensation or service pension or retirement pay. 3.453 Section 3.453 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Pension, Compensation, and Dependency and Indemnity Compensation...

38 CFR 17.35 - Hospital care and medical services in foreign countries.

Science.gov (United States)

2010-07-01

... VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries § 17.35 Hospital care and medical services in foreign countries. The Secretary may furnish hospital care and... associated with and held to be aggravating a service-connected disability; (b) If the care is furnished to a...

76 FR 30244 - Veterans' Rural Health Advisory Committee; Notice of Meeting

Science.gov (United States)

2011-05-24

... on health care issues affecting enrolled Veterans residing in rural areas. The Committee examines... Rural Health Strategic Plan discussion and work session and the other is the Committee's annual report... DEPARTMENT OF VETERANS AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The...

Veteran Affairs Centers of Excellence in Primary Care Education: transforming nurse practitioner education.

Science.gov (United States)

Rugen, Kathryn Wirtz; Watts, Sharon A; Janson, Susan L; Angelo, Laura A; Nash, Melanie; Zapatka, Susan A; Brienza, Rebecca; Gilman, Stuart C; Bowen, Judith L; Saxe, JoAnne M

2014-01-01

To integrate health care professional learners into patient-centered primary care delivery models, the Department of Veterans Affairs has funded five Centers of Excellence in Primary Care Education (CoEPCEs). The main goal of the CoEPCEs is to develop and test innovative structural and curricular models that foster transformation of health care training from profession-specific "silos" to interprofessional, team-based educational and care delivery models in patient-centered primary care settings. CoEPCE implementation emphasizes four core curricular domains: shared decision making, sustained relationships, interprofessional collaboration, and performance improvement. The structural models allow interprofessional learners to have longitudinal learning experiences and sustained and continuous relationships with patients, faculty mentors, and peer learners. This article presents an overview of the innovative curricular models developed at each site, focusing on nurse practitioner (NP) education. Insights on transforming NP education in the practice setting and its impact on traditional NP educational models are offered. Preliminary outcomes and sustainment examples are also provided. Published by Mosby, Inc.

Epidemiology and burden of influenza in the U.S. Department of Veterans Affairs.

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Lucero-Obusan, Cynthia; Schirmer, Patricia L; Wendelboe, Aaron; Oda, Gina; Holodniy, Mark

2018-03-01

We describe influenza activity in the US Veterans Affairs (VA) population for the 2010-2011 through 2015-2016 seasons and compare with national CDC FluView data. VA confirmed influenza cases ranged from 1005 to 11 506 per season; triage calls from 6090 to 10 346; outpatient visits from 3849 to 13 406; antiviral prescriptions from 3650 to 32 826; hospitalizations from 546 to 4673; and deaths in hospitalized patients from 17 to 139. Peak activity was generally the same as observed nationally by the CDC. For the seasons analyzed, correlation between VA and CDC %ILI visits (r = .863), influenza hospitalizations (r = .953), positive tests (r = .948), and percent of tests positive (r = .938) was strong. Understanding influenza burden is important for evaluating prevention priorities and resource allocation within VA. © 2017 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Substance use disorders in military veterans: prevalence and treatment challenges

Directory of Open Access Journals (Sweden)

Teeters JB

2017-08-01

Full Text Available Jenni B Teeters,1,2 Cynthia L Lancaster,1,2 Delisa G Brown,3 Sudie E Back1,2 1Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; 2Ralph H Johnson Veterans Affairs (VA Medical Center, Charleston, SC, USA, 3Department of Human Development and Psychoeducation, Howard University, Washington, DC, USA Abstract: Substance use disorders (SUDs are a significant problem among our nation’s military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening and evidence-based treatment, as well as relevant treatment challenges. Among psychotherapeutic approaches, behavioral interventions for the management of SUDs typically involve short-term, cognitive-behavioral therapy interventions. These interventions focus on the identification and modification of maladaptive thoughts and behaviors associated with increased craving, use, or relapse to substances. Additionally, client-centered motivational interviewing approaches focus on increasing motivation to engage in treatment and reduce substance use. A variety of pharmacotherapies have received some support in the management of SUDs, primarily to help with the reduction of craving or withdrawal symptoms. Currently approved medications as well as treatment challenges are discussed. Keywords: addiction, alcohol use disorders, drug use disorders, treatment, pharmacotherapy, psychotherapy

Interprofessional transformation of clinical education: The first six years of the Veterans Affairs Centers of Excellence in Primary Care Education.

Science.gov (United States)

Harada, Nancy D; Traylor, Laural; Rugen, Kathryn Wirtz; Bowen, Judith L; Smith, C Scott; Felker, Bradford; Ludke, Deborah; Tonnu-Mihara, Ivy; Ruberg, Joshua L; Adler, Jayson; Uhl, Kimberly; Gardner, Annette L; Gilman, Stuart C

2018-02-20

This paper describes the Centers of Excellence in Primary Care Education (CoEPCE), a seven-site collaborative project funded by the Office of Academic Affiliations (OAA) within the Veterans Health Administration of the United States Department of Veterans Affairs (VA). The CoEPCE was established to fulfill OAA's vision of large-scale transformation of the clinical learning environment within VA primary care settings. This was accomplished by funding new Centers within VA facilities to develop models of interprofessional education (IPE) to teach health professions trainees to deliver high quality interprofessional team-based primary care to Veterans. Using reports and data collected and maintained by the National Coordinating Center over the first six years of the project, we describe program inputs, the multicomponent intervention, activities undertaken to develop the intervention, and short-term outcomes. The findings have implications for lessons learned that can be considered by others seeking large-scale transformation of education within the clinical workplace and the development of interprofessional clinical learning environments. Within the VA, the CoEPCE has laid the foundation for IPE and collaborative practice, but much work remains to disseminate this work throughout the national VA system.

Mental health and substance use disorder spending in the Department of Veterans Affairs, fiscal years 2000-2007.

Science.gov (United States)

Wagner, Todd H; Sinnott, Patricia; Siroka, Andrew M

2011-04-01

This study analyzed spending for treatment of mental health and substance use disorders in the Department of Veterans Affairs (VA) in fiscal years (FYs) 2000 through 2007. VA spending as reported in the VA Decision Support System was linked to patient utilization data as reported in the Patient Treatment Files, the National Patient Care Database, and the VA Fee Basis files. All care and costs from FY 2000 to FY 2007 were analyzed. Over the study period the number of veterans treated at the VA increased from 3.7 million to over 5.1 million (an average increase of 4.9% per year), and costs increased .7% per person per year. For mental health and substance use disorder treatment, the volume of inpatient care decreased markedly, residential care increased, and spending decreased on average 2% per year (from $668 in FY 2000 to $578 per person in FY 2007). FY 2007 saw large increases in mental health spending, bucking the trend from FY 2000 through FY 2006. VA's continued emphasis on outpatient and residential care was evident through 2007. This trend in spending might be unimpressive if VA were enrolling healthier Veterans, but the opposite seems to be true: over this time period the prevalence of most chronic conditions, including depression and posttraumatic stress disorder, increased. VA spending on mental health care grew rapidly in 2007, and given current military activities, this trend is likely to increase.

Developing a Leadership Development Program for the Veterans Benefits Administration within the Department of Veterans Affairs

Science.gov (United States)

2014-06-13

highest priorities: Veteran homelessness, “ VBA access ” to allow improved awareness of available VA services and benefits, and the backlog of benefits...Veterans by 2015. VBA access refers to improved Veteran awareness of the various VA benefits and services available, particularly through outreach and...claim completion time. While all three of these priorities impact VBA , the second two--increased access and decreased backlog--directly relate to

Visual symptomatology and referral patterns for Operation Iraqi Freedom and Operation Enduring Freedom veterans with traumatic brain injury.

Science.gov (United States)

Bulson, Ryan; Jun, Weon; Hayes, John

2012-01-01

Advances in protective armor technology and changes in the "patterns of war" have created a population of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans with traumatic brain injury (TBI) that provide a unique challenge to Department of Veterans Affairs (VA) healthcare practitioners. The purpose of the study was to determine the frequency of symptomatic ocular and visual sequelae of TBI in OIF/OEF veterans at the Portland VA Medical Center, a Polytrauma Support Clinic Team site. A retrospective analysis of 100 OIF/OEF veterans with TBI was conducted to determine the prevalence of ocular and visual complaints. Referral patterns were also investigated. Visual symptoms were reported in approximately 50% of veterans with TBI. Loss of consciousness, but not number of deployments or number of blast exposures, was found to have a statistically significant association with severity of reported visual symptoms. The most commonly reported symptoms included blurred vision (67%), photosensitivity (50%), and accommodative problems (40%). Visual symptoms of OIF/OEF veterans at the Portland VA Medical Center are reported at slightly lower rates than similar studies conducted at the Palo Alto and Edward Hines Jr VA facilities.

77 FR 7243 - Proposed Information Collection (Operation Enduring Freedom/Operation Iraqi Freedom Veterans...

Science.gov (United States)

2012-02-10

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0728] Proposed Information Collection (Operation Enduring Freedom/ Operation Iraqi Freedom Veterans Health Needs Assessment) Activities Under OMB....'' SUPPLEMENTARY INFORMATION: Title: Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs...

77 FR 3843 - Agency Information Collection (Board of Veterans' Appeals Customer Satisfaction With Hearing...

Science.gov (United States)

2012-01-25

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0548] Agency Information Collection (Board of Veterans' Appeals Customer Satisfaction With Hearing Survey) Under OMB Review AGENCY: Board of Veterans.... Title: Board of Veterans' Appeals Customer Satisfaction with Hearing Survey, VA Form 0745. OMB Control...

76 FR 78569 - Medical Benefits for Newborn Children of Certain Woman Veterans

Science.gov (United States)

2011-12-19

... conform to amendments made by the enactment of the Caregivers and Veteran Omnibus Health Services Act of... the Caregivers and Veterans Omnibus Health Services Act of 2010, Public Law 111-163. Section 206 of... in what is known as the VA ``medical benefits package.'' This rulemaking amends Sec. 17.38(a) to...

75 FR 39618 - Proposed Information Collection (Request for Identifying Information Re: Veteran's Loan Records...

Science.gov (United States)

2010-07-09

..., benefits will not be paid or furnished by reason of an incomplete application. Affected Public: Individuals... Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits....Regulations.gov or to Nancy J. Kessinger, Veterans Benefits Administration (20M35), Department of Veterans...

38 CFR 51.42 - Drugs and medicines for certain veterans.

Science.gov (United States)

2010-07-01

... AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Per Diem Payments § 51.42... illness or injury for a veteran receiving care in a State home, if: (1) The veteran: (i) Has a singular or... of such drugs and medicines for a service-connected disability; and (ii) Is in need of nursing home...

Zolpidem prescribing and adverse drug reactions in hospitalized general medicine patients at a Veterans Affairs hospital.

Science.gov (United States)

Mahoney, Jane E; Webb, Melissa J; Gray, Shelly L

2004-03-01

Zolpidem is prescribed for sleep disruption in hospitalized patients, but data on the incidence of adverse drug reactions (ADRs) are based largely on outpatient studies. Thus, the incidence of ADRs in hospitalized patients may be much higher. The goal of this study was to describe prescribing patterns of zolpidem for hospitalized medical patients aged 50 years, the incidence of ADRs possibly and probably associated with its use, and the factors associated with central nervous system (CNS) ADRs. This case series was conducted in 4 general medicine wards at a Veterans Affairs hospital and was a consecutive sample of patients aged 50 years who were hospitalized between 1993 and 1997 and received zolpidem as a hypnotic during hospitalization, but had not received it in the previous 3 months. Chart review was conducted by 2 evaluators. Data extracted from the medical records included admission demographic characteristics, medications, comorbidities, and levels of function in performing basic and instrumental activities of daily living. The main outcome measure was ADRs possibly or probably related to zolpidem use. The association between zolpidem and the occurrence of CNS ADRs (eg, confusion, dizziness, daytime somnolence) was analyzed separately. The review included 119 medical patients aged > or =50 years who had newly received zolpidem for sleep disruption during hospitalization. The median age of the population was 70 years; 86 (72.3%) patients were aged 65 years. The initial zolpidem dose was 5 mg in 42 patients (35.3%) and 10 mg in 77 patients (64.7%). Twenty-three patients had a respective 16 and 10 ADRs possibly and probably related to zolpidem use (19.3% incidence). Of a total of 26 ADRs, 21 (80.8%) were CNS ADRs, occurring with both zolpidem 5 mg (10.8% of users) and 10 mg (18.3% of users). On univariate analyses, the only factor significantly associated with a CNS ADR was functional impairment at baseline (P = 0.003). Zolpidem was discontinued in 38.8% of

Extent and reasons for nonadherence to antihypertensive, cholesterol, and diabetes medications: the association with depressive symptom burden in a sample of American veterans

Directory of Open Access Journals (Sweden)

Weidenbacher HJ

2015-02-01

Full Text Available Hollis J Weidenbacher,1 Christopher A Beadles,1,2 Matthew L Maciejewski,1,3 Bryce B Reeve,2 Corrine I Voils1,3 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA; 3Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA Objective: Persons with depressive symptoms generally have higher rates of medication nonadherence than persons without depressive symptoms. However, little is known about whether this association differs by comorbid medical condition or whether reasons for nonadherence differ by depressive symptoms or comorbid medical condition. Methods: Self-reported extent of nonadherence, reasons for nonadherence, and depressive symptoms among 1,026 veterans prescribed medications for hypertension, dyslipidemia, and/or type 2 diabetes were assessed. Results: In multivariable logistic regression adjusted for clinical and demographic factors, the odds of nonadherence were higher among participants with high depressive symptom burden for dyslipidemia (n=848; odds ratio [OR]: 1.42, P=0.03 but not hypertension (n=916; OR: 1.24, P=0.15, or type 2 diabetes (n=447; OR: 1.15, P=0.51. Among participants reporting nonadherence to antihypertensive and antilipemic medications, those with greater depressive symptom burden had greater odds of endorsing medication nonadherence reasons related to negative expectations and excessive economic burden. Neither extent of nonadherence nor reasons for nonadherence differed by depressive symptom burden among patients with diabetes. Conclusion: These findings suggest that clinicians may consider tailoring interventions to improve adherence to antihypertensive and antilipemic medications to specific medication concerns of participants with depressive symptoms

38 CFR 10.43 - Claim by guardian of child of veteran.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Claim by guardian of... AFFAIRS ADJUSTED COMPENSATION Adjusted Compensation; General § 10.43 Claim by guardian of child of veteran. A claim made by a legal guardian on behalf of his or her ward, a child of a veteran, shall be...

78 FR 36309 - Research Advisory Committee on Gulf War Veterans' Illnesses, Notice of Meeting

Science.gov (United States)

2013-06-17

... DEPARTMENT OF VETERANS AFFAIRS Research Advisory Committee on Gulf War Veterans' Illnesses, Notice... Act, 5 U.S.C. App., that the Research Advisory Committee on Gulf War Veterans' Illnesses will meet on... operations during the Gulf War. [[Page 36310

38 CFR 17.90 - Medical care for veterans receiving vocational training under 38 U.S.C. chapter 15.

Science.gov (United States)

2010-07-01

....S.C. chapter 15. Hospital care, nursing home care and medical services may be provided to any... and medical services means class V dental care, priority III medical services, nursing home care and... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Medical care for veterans...

38 CFR 51.41 - Per diem for certain veterans based on service-connected disabilities.

Science.gov (United States)

2010-07-01

... facility, if the veteran: (1) Is in need of nursing home care for a VA adjudicated service-connected...' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Per Diem Payments § 51.41 Per diem for certain veterans based on service-connected disabilities...

76 FR 70827 - Proposed Information Collection (Board of Veterans' Appeals Customer Satisfaction With Hearing...

Science.gov (United States)

2011-11-15

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0548] Proposed Information Collection (Board of Veterans' Appeals Customer Satisfaction With Hearing Survey Card) Activity; Comment Request AGENCY... information technology. Title: Board of Veterans' Appeals Customer Satisfaction with Hearing Survey Card, VA...

HIV rapid testing in a Veterans Affairs hospital ED setting: a 5-year sustainability evaluation.

Science.gov (United States)

Knapp, Herschel; Hagedorn, Hildi; Anaya, Henry D

2014-08-01

Routine HIV testing in primary care settings is now recommended in the United States. The US Department of Veterans Affairs (VA) has increased the number of patients tested for HIV, but overall HIV testing rates in VA remain low. A proven strategy for increasing such testing involves nurse-initiated HIV rapid testing (HIV RT). The purpose of this work was to use a mixed methodology approach to evaluate the 5-year sustainability of an intervention that implemented HIV RT in a VA emergency department setting in a large, urban VA medical center to reduce missed diagnostic and treatment opportunities in this vulnerable patient population. In-person semistructured interviews were conducted with providers and stakeholders. Interview notes were qualitatively coded for emerging themes. Quarterly testing rates were evaluated for a 5-year time span starting from the launch in July 2008. Findings indicate that HIV RT was sustained by the enthusiasm of 2 clinical champions who oversaw the registered nurses responsible for conducting the testing. The departure of the clinical champions was correlated with a substantial drop-off in testing. Findings also indicate potential strategies for improving sustainability including engaging senior leadership in the project, engaging line staff in the implementation planning from the start to increase ownership over the innovation, incorporating information into initial training explaining the importance of the innovation to quality patient care, providing ongoing training to maintain skills, and providing routine progress reports to staff to demonstrate the ongoing impact of their efforts. Published by Elsevier Inc.

Sexual Trauma: Women Veterans Health Care

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... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

Aging Veterans and Posttraumatic Stress Symptoms

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... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

Comparative effectiveness trial of family-supported smoking cessation intervention versus standard telephone counseling for chronically ill veterans using proactive recruitment

Directory of Open Access Journals (Sweden)

Bastian LA

2012-09-01

Full Text Available Lori A Bastian,1–3 Laura J Fish,4 Jennifer, M Gierisch,3,5 Lesley D Rohrer,3 Karen M Stechuchak,3 Steven C Grambow3,61Veterans Affairs Connecticut, West Haven, CT, USA; 2Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA; 3Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 4Duke Comprehensive Cancer Center, 5Department of Medicine, 6Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USAObjectives: Smoking cessation among patients with chronic medical illnesses substantially decreases morbidity and mortality. Chronically ill veteran smokers may benefit from interventions that assist them in harnessing social support from family and friends.Methods: We proactively recruited veteran smokers who had cancer, cardiovascular disease, or other chronic illnesses (diabetes, chronic obstructive pulmonary disease, hypertension and randomized them to either standard telephone counseling or family-supported telephone counseling focused on increasing support for smoking cessation from family and friends. Participants each received a letter from a Veterans Affairs physician encouraging them to quit smoking, a self-help cessation kit, five telephone counseling sessions, and nicotine replacement therapy, if not contraindicated. The main outcome was 7-day point prevalent abstinence at 5 months.Results: We enrolled 471 participants with mean age of 59.2 (standard deviation [SD] = 7.9 years. 53.0% were white, 8.5% were female, and 55.4% were married/living as married. Overall, 42.9% had cardiovascular disease, 34.2% had cancer, and 22.9% had other chronic illnesses. At baseline, participants were moderately dependent on cigarettes as measured by the Heaviness of Smoking Index (mean = 2.8, SD = 1.6, expressed significant depressive symptoms as measured by the Center for Epidemiological Studies Depression scale (54.8% > 10, and

Impact of Dual Use of Department of Veterans Affairs and Medicare Part D Drug Benefits on Potentially Unsafe Opioid Use.

Science.gov (United States)

Gellad, Walid F; Thorpe, Joshua M; Zhao, Xinhua; Thorpe, Carolyn T; Sileanu, Florentina E; Cashy, John P; Hale, Jennifer A; Mor, Maria K; Radomski, Thomas R; Hausmann, Leslie R M; Donohue, Julie M; Gordon, Adam J; Suda, Katie J; Stroupe, Kevin T; Hanlon, Joseph T; Cunningham, Francesca E; Good, Chester B; Fine, Michael J

2018-02-01

To estimate the prevalence and consequences of receiving prescription opioids from both the Department of Veterans Affairs (VA) and Medicare Part D. Among US veterans enrolled in both VA and Part D filling 1 or more opioid prescriptions in 2012 (n = 539 473), we calculated 3 opioid safety measures using morphine milligram equivalents (MME): (1) proportion receiving greater than 100 MME for 1 or more days, (2) mean days receiving greater than 100 MME, and (3) proportion receiving greater than 120 MME for 90 consecutive days. We compared these measures by opioid source. Overall, 135 643 (25.1%) veterans received opioids from VA only, 332 630 (61.7%) from Part D only, and 71 200 (13.2%) from both. The dual-use group was more likely than the VA-only group to receive greater than 100 MME for 1 or more days (34.3% vs 10.9%; adjusted risk ratio [ARR] = 3.0; 95% confidence interval [CI] = 2.9, 3.1), have more days with greater than 100 MME (42.5 vs 16.9 days; adjusted difference = 16.4 days; 95% CI = 15.7, 17.2), and to receive greater than 120 MME for 90 consecutive days (7.8% vs 3.1%; ARR = 2.2; 95% CI = 2.1, 2.3). Among veterans dually enrolled in VA and Medicare Part D, dual use of opioids was associated with more than 2 to 3 times the risk of high-dose opioid exposure.

Rehabilitation of Combat-Related Injuries in the Veterans Administration: A Web of Support.

Science.gov (United States)

Howell, Paul; Capehart, Bruce P; Hoenig, Helen

2015-01-01

The Department of Veterans Affairs provides acute, subacute, and continuing rehabilitation for veterans using a hub-and-spoke system of hospitals and outpatient facilities. Using traumatic brain injury as an example, this commentary illustrates how this system provides interdisciplinary rehabilitative care to veterans throughout North Carolina.

Older veterans and emergency department discharge information.

Science.gov (United States)

Hastings, Susan; Stechuchak, Karen; Oddone, Eugene; Weinberger, Morris; Tucker, Dana; Knaack, William; Schmader, Kenneth

2012-10-01

Study goals were to assess older veterans' understanding of their emergency department (ED) discharge information and to determine the association between understanding discharge information and patient assessment of overall quality of care. Telephone interviews were conducted with 305 patients aged 65 or older (or their proxies) within 48 h of discharge from a Veterans Affairs Medical Center ED. Patients were asked about their perceived understanding (at the time of ED discharge) of information about their ED diagnosis, expected course of illness, contingency plan (ie, return precautions, who to call if it got worse, potential medication side effects) and follow-up care. Overall quality of ED care was rated on a four-point scale of poor, fair, good or excellent. Patients or their proxies reported not understanding information about their ED diagnosis (21%), expected course of illness (50%), contingency plan (43%), and how soon they needed to follow-up with their primary care provider (25%). In models adjusted for age and race, a positive association was observed between perceived understanding of the cause of the problem (OR 2.3; 95% CI 1.3 to 4.0), expected duration of symptoms (OR 1.6; 95% CI 1.0 to 2.5) and the contingency plan (OR 2.2; CI 1.3 to 3.4), and rating overall ED care as excellent. Older veterans may not understand key items of information at the time ED discharge, and this may have an impact on how they view the quality of ED care. Strategies are needed to improve communication of ED discharge information to older veterans and their families.

Mindfulness as a Weight Loss Treatment for Veterans.

Science.gov (United States)

Stanton, Michael V; Matsuura, Justin; Fairchild, Jennifer Kaci; Lohnberg, Jessica A; Bayley, Peter J

2016-01-01

Despite substantial evidence for their effectiveness in treating disordered eating and obesity, mindfulness-based treatments have not been broadly implemented among Veterans. A number of reviews have reported mindfulness to be beneficial in promoting healthy eating behaviors and weight loss among non-Veteran samples. We discuss this approach in the context of the Veterans Affairs system, the largest integrated healthcare provider in the U.S. and in the context of Veterans, among whom obesity is at epidemic proportions. In this article, we discuss what is known about treating obesity using a mindfulness approach, mindfulness interventions for Veterans, a new pilot mindfulness-based weight loss program designed for Veterans, and future directions for this type of obesity treatment in Veterans. We conclude that this population may be uniquely poised to benefit from mindfulness-based treatments.

77 FR 31071 - Research Advisory Committee on Gulf War Veterans' Illnesses, Notice of Meeting

Science.gov (United States)

2012-05-24

... DEPARTMENT OF VETERANS AFFAIRS Research Advisory Committee on Gulf War Veterans' Illnesses, Notice... Advisory Committee Act) that the Research Advisory Committee on Gulf War Veterans' Illnesses will meet on... Asia theater of operations during the Gulf War. The Committee will review VA program activities related...

75 FR 28686 - Research Advisory Committee on Gulf War Veterans' Illnesses; Notice of Meeting

Science.gov (United States)

2010-05-21

... DEPARTMENT OF VETERANS AFFAIRS Research Advisory Committee on Gulf War Veterans' Illnesses; Notice... Advisory Committee Act) that the Research Advisory Committee on Gulf War Veterans' Illnesses will meet on... Asia theater of operations during the Gulf War. The Committee will review VA program activities related...

76 FR 9407 - Research Advisory Committee on Gulf War Veterans' Illnesses; Notice of Meeting

Science.gov (United States)

2011-02-17

... DEPARTMENT OF VETERANS AFFAIRS Research Advisory Committee on Gulf War Veterans' Illnesses; Notice... Advisory Committee Act) that the Research Advisory Committee on Gulf War Veterans' Illnesses will meet on... Southwest Asia theater of operations during the Gulf War. The Committee will review VA program activities...

75 FR 65405 - Research Advisory Committee on Gulf War Veterans' Illnesses; Notice of Meeting

Science.gov (United States)

2010-10-22

... DEPARTMENT OF VETERANS AFFAIRS Research Advisory Committee on Gulf War Veterans' Illnesses; Notice... Advisory Committee Act) that the Research Advisory Committee on Gulf War Veterans' Illnesses will meet on... Asia theater of operations during the Gulf War. The Committee will review VA program activities related...

JPRS Report, Soviet Union, Military Affairs.

Science.gov (United States)

1988-01-07

Meetings of students and veterans, militarized physical culture celebrations , department and school activities which develop a sense of patriotism, formal...they capable of making military affairs interesting to a young men in Adidas jackets with dyed- hackle hairdos, of getting them to love military

Health Insurance and the Labor Supply Decisions of Older Workers: Evidence from a U.S. Department of Veterans Affairs Expansion.

Science.gov (United States)

Boyle, Melissa A; Lahey, Joanna N

2010-08-01

This paper exploits a major mid-1990s expansion in the U.S. Department of Veterans Affairs health care system to provide evidence on the labor market effects of expanding health insurance availability. Using data from the Current Population Survey, we employ a difference-in-differences strategy to compare the labor market behavior of older veterans and non-veterans before and after the VA health benefits expansion to test the impact of public health insurance on labor supply. We find that older workers are significantly more likely to decrease work both on the extensive and intensive margins after receiving access to non-employer based insurance. Workers with some college education or a college degree are more likely to transition into self-employment, a result consistent with "job-lock" effects. However, less-educated workers are more likely to leave self-employment, a result suggesting that the positive income effect from receiving public insurance dominates the "job-lock" effect for these workers. Some relatively disadvantaged sub-populations may also increase their labor supply after gaining greater access to public insurance, consistent with complementary positive health effects of health care access or decreased work disincentives for these groups. We conclude that this reform has affected employment and retirement decisions, and suggest that future moves toward universal coverage or expansions of Medicare are likely to have significant labor market effects.

Using a Cognitive Information Processing Approach to Group Career Counseling with Visually Impaired Veterans

Science.gov (United States)

Osborne, Lauren K.

2014-01-01

Unemployment continues to be a growing concern among both civilian and veteran populations. As 14% of the veteran population currently identify as disabled because of service, this population's need for specialized vocational rehabilitation is increasing. Specifically in Veterans Affairs (VA) Blind Rehabilitation Centers (BRC) where holistic…

75 FR 8789 - Research Advisory Committee on Gulf War Veterans' Illnesses; Notice of Meeting

Science.gov (United States)

2010-02-25

... DEPARTMENT OF VETERANS AFFAIRS Research Advisory Committee on Gulf War Veterans' Illnesses; Notice... Advisory Committee Act) that the Research Advisory Committee on Gulf War Veterans' Illnesses will meet on... theater of operations during the Gulf War. The Committee will review VA program activities related to Gulf...

76 FR 31018 - Research Advisory Committee on Gulf War Veterans' Illnesses; Notice of Meeting

Science.gov (United States)

2011-05-27

... DEPARTMENT OF VETERANS AFFAIRS Research Advisory Committee on Gulf War Veterans' Illnesses; Notice... Advisory Committee Act) that the Research Advisory Committee on Gulf War Veterans' Illnesses will meet on... consequences of military service in the Southwest Asia theater of operations during the Gulf War. The Committee...

77 FR 2353 - Research Advisory Committee on Gulf War Veterans' Illnesses; Notice of Meeting

Science.gov (United States)

2012-01-17

... DEPARTMENT OF VETERANS AFFAIRS Research Advisory Committee on Gulf War Veterans' Illnesses; Notice... Advisory Committee Act) that the Research Advisory Committee on Gulf War Veterans' Illnesses will meet on... consequences of military service in the Southwest Asia theater of operations during the Gulf War. The Committee...

78 FR 77205 - Research Advisory Committee on Gulf War Veterans' Illnesses; Notice of Meeting

Science.gov (United States)

2013-12-20

... DEPARTMENT OF VETERANS AFFAIRS Research Advisory Committee on Gulf War Veterans' Illnesses; Notice... Advisory Committee Act) that the Research Advisory Committee on Gulf War Veterans' Illnesses will meet on... service in the Southwest Asia theater of operations during the Gulf War. The Committee will review VA...

76 FR 77455 - Servicemembers' Group Life Insurance and Veterans' Group Life Insurance-Slayer's Rule Exclusion

Science.gov (United States)

2011-12-13

... and Veterans' Group Life Insurance--Slayer's Rule Exclusion AGENCY: Department of Veterans Affairs... Veterans' Group Life Insurance--Slayer's Rule Exclusion.'' Copies of comments received will be available...) (slayer's rule ``is undoubtedly an implicit provision of the Servicemen's Group Life Insurance Act of 1965...

Treatment-seeking veterans of Iraq and Afghanistan: comparison with veterans of previous wars.

Science.gov (United States)

Fontana, Alan; Rosenheck, Robert

2008-07-01

Differences in the characteristics and mental health needs of veterans of the Iraq/Afghanistan war when compared with those of veterans who served in the Persian Gulf war and in the Vietnam war may have important implications for Veterans Affairs (VA) program and treatment planning. Subjects were drawn from administrative data bases of veterans who sought treatment from specialized VA programs for treatment of posttraumatic stress disorder (PTSD). Current Iraq/Afghanistan veterans were compared with 4 samples of outpatient and inpatient Persian Gulf and Vietnam veterans whose admission to treatment was either contemporaneous or noncontemporaneous with their admission. A series of analyses of covariance was used hierachically to control for program site and age. In analyses of contemporaneous veterans uncontrolled for age, Iraq/Afghanistan veterans differed most notably from Vietnam veterans by being younger, more likely to be female, less likely to be either married or separated/divorced, more often working, less likely to have ever been incarcerated, and less likely to report exposure to atrocities in the military. Regarding clinical status, Iraq/Afghanistan veterans were less often diagnosed with substance abuse disorders, manifested more violent behavior, and had lower rates of VA disability compensation because of PTSD. Differences are more muted in comparisons with Persian Gulf veterans, particularly in those involving noncontemporaneous samples, or those that controlled for age differences. Among recent war veterans with PTSD, social functioning has largely been left intact. There is a window of opportunity, therefore, for developing and focusing on treatment interventions that emphasize the preservation of these social assets.

Gout Self-Management in African American Veterans: A Qualitative Exploration of Challenges and Solutions From Patients' Perspectives.

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Singh, Jasvinder A; Herbey, Ivan; Bharat, Aseem; Dinnella, Janet E; Pullman-Mooar, Sally; Eisen, Seth; Ivankova, Nataliya

2017-11-01

To explore gout self-management and associated challenges and solutions in African Americans. We conducted semistructured interviews with 35 African American veterans with gout, who received health care at Birmingham or Philadelphia Veterans Affairs (VA) medical centers, had filled urate-lowering therapy (ULT; most commonly allopurinol) for at least 6 months, and had a ULT medication possession ratio ≥80%. The interview protocol was constructed to explore key concepts related to gout self-management, including initial diagnosis of gout, beginning medical care for gout, the course of the gout, ULT medication adherence, dietary strategies, comorbidity and side effects, and social support. Thirty-five African American male veterans with gout who had ≥80% ULT adherence (most commonly, allopurinol) were interviewed at Birmingham (n = 18) or Philadelphia (n = 17) VA medical centers. Mean age was 65 years, mean body mass index was 31.9 kg/m 2 , 97% had hypertension, 23% had coronary artery disease, and 31% had renal failure. The main themes motivating African American veterans to better gout self-management were fear of pain, adherence to medications, self-discipline, lifestyle changes, information gathering, and developing a positive outlook. Birmingham participants more frequently revealed skipping gout medications. More Philadelphia participants discussed lifestyle/diet changes to prevent gout flares, indicated limiting social activities that involved drinking, and sought more information about gout self-management from health care providers and internet sources. Identified themes, including cultural differences by site, led to the development of a patient-centered intervention to improve gout self-management in African American men with gout. © 2017, American College of Rheumatology.

Mindfulness as a Weight Loss Treatment for Veterans

Directory of Open Access Journals (Sweden)

Michael Vicente Stanton

2016-08-01

Full Text Available Despite substantial evidence for their effectiveness in treating disordered eating and obesity, mindfulness-based treatments have not been broadly implemented among Veterans. A number of reviews have reported mindfulness to be beneficial in promoting healthy eating behaviors and weight loss among non-Veteran samples. We discuss this approach in the context of the Veterans Affairs system, the largest integrated healthcare provider in the United States and in the context of Veterans, among whom obesity is at epidemic proportions. In this article, we discuss what is known about treating obesity using a mindfulness approach, mindfulness interventions for Veterans, a new pilot mindfulness-based weight loss program designed for Veterans, and future directions for this type of obesity treatment in Veterans. We conclude that this population may be uniquely poised to benefit from mindfulness-based treatments.

38 CFR 17.351 - Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center.

Science.gov (United States)

2010-07-01

... replacement and upgrading of equipment at Veterans Memorial Medical Center. 17.351 Section 17.351 Pensions... Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center. Grants to assist the Republic of the Philippines in the replacement and upgrading of equipment and in...

Women Veterans Health Care: Frequently Asked Questions

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... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

Chronic Fatigue Syndrome in Gulf War Veterans

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... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

Transfer of information from personal health records: a survey of veterans using My HealtheVet.

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Turvey, Carolyn L; Zulman, Donna M; Nazi, Kim M; Wakefield, Bonnie J; Woods, Susan S; Hogan, Timothy P; Weaver, Frances M; McInnes, Keith

2012-03-01

Personal health records provide patients with ownership of their health information and allow them to share information with multiple healthcare providers. However, the usefulness of these records relies on patients understanding and using their records appropriately. My HealtheVet is a Web-based patient portal containing a personal health record administered by the Veterans Health Administration. The goal of this study was to explore veterans' interest and use of My HealtheVet to transfer and share information as well as to identify opportunities to increase veteran use of the My HealtheVet functions. Two waves of data were collected in 2010 through an American Customer Satisfaction Index Web-based survey. A random sample of veterans using My HealtheVet was invited to participate in the survey conducted on the My HealtheVet portal through a Web-based pop-up browser window. Wave One results (n=25,898) found that 41% of veterans reported printing information, 21% reported saving information electronically, and only 4% ever sent information from My HealtheVet to another person. In Wave Two (n=18,471), 30% reported self-entering medication information, with 18% sharing this information with their Veterans Affairs (VA) provider and 9.6% sharing with their non-VA provider. Although veterans are transferring important medical information from their personal health records, increased education and awareness are needed to increase use. Personal health records have the potential to improve continuity of care. However, more research is needed on both the barriers to adoption as well as the actual impact on patient health outcomes and well-being.

Introduction of Ambulatory Medical Training in a Veterans Administration Hospital.

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Casciato, Dennis A.

1979-01-01

The implementation of a continuity of a care clinic in a highly subspecialized Veterans Administration internal medicine training program for postgraduate medical students is described, with focus on resolving problems created by the idiosyncratic administrative features and resource limitations of the hospital. (Author/JMD)

41 CFR 102-73.225 - What types of special purpose space may the Department of Veterans Affairs lease?

Science.gov (United States)

2010-07-01

...: (a) Guidance and training centers located at schools and colleges. (b) Space used for veterans hospitals, including outpatient and medical-related clinics, such as drug, mental health, and alcohol. Limitations on the Use of Delegated Authority ...

Comparing the Quality of Ambulatory Surgical Care for Skin Cancer in a Veterans Affairs Clinic and a Fee-For-Service Practice Using Clinical and Patient-Reported Measures.

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Dizon, Matthew P; Linos, Eleni; Arron, Sarah T; Hills, Nancy K; Chren, Mary-Margaret

2017-01-01

The Institute of Medicine has identified serious deficiencies in the measurement of cancer care quality, including the effects on quality of life and patient experience. Moreover, comparisons of quality in Veterans Affairs Medical Centers (VA) and other sites are timely now that many Veterans can choose where to seek care. To compare quality of ambulatory surgical care for keratinocyte carcinoma (KC) between a VA and fee-for-service (FFS) practice, we used unique clinical and patient-reported data from a comparative effectiveness study. Patients were enrolled in 1999-2000 and followed for a median of 7.2 years. The practices differed in a few process measures (e.g., median time between biopsy and treatment was 7.5 days longer at VA) but there were no substantial or consistent differences in clinical outcomes or a broad range of patient-reported outcomes. For example, 5-year tumor recurrence rates were equally low (3.6% [2.3-5.5] at VA and 3.4% [2.3-5.1] at FFS), and similar proportions of patients reported overall satisfaction at one year (78% at VA and 80% at FFS, P = 0.69). These results suggest that the quality of care for KC can be compared comprehensively in different health care systems, and suggest that quality of care for KC was similar at a VA and FFS setting.

Medical and psychosocial barriers to weight management in older veterans with and without serious mental illness.

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Muralidharan, Anjana; Klingaman, Elizabeth A; Prior, Steven J; Molinari, Victor; Goldberg, Richard W

2016-11-01

Older adults with serious mental illness (SMI) are an understudied population with complex care needs and high rates of obesity/overweight. Little is known about the experiences of older adults with SMI with weight management. The present study is an observational study of veterans ages 55 and over with a body mass index in the overweight or obese range, comparing Veterans with schizophrenia or bipolar disorder (n = 9044) to their same-age peers with no mental health disorders (n = 71156), on their responses to a questionnaire assessment of medical and psychosocial factors related to weight management. Responses to the questionnaire between August, 2005 and May, 2013 were used to examine the following: demographics, clinical characteristics, medical barriers to weight management, current weight loss plan, reliability of social support, reasons for being overweight, and weight loss barriers. Physical health concerns were highly prevalent in both groups. Veterans in the SMI group endorsed more medical issues and were significantly more likely to endorse experiences that indicated that their medical conditions were poorly controlled (e.g., shortness of breath). Veterans in the SMI group were more likely to endorse many barriers to healthy eating and physical activity, across medical, psychological, social, and environmental domains. Even within a sample at medically high-risk for complications related to obesity and metabolic syndrome, older veterans with SMI and overweight/obesity experience more challenges with weight management than their same-age peers with overweight/obesity and no mental health disorders. Weight management interventions for this population should take a multifaceted approach. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Trends in Opioid Use Disorder Diagnoses and Medication Treatment Among Veterans With Posttraumatic Stress Disorder.

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Shiner, Brian; Leonard Westgate, Christine; Bernardy, Nancy C; Schnurr, Paula P; Watts, Bradley V

2017-01-01

Despite long-standing interest in posttraumatic stress disorder (PTSD) and opioid use disorder comorbidity, there is a paucity of data on the prevalence of opioid use disorder in patients with PTSD. Therefore, there is limited understanding of the use of medications for opioid use disorder in this population. We determined the prevalence of diagnosed opioid use disorder and use of medications for opioid use disorder in a large cohort of patients with PTSD. We obtained administrative and pharmacy data for veterans who initiated PTSD treatment in the Department of Veterans Affairs (VA) between 2004 and 2013 (N = 731,520). We identified those with a comorbid opioid use disorder diagnosis (2.7%; n = 19,998) and determined whether they received a medication for opioid use disorder in the year following their initial clinical PTSD diagnosis (29.6%; n = 5,913). Using logistic regression, we determined the predictors of receipt of opioid use disorder medications. Comorbid opioid use disorder diagnoses increased from 2.5% in 2004 to 3.4% in 2013. Patients with comorbid opioid use disorder used more health services and had more comorbidities than other patients with PTSD. Among patients with PTSD and comorbid opioid use disorder, use of medications for opioid use disorder increased from 22.6% to 35.1% during the same time period. Growth in the use of buprenorphine (2.0% to 22.7%) was accompanied by relative decline in use of methadone (19.3% to 12.7%). Patients who received buprenorphine were younger and more likely to be rural, White, and married. Patients who received methadone were older, urban, unmarried, from racial and ethnic minorities, and more likely to see substance abuse specialists. While use of naltrexone increased (2.8% to 8.6%), most (87%) patients who received naltrexone also had an alcohol use disorder. Controlling for patient factors, there was a substantial increase in the use of buprenorphine, a substantial decrease in the use of methadone, and no change

Lower urinary tract dysfunction in male Iraq and Afghanistan war veterans: association with mental health disorders: a population-based cohort study.

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Breyer, Benjamin N; Cohen, Beth E; Bertenthal, Daniel; Rosen, Raymond C; Neylan, Thomas C; Seal, Karen H

2014-02-01

To determine the prevalence and correlates of lower urinary tract symptoms (LUTS) among returned Iraq and Afghanistan veterans; in particular its association with mental health diagnoses and medication use. We performed a retrospective cohort study of Iraq and Afghanistan veterans who were new users of U.S. Department of Veterans Affairs health care. Mental health diagnoses were defined by International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes from medical records. LUTS was defined by ICD-9-CM code, use of prescription medication for LUTS, or procedure for LUTS. We determined the independent association of mental health diagnoses and LUTS after adjusting for sociodemographic and military service characteristics, comorbidities, and medications. Of 519,189 veterans, 88% were men and the mean age was 31.8 years (standard deviation ± 9.3). The overall prevalence of LUTS was 2.2% (11,237/519,189). Veterans with post-traumatic stress disorder (PTSD) were significantly more likely to have a LUTS diagnosis, prescription, or related procedure (3.5%) compared with veterans with no mental health diagnoses (1.3%) or a mental health diagnosis other than PTSD (3.1%, P <.001). In adjusted models, LUTS was significantly more common in veterans with PTSD with and without other mental health disorders vs those without mental health disorders (adjusted relative risk [ARR] = 2.04, 95% confidence interval [CI] = 1.94-2.15) and in veterans prescribed opioids (ARR = 2.46, 95% CI = 2.36-2.56). In this study of young returned veterans, mental health diagnoses and prescription for opioids were independently associated with increased risk of receiving a diagnosis, treatment, or procedure for LUTS. Provider awareness may improve the detection and treatment of LUTS, and improve patient care and quality of life. Copyright © 2014. Published by Elsevier Inc.

Payment or reimbursement for certain medical expenses for Camp Lejeune family members. Interim final rule.

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2014-09-24

The Department of Veterans Affairs (VA) is promulgating regulations to implement statutory authority to provide payment or reimbursement for hospital care and medical services provided to certain veterans' family members who resided at Camp Lejeune, North Carolina, for at least 30 days during the period beginning on January 1, 1957, and ending on December 31, 1987. Under this rule, VA will reimburse family members, or pay providers, for medical expenses incurred as a result of certain illnesses and conditions that may be attributed to exposure to contaminated drinking water at Camp Lejeune during this time period. Payment or reimbursement will be made within the limitations set forth in statute and Camp Lejeune family members will receive hospital care and medical services that are consistent with the manner in which we provide hospital care and medical services to Camp Lejeune veterans.

Medical costs of war in 2035: long-term care challenges for veterans of Iraq and Afghanistan.

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Geiling, James; Rosen, Joseph M; Edwards, Ryan D

2012-11-01

War-related medical costs for U.S. veterans of Iraq and Afghanistan may be enormous because of differences between these wars and previous conflicts: (1) Many veterans survive injuries that would have killed them in past wars, and (2) improvised explosive device attacks have caused "polytraumatic" injuries (multiple amputations; brain injury; severe facial trauma or blindness) that require decades of costly rehabilitation. In 2035, today's veterans will be middle-aged, with health issues like those seen in aging Vietnam veterans, complicated by comorbidities of posttraumatic stress disorder, traumatic brain injury, and polytrauma. This article cites emerging knowledge about best practices that have demonstrated cost-effectiveness in mitigating the medical costs of war. We propose that clinicians employ early interventions (trauma care, physical therapy, early post-traumatic stress disorder diagnosis) and preventive health programs (smoking cessation, alcohol-abuse counseling, weight control, stress reduction) to treat primary medical conditions now so that we can avoid treating costly secondary and tertiary complications in 2035. (We should help an amputee reduce his cholesterol and maintain his weight at age 30, rather than treating his heart disease or diabetes at age 50.) Appropriate early interventions for primary illness should preserve veterans' functional status, ensure quality clinical care, and reduce the potentially enormous cost burden of their future health care.

Impact of the Northridge earthquake on the mental health of veterans: results from a panel study.

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Dobalian, Aram; Stein, Judith A; Heslin, Kevin C; Riopelle, Deborah; Venkatesh, Brinda; Lanto, Andrew B; Simon, Barbara; Yano, Elizabeth M; Rubenstein, Lisa V

2011-09-01

The 1994 earthquake that struck Northridge, California, led to the closure of the Veterans Health Administration Medical Center at Sepulveda. This article examines the earthquake's impact on the mental health of an existing cohort of veterans who had previously used the Sepulveda Veterans Health Administration Medical Center. From 1 to 3 months after the disaster, trained interviewers made repeated attempts to contact participants by telephone to administer a repeated measures follow-up design survey based on a survey that had been done preearthquake. Postearthquake data were obtained on 1144 of 1800 (64%) male veterans for whom there were previous data. We tested a predictive latent variable path model of the relations between sociodemographic characteristics, predisaster physical and emotional health measures, and postdisaster emotional health and perceived earthquake impact. Perceived earthquake impact was predicted by predisaster emotional distress, functional limitations, and number of health conditions. Postdisaster emotional distress was predicted by preexisting emotional distress and earthquake impact. The regression coefficient from earthquake impact to postearthquake emotional distress was larger than that of the stability coefficient from preearthquake emotional distress. Postearthquake emotional distress also was affected indirectly by preearthquake emotional distress, health conditions, younger age, and lower socioeconomic status. The postdisaster emotional health of veterans who experienced greater earthquake impact would have likely benefited from postdisaster intervention, regardless of their predisaster emotional health. Younger veterans and veterans with generally poor physical and emotional health were more vulnerable to greater postearthquake emotional distress. Veterans of lower socioeconomic status were disproportionately likely to experience more effects of the disaster because they had more predisaster emotional distress, more functional

Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project.

Science.gov (United States)

Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly; Dismuke, Clara; Janjua, Rabeea; Lynch, Mary G

2017-01-01

Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year. Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans. By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

Tagline: Information Extraction for Semi-Structured Text Elements in Medical Progress Notes

Science.gov (United States)

Finch, Dezon Kile

2012-01-01

Text analysis has become an important research activity in the Department of Veterans Affairs (VA). Statistical text mining and natural language processing have been shown to be very effective for extracting useful information from medical documents. However, neither of these techniques is effective at extracting the information stored in…

Veteran satisfaction and treatment preferences in response to a posttraumatic stress disorder specialty clinic orientation group.

Science.gov (United States)

Schumm, Jeremiah A; Walter, Kristen H; Bartone, Anne S; Chard, Kathleen M

2015-06-01

To maximize accessibility to evidence-based treatments for posttraumatic stress disorder (PTSD), the United States Department of Veterans Affairs (VA) has widely disseminated cognitive processing therapy (CPT) and prolonged exposure (PE) therapy to VA clinicians. However, there is a lack of research on veteran preferences when presented with a range of psychotherapy and medication options. This study uses a mixed-method approach to explore veteran satisfaction with a VA PTSD specialty clinic pre-treatment orientation group, which provides education about available PTSD treatment options. This study also tested differences in treatment preference in response to the group. Participants were 183 US veterans. Most were White, male, and referred to the clinic by a VA provider. Results indicated high satisfaction with the group in providing an overview of services and helping to inform treatment choice. Most preferred psychotherapy plus medications (63.4%) or psychotherapy only (30.1%). Participants endorsed a significantly stronger preference for CPT versus other psychotherapies. PE was significantly preferred over nightmare resolution therapy and present-centered therapy, and both PE and cognitive-behavioral conjoint therapy were preferred over virtual reality exposure therapy. Results suggest that by informing consumers about evidence-based treatments for PTSD, pre-treatment educational approaches may increase consumer demand for these treatment options. Published by Elsevier Ltd.

Professional Quality of Life of Veterans Affairs Staff and Providers in a Patient-Centered Care Environment.

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Locatelli, Sara M; LaVela, Sherri L

2015-01-01

Changes to the work environment prompted by the movement toward patient-centered care have the potential to improve occupational stress among health care workers by improving team-based work activities, collaboration, and employee-driven quality improvement. This study was conducted to examine professional quality of life among providers at patient-centered care pilot facilities. Surveys were conducted with 76 Veterans Affairs employees/providers at facilities piloting patient-centered care interventions, to assess demographics, workplace practices and views (team-based environment, employee voice, quality of communication, and turnover intention), and professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress).Professional quality-of-life subscales were not related to employee position type, age, or gender. Employee voice measures were related to lower burnout and higher compassion satisfaction. In addition, employees who were considering leaving their position showed higher burnout and lower compassion satisfaction scores. None of the work practices showed relationships with secondary traumatic stress.

The spiritual health of veterans with a history of suicide ideation

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Kopacz, Marek S.

2014-01-01

Introduction: In recent years, considerable empirical attention has been devoted to examining the increased risk of suicide observed in some Veteran populations. This has led to a renewed focus on developing novel support options which can be used to respond to Veterans in distress, reducing their risk of suicide. Spirituality and religion, however, have been largely absent from any public discourse related to suicide prevention, not least of all in Veteran populations. Aim: The aim of this cross-sectional study is to compare the self-rated spiritual health of Veterans with and without suicide ideation. Identifying differences which may exist between these two groups could highlight the relevance of spiritual well-being to Veteran suicide prevention efforts. Materials and Methods: Data were collected using pencil-and-paper surveys, called Spiritual Assessments, distributed within the general population of in- and outpatients at a U.S. Department of Veterans Affairs Medical Center. Using Likert-type scales, this study examines the self-rated spiritual health, spiritual devotion, and significance ascribed to spirituality in a sample of 5378 Veterans. Statistical analysis took place using chi-squared to examine differences in the distribution of responses between ideators and non-ideators. Results: Ideators significantly more often rated their spiritual health as worse than that of non-ideators. Even with similar levels of spiritual devotion or significance ascribed to spiritual life, ideators continued to significantly more often rate their spiritual health as worse than that of non-ideators. Conclusion: The results show that Veterans with suicide ideation more often rate their spiritual health as worse than that of Veterans without suicide ideation. This suggests that spiritual well-being may indeed be relevant to suicide prevention efforts in Veteran populations. PMID:25750787

Applying Lean Six Sigma to improve medication management.

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Nayar, Preethy; Ojha, Diptee; Fetrick, Ann; Nguyen, Anh T

2016-01-01

A significant proportion of veterans use dual care or health care services within and outside the Veterans Health Administration (VHA). In this study conducted at a VHA medical center in the USA, the authors used Lean Six Sigma principles to develop recommendations to eliminate wasteful processes and implement a more efficient and effective process to manage medications for dual care veteran patients. The purpose of this study is to: assess compliance with the VHA's dual care policy; collect data and describe the current process for co-management of dual care veterans' medications; and draft recommendations to improve the current process for dual care medications co-management. Input was obtained from the VHA patient care team members to draw a process map to describe the current process for filling a non-VHA prescription at a VHA facility. Data were collected through surveys and direct observation to measure the current process and to develop recommendations to redesign and improve the process. A key bottleneck in the process that was identified was the receipt of the non-VHA medical record which resulted in delays in filling prescriptions. The recommendations of this project focus on the four domains of: documentation of dual care; veteran education; process redesign; and outreach to community providers. This case study describes the application of Lean Six Sigma principles in one urban Veterans Affairs Medical Center (VAMC) in the Mid-Western USA to solve a specific organizational quality problem. Therefore, the findings may not be generalizable to other organizations. The Lean Six Sigma general principles applied in this project to develop recommendations to improve medication management for dual care veterans are applicable to any process improvement or redesign project and has valuable lessons for other VAMCs seeking to improve care for their dual care veteran patients. The findings of this project will be of value to VA providers and policy makers and health

Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout.

Science.gov (United States)

Fischer, Melanie S; Bhatia, Vickie; Baddeley, Jenna L; Al-Jabari, Rawya; Libet, Julian

2017-07-28

Family services within Veterans Affairs Medical Centers fulfill an important role in addressing relationship distress among Veterans, which is highly prevalent and comorbid with psychopathology. However, even for evidence-based couple therapies, effectiveness is weaker compared to controlled studies, maybe because many Veteran couples drop out early and do not reach the "active" treatment stage after the 3-4 session assessment. In order to improve outcomes, it is critical to identify couples at high risk for early dropout, and understand whether couples may benefit from the assessment as an intervention. The current study examined (a) demographics, treatment delivery mode, relationship satisfaction, and psychological symptoms as predictors of dropout during and immediately following the assessment phase, and (b) changes in relationship satisfaction during assessment. 174 couples completed questionnaires during routine intake procedures. The main analyses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out during the assessment phase and 24.74% of the remaining couples immediately following the first treatment session. More severe depressive symptoms in non-Veteran partners were associated with dropout during assessment. Relationship satisfaction improved significantly during the assessment phase for couples who did not drop out, with larger gains for non-Veteran partners. No demographics or treatment delivery mode were associated with dropout. Although more research is needed on engaging couples at risk for early dropout and maximizing early benefits, the findings suggest that clinicians should attend to the civilian partner's and Veteran's depressive symptoms at intake and consider the assessment part of active treatment. © 2017 Family Process Institute.

Payment or Reimbursement for Certain Medical Expenses for Camp Lejeune Family Members. Final rule.

Science.gov (United States)

2017-05-05

The Department of Veterans Affairs (VA) adopts as final an interim final rule addressing payment or reimbursement of certain medical expenses for family members of Camp Lejeune veterans. Under this rule, VA reimburses family members, or pays providers, for medical expenses incurred as a result of certain illnesses and conditions that may be associated with contaminants present in the base water supply at U.S. Marine Corps Base Camp Lejeune (Camp Lejeune), North Carolina, from August 1, 1953, to December 31, 1987. Payment or reimbursement is made within the limitations set forth in statute and Camp Lejeune family members receive hospital care and medical services that are consistent with the manner in which we provide hospital care and medical services to Camp Lejeune veterans. The statutory authority has since been amended to also include certain veterans' family members who resided at Camp Lejeune, North Carolina, for no less than 30 days (consecutive or nonconsecutive) between August 1, 1953, and December 31, 1987. This final rule will reflect that statutory change and will address public comments received in response to the interim final rule.

Unique factors rural Veterans' Affairs hospitals face when implementing health care-associated infection prevention initiatives.

Science.gov (United States)

Harrod, Molly; Manojlovich, Milisa; Kowalski, Christine P; Saint, Sanjay; Krein, Sarah L

2014-01-01

Health care-associated infection (HAI) is costly to hospitals and potentially life-threatening to patients. Numerous infection prevention programs have been implemented in hospitals across the United States. Yet, little is known about infection prevention practices and implementation in rural hospitals. The purpose of this study was to understand the infection prevention practices used by rural Veterans' Affairs (VA) hospitals and the unique factors they face in implementing these practices. This study used a sequential, mixed methods approach. Survey data to identify the HAI prevention practices used by rural VA hospitals were collected, analyzed, and used to inform the development of a semistructured interview guide. Phone interviews were conducted followed by site visits to rural VA hospitals. We found that most rural VA hospitals were using key recommended infection prevention practices. Nonetheless, a number of challenges with practice implementation were identified. The 3 most prominent themes were: (1) lack of human capital including staff with HAI expertise; (2) having to cultivate needed resources; and (3) operating as a system within a system. Rural VA hospitals are providing key infection prevention services to ensure a safe environment for the veterans they serve. However, certain factors, such as staff expertise, limited resources, and local context impacted how and when these practices were used. The creative use of more accessible alternative resources as well as greater flexibility in implementing HAI-related initiatives may be important strategies to further improve delivery of these important services by rural VA hospitals. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Opioid Therapy for Chronic Pain: Overview of the 2017 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline.

Science.gov (United States)

Rosenberg, Jack M; Bilka, Brandon M; Wilson, Sara M; Spevak, Christopher

2018-05-01

The US Department of Veterans Affairs (VA) and US Department of Defense (DoD) revised the 2010 clinical practice guideline (CPG) for the management of opioid therapy for chronic pain, considering the specific needs of the VA and DoD and new evidence regarding prescribing opioid medication for non-end-of-life-related chronic pain. This paper summarizes the major recommendations and compares them with the US Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids. This Opioid Therapy CPG was developed for VA-DoD service members, veterans, and their families. The VA/DoD Evidence-Based Practice Work Group convened a VA/DoD guideline renewal development effort and conformed to the guidelines established by the VA/DoD Joint Executive Council (JEC) and VA/DoD Health Executive Council (HEC). The panel developed questions, searched and evaluated the literature, developed recommendations using GRADE methodology, and developed algorithms. Passage of the CARA Act by Congress compelled consideration and comparison with the CDC opioid therapy guideline mid-development. There were 18 recommendations made. This article focuses on guideline development and key recommendations with CDC comparisons taken from four major areas, including: initiation and continuation of opioids;type, dose, follow-up, and taper of opioids;risk mitigation;acute pain. Guideline development and recommendations are presented. There was substantial overlap with the CDC opioid guideline. Additionally, there were items particularly relevant to the VA-DoD, including risk mitigation, suicide prevention, and preventing opioid use disorder in young patients. Our guideline highlights avoiding opioid therapy longer than 90 days as a critical juncture.

[The coordination of the forensic medical service with the medical criminology subdivisions of internal affairs organs in the personal identification of unidentified corpses].

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Pashinian, G A; Tuchik, E S

1997-01-01

In order to improve the cooperation between medical criminology departments of the organs of home affairs and forensic medical service in personality identification of unidentified corpses, the authors propose amendments to the routine procedure regulated by documents of the Ministry of Home Affairs of the Russian Federation, for these documents are in need of serious correction and revision, so that they conform to the judicial legislation and other documents.

Balancing Demand and Supply for Veterans' Health Care: A Summary of Three RAND Assessments Conducted Under the Veterans Choice Act.

Science.gov (United States)

Farmer, Carrie M; Hosek, Susan D; Adamson, David M

2016-06-20

In response to concerns that the Department of Veterans Affairs (VA) has faced about veterans' access to care and the quality of care delivered, Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 ("Veterans Choice Act") in August 2014. The law was passed to help address access issues by expanding the criteria through which veterans can seek care from civilian providers. In addition, the law called for a series of independent assessments of the VA health care system across a broad array of topics related to the delivery of health care services to veterans in VA-owned and -operated facilities, as well as those under contract to VA. RAND conducted three of these assessments: Veteran demographics and health care needs (A), VA health care capabilities (B), and VA authorities and mechanisms for purchasing care (C). This article summarizes the findings of our assessments and includes recommendations from the reports for improving the match between veterans' needs and VA's capabilities, including VA's ability to purchase necessary care from the private sector.

Location of cancer surgery for older veterans with cancer.

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Kouri, Elena M; Landrum, Mary Beth; Lamont, Elizabeth B; Bozeman, Sam; McNeil, Barbara J; Keating, Nancy L

2012-04-01

Many veterans undergo cancer surgery outside of the Veterans Health Administration (VHA). We assessed to what extent these patients obtained care in the VHA before surgery. VHA-Medicare data, VHA administrative data, and Veterans Affairs Central Cancer Registry data. We identified patients aged ≥65 years in the VHA-Medicare cohort who underwent lung or colon cancer resection outside the VHA and assessed VHA visits in the year before surgery. Over 60% of patients in the VHA-Medicare cohort who received lung or colon cancer surgeries outside the VHA did not receive any care in VHA before surgery. Veterans' receipt of major cancer surgery outside the VHA probably reflects usual private sector care among veterans who are infrequent VHA users. © Health Research and Educational Trust.

Emerging Pathogens Initiative (EPI)

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Department of Veterans Affairs — The Emerging Pathogens Initiative (EPI) database contains emerging pathogens information from the local Veterans Affairs Medical Centers (VAMCs). The EPI software...

Can the Theory of Planned Behavior Predict Dietary Intention and Future Dieting in an Ethnically Diverse Sample of Overweight and Obese Veterans Attending Medical Clinics?

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Lash, Denise N.; Smith, Jane Ellen; Rinehart, Jenny K.

2016-01-01

Obesity has become a world-wide epidemic; in the United States (U.S.) approximately two-thirds of adults are classified as overweight or obese. Military veterans’ numbers are even higher, with 77% of retired or discharged U.S. veterans falling in these weight categories. One of the most common methods of changing one’s weight is through dieting, yet little is known regarding the factors that facilitate successful dieting behavior. The current investigation tested the Theory of Planned Behavior’s (TPB) ability to predict dietary intention and future dieting in a sample of 84 overweight and obese patients attending medical clinics at a Veterans Affairs Hospital in the southwestern part of the U.S. Participants primarily were male (92%) and ethnic/racial minorities (58%). Perceived need and anticipated regret were added to the standard TPB model. While the TPB predicted dietary intention, it did not significantly account for improved dietary behaviors. Anticipated regret significantly enhanced the basic TPB’s ability to predict intention to diet, while perceived need did not. These findings highlight the difficulty in predicting sustained change in a complex behavior such as dieting to lose weight. The need for more work with older, overweight/obese medical patients attending veterans’ facilities is stressed, as is the need for such work with male patients and ethnic minorities in particular. PMID:26792774

Residency Allocation Database

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Department of Veterans Affairs — The Residency Allocation Database is used to determine allocation of funds for residency programs offered by Veterans Affairs Medical Centers (VAMCs). Information...

Optometry within hospitals at the Veterans Administration.

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Soroka, Mort; Crump, Trafford; Bennett, Amy

2005-11-01

This study was designed to determine the use of optometrists with the Veterans Health Administration hospital system and to develop accurate statistics regarding the number and type of services these doctors provide. The findings help describe their responsibilities in the treatment and management of ocular diseases and their use of diagnostic and therapeutic drugs. The study also investigated what, if any, role optometrists play beyond care in the education and research practices of the hospital. A descriptive analysis was conducted through the use of surveys and interviews of department chiefs or medical directors. A survey was sent out to 149 Veterans Affairs (VA) Hospitals, located using the VA facility locator Web site. Data were tabulated, aggregated, and analyzed. A response rate of 81% was achieved (122 surveys returned), 98% of which (120 facilities) provide eye services to their patients in either an outpatient or inpatient capacity. One hundred seventeen (98%) of these had optometrists affiliated with their facility. These optometrists were responsible for providing a range of services, prescribing the use of diagnostic or therapeutic drugs, and participating in educational training of other health personnel. Optometry has developed a strong partnership with the Veterans Health Administration, and act as an integral part of its hospital services. The VA has developed a workforce mix that should serve as a model for managed care organizations.

Physicians' Perspectives Regarding Prescription Drug Monitoring Program Use Within the Department of Veterans Affairs: a Multi-State Qualitative Study.

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Radomski, Thomas R; Bixler, Felicia R; Zickmund, Susan L; Roman, KatieLynn M; Thorpe, Carolyn T; Hale, Jennifer A; Sileanu, Florentina E; Hausmann, Leslie R M; Thorpe, Joshua M; Suda, Katie J; Stroupe, Kevin T; Gordon, Adam J; Good, Chester B; Fine, Michael J; Gellad, Walid F

2018-03-08

The Department of Veterans Affairs (VA) has implemented robust strategies to monitor prescription opioid dispensing, but these strategies have not accounted for opioids prescribed by non-VA providers. State-based prescription drug monitoring programs (PDMPs) are a potential tool to identify VA patients' receipt of opioids from non-VA prescribers, and recent legislation requires their use within VA. To evaluate VA physicians' perspectives and experiences regarding use of PDMPs to monitor Veterans' receipt of opioids from non-VA prescribers. Qualitative study using semi-structured interviews. Forty-two VA primary care physicians who prescribed opioids to 15 or more Veterans in 2015. We sampled physicians from two states with PDMPs (Massachusetts and Illinois) and one without prescriber access to a PDMP at the time of the interviews (Pennsylvania). From February to August 2016, we conducted semi-structured telephone interviews that addressed the following topics regarding PDMPs: overall experiences, barriers to optimal use, and facilitators to improve use. VA physicians broadly supported use of PDMPs or desired access to one, while exhibiting varying patterns of PDMP use dictated by state laws and their clinical judgment. Physicians noted administrative burdens and incomplete or unavailable prescribing data as key barriers to PDMP use. To facilitate use, physicians endorsed (1) linking PDMPs with the VA electronic health record, (2) using templated notes to document PDMP use, and (3) delegating routine PDMP queries to ancillary staff. Despite the time and administrative burdens associated with their use, VA physicians in our study broadly supported PDMPs. The application of our findings to ongoing PDMP implementation efforts may strengthen PDMP use both within and outside VA and improve the safe prescribing of opioids.

Veterans Affairs: Sustained Management Attention Needed to Address Numerous IT Challenges

Science.gov (United States)

2016-06-22

territories and the Philippines. The department’s three major components—the Veterans Benefits Administration ( VBA ), the Veterans Health Administration...VHA), and the National Cemetery Administration (NCA)—are primarily responsible for carrying out its mission. More specifically, VBA provides a...used for the determination of benefits, benefits claims processing, patient admission to hospitals and clinics, and access to health records, among

Endocrinology Telehealth Consultation Improved Glycemic Control Similar to Face-to-Face Visits in Veterans.

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Liu, Winnie; Saxon, David R; McNair, Bryan; Sanagorski, Rebecca; Rasouli, Neda

2016-09-01

Rates of diabetes for veterans who receive health care through the Veterans Health Administration are higher than rates in the general population. Furthermore, many veterans live in rural locations, far from Veterans Affairs (VA) hospitals, thus limiting their ability to readily seek face-to-face endocrinology care for diabetes. Telehealth (TH) technologies present an opportunity to improve access to specialty diabetes care for such patients; however, there is a lack of evidence regarding the ability of TH to improve glycemic control in comparison to traditional face-to-face consultations. This was a retrospective cohort study of all new endocrinology diabetes consultations at the Denver VA Medical Center over a 1-year period. A total of 189 patients were included in the analysis. In all, 85 patients had received face-to-face (FTF) endocrinology consultation for diabetes and 104 patients had received TH consultation. Subjects were mostly males (94.7%) and the mean age was 62.8 ± 10.1 years old. HbA1c improved from 9.76% (9.40% to 10.11%) to 8.55% (8.20% to 8.91%) (P Endocrinology TH consultations improved short-term glycemic control as effectively as traditional FTF visits in a veteran population with diabetes. © 2016 Diabetes Technology Society.

Communications and Collaboration Keep San Francisco VA Medical Center Project on Track

International Nuclear Information System (INIS)

Federal Energy Management Program

2001-01-01

This case study about energy saving performance contacts (ESPCs) presents an overview of how the Veterans Affairs Medical Center in San Francisco established an ESPC contract and the benefits derived from it. The Federal Energy Management Program instituted these special contracts to help federal agencies finance energy-saving projects at their facilities

Correlates of Initiation of Treatment for Chronic Hepatitis C Infection in United States Veterans, 2004-2009.

Directory of Open Access Journals (Sweden)

Adi V Gundlapalli

Full Text Available We describe the rates and predictors of initiation of treatment for chronic hepatitis C (HCV infection in a large cohort of HCV positive Veterans seen in U.S. Department of Veterans Affairs (VA facilities between January 1, 2004 and December 31, 2009. In addition, we identify the relationship between homelessness among these Veterans and treatment initiation. Univariate and multivariable Cox Proportional Hazards regression models with time-varying covariates were used to identify predictors of initiation of treatment with pegylated interferon alpha plus ribavirin. Of the 101,444 HCV treatment-naïve Veterans during the study period, rates of initiation of treatment among homeless and non-homeless Veterans with HCV were low and clinically similar (6.2% vs. 7.4%, p<0.0001. For all U.S. Veterans, being diagnosed with genotype 2 or 3, black or other/unknown race, having Medicare or other insurance increased the risk of treatment. Veterans with age ≥50 years, drug abuse, diabetes, and hemoglobin < 10 g/dL showed lower rates of treatment. Initiation of treatment for HCV in homeless Veterans is low; similar factors predicted initiation of treatment. Additionally, exposure to treatment with medications for diabetes predicted lower rates of treatment. As newer therapies become available for HCV, these results may inform further studies and guide strategies to increase treatment rates in all U.S. Veterans and those who experience homelessness.

76 FR 16354 - Per Diem Payments for the Care Provided to Eligible Veterans Evacuated From a State Home as a...

Science.gov (United States)

2011-03-23

... Payments for the Care Provided to Eligible Veterans Evacuated from a State Home as a Result of an Emergency..., Office of Patient Care Services (114), Veterans Health Administration, Department of Veterans Affairs... for each eligible veteran receiving nursing home care, domiciliary care, and adult day health care in...

Military veteran mortality following a survived suicide attempt

Directory of Open Access Journals (Sweden)

Conigliaro Joseph

2011-05-01

Full Text Available Abstract Background Suicide is a global public health problem. Recently in the U.S., much attention has been given to preventing suicide and other premature mortality in veterans returning from Iraq and Afghanistan. A strong predictor of suicide is a past suicide attempt, and suicide attempters have multiple physical and mental comorbidities that put them at risk for additional causes of death. We examined mortality among U.S. military veterans after hospitalization for attempted suicide. Methods A retrospective cohort study was conducted with all military veterans receiving inpatient treatment during 1993-1998 at United States Veterans Affairs (VA medical facilities following a suicide attempt. Deaths occurring during 1993-2002, the most recent available year at the time, were identified through VA Beneficiary and Records Locator System data and National Death Index data. Mortality data for the general U.S. adult population were also obtained from the National Center for Health Statistics. Comparisons within the veteran cohort, between genders, and against the U.S. population were conducted with descriptive statistics and standardized mortality ratios. The actuarial method was used estimate the proportion of veterans in the cohort we expect would have survived through 2002 had they experienced the same rate of death that occurred over the study period in the U.S. population having the age and sex characteristics. Results During 1993-1998, 10,163 veterans were treated and discharged at a VA medical center after a suicide attempt (mean age = 44 years; 91% male. There was a high prevalence of diagnosed alcohol disorder or abuse (31.8%, drug dependence or abuse (21.8%, psychoses (21.2%, depression (18.5%, and hypertension (14.2%. A total of 1,836 (18.1% veterans died during follow up (2,941.4/100,000 person years. The cumulative survival probability after 10 years was 78.0% (95% CI = 72.9, 83.1. Hence the 10-year cumulative mortality risk was 22

Induced abortion among women veterans: data from the ECUUN study.

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Schwarz, Eleanor Bimla; Sileanu, Florentina E; Zhao, Xinhua; Mor, Maria K; Callegari, Lisa S; Borrero, Sonya

2018-01-01

We compared rates of induced abortion among women veterans receiving Veterans Affairs (VA) healthcare to rates in the general US population, as current policy prohibits VA provision of abortion counseling or services even when pregnancy endangers a veteran's life. We analyzed data from 2298 women veterans younger than 45 years who completed a telephone-based, cross-sectional survey of randomly sampled English-speaking women from across the United States who had received VA healthcare. We compared lifetime, last-5-year and last-year rates of unintended pregnancy and abortion among participants to age-matched data from the National Survey of Family Growth. As few abortions were reported in the last year, we used multivariable logistic regression to examine associations between abortion in the last 5 years and age, race/ethnicity, income, education, religion, marital status, parity, geography, deployment history, housing instability, and past medical and mental health among VA patients. Women veterans were more likely than matched US women to report ever having an abortion [17.7%, 95% confidence interval (CI): 16.1%-19.3% vs. 15.2% of US women]. In the last 5 years, unintended pregnancy and abortion were reported by veterans at rates similar to US women. In multivariable models, VA patients were more likely to report abortion in the last 5 years if their annual income was less than $40,000 (adjusted odds ratio (OR) 2.95, 95% CI 1.30-6.70), they had experienced homelessness or housing instability (adjusted OR 1.91, 95% CI 1.01-3.62), they were single (adj. OR 2.46, 95% CI 1.23-4.91) and/or they had given birth (adjusted OR 2.29, 95% CI 1.19-4.40). Women veterans face unintended pregnancy and seek abortion as often as the larger US population. The Veterans Health Care Act, which prohibits provision of abortion services, increases vulnerable veterans' out-of-pocket healthcare costs and limits veterans' reproductive freedom. Copyright © 2017. Published by Elsevier Inc.

Posttraumatic stress disorder and correlates of disease activity among veterans with ankylosing spondylitis.

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Liew, Jean; Lucas Williams, J; Dobscha, Steven; Barton, Jennifer L

2017-10-01

The objective of this retrospective study was to evaluate the prevalence of comorbid Posttraumatic stress disorder (PTSD) and the association of PTSD with pain, disease activity, and medication use in ankylosing spondylitis (AS). Veterans with one or more visit to an outpatient rheumatology clinic at a single Veterans Affairs site during a 2-year study period were identified by ICD codes for AS and included if there was documentation of AS diagnosis by a rheumatologist. Data were collected on PTSD diagnosis, demographics, pain scores, disease activity by the Bath AS Disease Activity Index (BASDAI), and medication use. Characteristics were compared by PTSD status using t tests for continuous variables and Chi-square or Fischer's exact test for categorical variables. Of 113 Veterans with AS, 20 (18%) had a diagnosis of PTSD. Those with PTSD were significantly younger, 52 ± 17 years, as compared to those without PTSD, 59 ± 14 years (p = 0.04). BASDAI was recorded for 30% with a mean score of 4.3 ± 2.0. Those with PTSD had higher mean pain and BASDAI scores as compared to those without PTSD (p = 0.06 for both comparisons). Prescribed medications were similar for both groups in regards to synthetic disease modifying antirheumatic drugs (DMARDs), biologics, and opioids, although those with PTSD were significantly more likely to receive NSAIDs (p = 0.03). Veterans with AS and comorbid PTSD were younger and had higher reported pain and disease activity scores compared to those without PTSD in this single site study. These findings underscore the importance of identifying PTSD in patients with AS.

Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process.

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Lisi, Anthony J; Salsbury, Stacie A; Hawk, Cheryl; Vining, Robert D; Wallace, Robert B; Branson, Richard; Long, Cynthia R; Burgo-Black, A Lucille; Goertz, Christine M

2018-02-01

The purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. The research method used was a consensus process. A multidisciplinary investigative team reviewed clinical guidelines and Veterans Affairs pain and mental health initiatives to develop seed statements and care algorithms to guide chiropractic management and collaborative care of veterans with low back pain. A 5-member advisory committee approved initial recommendations. Veterans Affairs-based panelists (n = 58) evaluated the pathway via e-mail using a modified RAND/UCLA methodology. Consensus was defined as agreement by 80% of panelists. The modified Delphi process was conducted in July to December 2016. Most (93%) seed statements achieved consensus during the first round, with all statements reaching consensus after 2 rounds. The final care pathway addressed the topics of informed consent, clinical evaluation including history and examination, screening for red flags, documentation, diagnostic imaging, patient-reported outcomes, adverse event reporting, chiropractic treatment frequency and duration standards, tailored approaches to chiropractic care in veteran populations, and clinical presentation of common mental health conditions. Care algorithms outlined chiropractic case management and interprofessional collaboration and referrals between doctors of chiropractic and primary care and mental health providers. This study offers an integrative care pathway that includes chiropractic care for veterans with low back pain. Copyright © 2018. Published by Elsevier Inc.

Mental health treatment-related stigma and professional help seeking among student veterans.

Science.gov (United States)

Currier, Joseph M; McDermott, Ryon C; McCormick, Wesley H

2017-11-01

Record numbers of military veterans are enrolling at colleges/universities across the United States. Although a substantive subset might suffer from mental health problems, the majority of these students might not be amenable to utilizing services. The purpose of this study was to examine the role of treatment-related stigma in intentions to seek professional help among undergraduate student veterans at a university on the U.S. Gulf Coast. Focusing on 251 veterans and a gender-matched comparison group of 251 nonveterans, student veterans endorsed higher probabilities of seeking care from physicians (d = .77) and psychologists or other professionals (d = .67). In addition, nonveteran students had greater self-stigma about seeking help (d = -.27) but veterans had more negative beliefs about treatment efficacy (d = 1.07). When compared with veterans who did not exceed clinical thresholds, those with a probable need for treatment had more stigma (ds = .63). Multivariate analyses also revealed an inverse main effect of self-stigma on intentions to seek help from both professional categories. However, military experience differentially moderated associations between treatment-related beliefs and intentions to seek mental health services. Finally, exploratory analyses identified that student veterans were most likely to engage in therapy/counseling at a Veterans Affairs Medical Center or Clinic, Vet Center, or other noninstitutionally sponsored settings in the community (e.g., private practices, faith-based organizations). Looking ahead, these findings will inform research and the provision of services for addressing the mental health needs of this substantive subpopulation of college students in the United States. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Creating a sampling frame for population-based veteran research: Representativeness and overlap of VA and Department of Defense databases

OpenAIRE

Donna L. Washington, MD, MPH; Su Sun, MPH; Mark Canning, BA

2010-01-01

Most veteran research is conducted in Department of Veterans Affairs (VA) healthcare settings, although most veterans obtain healthcare outside the VA. Our objective was to determine the adequacy and relative contributions of Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), and Department of Defense (DOD) administrative databases for representing the U.S. veteran population, using as an example the creation of a sampling frame for the National Survey of Women Vete...

Clinical characteristics of older male military veterans seeking treatment for erectile dysfunction.

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Beaudreau, Sherry A; Rideaux, Tiffany; Zeiss, Robert A

2011-02-01

Male sexual dysfunction is a significant international public health issue affecting both middle-aged and older adults. To date, however, no studies have compared age differences in psychiatric issues, frequency of sexual activity and treatment recommendations between older and middle-aged male military Veterans seeking treatment for erectile dysfunction (ED) in the U.S.A. Data were collected between 1982 and 2003 at the Palo Alto Veterans Affairs Andrology Clinic. The 1,250 participants, aged 22 to 87 years (median = 63), completed a semi-structured interview. Using multiple linear regressions, we examined age differences in five domains: medical and endocrine risk factors; psychiatric and psychosocial risk factors; frequency of sexual behaviors; self-reported and objectively measured erectile function; and treatment recommendations. Compared with middle-aged adults, older adults were more likely to present for ED treatment with medical risk factors and were more often recommended a vacuum pump treatment. Middle-aged male Veterans were more likely to experience psychiatric risk factors for ED and were more sexually active than older Veterans. Despite greater objective erectile ability in middle-aged adults, there were no age differences in maximum self-reported erectile functioning. These results provide some evidence of age-related characteristics and treatment needs of male patients seeking treatment for sexual dysfunction. We encourage health care professionals working with adults across the lifespan to consider ways to individualize psychoeducation and brief psychotherapy for the treatment of ED to the specific needs of the patient, which may vary between middle-aged and older cohorts of patients.

A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months.

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Bass, David M; Judge, Katherine S; Snow, A Lynn; Wilson, Nancy L; Morgan, Robert O; Maslow, Katie; Randazzo, Ronda; Moye, Jennifer A; Odenheimer, Germaine L; Archambault, Elizabeth; Elbein, Richard; Pirraglia, Paul; Teasdale, Thomas A; McCarthy, Catherine A; Looman, Wendy J; Kunik, Mark E

2014-01-01

"Partners in Dementia Care" (PDC) tested the effectiveness of a care-coordination program integrating healthcare and community services and supporting veterans with dementia and their caregivers. Delivered via partnerships between Veterans Affairs medical centers and Alzheimer's Association chapters, PDC targeted both patients and caregivers, distinguishing it from many non-pharmacological interventions. Hypotheses posited PDC would improve five veteran self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain and 5) depression. Greater impact was expected for more impaired veterans. A unique feature was self-reported research data collected from veterans with dementia. Five matched communities were study sites. Two randomly selected sites received PDC for 12 months; comparison sites received usual care. Three structured telephone interviews were completed every 6 months with veterans who could participate. Of 508 consenting veterans, 333 (65.6%) completed baseline interviews. Among those who completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194 (58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had significantly less adverse outcomes than those receiving usual care, particularly for more impaired veterans after 6 months, including reduced relationship strain (B = -0.09; p = 0.05), depression (B = -0.10; p = 0.03), and unmet need (B = -0.28; p = 0.02; and B = -0.52; p = 0.08). PDC veterans also had less embarrassment about memory problems (B = -0.24; p = 0.08). At 12 months, more impaired veterans had further reductions in unmet need (B = -0.96; p needs and improve the psychosocial functioning of persons with dementia. NCT00291161.

Evolution of faculty affairs and faculty development offices in U.S. medical schools: a 10-year follow-up survey.

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Sonnino, Roberta E; Reznik, Vivian; Thorndyke, Luanne A; Chatterjee, Archana; Ríos-Bedoya, Carlos F; Mylona, Elza; Nelson, Kathleen G; Weisman, Carol S; Morahan, Page S; Wadland, William C

2013-09-01

To determine how U.S. MD-granting medical schools manage, fund, and evaluate faculty affairs/development functions and to determine the evolution of these offices between 2000 and 2010. In December 2010, the authors invited faculty affairs designees at 131 U.S. MD-granting medical schools to complete a questionnaire developed by the Association of American Medical Colleges Group on Faculty Affairs, based on a 2000 survey. Schools were asked about core functions, budget, staffing, and performance metrics. The authors analyzed the data using descriptive statistics. A total of 111 schools (84.7%) responded. Fifty percent of the offices were established since 2000. Seventy-eight percent reported their top core function as administrative support for appointments, promotions, and tenure, as in 2000. Faculty policies, appointments, databases, governance support, grievance proceedings, management issues, and annual trend analyses continued as major functions. All 11 core functions identified in 2000 remain predominantly provided by central offices of faculty affairs, except support of major leadership searches. Web site communication emerged as a new core function. Similar to 2000, several other offices were responsible for some faculty development functions. Office size and budget correlated positively with size of the faculty and age of the office (P schools (31.5%) reported formally evaluating their faculty affairs office. The number of faculty affairs offices and their responsibilities have substantially increased since 2000. Most major core functions have not changed. These offices are now an established part of the central administration of most medical schools.

Benchmarking the quality of schizophrenia pharmacotherapy: a comparison of the Department of Veterans Affairs and the private sector.

Science.gov (United States)

Leslie, Douglas L; Rosenheck, Robert A

2003-09-01

Comparing quality of care between large health care systems is important for health systems management. This study used measures of the quality of pharmacotherapy for patients with schizophrenia and compared these measures across a sample of patients from the Department of Veterans Affairs (VA) and the private sector. A random sample of all patients diagnosed with schizophrenia in the VA during fiscal year (FY) 2000 was identified using administrative data. In the private sector, a sample of patients diagnosed with schizophrenia in 2000 was identified using MEDSTAT's MarketScan database. For both groups, use of antipsychotic medications was studied and measures of the quality of pharmacotherapy were constructed, including whether patients were prescribed any antipsychotic medication, one of the newer atypical antipsychotics, and whether dosing adhered to established treatment recommendations. These measures were compared across the two groups using logistic regression models, controlling for age, gender, and comorbid diagnoses. Most patients with a diagnosis of schizophrenia (82% in the VA and 73% in the private sector) received an antipsychotic medication, usually one of the newer atypical drugs. Patients in the VA were more likely to be dosed above treatment recommendations, and less likely to be dosed below treatment recommendations. Overall, differences in proportion schizophrenia patients dosed according to recommendations were not statistically different across the two systems (60% in the VA, 58% in the private sector). Differences between the two systems were mixed, with the VA outperforming the private sector with respect to some measures and doing worse on others. Although the VA and the private sector were comparable with respect to the quality measures used in this study, there is room for improvement in both systems. Treatment recommendations are based on the best available clinical evidence of effectiveness and safety. Quality of care might be improved

Comparative effectiveness research and medical informatics.

Science.gov (United States)

D'Avolio, Leonard W; Farwell, Wildon R; Fiore, Louis D

2010-12-01

As is the case for environmental, ecological, astronomical, and other sciences, medical practice and research finds itself in a tsunami of data. This data deluge, due primarily to the introduction of digitalization in routine medical care and medical research, affords the opportunity for improved patient care and scientific discovery. Medical informatics is the subdiscipline of medicine created to make greater use of information in order to improve healthcare. The 4 areas of medical informatics research (information access, structure, analysis, and interaction) are used as a framework to discuss the overlap in information needs of comparative effectiveness research and potential contributions of medical informatics. Examples of progress from the medical informatics literature and the Veterans Affairs Healthcare System are provided. Published by Elsevier Inc.

Veterans in substance abuse treatment program self-initiate box gardening as a stress reducing therapeutic modality.

Science.gov (United States)

Lehmann, Lauren P; Detweiler, Jonna G; Detweiler, Mark B

2018-02-01

To assess the experiences of a veteran initiated horticultural therapy garden during their 28-day inpatient Substance Abuse Residential Rehabilitation Treatment Program (SARRTP). Retrospective study. Veterans Affairs Medical Center (VAMC), Salem, Virginia, USA INTERVENTIONS: Group interviews with veterans from the last SARRTP classes and individual interviews with VAMC greenhouse staff in summer of 2016. Time spent in garden, frequency of garden visits, types of passive and active garden activities, words describing the veterans' emotional reactions to utilizing the garden. In 3 summer months of 2016, 50 percent of the 56 veterans interviewed visited and interacted with the gardens during their free time. Frequency of visits generally varied from 3 times weekly to 1-2 times a day. Amount of time in the garden varied from 10min to 2h. The veterans engaged in active and/or passive gardening activities during their garden visits. The veterans reported feeling "calm", "serene", and "refreshed" during garden visitation and after leaving the garden. Although data was secured only at the end of the 2016 growing season, interviews of the inpatient veterans revealed that they used their own initiative and resources to continue the horticulture therapy program for 2 successive growing years after the original pilot project ended in 2014. These non-interventionist, therapeutic garden projects suggest the role of autonomy and patient initiative in recovery programs for veterans attending VAMC treatment programs and they also suggest the value of horticulture therapy as a meaningful evidence- based therapeutic modality for veterans. Published by Elsevier Ltd.

Patient Ethnicity Affects Triage Assessments and Patient Prioritization in U.S. Department of Veterans Affairs Emergency Departments

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Vigil, Jacob M.; Coulombe, Patrick; Alcock, Joe; Kruger, Eric; Stith, Sarah S.; Strenth, Chance; Parshall, Mark; Cichowski, Sara B.

2016-01-01

Abstract Ethnic minority patients receive lower priority triage assignments in Veteran's Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment. The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses. A total of 359,642 patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans). This study provides evidence for systemic differences in how patients’ vital signs are applied for determining ESI scores for different ethnic groups. Additional prospective research will be needed to determine how this specific person-level mechanism affects healthcare quality and outcomes. PMID:27057847

Military veterans and Social Security.

Science.gov (United States)

Olsen, Anya

There are 9.4 million military veterans receiving Social Security benefits, which means that almost one out of every four adult Social Security beneficiaries has served in the United States military. In addition, veterans and their families make up almost 40 percent of the adult Social Security beneficiary population. Policymakers are particularly interested in military veterans and their families and have provided them with benefits through several government programs, including Social Security credits, home loan guarantees, and compensation and pension payments through the Department of Veterans Affairs. It is therefore important to understand the economic and demographic characteristics of this population. Information in this article is based on data from the March 2004 Current Population Survey, a large, nationally representative survey of U.S. households. Veterans are overwhelmingly male compared with all adult Social Security beneficiaries who are more evenly split between males and females. Military veterans receiving Social Security are more likely to be married and to have finished high school compared with all adult Social Security beneficiaries, and they are less likely to be poor or near poor than the overall beneficiary population. Fourteen percent of veterans receiving Social Security benefits have income below 150 percent of poverty, while 25 percent of all adult Social Security beneficiaries are below this level. The higher economic status among veterans is also reflected in the relatively high Social Security benefits they receive. The number of military veterans receiving Social Security benefits will remain high over the next few decades, while their make-up and characteristics will change. In particular, the number of Vietnam War veterans who receive Social Security will increase in the coming decades, while the number of veterans from World War II and the Korean War will decline.

Modeling veterans healthcare administration disclosure processes :

Energy Technology Data Exchange (ETDEWEB)

Beyeler, Walter E; DeMenno, Mercy B.; Finley, Patrick D.

2013-09-01

As with other large healthcare organizations, medical adverse events at the Department of Veterans Affairs (VA) facilities can expose patients to unforeseen negative risks. VHA leadership recognizes that properly handled disclosure of adverse events can minimize potential harm to patients and negative consequences for the effective functioning of the organization. The work documented here seeks to help improve the disclosure process by situating it within the broader theoretical framework of issues management, and to identify opportunities for process improvement through modeling disclosure and reactions to disclosure. The computational model will allow a variety of disclosure actions to be tested across a range of incident scenarios. Our conceptual model will be refined in collaboration with domain experts, especially by continuing to draw on insights from VA Study of the Communication of Adverse Large-Scale Events (SCALE) project researchers.

Hepatitis C Virus (HCV) Registry Veterans in VHA Care in 2015, for the Nation, by VISN and by Station

Data.gov (United States)

Department of Veterans Affairs — This report describes the number of Hepatitis C Virus (HCV) registry Veterans in VHA care in 2015 based on serologic evidence of HCV infection status (HCV Positive)...

Associations between subjective sleep quality and brain volume in Gulf War veterans.

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Chao, Linda L; Mohlenhoff, Brian S; Weiner, Michael W; Neylan, Thomas C

2014-03-01

To investigate whether subjective sleep quality is associated with brain volume independent of comorbid psychiatric conditions. Cross-sectional. Department of Veterans Affairs (VA) Medical Center. One hundred forty-four Gulf War Veterans (mean age 45 years; range: 31-70 years; 14% female). None. Total cortical, lobar gray matter, and hippocampal volumes were quantified from 1.5 Tesla magnetic resonance images using Freesurfer version 4.5. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regressions were used to determine the association of sleep quality with total and regional brain volumes. The global PSQI score was positively correlated with lifetime and current posttraumatic stress disorder (PTSD) and current depressive symptoms (P sleep quality. Poorer subjective sleep quality was associated with reduced total cortical and regional frontal lobe volumes independent of comorbid psychiatric conditions. Future work will be needed to examine if effective treatment of disturbed sleep leads to improved structural and functional integrity of the frontal lobes.

Veterans Affairs: Presumptive Service Connection and Disability Compensation

Science.gov (United States)

2011-03-28

aggravation of disease) and third element (nexus between in-service occurrence/aggravation of disease and current disease) of the prima facie case for...occurring within two years of separation from active duty military service. In the following years, additions to the presumptive list were made by...the change of mission for U.S. forces in Iraq. 4 Veterans Benefits Disability Commission, Honoring the Call to Duty : Veterans’ Disability Benefits in

Profile of Sheltered Homeless Veterans for Fiscal Years 2009 and 2010

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Department of Veterans Affairs — This brief uses data from the 2009 and 2010 Annual Homeless Assessment Reports (AHAR) to Congress. The reports were sponsored by the Department of Housing and Urban...

Regional variation in post-stroke multidisciplinary rehabilitation care among veteran residents in community nursing homes

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Jia H

2017-03-01

Full Text Available Huanguang Jia,1 Qinglin Pei,1 Charles T Sullivan,1 Diane C Cowper Ripley,1 Samuel S Wu,1 W Bruce Vogel,1 Xinping Wang,1 Douglas E Bidelspach,2 Jennifer L Hale-Gallardo,1 Barbara E Bates3 1Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL, 2Physical Medicine and Rehabilitation Service, Department of Veterans Affairs, Washington, DC, 3Aleda E. Lutz VA Medical Center, Saginaw, MI, USA Introduction: Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors’ functional recovery and daily living activities. The US Department of Veterans Affairs (VA places veterans needing post-acute institutional care in private community nursing homes (CNHs. These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans’ health services as well as the geographic variation of the service utilization. Aim: The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care. Methods: This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents for the study CNHs was linked with veterans’ inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation

Complementary and alternative medicine use among veterans with chronic noncancer pain

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Lauren M. Denneson, PhD; Kathryn Corson, PhD; Steven K. Dobscha, MD

2011-01-01

We describe prior use and willingness to try complementary and alternative medicine (CAM) among 401 veterans experiencing chronic noncancer pain and explore differences between CAM users and nonusers. Participants in a randomized controlled trial of a collaborative intervention for chronic pain from five Department of Veterans Affairs (VA) primary care clinics self-reported prior use and willingness to try chiropractic care, massage therapy, herbal medicines, and acupuncture. Prior CAM users ...

Collaborating across the Departments of Veterans Affairs and Defense to integrate mental health and chaplaincy services.

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Nieuwsma, Jason A; Jackson, George L; DeKraai, Mark B; Bulling, Denise J; Cantrell, William C; Rhodes, Jeffrey E; Bates, Mark J; Ethridge, Keith; Lane, Marian E; Tenhula, Wendy N; Batten, Sonja V; Meador, Keith G

2014-12-01

Recognizing that clergy and spiritual care providers are a key part of mental health care systems, the Department of Veterans Affairs (VA) and Department of Defense (DoD) jointly examined chaplains' current and potential roles in caring for veterans and service members with mental health needs. Our aim was to evaluate the intersection of chaplain and mental health care practices in VA and DoD in order to determine if improvement is needed, and if so, to develop actionable recommendations as indicated by evaluation findings. A 38-member multidisciplinary task group partnered with researchers in designing, implementing, and interpreting a mixed methods study that included: 1) a quantitative survey of VA and DoD chaplains; and 2) qualitative interviews with mental health providers and chaplains. Quantitative: the survey included all full-time VA chaplains and all active duty military chaplains (n = 2,163 completed of 3,464 invited; 62 % response rate). Qualitative: a total of 291 interviews were conducted with mental health providers and chaplains during site visits to 33 VA and DoD facilities. Quantitative: the online survey assessed intersections between chaplaincy and mental health care and took an average of 37 min to complete. Qualitative: the interviews assessed current integration of mental health and chaplain services and took an average of 1 h to complete. When included on interdisciplinary mental health care teams, chaplains feel understood and valued (82.8-100 % of chaplains indicated this, depending on the team). However, findings from the survey and site visits suggest that integration of services is often lacking and can be improved. Closely coordinating with a multidisciplinary task group in conducting a mixed method evaluation of chaplain-mental health integration in VA and DoD helped to ensure that researchers assessed relevant domains and that findings could be rapidly translated into actionable recommendations.

Improving Care for Veterans with PTSD: Comparing Risks and Benefits of Antipsychotics Versus Other Medications to Augment First-Line Pharmacologic Therapy

Science.gov (United States)

2017-10-01

Afghanistan Veterans  seen in VA care receiving this diagnosis. In addition to  counseling  therapies, several medications are effective in treating PTSD...disorder in Veterans, with nearly 1 in 3 returning Iraq and Afghanistan Veterans seen in VA care receiving this diagnosis. In addition to counseling ...than those prescribed non-antipsychotics. 4 Table 1: Characteristics by augmenting medication group Variable AAP (N=24,131) N (column %) NAP

Racial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study

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Duckworth William C

2006-05-01

Full Text Available Abstract Background Racial/ethnic disparities in cardiovascular disease complications have been observed in diabetic patients. We examined the association between race/ethnicity and cardiovascular disease risk factor control in a large cohort of insulin-treated veterans with type 2 diabetes. Methods We conducted a cross-sectional observational study at 3 Veterans Affairs Medical Centers in the American Southwest. Using electronic pharmacy databases, we randomly selected 338 veterans with insulin-treated type 2 diabetes. We collected medical record and patient survey data on diabetes control and management, cardiovascular disease risk factors, comorbidity, demographics, socioeconomic factors, psychological status, and health behaviors. We used analysis of variance and multivariate linear regression to determine the effect of race/ethnicity on glycemic control, insulin treatment intensity, lipid levels, and blood pressure control. Results The study cohort was comprised of 72 (21.3% Hispanic subjects (H, 35 (10.4% African Americans (AA, and 226 (67% non-Hispanic whites (NHW. The mean (SD hemoglobin A1c differed significantly by race/ethnicity: NHW 7.86 (1.4%, H 8.16 (1.6%, AA 8.84 (2.9%, p = 0.05. The multivariate-adjusted A1c was significantly higher for AA (+0.93%, p = 0.002 compared to NHW. Insulin doses (unit/day also differed significantly: NHW 70.6 (48.8, H 58.4 (32.6, and AA 53.1 (36.2, p Conclusion In our cohort, insulin-treated minority veterans, particularly AA, had poorer glycemic control and received lower doses of insulin than NHW. However, we found no differences for control of other cardiovascular disease risk factors. The diabetes treatment disparity could be due to provider behaviors and/or patient behaviors or preferences. Further research with larger sample sizes and more geographically diverse populations are needed to confirm our findings.

Family problems among recently returned military veterans referred for a mental health evaluation.

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Sayers, Steven L; Farrow, Victoria A; Ross, Jennifer; Oslin, David W

2009-02-01

Existing evidence suggests that military veterans with mental health disorders have poorer family functioning, although little research has focused on this topic. To test whether psychiatric symptoms are associated with family reintegration problems in recently returned military veterans. Cross-sectional survey of a clinical population. Respondents who were referred to behavioral health evaluation from April 2006 through August 2007 were considered for the survey. Philadelphia Veterans Affairs Medical Center, Pa. 199 military veterans who served in Iraq or Afghanistan after 2001 and were referred for behavioral health evaluation from primary care (mean age = 32.7 years, SD = 9.1). Measures included the Mini-International Neuropsychiatric Interview for psychiatric diagnoses, the 9-item Patient Health Questionnaire for depression diagnosis and severity, and screening measures of alcohol abuse and illicit substance use. A measure of military family readjustment problems and a screening measure of domestic abuse were developed for this study. Three fourths of the married/cohabiting veterans reported some type of family problem in the past week, such as feeling like a guest in their household (40.7%), reporting their children acting afraid or not being warm toward them (25.0%), or being unsure about their family role (37.2%). Among veterans with current or recently separated partners, 53.7% reported conflicts involving "shouting, pushing, or shoving," and 27.6% reported that this partner was "afraid of them." Depression and posttraumatic stress disorder symptoms were both associated with higher rates of family reintegration problems. Mental health problems may complicate veterans' readjustment and reintegration into family life. The findings suggest an opportunity to improve the treatment of psychiatric disorders by addressing family problems. Copyright 2009 Physicians Postgraduate Press, Inc.

Listening to the Patient: Women Veterans' Insights About Health Care Needs, Access, and Quality in Rural Areas.

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Brooks, Elizabeth; Dailey, Nancy K; Bair, Byron D; Shore, Jay H

2016-09-01

Many work to ensure that women veterans receive appropriate and timely health care, yet the needs of those living in rural areas are often ignored. This is a critical oversight given the multitude of reports documenting rural access problems and health disparities. Lacking this, we are unable to plan for and evaluate appropriate care for this specific group. In this project, we spoke with rural women veterans to document service needs and quality of care from their perspective. Rural women veterans' views about health care access and quality were ascertained in a series of five, semistructured focus groups (n = 35) and completion of a demographic questionnaire. Content analysis documented focus-group themes. Participants said that local dental, mental health, and gender-specific care options were needed, as well as alternative healing options. Community-based support for women veterans and interaction with female peers were absent. Participants' support for telehealth was mixed, as were requests for gender-specific care. Personal experiences in the military impacted participants' current service utilization. Action by both Veterans Affairs and the local community is vital to improving the health of women veterans. Service planning should consider additional Veterans Affairs contracts, mobile health vans, peer support, and enhanced outreach. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Impact of Supported Housing on Social Relationships Among Homeless Veterans.

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O'Connell, Maria J; Kasprow, Wesley J; Rosenheck, Robert A

2017-02-01

This study examined social network structure and function among a sample of 460 homeless veterans who participated in an experimental trial of the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program. Participants were randomly assigned to HUD-VASH (housing subsidies and case management), case management only, or standard care. Mixed-model longitudinal analysis was used to compare treatment groups on social network outcomes over 18 months. Veterans in HUD-VASH reported significantly greater increases in social support than veterans in the two other groups, as well as greater frequency of contacts, availability of tangible and emotional support, and satisfaction with nonkin relationships over time. These gains largely involved relationships with providers and other veterans encountered in treatment. Supported housing may play a pivotal role in fostering constructive new relationships with persons associated with service programs but may have a more limited impact on natural support networks.

Where Do Soldiers Really Come From? A Faculty Development Workshop on Veteran-Centered Care.

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Lypson, Monica L; Ross, Paula T; Zimmerman, Natalie; Goldrath, Kathryn E; Ravindranath, Divy

2016-10-01

Addressing the medical concerns of veterans in both civilian health care systems and the Veterans Affairs (VA) health care system, where staff are familiar with issues of military reintegration, remains difficult but is increasingly important. In 2013, the authors developed and implemented a faculty development workshop for practicing clinicians using the documentary Where Soldiers Come From. The workshop included topics on unconscious bias, the service member trajectory, health care disparities, and strategies for overcoming barriers to treating veterans with posttraumatic stress disorder and traumatic brain injury. The workshop engaged faculty in the following active-learning techniques: images in education; trigger video; critical thinking and reflective writing; think-pair-share; and large-group discussion. The workshop has been conducted at three locations with 46 health care professionals. Thirty-one of 37 (84%) participants who completed the workshop evaluation were VA employees. The evaluation results show 25/32 (78.1%) participants indicated the workshop activities changed their knowledge, attitudes, and/or skills; 22/34 (64.7%) stated they had a better understanding of how to develop a care plan for veterans; and 27/34 (79.4%) stated they gained a better understanding of how to prepare for issues around returning veterans. To address the issue of veteran-centered care education more broadly, the authors have developed a massive open online course for health professionals, using most of the content from this workshop, which will be offered in spring 2016. Another important next step will be to deliver this workshop to and collect evaluation data from non-VA providers.

Variation in Postsepsis Readmission Patterns: A Cohort Study of Veterans Affairs Beneficiaries

Science.gov (United States)

2017-01-01

Rationale: Rehospitalization is common after sepsis, but little is known about the variation in readmission patterns across patient groups and care locations. Objectives: To examine the variation in postsepsis readmission rates and diagnoses by patient age, nursing facility use, admission year, and hospital among U.S. Veterans Affairs (VA) beneficiaries. Methods: Observational cohort study of VA beneficiaries who survived a sepsis hospitalization (2009–2011) at 114 VA hospitals, stratified by age (readmission after sepsis hospitalization and proportion of readmissions resulting from specific diagnoses, including the proportion of “potentially preventable” readmissions. Readmission diagnoses were similar from 2009 to 2011, with little variation in readmission rates across hospitals. The top six readmission diagnoses (heart failure, pneumonia, sepsis, urinary tract infection, acute renal failure, and chronic obstructive pulmonary disease) accounted for 30% of all readmissions. Although about one in five readmissions had a principal diagnosis for infection, 58% of all readmissions received early systemic antibiotics. Infection accounted for a greater proportion of readmissions among patients discharged to nursing facilities compared with patients discharged to home (25.0–27.1% vs. 16.8%) and among older vs. younger patients (22.2% vs. 15.8%). Potentially preventable readmissions accounted for a quarter of readmissions overall and were more common among older patients and patients discharged to nursing facilities. Conclusions: Hospital readmission rates after sepsis were similar by site and admission year. Heart failure, pneumonia, sepsis, and urinary tract infection were common readmission diagnoses across all patient groups. Readmission for infection and potentially preventable diagnoses were more common in older patients and patients discharged to nursing facilities. PMID:27854510

Veterans Health Care: Improvements Needed in Operationalizing Strategic Goals and Objectives

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2016-10-01

sess. (2016) (statement of Robert McDonald , Secretary, U.S. Department of Veterans Affairs). The other priorities include delivering a unified veteran...posted products, go to http://www.gao.gov and select “E-mail Updates.” The price of each GAO publication reflects GAO’s actual cost of production...and distribution and depends on the number of pages in the publication and whether the publication is printed in color or black and white. Pricing and

Off-Label Prescribing of Second-Generation Antipsychotics to Elderly Veterans with Posttraumatic Stress Disorder and Dementia.

Science.gov (United States)

Semla, Todd P; Lee, Austin; Gurrera, Ronald; Bajor, Laura; Li, Mingfei; Miller, Donald R; Smith, Eric G; Wang, Chao; Wan, Yun; Kazis, Lewis E; Bauer, Mark S

2017-08-01

To determine whether elderly veterans with posttraumatic stress disorder (PTSD) and dementia are more likely to be prescribed second-generation antipsychotics (SGAs) than those with PTSD alone. National serial cross-sectional study. Veterans Health Affairs inpatient and outpatient settings. Veterans aged 65 and older with PTSD (excluding schizophrenia or bipolar disorder) with or without concomitant dementia who received care from the Veterans Health Administration between 2003 and 2010 were identified using International Classification of Diseases, Ninth Revision, codes (N = 93,068; 11.1% with dementia). Trends in SGA prescribing and odds of being prescribed an SGA were determined using a multivariable logistic regression model adjusted for clinical, sociodemographic, and geographic covariates. Between 2004 and 2009, SGA prescribing declined annually from 7.0% to 5.1% of elderly veterans with PTSD without dementia and 13.2% to 8.9% in those with dementia; findings over time consistently indicated that veterans with PTSD and dementia had at least twice the odds of being prescribed an SGA as those without PTSD (odds ratios 2.03 (95% confidence interval (CI) = 1.82-2.26) to 2.33 (95% CI = 2.10-2.58). Although the prescribing of SGAs to elderly veterans with PTSD has decreased, prescribing an SGA to those with dementia remained consistently higher than for those with PTSD alone and is problematic given the high prevalence of medical comorbidities in this aging population coupled with the lack of compelling evidence for effectiveness of SGAs in individuals with dementia. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Veterans Affairs: Better Understanding Needed to Enhance Services to Veterans Readjusting to Civilian Life

Science.gov (United States)

2014-09-01

Psychosomatics , vol. 51, no. 6 (Nov. - Dec. 2010): 505. 21 D. Baker, P. Heppner, N. Afari, S. Nunnink, M. Kilmer, A. Simmons, L. Harder, and B. Bosse, “Trauma...Psychiatric, and Alcohol-Related Disorders Among Veterans Returning from Iraq and Afghanistan,” Psychosomatics , vol. 51, no. 6 (Nov. - Dec. 2010): 503...September 28, 2012. Defense Health: Coordinating Authority Needed for Psychological Health and Traumatic Brain Injury Activities. GAO-12-154

Veteran Family Reintegration: Strategic Insights to Inform Stakeholders’ Efforts

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Raun L Lazier

2016-04-01

Full Text Available In 2015, the Department of Veterans Affairs Office of Policy and Planning convened the first of its kind forum to inform stakeholders about national policy needs to advance the outcomes for veterans and their families as they reintegrate back to civilian life after military service. This article reports of the proceedings of the forum, which brought together more than 30 participants from across the federal government, private sector, nongovernmental organizations, and academic institutions. During the forum, participants discussed the need for a conceptual framework and standard lexicon to support veteran family reintegration policy and strategy. Forum participants highlighted the importance of a collaborative relationship between researchers and policy makers, and identified research gaps and emerging topics that will help inform national reintegration outcomes.

Student Veteran perceptions of facilitators and barriers to achieving academic goals.

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Norman, Sonya B; Rosen, Jay; Himmerich, Sara; Myers, Ursula S; Davis, Brittany; Browne, Kendall C; Piland, Neill

2015-01-01

According to recent estimates, over 1 million Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans are utilizing the post-9/11 GI Bill to pursue higher education. Data collected by the Department of Defense suggests that greater than 17% of returning Veterans may suffer from mental and physical health disorders, which can negatively affect school performance. The current study explored student Veterans' perceived facilitators and barriers to achieving academic goals. Thirty-one student Veterans completed self-report measures and interviews. Results suggested that Veterans that were reporting problems or symptoms in one mental or physical health domain were likely to be reporting symptoms or problems in others as well. The interview data were coded, and three overarching themes related to barriers and facilitators emerged: person features (e.g., discipline and determination, symptoms and stressors), institutional structure (i.e., what schools and the Department of Veterans Affairs do that was perceived to help or hinder student Veteran success), and policy concerns (i.e., how the structure of the GI Bill affects student Veteran school experience). Results from this research indicate the need for larger studies and program development efforts aimed at enhancing academic outcomes for Veterans.

38 CFR 17.81 - Contracts for residential treatment services for veterans with alcohol or drug dependence or...

Science.gov (United States)

2010-07-01

... treatment services for veterans with alcohol or drug dependence or abuse disabilities. 17.81 Section 17.81... dependence or abuse disabilities. (a) Contracts for treatment services authorized under § 17.80(a) may be... Department of Veterans Affairs sponsored residents to adjust to and maintain freedom from dependence on or...

Predictors of cognitive decline in older adult type 2 diabetes from the Veterans Affairs Diabetes Trial

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Mark Zimering

2016-09-01

Full Text Available Aims: Cognitive decline disproportionately affects older adult type 2 diabetes. We tested whether randomized intensive glucose-lowering reduces the rate(s of cognitive decline in adults with advanced type 2 diabetes (mean: age, 60 years; diabetes duration, 11 years from the Veterans Affairs Diabetes Trial. Methods: A battery of neuropsychological tests (digit span, digit symbol substitution (DSym, and Trails-making Part B (TMT-B was administered at baseline in ~1700 participants and repeated at year 5. Thirty-six risk factors were evaluated as predictors of cognitive decline in multivariable regression analyses.Results: The mean age-adjusted, DSym or TMT-B declined significantly in all study participants (P < 0.001. Randomized intensive glucose-lowering did not significantly alter the rate of cognitive decline. The final model of risk factors associated with 5-year decline in age-adjusted TMT-B included as significant predictors: longer baseline diabetes duration (beta = -0.028; P = 0.0057, lower baseline diastolic blood pressure (beta = 0.028; P < 0.001, and baseline calcium channel blocker medication use (beta = -0.639; P < 0.001. Higher baseline pulse pressure was significantly associated with decline in age-adjusted TMT-B suggesting a role for both higher systolic and lower diastolic blood pressure. Baseline thiazide diuretic use (beta= -0.549; P =0.015 was an additional significant predictor of 5-year decline in age-adjusted digit symbol score. Post-baseline systolic blood pressure-lowering was significantly associated (P < 0.001 with decline in TMT-B performance. There was a significant inverse association between post-baseline plasma triglyceride- lowering (P = 0.045 and decline in digit symbol substitution task performance.Conclusions: A five-year period of randomized intensive glucose-lowering did not significantly reduce the rate of cognitive decline in older-aged adults with type 2 diabetes. Systolic and diastolic blood pressure as

A Study to Develop Alternative Approaches for Implementing Product Line Management in the South Texas Veterans Health Care System

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1997-05-01

Transformation of the Veterans Healthcare System." Department of Veterans Affairs, Washington, D.C., March, 1996. 88 Kotler , Philip. "Managing...Avenue Biloxi MS 39531 Baltimore VAMC ION Green Street Baltimore MD 21201 Battle Creek VAMC 5500 Armstrong Road Battle Creek MI 49016 Bedford

A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans.

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Navid Ghaffarzadegan

Full Text Available Post-traumatic stress disorder (PTSD stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a "system of systems." This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources. The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed.

A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans

Science.gov (United States)

Ghaffarzadegan, Navid; Ebrahimvandi, Alireza; Jalali, Mohammad S.

2016-01-01

Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a “system of systems.” This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed. PMID:27716776

Outcomes after cataract surgery in eyes with pseudoexfoliation: Results from the Veterans Affairs Ophthalmic Surgery Outcomes Data Project.

Science.gov (United States)

Turalba, Angela; Cakiner-Egilmez, Tulay; Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Chomsky, Amy S; Vollman, David E; Baze, Elizabeth F; Lawrence, Mary G; Daly, Mary K

2017-02-01

To compare clinical outcomes of cataract surgery in eyes with and without pseudoexfoliation (PXF). Retrospective deidentified data analysis. A total of 123 PXF and 4776 non-PXF eyes of patients who underwent cataract surgery. We compared data on visual acuity, Visual Function Questionnaire (VFQ)-based quality of life, and complications in PXF and non-PXF eyes from the Veterans Affairs (VA) Ophthalmic Surgery Outcomes Data Project across 5 VA medical centres. Pupillary expansion devices were used in 31 (25.2%) PXF cases and 398 (8.4%) non-PXF cases (p < 0.0001). Capsular tension rings were used in 6 (4.9%) PXF cases and 55 (1.2%) non-PXF cases (p < 0.004). The following complications occurred more frequently in PXF cases: zonular dehiscence without vitrectomy (4 [3.3%] PXF cases vs 40 [0.8%] non-PXF cases p = 0.02), persistent inflammation (28 [24.1%] vs 668 [14.5%]; p = 0.007), and persistent intraocular pressure elevation (5 [4.3%] vs 68 [1.5%]; p = 0.03). Best corrected visual acuity (BCVA) improved in both groups after 1 month, but 87 (83.7%) PXF cases achieved postoperative BCVA better than or equal to 20/40 compared to 3991 (93.8%) non-PXF cases (p = 0.0003). There was no significant difference in the postoperative composite VFQ scores between PXF (82.1 ± 16.9) and non-PXF cases (84.2 ± 16.8, p = 0.09). Several complications occurred more frequently in the PXF group compared to the non-PXF group, and fewer PXF cases achieved BCVA better than or equal to 20/40. Despite this, both groups experienced similar improvement in vision-related quality of life after cataract surgery. Published by Elsevier Inc.

Utility of home sleep apnea testing in high-risk veterans.

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Cairns, Alyssa; Sarmiento, Kathleen; Bogan, Richard

2017-09-01

Many Veterans Affairs Medical Centers (VAMCs) have implemented home sleep apnea testing (HSAT) in lieu of traditional in-lab testing to establish a timely and cost-sensitive diagnosis of obstructive sleep apnea (OSA). However, concern remains for the sensitivity and specificity of said technology in this population as many veterans are at increased risk for many of the comorbid conditions that can limit the accuracy of HSAT results. Hence, the purpose of this study is to evaluate rate of incongruent outcomes (e.g., negative HSAT results despite high clinical symptomology) as well as differences in study quality metrics and predictors of OSA between veteran sleep patients and general sleep patients being evaluated by a home sleep test. A random sample of HSAT outcomes from 1500 veterans and 1500 general sleep clinic patients was retrieved from a repository of anonymized HSAT outcomes from 2009 to 2013. General sleep clinic data were from patients referred for home sleep testing from a variety of clinical practices across North America, whereas VAMC patients were tested using a central dissemination process. All patients were tested for OSA using the Apnea Risk and Evaluation System (ARES), an HSAT that simultaneously records airflow, pulse oximetry, snoring, accelerometry, and EEG. Sample differences and rates of comorbidities, HSAT outcomes, predictors of OSA, and pretest OSA risk information were evaluated between groups. The presence of OSA was defined as an apnea-hypopnea index (AHI; using 4% desaturation criterion) of ≥5 and ≥15 events per hour. Sample differences in predictors of OSA were evaluated using logistic multiple regression. Veterans (91.3% male) were more likely to report comorbidities, especially depression, insomnia, hypertension, diabetes, restless legs syndrome (RLS), and use of sleep and pain medications compared to general sleep clinic patients (57.1% male). Despite differences in the rate of medical comorbidities, no differences were

Barriers and facilitators to providing primary care-based weight management services in a patient centered medical home for Veterans: a qualitative study.

Science.gov (United States)

Jay, Melanie; Chintapalli, Sumana; Squires, Allison; Mateo, Katrina F; Sherman, Scott E; Kalet, Adina L

2015-11-14

Obesity is highly prevalent among Veterans. In the United States, the Veterans Health Administration (VHA) offers a comprehensive weight management program called MOVE!. Yet, fewer than 10 % of eligible patients ever attend one MOVE! visit. The VHA has a patient-centered medical home (PCMH) model of primary care (PC) called Patient-Aligned Care Teams (PACT) at all Veterans Affairs (VA) Medical Centers. PACT teamlets conduct obesity screening, weight management counseling, and refer to MOVE!. As part of a needs assessment to improve delivery of weight management services, the purpose of this study was to assess PACT teamlet and MOVE! staff: 1) current attitudes and perceptions regarding obesity care; 2) obesity-related counseling practices 3) experiences with the MOVE! program; and 4) targets for interventions to improve implementation of obesity care in the PC setting. We recruited 25 PACT teamlet members from a single VA study site-11 PC physicians, 5 registered nurses, 5 licensed practical nurses, 1 clerical assistant, and 3 MOVE! staff (2 dietitians, 1 psychologist)-for individual interviews using a combination of convenience and snowball sampling. Audio recorded interviews were professionally transcribed and iteratively coded by two independent reviewers. The analytic process was guided by discourse analysis in order to discover how the participants perceived and provided weight management care and what specific attitudes affected their practices, all as bounded within the organization. Emerging themes included: 1) role perceptions, 2) anticipated outcomes of weight management counseling and programs, and 3) communication and information dissemination. Perceived role among PCPs was influenced by training, whereas personal experience with their own weight management impacted role perception among LPNs/RNs. Attitudes about whether or not they could impact patients' weight outcomes via counseling or referral to MOVE! varied. System-level communication about VHA

Long-Term Neurobehavioral Symptoms and Return to Productivity in Operation Enduring Freedom/Operation Iraqi Freedom Veterans With and Without Traumatic Brain Injury.

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Mortera, Marianne H; Kinirons, Stacy A; Simantov, Jessie; Klingbeil, Heidi

2018-02-01

To describe Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans who underwent the Comprehensive Traumatic Brain Injury Evaluation (CTBIE), differences between the traumatic brain injury (TBI) and non-TBI subgroups, and factors associated with return to productivity (RTP). Retrospective medical record review. Medical center. Medical records of OEF/OIF veterans (N=236) who underwent the CTBIE between 2009 and 2013. Not applicable. Demographic characteristics, injury history, clinical presentation, and factors associated with RTP. Veteran sample included 90.7% men, was 45.3% white and 34.7% black, with half of Hispanic origin, and had a mean age of 33 years. The mean time since injury was approximately 4 years. Reported symptoms were high, with >90% reporting anxiousness, irritability, sleep difficulty, forgetfulness, and headaches. TBI diagnosis was found in 163 veterans (69%). The TBI subgroup was younger (TBI: 32.5y vs non-TBI: 34.9y; P=.02), reported a greater number of injuries (P<.001), and had significantly higher rates of half of the reported symptoms. Greatest differences were noted with forgetfulness (TBI: 95.7% vs non-TBI: 79.5%; P<.001), poor concentration (TBI: 90.2% vs non-TBI: 76.7%; P=.007), and headaches (TBI: 93.9% vs non-TBI: 83.6%; P=.014). RTP was 60.6% for the total veteran population. Factors associated with RTP were race (white) (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.13-3.55; P=.018), sensitivity to light (OR, 2.58; 95% CI, 1.17-5.66; P=.018), and fatigue (OR, 3.68; 95% CI, 1.51-8.95; P=.004). Veterans that did RTP were 3 times less likely to report depression (OR, .32; 95% CI, .12-.85; P=.022). Veterans reported a substantial number of lingering symptoms, with a higher prevalence in veterans with TBI. Veterans with reported depression were less likely to RTP. Future research should focus on the relation between depression and non-RTP and the effectiveness of Department of Veterans Affairs services. Copyright

A comparison of HAART outcomes between the US military HIV Natural History Study (NHS and HIV Atlanta Veterans Affairs Cohort Study (HAVACS.

Directory of Open Access Journals (Sweden)

Jodie L Guest

Full Text Available INTRODUCTION: The Department of Defense (DoD and the Department of Veterans Affairs (VA provide comprehensive HIV treatment and care to their beneficiaries with open access and few costs to the patient. Individuals who receive HIV care in the VA have higher rates of substance abuse, homelessness and unemployment than individuals who receive HIV care in the DoD. A comparison between individuals receiving HIV treatment and care from the DoD and the VA provides an opportunity to explore the impact of individual-level characteristics on clinical outcomes within two healthcare systems that are optimized for clinic retention and medication adherence. METHODS: Data were collected on 1065 patients from the HIV Atlanta VA Cohort Study (HAVACS and 1199 patients from the US Military HIV Natural History Study (NHS. Patients were eligible if they had an HIV diagnosis and began HAART between January 1, 1996 and June 30, 2010. The analysis examined the survival from HAART initiation to all-cause mortality or an AIDS event. RESULTS: Although there was substantial between-cohort heterogeneity and the 12-year survival of participants in NHS was significantly higher than in HAVACS in crude analyses, this survival disparity was reduced from 21.5% to 1.6% (mortality only and 26.8% to 4.1% (combined mortality or AIDS when controlling for clinical and demographic variables. CONCLUSION: We assessed the clinical outcomes for individuals with HIV from two very similar government-sponsored healthcare systems that reduced or eliminated many barriers associated with accessing treatment and care. After controlling for clinical and demographic variables, both 12-year survival and AIDS-free survival rates were similar for the two study cohorts who have open access to care and medication despite dramatic differences in socioeconomic and behavioral characteristics.

Translating standards into practice: experience and lessons learned at the Department of Veterans Affairs.

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Bouhaddou, Omar; Cromwell, Tim; Davis, Mike; Maulden, Sarah; Hsing, Nelson; Carlson, David; Cockle, Jennifer; Hoang, Catherine; Fischetti, Linda

2012-08-01

The increased need for interoperable electronic health records in health care organizations underscores the importance of standards. The US Department of Veterans Affairs (VA) has a long history of developing and adopting various types of health care data standards. The authors present in detail their experience in this domain. A formal organization within VA is responsible for helping to develop and implement standards. This group has produced a Standards Life Cycle (SLC) process endorsed by VA key business and information technology (IT) stakeholders. It coordinates the identification, description, and implementation of standards aligned with VA business requirements. In this paper, we review the adoption of four standards in the categories of security and privacy, terminology, health information exchange, and modeling tools; emphasizing the implementation approach used in each. In our experience, adoption is facilitated by internal staff with expertise in standards development and adoption. Use of processes such as an SLC and tools such as an enterprise requirement repository help formally track and ensure that IT development and acquisition incorporate these standards. An organization should adopt standards that are aligned with its business priorities and favor those that are more readily implementable. To assist with this final point, we offer a standard "Likelihood of Adoption Scale," which changes as standards specifications evolve from PDF documents only, to PDF documents with construction and testing tools, to fully functional reference implementations. Copyright © 2012 Elsevier Inc. All rights reserved.

VA Health Care: VA Spends Millions on Post-Traumatic Stress Disorder Research and Incorporates Research Outcomes into Guidelines and Policy for Post-Traumatic Stress Disorder Services

Science.gov (United States)

2011-01-01

post - traumatic stress disorder ( PTSD ) and...Veterans Affairs (VA) Intramural Post - Traumatic Stress Disorder ( PTSD ) Research Funding and VA’s Medical and Prosthetic Research Appropriation...Table 6: Department of Veterans Affairs (VA) Research Centers and Programs That Conduct or Support Post - Traumatic Stress Disorder ( PTSD ) Research

Improving diabetes medication adherence: successful, scalable interventions

Directory of Open Access Journals (Sweden)

Zullig LL

2015-01-01

Full Text Available Leah L Zullig,1,2 Walid F Gellad,3,4 Jivan Moaddeb,2,5 Matthew J Crowley,1,2 William Shrank,6 Bradi B Granger,7 Christopher B Granger,8 Troy Trygstad,9 Larry Z Liu,10 Hayden B Bosworth1,2,7,11 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University, Durham, NC, USA; 3Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, PA, USA; 4Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; 5Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA; 6CVS Caremark Corporation; 7School of Nursing, Duke University, Durham, NC, USA; 8Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; 9North Carolina Community Care Networks, Raleigh, NC, USA; 10Pfizer, Inc., and Weill Medical College of Cornell University, New York, NY, USA; 11Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA Abstract: Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US healthcare system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population. We identify key characteristics that make these interventions effective and scalable. This information is intended to inform healthcare systems seeking proven, low resource, cost-effective solutions to improve medication adherence. Keywords: medication adherence, diabetes mellitus, chronic disease, dissemination research

MMPI-2 Symptom Validity (FBS) Scale: psychometric characteristics and limitations in a Veterans Affairs neuropsychological setting.

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Gass, Carlton S; Odland, Anthony P

2014-01-01

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Symptom Validity (Fake Bad Scale [FBS]) Scale is widely used to assist in determining noncredible symptom reporting, despite a paucity of detailed research regarding its itemmetric characteristics. Originally designed for use in civil litigation, the FBS is often used in a variety of clinical settings. The present study explored its fundamental psychometric characteristics in a sample of 303 patients who were consecutively referred for a comprehensive examination in a Veterans Affairs (VA) neuropsychology clinic. FBS internal consistency (reliability) was .77. Its underlying factor structure consisted of three unitary dimensions (Tiredness/Distractibility, Stomach/Head Discomfort, and Claimed Virtue of Self/Others) accounting for 28.5% of the total variance. The FBS's internal structure showed factoral discordance, as Claimed Virtue was negatively related to most of the FBS and to its somatic complaint components. Scores on this 12-item FBS component reflected a denial of socially undesirable attitudes and behaviors (Antisocial Practices Scale) that is commonly expressed by the 1,138 males in the MMPI-2 normative sample. These 12 items significantly reduced FBS reliability, introducing systematic error variance. In this VA neuropsychological referral setting, scores on the FBS have ambiguous meaning because of its structural discordance.

Long-term effects of military service on mental health among veterans of the Vietnam War era.

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Brooks, Matthew S; Laditka, Sarah B; Laditka, James N

2008-06-01

Comparing outcomes of veterans who served in Vietnam and those who served elsewhere, we examined treatment of post-traumatic stress disorder, treatment of other mental health conditions, psychiatric treatment location, and six mental health well-being measures. The analytic sample consisted of nationally representative data from the 2001 National Survey of Veterans. Analyses included multivariate logistic regression that controlled for sociodemographic characteristics. Of Vietnam War-era veterans in the National Survey of Veterans (N = 7,914), 3,937 served in Vietnam and 3,977 served elsewhere. These veterans were stratified into or = 60 years of age (N = 1,766). Veterans who served in Vietnam had notably poorer mental health than did those who served elsewhere. There were striking mental health differences between younger and older veterans; younger veterans had substantially worse measures of mental health. These results suggest greater resource needs among younger Vietnam War veterans. Clinicians and the Department of Veterans Affairs should focus on mental health services for younger veterans.

A Descriptive Study of Veteran Students Attending The University of South Carolina, Fall 1975. No. 30-76.

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Thurber, Robert G.; And Others

The Office of Veteran Student Affairs (OVSA) at the University of South Carolina serves a total population of 3,310 veteran students. This survey, conducted during the fall semester of 1975, was designed to obtain data about the personal background of the respondents, their attitudes toward the services provided by the several offices serving…

Innovation in a Learning Health Care System: Veteran-Directed Home- and Community-Based Services.

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Garrido, Melissa M; Allman, Richard M; Pizer, Steven D; Rudolph, James L; Thomas, Kali S; Sperber, Nina R; Van Houtven, Courtney H; Frakt, Austin B

2017-11-01

A path-breaking example of the interplay between geriatrics and learning healthcare systems is the Veterans Health Administration's (VHA's) planned roll-out of a program for providing participant-directed home- and community-based services to veterans with cognitive and functional limitations. We describe the design of a large-scale, stepped-wedge, cluster-randomized trial of the Veteran-Directed Home- and Community-Based Services (VD-HCBS) program. From March 2017 through December 2019, up to 77 Veterans Affairs Medical Centers will be randomized to times to begin offering VD-HCBS to veterans at risk of nursing home placement. Services will be provided to community-dwelling participants with support from Aging and Disability Network Agencies. The VHA Partnered Evidence-based Policy Resource Center (PEPReC) is coordinating the evaluation, which includes collaboration from operational stakeholders from the VHA and Administration for Community Living and interdisciplinary researchers from the Center of Innovation in Long-Term Services and Supports and the Center for Health Services Research in Primary Care. For older veterans with functional limitations who are eligible for VD-HCBS, we will evaluate health outcomes (hospitalizations, emergency department visits, nursing home admissions, days at home) and healthcare costs associated with VD-HCBS availability. Learning healthcare systems facilitate diffusion of innovation while enabling rigorous evaluation of effects on patient outcomes. The VHA's randomized rollout of VD-HCBS to veterans at risk of nursing home placement is an example of how to achieve these goals simultaneously. PEPReC's experience designing an evaluation with researchers and operations stakeholders may serve as a framework for others seeking to develop rapid, rigorous, large-scale evaluations of delivery system innovations targeted to older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

The Veteran-Initiated Electronic Care Coordination: A Multisite Initiative to Promote and Evaluate Consumer-Mediated Health Information Exchange.

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Klein, Dawn M; Pham, Kassi; Samy, Leila; Bluth, Adam; Nazi, Kim M; Witry, Matthew; Klutts, J Stacey; Grant, Kathleen M; Gundlapalli, Adi V; Kochersberger, Gary; Pfeiffer, Laurie; Romero, Sergio; Vetter, Brian; Turvey, Carolyn L

2017-04-01

Information continuity is critical to person-centered care when patients receive care from multiple healthcare systems. Patients can access their electronic health record data through patient portals to facilitate information exchange. This pilot was developed to improve care continuity for rural Veterans by (1) promoting the use of the Department of Veterans Affairs (VA) patient portal to share health information with non-VA providers, and (2) evaluating the impact of health information sharing at a community appointment. Veterans from nine VA healthcare systems were trained to access and share their VA Continuity of Care Document (CCD) with their non-VA providers. Patients and non-VA providers completed surveys on their experiences. Participants (n = 620) were primarily older, white, and Vietnam era Veterans. After training, 78% reported the CCD would help them be more involved in their healthcare and 86% planned to share it regularly with non-VA providers. Veterans (n = 256) then attended 277 community appointments. Provider responses from these appointments (n = 133) indicated they were confident in the accuracy of the information (97%) and wanted to continue to receive the CCD (96%). Ninety percent of providers reported the CCD improved their ability to have an accurate medication list and helped them make medication treatment decisions. Fifty percent reported they did not order a laboratory test or another procedure because of information available in the CCD. This pilot demonstrates feasibility and value of patient access to a CCD to facilitate information sharing between VA and non-VA providers. Outreach and targeted education are needed to promote consumer-mediated health information exchange.

Research on PTSD prevalence in OEF/OIF Veterans: expanding investigation of demographic variables

OpenAIRE

Averill, Lynnette A.; Fleming, CJ Eubanks; Holens, Pamela L.; Larsen, Sadie E.

2015-01-01

Background: A series of recent articles has reported on well-designed studies examining base rates of posttraumatic stress disorder (PTSD) screenings within the Operation Enduring Freedom (Afghanistan conflict)/Operation Iraqi Freedom (Iraq conflict) (OEF/OIF) military population. Although these studies have a number of strengths, this line of research points out several key areas in need of further examination.Objective: Many OEF/OIF Veterans do not use available Veterans Affairs (VA) servic...

Understanding the health of veterans who are homeless: A review of the literature.

Science.gov (United States)

Weber, Jillian; Lee, Rebecca C; Martsolf, Donna

2017-09-01

The United States Department of Housing and Urban Development estimates that almost 50,000 veterans are homeless on any given night. Homeless veterans are at greater risk of health disparities than their housed counterparts due to the multifactorial nature of their health and social needs. The Department of Veterans Affairs, in collaboration with more than a dozen other federal agencies, has concentrated efforts to improve the health of this vulnerable population while enacting a plan to eliminate veteran homelessness within the near future. Understanding the unique health needs of veterans who are homeless allows the profession of nursing to better support these efforts. The purpose of this literature review was to provide comprehensive knowledge to nurses about the health of homeless veterans for their use in clinical practice, research, and in contributing to the positive health outcomes for this vulnerable population. © 2017 Wiley Periodicals, Inc.

77 FR 16898 - Genomic Medicine Program Advisory Committee, Notice of Meeting

Science.gov (United States)

2012-03-22

... protecting the privacy of Veterans. The meeting focus will be on policies, regulations, and implications for... Secretary of Veterans Affairs on using genetic information to optimize medical care of Veterans, and to...

Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing.

Science.gov (United States)

Fried, Terri R; Niehoff, Kristina M; Street, Richard L; Charpentier, Peter A; Rajeevan, Nallakkandi; Miller, Perry L; Goldstein, Mary K; O'Leary, John R; Fenton, Brenda T

2017-10-01

To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. Randomized clinical trial. Primary care clinics at a Veterans Affairs Medical Center. Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128). TRIM extracts information on medications and chronic conditions from the EHR and contains data entry screens for information obtained from brief chart review and telephonic patient assessment. These data serve as input for automated algorithms identifying medication reconciliation discrepancies, potentially inappropriate medications (PIMs), and potentially inappropriate regimens. Clinician feedback reports summarize discrepancies and provide recommendations for deprescribing. Patient feedback reports summarize discrepancies and self-reported medication problems. Primary: subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) related to shared decision-making; clinician and patient communication. Secondary: changes in medications. 29.7% of TRIM participants and 15.6% of control participants provided the highest PACIC ratings; this difference was not significant. Adjusting for covariates and clustering of patients within clinicians, TRIM was associated with significantly more-active patient communication and facilitative clinician communication and with more medication-related communication among patients and clinicians. TRIM was significantly associated with correction of medication discrepancies but had no effect on number of medications or reduction in PIMs. TRIM improved communication about medications and accuracy of documentation. Although there was no association with prescribing, the small sample size provided limited power to examine medication-related outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The

Mail-order pharmacy experience of veterans living with AIDS/HIV.

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Desai, Karishma Rohanraj; Chewning, Betty; Wilcox, Andrew; Safdar, Nasia

2018-02-01

The VA system is the largest single provider of healthcare in the United States and to individuals infected with HIV specifically. High quality medication management is particularly important since HIV is a chronic infectious condition which requires taking multiple medications with strict requirements for adherence to medication regimens. Veterans Administration (VA) patients are required to obtain all chronic medications using the VA mail-order pharmacy system. Drawing on Donabedian's Quality Improvement framework, this study sought to examine experiences that Veterans with HIV have with the Veterans Administration medication mail-order system, and to explore opportunities for quality improvement. A sequential, explanatory mixed-methods design was used to interview Veterans receiving care at a Midwestern Veterans Administration Hospital using a mail-order experience survey followed by in-depth interviews. All 57 Veterans, out of 72, who were successfully contacted consented to participate. Overall, Veterans evaluated the mail-order service positively and valued the accuracy (correct medication delivery). However, a notable problem emerged with respect to assuring access to HIV medications with about half (47%) indicating running out of HIV medication. Respondents identified structural issues with respect to days covered by mailed medications (90 versus current 30 days) and process issues with scheduling new refills. Veterans also indicated the information sheets were too long, complex and not helpful for their queries. Patients were open to pharmacists playing an active role during clinic visits and felt this would help manage their conditions better. Veterans generally reported that the VA Mail-order service was of high quality. However, some findings indicate there are opportunities to improve this service to be more patient-centered particularly for vulnerable HIV patients. Copyright © 2017 Elsevier Inc. All rights reserved.

The health and wellbeing needs of veterans: a rapid review.

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Oster, Candice; Morello, Andrea; Venning, Anthony; Redpath, Paula; Lawn, Sharon

2017-12-29

For the majority of serving members, life in the military has a positive effect on wellbeing. However, the type, intensity and duration of service, along with the transition from fulltime military to civilian life, may have a negative effect on veterans' wellbeing. Such negative consequences, alongside the growing veteran population, indicate the need for greater exploration of veterans' physical, mental and social wellbeing. The current paper reports on the findings of a rapid review of the literature on the health and wellbeing needs of veterans, commissioned by the Australian Department of Veterans' Affairs to inform future programs and services. The databases Embase, Medline, Cinahl, PubMed, Web of Science and Cochrane Database were searched for systematic reviews reporting on veterans' physical, mental and social wellbeing published in English in peer-reviewed journals. A total of 21 systematic reviews were included. The reviews reported on a range of mental, physical and social health problems affecting veterans. While there was limited information on prevalence rates of physical, mental and social health problems in veterans compared to civilian populations, the reviews demonstrated the interconnection between these domains and the effect of demographic and military service factors. A key finding of the review is the interconnection of the mental, physical, and social health of veterans, highlighting the importance that an integrated approach to veterans' wellbeing is adopted. It is suggested that understanding key factors, such as demographic factors and factors relating to military service, can support improved service provision for veterans.

Physical health status of female veterans: contributions of sex partnership and in-military rape.

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Booth, Brenda M; Davis, Teri D; Cheney, Ann M; Mengeling, Michelle A; Torner, James C; Sadler, Anne G

2012-01-01

The aim of this study was to determine whether current physical health status in female veterans is associated with rape during military service and same-sex partnership. Retrospective computer-assisted telephone interviews of 1004 Midwestern US female veterans identified from Veterans Affairs electronic records were conducted. Data included rape history including rape in military, sex partnership history, demographics, and medical history including chronic pain, mental health (depression and posttraumatic stress disorder [PTSD]), and the physical health component of the Short-Form 12-item interview (PCS-12). Physical health in this sample was lower than norm values [PCS-12: mean (standard deviation) = 43 [12]; norm: mean (standard deviation) = 50 [10]). Fifty-one percent of the participants reported rape in their lifetime, 25% reported rape in military, 11% reported history of women as sex partners, and 71% reported history of chronic pain. Multiple regression analysis indicated that physical health (PCS-12) was associated with chronic pain history (β = -.40, p rape in military (β = -.09, p = .002), and current PTSD (β = .07, p = .03), adjusting for demographic data. Mediational analysis indicated that chronic pain history significantly mediated relationships of women who have sex with women, childhood rape, PTSD, depression, and current substance use disorder with PCS-12. Both rape and sex partnership are adversely associated with lower physical functioning in female veterans. Clinicians evaluating the physical health of this population should therefore consider obtaining detailed sexual histories, and a multidisciplinary team is needed to address mental health issues in female veterans.

Factors associated with having a medical marijuana card among Veterans with recent substance use in VA outpatient treatment.

Science.gov (United States)

Davis, Alan K; Bonar, Erin E; Ilgen, Mark A; Walton, Maureen A; Perron, Brian E; Chermack, Stephen T

2016-12-01

Psychiatric symptoms, somatic problems, and co-occurring substance use have been associated with medical marijuana consumption among civilian patients with substance use disorders. It is possible that these factors may impact Veterans' ability to engage in or adhere to mental health and substance use disorder treatment. Therefore, we examined whether psychiatric functioning, substance use, and somatic problems were associated with medical marijuana use among Veterans receiving substance use disorder and/or mental health treatment. Participants (n=841) completed screening measures for a randomized controlled trial and 67 (8%) reported that they had a current medical marijuana card. Most of these participants (78%) reported using marijuana to treat severe/chronic pain. Significant bivariate differences revealed that, compared to participants without a medical marijuana card, those with a card were more likely to be in a middle income bracket, unemployed, and they had a significantly higher number of recent days of marijuana use, synthetic marijuana use, and using sedatives prescribed to them. Additionally, a significantly higher proportion of participants with a medical marijuana card scored above the clinical cutoff for posttraumatic stress disorder (PTSD) symptoms, had significantly higher severity of sleep-related problems, and reported a higher level of pain. These findings highlight the co-occurrence of substance use, PTSD symptoms, sleep-related problems, and chronic pain among Veterans who use medical marijuana. Future research should investigate the inter-relationships among medical marijuana use and other clinical issues (e.g., PTSD symptoms, sleep, pain) over time, and potential implications of medical marijuana use on treatment engagement and response. Copyright © 2016 Elsevier Ltd. All rights reserved.

Hearing testing in the U.S. Department of Defense: Potential impact on Veterans Affairs hearing loss disability awards.

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Nelson, J T; Swan, A A; Swiger, B; Packer, M; Pugh, M J

2017-06-01

Hearing loss is the second most common disability awarded by the U.S. Department of Veterans Affairs (VA) to former members of the U.S. uniformed services. Hearing readiness and conservation practices differ among the four largest uniformed military services (Air Force, Army, Marine Corps, and Navy). Utilizing a data set consisting of all hearing loss claims submitted to the VA from fiscal years 2003-2013, we examined characteristics of veterans submitting claims within one year of separation from military service. Our results indicate that having a hearing loss disability claim granted was significantly more likely for men, individuals over the age of 26 years at the time of the claim, individuals most recently serving in the U.S. Army, and those with at least one hearing loss diagnosis. Importantly, individuals with at least one test record in the Defense Occupational and Environmental Health Readiness System-Hearing Conservation (DOEHRS-HC) system were significantly less likely to have a hearing loss disability claim granted by the VA. Within the DOEHRS-HC cohort, those with at least one threshold shift or clinical hearing loss diagnosis while on active duty were more than two and three times more likely to have a hearing loss disability claim granted, respectively. These findings indicate that an established history of reduced hearing ability while on active duty was associated with a significantly increased likelihood of an approved hearing loss disability claim relative to VA claims without such a history. Further, our results show a persistent decreased rate of hearing loss disability awards overall. These findings support increased inclusion of personnel in DoD hearing readiness and conservation programs to reduce VA hearing loss disability awards. Copyright © 2016 Elsevier B.V. All rights reserved.

Stigma, help-seeking attitudes, and use of psychotherapy in veterans with diagnoses of posttraumatic stress disorder.

Science.gov (United States)

Rosen, Craig S; Greenbaum, Mark A; Fitt, Julie E; Laffaye, Charlene; Norris, Virginia A; Kimerling, Rachel

2011-11-01

Survey and medical record data from 482 Veterans Affairs (VA) patients who recently received diagnoses of posttraumatic stress disorder (PTSD) were examined to determine need and predisposing factors associated with utilization of psychotherapy and counseling. More than half (58%) of participants initiated VA psychotherapy for PTSD within a year of diagnosis. Of those, one third completed eight or more sessions. Roughly two thirds of participants initiated counseling at a Vet Center. Initiating PTSD psychotherapy was associated with greater impairment but not with stigma, concerns about fitting in, or satisfaction with care. The use of Vet Center counseling was associated with desire for help, concerns about fitting in, and satisfaction with care. Unexpectedly, veterans with greater stigma concerns completed more psychotherapy visits and Vet Center counseling. Negative attitudes about mental health treatment did not seem to be substantial barriers to engaging in psychotherapy among these VA patients. Future research should consider enabling treatment system factors in addition to predisposing patient characteristics.

Transgender Veterans' Satisfaction With Care and Unmet Health Needs.

Science.gov (United States)

Lehavot, Keren; Katon, Jodie G; Simpson, Tracy L; Shipherd, Jillian C

2017-09-01

Transgender individuals are overrepresented among Veterans. However, little is known regarding their satisfaction with Veterans Administration (VA) care and unmet health needs. This study examined transgender Veterans' satisfaction with VA medical and mental health care, prevalence of delaying care, and correlates of these outcomes. We used data from transgender Veterans collected in 2014 through an online, national survey. In total, 298 transgender Veterans living in the United States. We assessed patient satisfaction with VA medical and mental health care and self-reported delays in seeking medical and mental health care in the past year. Potential correlates associated with these 4 outcomes included demographic, health, and health care variables. Over half of the sample used VA (56%) since their military discharge. Among transgender Veterans who had used VA, 79% were satisfied with medical care and 69% with mental health care. Lower income was associated with dissatisfaction with VA medical care, and being a transgender man was associated with dissatisfaction with VA mental health care. A substantial proportion reported delays in seeking medical (46%) or mental (38%) health care in the past year (not specific to VA). Screening positive for depression and/or posttraumatic stress disorder was associated with delays in seeking both types of care. Although the majority of transgender Veterans are satisfied with VA health care, certain subgroups are less likely to be satisfied with care. Further, many report delaying accessing care, particularly those with depression and/or posttraumatic stress disorder symptoms. Adapting health care settings to better engage these vulnerable Veterans may be necessary.

Eight years of decreased methicillin-resistant Staphylococcus aureus health care-associated infections associated with a Veterans Affairs prevention initiative.

Science.gov (United States)

Evans, Martin E; Kralovic, Stephen M; Simbartl, Loretta A; Jain, Rajiv; Roselle, Gary A

2017-01-01

Declines in methicillin-resistant Staphylococcus aureus (MRSA) health care associated infections (HAIs) were previously reported in Veterans Affairs acute care (2012), spinal cord injury (SCIU) (2011), and long-term-care facilities (LTCFs) (2012). Here we report continuing declines in infection rates in these settings through September 2015. Monthly data entered into a national database from 127 acute care facilities, 22 SCIUs, and 133 LTCFs were evaluated for trends using negative binomial regression. There were 23,153,240 intensive care unit (ICU) and non-ICU, and 1,794,234 SCIU patient-days from October 2007-September 2015, and 22,262,605 LTCF resident-days from July 2009-September 2015. Admission nasal swabbing remained >92% in all 3 venues. Admission prevalence changed from 13.2%-13.5% in acute care, from 35.1%-32.0% in SCIUs, and from 23.1%-25.0% in LTCFs during the analysis periods. Monthly HAI rates fell 87.0% in ICUs, 80.1% in non-ICUs, 80.9% in SCIUs, and 49.4% in LTCFs (all P values Prevention Initiative. Published by Elsevier Inc.

Childhood antecedents of incarceration and criminal justice involvement among homeless veterans.

Science.gov (United States)

Tsai, Jack; Rosenheck, Robert A

2013-10-01

Although criminal justice involvement and incarceration are common problems for homeless veterans, few studies have examined childhood risk factors for criminal justice involvement among veterans. This study examined the association between three types of childhood problems, family instability, conduct disorder behaviors, and childhood abuse, and criminal justice involvement and incarceration in adulthood. Data from 1,161 homeless veterans across 19 sites participating in the Housing and Urban Development-Veterans Affairs Supportive Housing program were examined. After controlling for sociodemographics and mental health diagnoses, veterans who reported more conduct disorder behaviors during childhood tended to report more criminal charges of all types, more convictions, and longer periods of incarceration during adulthood. However, the variance explained in criminal behavior by childhood was not large, suggesting that there are other factors that affect the trajectory by which homeless veterans become involved in the criminal justice system. Further research is needed to intervene in the pathway to the criminal justice system and guide efforts to prevent incarceration among veterans. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Homelessness and money mismanagement in Iraq and Afghanistan veterans.

Science.gov (United States)

Elbogen, Eric B; Sullivan, Connor P; Wolfe, James; Wagner, Henry Ryan; Beckham, Jean C

2013-12-01

We examined the empirical link between money mismanagement and subsequent homelessness among veterans. We used a random sample of Iraq and Afghanistan War era veterans from the National Post-Deployment Adjustment Survey in 2009-2011. Veterans were randomly selected from a roster of all US military service members in Operation Iraqi Freedom or Operation Enduring Freedom who were separated from active duty or in the Reserves/National Guard. Veterans (n = 1090) from 50 states and all military branches completed 2 waves of data collection 1 year apart (79% retention rate). Thirty percent reported money mismanagement (e.g., bouncing or forging a check, going over one's credit limit, falling victim to a money scam in the past year). Multivariate analysis revealed money mismanagement (odds ratio [OR] = 4.09, 95% CI = 1.87, 8.94) was associated with homelessness in the next year, as were arrest history (OR = 2.65, 95% CI = 1.33, 5.29), mental health diagnosis (OR = 2.59, 95% CI = 1.26, 5.33), and income (OR = 0.30, 95% CI = 0.13, 0.71). Money mismanagement, reported by a substantial number of veterans, was related to a higher rate of subsequent homelessness. The findings have implications for policymakers and clinicians, suggesting that financial education programs offered by the US Departments of Defense and Veterans Affairs may be targeted to effectively address veteran homelessness.

38 CFR 17.180 - Delegation of authority.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Delegation of authority. 17.180 Section 17.180 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Veterans Canteen Service § 17.180 Delegation of authority. In connection with the Veterans Canteen Service...

Factors Concerning Veterans With Dementia, Their Caregivers, and Coordination of Care: A Systematic Literature Review.

Science.gov (United States)

Mileski, Michael; Scott Kruse, Clemens; Brooks, Matthew; Haynes, Christine; Collingwood, Ying; Rodriguez, Rachel

2017-11-01

Military veterans diagnosed with dementia compose a large portion of our population. Often ignored are their caregivers and their plight as well as the availability, quality, and accessibility of health care for this demographic. The purpose of this systematic literature review is three fold: to identify opportunities available to increase public awareness on the subject; to identify areas of improvement in the level of care and quality of life for our nation's veterans; and to identify if adequate resources are available to veterans with dementia and their caregivers. The authors conducted systematic searches of three databases: PubMed via The National Center for Biotechnology Information, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), and Google. Data were collected regarding providing care to veterans who are suffering from dementia or Alzheimer's disease and their caregivers between 2008 and June 2016. Search results were filtered by date range, full text, English language, Boolean operators, and academic journals (n = 14). The review confirmed there are many facilitators and barriers in the coordination of care offered to veterans with dementia. Facilitators of quality care include veteran's expectations, family support, program development, and the availability of services. These positive aspects are aided by several community-based support services, new technology, and preventative care. Barriers are caregiver expectations, coordination of care, providers, and informal and formal costs. These negative facets are due to lack of educational resources, an increased veteran population diagnosed with dementia, limited knowledge of resources, and limited medical service in rural areas. Overall, there are a number of community programs that want to, and can, help veterans with dementia. There are also a number of ways to help veterans with dementia cope with their issues, which include

CKD screening and management in the Veterans Health Administration: the impact of system organization and an innovative electronic record.

Science.gov (United States)

Patel, Thakor G; Pogach, Leonard M; Barth, Robert H

2009-03-01

At the beginning of this decade, Healthy People 2010 issued a series of objectives to "reduce the incidence, morbidity, mortality and health care costs of chronic kidney disease." A necessary feature of any program to reduce the burden of kidney disease in the US population must include mechanisms to screen populations at risk and institute early the aspects of management, such as control of blood pressure, management of diabetes, and, in patients with advanced chronic kidney disease (CKD), preparation for dialysis therapy and proper vascular access management, that can retard CKD progression and improve long-term outcome. The Department of Veterans Affairs and the Veterans Health Administration is a broad-based national health care system that is almost uniquely situated to address these issues and has developed a number of effective approaches using evidence-based clinical practice guidelines, performance measures, innovative use of a robust electronic medical record system, and system oversight during the past decade. In this report, we describe the application of this systems approach to the prevention of CKD in veterans through the treatment of risk factors, identification of CKD in veterans, and oversight of predialysis and dialysis care. The lessons learned and applicability to the private sector are discussed.

Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans.

Science.gov (United States)

Raskind, Murray A; Peskind, Elaine R; Chow, Bruce; Harris, Crystal; Davis-Karim, Anne; Holmes, Hollie A; Hart, Kimberly L; McFall, Miles; Mellman, Thomas A; Reist, Christopher; Romesser, Jennifer; Rosenheck, Robert; Shih, Mei-Chiung; Stein, Murray B; Swift, Robert; Gleason, Theresa; Lu, Ying; Huang, Grant D

2018-02-08

In randomized trials, prazosin, an α 1 -adrenoreceptor antagonist, has been effective in alleviating nightmares associated with post-traumatic stress disorder (PTSD) in military veterans. We recruited veterans from 13 Department of Veterans Affairs medical centers who had chronic PTSD and reported frequent nightmares. Participants were randomly assigned to receive prazosin or placebo for 26 weeks; the drug or placebo was administered in escalating divided doses over the course of 5 weeks to a daily maximum of 20 mg in men and 12 mg in women. After week 10, participants continued to receive prazosin or placebo in a double-blind fashion for an additional 16 weeks. The three primary outcome measures were the change in score from baseline to 10 weeks on the Clinician-Administered PTSD Scale (CAPS) item B2 ("recurrent distressing dreams"; scores range from 0 to 8, with higher scores indicating more frequent and more distressing dreams); the change in score from baseline to 10 weeks on the Pittsburgh Sleep Quality Index (PSQI; scores range from 0 to 21, with higher scores indicating worse sleep quality); and the Clinical Global Impression of Change (CGIC) score at 10 weeks (scores range from 1 to 7, with lower scores indicating greater improvement and a score of 4 indicating no change). A total of 304 participants underwent randomization; 152 were assigned to prazosin, and 152 to placebo. At 10 weeks, there were no significant differences between the prazosin group and the placebo group in the mean change from baseline in the CAPS item B2 score (between-group difference, 0.2; 95% confidence interval [CI], -0.3 to 0.8; P=0.38), in the mean change in PSQI score (between-group difference, 0.1; 95% CI, -0.9 to 1.1; P=0.80), or in the CGIC score (between-group difference, 0; 95% CI, -0.3 to 0.3; P=0.96). There were no significant differences in these measures at 26 weeks (a secondary outcome) or in other secondary outcomes. At 10 weeks, the mean difference between the

One-year incidence and predictors of homelessness among 300,000 U.S. Veterans seen in specialty mental health care.

Science.gov (United States)

Tsai, Jack; Hoff, Rani A; Harpaz-Rotem, Ilan

2017-05-01

The Department of Veterans Affairs (VA) is committed to preventing and ending homelessness among U.S. veterans, but there have been few estimates of the incidence of veteran homelessness and prospective studies to identify predictors of homelessness. This study examines the 1-year incidence of homelessness among veterans seen in VA specialty mental health clinics and identified sociodemographic and clinical predictors of homelessness. Using a retrospective cohort study design, data were extracted from the VA medical records of 306,351 veterans referred to anxiety and posttraumatic stress disorder clinics across 130 VA facilities from 2008-2012 and followed for 1 year after referral. Homeless incidence was defined as new use of any VA homeless services or a documented International Classification of Diseases (9th rev.) V60.0 (lack of housing) code during the year. Of the total sample, 5.6% (7.8% for women and 5.4% for men) experienced homelessness within 1 year after referral to VA specialty mental health care. Veterans who were unmarried or diagnosed with a drug use disorder were more than twice as likely to become homeless; those who were Black or had annual incomes less than $25,000 were more than one and a half times as likely to become homeless. Together, these findings suggest a notable and important percentage of veterans seen in VA specialty mental health clinics newly experience homelessness annually. Monitoring early signs of housing vulnerability and preventing homelessness in this vulnerable but treatment-engaged population may be important in the VA's efforts to end veteran homelessness. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Engaging veterans with substance abuse disorders into a research trial: success with study branding, networking, and presence.

Science.gov (United States)

Michalek, Anne Kathryn; Kan, David; Prochaska, Judith

2015-06-01

Recruiting and retaining clients in health interventions can be challenging especially when targeting multiple behavior change in high-risk populations. To inform the methods of trials working with similarly complex clinical populations, we describe multi-pronged efforts to recruit and retain a representative sample. In a two-group RCT, veterans were recruited from a Veteran Affairs Medical Center. The goal was to enroll 200 participants over a 25-month period, and to exceed 70 % follow-up for all treatment arms. To meet these goals, a four-pronged strategy was developed: branding, outreach/networking, onsite presence, and incentives. In month 1, 32 % of the proposed sample size was met (n = 64), and by month 2, 45 % (n = 90); the recruitment goal (n = 200) was achieved 13 months ahead of schedule. Retention exceeds 90 % at all time points out to 18 months. The multipronged recruitment and retention plan was efficient, cost effective, and may generalize to other health promotion initiatives.

The Veterans Affairs Cardiac Risk Score: Recalibrating the Atherosclerotic Cardiovascular Disease Score for Applied Use.

Science.gov (United States)

Sussman, Jeremy B; Wiitala, Wyndy L; Zawistowski, Matthew; Hofer, Timothy P; Bentley, Douglas; Hayward, Rodney A

2017-09-01

Accurately estimating cardiovascular risk is fundamental to good decision-making in cardiovascular disease (CVD) prevention, but risk scores developed in one population often perform poorly in dissimilar populations. We sought to examine whether a large integrated health system can use their electronic health data to better predict individual patients' risk of developing CVD. We created a cohort using all patients ages 45-80 who used Department of Veterans Affairs (VA) ambulatory care services in 2006 with no history of CVD, heart failure, or loop diuretics. Our outcome variable was new-onset CVD in 2007-2011. We then developed a series of recalibrated scores, including a fully refit "VA Risk Score-CVD (VARS-CVD)." We tested the different scores using standard measures of prediction quality. For the 1,512,092 patients in the study, the Atherosclerotic cardiovascular disease risk score had similar discrimination as the VARS-CVD (c-statistic of 0.66 in men and 0.73 in women), but the Atherosclerotic cardiovascular disease model had poor calibration, predicting 63% more events than observed. Calibration was excellent in the fully recalibrated VARS-CVD tool, but simpler techniques tested proved less reliable. We found that local electronic health record data can be used to estimate CVD better than an established risk score based on research populations. Recalibration improved estimates dramatically, and the type of recalibration was important. Such tools can also easily be integrated into health system's electronic health record and can be more readily updated.

Electronic Medical Record Service

Data.gov (United States)

Department of Veterans Affairs — This service provides web services used to obtain clinical data for patients. There are three service methods that allow write functionality signNote, writeNote and...

38 CFR 17.39 - Certain Filipino veterans.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Certain Filipino veterans... Enrollment Provisions and Medical Benefits Package § 17.39 Certain Filipino veterans. (a) Any Filipino... organized Filipino guerilla forces, or any new Philippine Scout is eligible for hospital care, nursing home...

Gender Differences in the Prevalence of Fibromyalgia and in Concomitant Medical and Psychiatric Disorders: A National Veterans Health Administration Study.

Science.gov (United States)

Arout, Caroline A; Sofuoglu, Mehmet; Bastian, Lori A; Rosenheck, Robert A

2018-04-02

Fibromyalgia is a poorly understood, chronically disabling pain syndrome. While research has focused on its clinical presentation and treatment, less is known about fibromyalgia's clinical epidemiology in real-world healthcare systems. Gender differences have been difficult to study because relatively few males are diagnosed with fibromyalgia. Veterans Health Administration (VHA) patients diagnosed with fibromyalgia nationwide in FY 2012 were compared to Veterans with other pain diagnoses on sociodemographic characteristics, medical and psychiatric diagnoses, health service use, and opioid and psychotropic prescription fills. Additional analyses compared characteristics of men and women diagnosed with fibromyalgia. Risk ratios and Cohen's d were used for bivariate comparisons, followed by logistic regression analyses to identify independent factors associated with a diagnosis of fibromyalgia in the VHA. Altogether, 77,087 of 2,216,621 Veterans with pain diagnoses (3.48%) were diagnosed with fibromyalgia. They were more likely to be female, younger than patients with other pain conditions, more likely to have multiple psychiatric comorbidities and other types of pain, and used more medical outpatient services. Women diagnosed with fibromyalgia were younger and more likely to have headaches, connective tissue diseases (CTD), and psychiatric comorbidities, while men had more comorbid medical conditions. In this large, predominantly older male sample of Veterans with pain diagnoses, those with fibromyalgia were far more likely to be women. Gender comparisons showed women with fibromyalgia were more likely to be diagnosed with psychiatric disorders and CTD, while males were more likely to be diagnosed with medical conditions. Fibromyalgia shows a striking, gender-dependent picture of multimorbidity, which should be considered in treatment.

Substance use comorbidity among veterans with posttraumatic stress disorder and other psychiatric illness.

Science.gov (United States)

Petrakis, Ismene L; Rosenheck, Robert; Desai, Rani

2011-01-01

There is considerable concern about the emergence of significant substance abuse among younger veterans of war in the Middle East, especially among those with Posttraumatic Stress Disorder (PTSD), but little information exists on the magnitude of this problem. Using national administrative data from the Department of Veterans Affairs (VA) (n = 1,001,996), we examined rates of diagnosed substance use disorders in Veterans who served in Iraq and Afghanistan diagnosed with PTSD compared to other psychiatric disorders; and compared rates among veterans of other service eras. Of VA patients with a selected mental disorder, 21.0% had a comorbid substance diagnosis. Veterans who served in the post-Vietnam era (VET) (1973-1991) had the highest rates of comorbidity. Logistic regression models indicated that veterans with each selected psychiatric diagnosis were significantly more likely to be dually diagnosed in comparison to veterans with PTSD; post-Vietnam veterans were significantly more likely to be dually diagnosed than veterans from other eras. Bipolar disorder and schizophrenia are most strongly associated with dual diagnosis in OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) veterans. There are high rates of substance use disorders among veterans with mental illness. The highest rates of comorbidity occur among those with bipolar disorder and schizophrenia; and in post-VET veterans.  © American Academy of Addiction Psychiatry.

Racial disparities in cancer care in the Veterans Affairs health care system and the role of site of care.

Science.gov (United States)

Samuel, Cleo A; Landrum, Mary Beth; McNeil, Barbara J; Bozeman, Samuel R; Williams, Christina D; Keating, Nancy L

2014-09-01

We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities. We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12,897), lung (n = 25,608), or prostate (n = 38,202) cancer from 2001 to 2004. We used logistic regression to assess racial disparities for each measure and hospital fixed-effects models to determine whether disparities were attributable to between- or within-hospital differences. Compared with Whites, Blacks had lower rates of early-stage colon cancer diagnosis (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.72, 0.90), curative surgery for stage I, II, or III rectal cancer (AOR = 0.57; 95% CI = 0.41, 0.78), 3-year survival for colon cancer (AOR = 0.75; 95% CI = 0.62, 0.89) and rectal cancer (AOR = 0.61; 95% CI = 0.42, 0.87), curative surgery for early-stage lung cancer (AOR = 0.50; 95% CI = 0.41, 0.60), 3-dimensional conformal or intensity-modulated radiation (3-D CRT/IMRT; AOR = 0.53; 95% CI = 0.47, 0.59), and potent antiemetics for highly emetogenic chemotherapy (AOR = 0.87; 95% CI = 0.78, 0.98). Adjustment for hospital fixed-effects minimally influenced racial gaps except for 3-D CRT/IMRT (AOR = 0.75; 95% CI = 0.65, 0.87) and potent antiemetics (AOR = 0.95; 95% CI = 0.82, 1.10). Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences.

Patch testing with uranyl acetate in veterans exposed to depleted uranium during the 1991 Gulf war and the Iraqi conflict.

Science.gov (United States)

Shvartsbeyn, Marianna; Tuchinda, Papapit; Gaitens, Joanna; Squibb, Katherine S; McDiarmid, Melissa A; Gaspari, Anthony A

2011-01-01

The Depleted Uranium Follow-Up Program is a clinical surveillance program run by the Baltimore Veterans Affairs Medical Center since 1993 for veterans of the Gulf and Iraqi wars who were exposed to depleted uranium (DU) as a result of "friendly-fire" incidents. In 2009, 40 veterans from this cohort were screened for skin reactivity to metals by patch-testing with extended metal series and uranyl acetate (0.25%, 2.5%, and 25%). A control arm comprised 46 patients without any known occupational exposures to DU who were seen at the University of Maryland Dermatology Clinic for evaluation of allergic contact dermatitis. Excluding irritant reactions, no patch-test reactions to uranyl acetate were observed in the participants. Irritant reactions to DU were more common in the clinic cohort, likely reflective of the demographic differences between the two arms of the study. Biologic monitoring of urine uranium concentrations in the DU program participants with 24-hour urine samples showed evidence of percutaneous uranium absorption from the skin patches. We conclude that dermatitis observed in a subset of the veterans was unrelated to their military DU exposure. Our data suggest that future studies of skin testing with uranyl acetate should utilize 0.25%, the least irritating concentration.

An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging.

Science.gov (United States)

Shimada, Stephanie L; Petrakis, Beth Ann; Rothendler, James A; Zirkle, Maryan; Zhao, Shibei; Feng, Hua; Fix, Gemmae M; Ozkaynak, Mustafa; Martin, Tracey; Johnson, Sharon A; Tulu, Bengisu; Gordon, Howard S; Simon, Steven R; Woods, Susan S

2017-09-01

We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities. We coded 1000 threads of SM communication sampled from 40 primary care teams. Most threads (94.5%) were initiated by patients (90.4%) or caregivers (4.1%); only 5.5% were initiated by primary care team members proactively reaching out to patients. Medication renewals and refills (47.2%), scheduling requests (17.6%), medication issues (12.9%), and health issues (12.7%) were the most common patient-initiated requests, followed by referrals (7.0%), administrative issues (6.5%), test results (5.4%), test issues (5.2%), informing messages (4.9%), comments about the patient portal or SM (4.1%), appreciation (3.9%), self-reported data (2.8%), life issues (1.5%), and complaints (1.5%). Very few messages were clinically urgent (0.7%) or contained other potentially challenging content. Message threads were mostly short (2.7 messages), comprising an average of 1.35 discrete content types. A substantial proportion of issues (24.2%) did not show any evidence of being resolved through SM. Time to response and extent of resolution via SM varied by message content. Proactive SM use by teams varied, but was most often for test results (32.7%), medication-related issues (21.8%), medication renewals (16.4%), or scheduling issues (18.2%). The majority of messages were transactional and initiated by patients or caregivers. Not all content categories were fully addressed over SM. Further education and training for both patients and clinical teams could improve the quality and efficiency of SM communication. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.

Post-Traumatic Stress Disorder in Kosovo Veterans

Directory of Open Access Journals (Sweden)

Mimoza Shahini

2016-03-01

Full Text Available Objective: The objective of this study was to explore the prevalence of post-traumatic stress disorder (PTSD at veterans 8 years after war, to find out relation of PTSD with other demographic and health related variables and discover the impact of depression and trauma on PTSD on 687 veterans from six municipalities in Kosovo. Method: Participants were 687 war veterans selected from six regions of Kosovo during 2008. The Harvard Trauma Questionnaire (HTQ-40, was administered to measure PTSD and Hopkins Symptom Checklist (HSCL-25 for depression and anxiety. Pearson chi-square, analysis of variance (ANOVA, and multiple regressions were used to analyze the data. Results: Results indicated that 11.2 % of veterans even 8 years after the war ended were suffering from PTSD. Six percent of veterans with PTSD did not seek medical help. They reported to have had emotional problems and physical problems, but they did not seek medical help. The findings suggest that self-medication may be one way of veterans dealing with PTSD symptoms. Veterans with PTSD symptoms were more concerned with “family issues” than those without PTSD symptoms. Conclusions: The study found that 8 years after the war the veterans of the war in Kosovo suffer PTSD symptoms and that a good number of them do not seek help for this problem. The establishment of adequate services by the state would transform these veterans’ dealing with PTSD not into a moral challenge but into a fundamental right to equal and high-quality services.

US hospital care for patients with HIV infection and pneumonia: the role of public, private, and Veterans Affairs hospitals in the early highly active antiretroviral therapy era.

Science.gov (United States)

Uphold, Constance R; Deloria-Knoll, Maria; Palella, Frank J; Parada, Jorge P; Chmiel, Joan S; Phan, Laura; Bennett, Charles L

2004-02-01

We evaluated differences in processes and outcomes of HIV-related pneumonia care among patients in Veterans Affairs (VA), public, and for-profit and not-for-profit private hospitals in the United States. We compared the results of our current study (1995 to 1997) with those of our previous study that included a sample of patients receiving care during the years 1987 to 1990 to determine how HIV-related pneumonia care had evolved over the last decade. The sample consisted of 1,231 patients with HIV infection who received care for Pneumocystis carinii pneumonia (PCP) and 750 patients with HIV infection who received care for community-acquired pneumonia (CAP) during the years 1995 to 1997. We conducted a retrospective medical record review and evaluated patient and hospital characteristics, HIV-related processes of care (timely use of anti-PCP medications, adjunctive corticosteroids), non-HIV-related processes of care (timely use of CAP treatment medications, diagnostic testing, ICU utilization, rates of endotracheal ventilation, placement on respiratory isolation), length of inpatient hospital stay, and inpatient mortality. Rates of timely use of antibiotics and adjunctive corticosteroids for treating PCP were high and improved dramatically from the prior decade. However, compliance with consensus guidelines that recommend public, private not-for-profit hospitals, and for-profit hospitals. This study provides the first overview of HIV-related pneumonia care in the early highly active antiretroviral therapy era, and contrasts current findings with those of a similarly conducted study from a decade earlier. Quality of care for patients with PCP improved, but further efforts are needed to facilitate the appropriate management of CAP. In the third decade of the epidemic, it will be important to monitor whether variations in processes of care for various HIV-related clinical diagnoses among different types of hospitals persist.

77 FR 39501 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Science.gov (United States)

2012-07-03

...-202-2783, (Formerly: Forensic Toxicology Laboratory Baptist Medical Center) Clinical Reference Lab... Minneapolis Veterans Affairs Medical Center, Forensic Toxicology Laboratory, 1 Veterans Drive, Minneapolis, MN... 65203, 573-882-1273 U.S. Army Forensic Toxicology Drug Testing Laboratory, 2490 Wilson St., Fort George...

Success of HIS DICOM interfaces in the integration of the healthcare enterprise at the Department of Veterans Affairs

Science.gov (United States)

Kuzmak, Peter M.; Dayhoff, Ruth E.

1999-07-01

The US Department of Veterans Affairs (VA) is integrating imaging into the healthcare enterprise using the Digital Imaging and Communication in Medicine (DICOM) standard protocols. Image management is directly integrated into the VistA Hospital Information System (HIS) software and the clinical database. Radiology images are acquired via DICOM, and are stored directly in the HIS database. Images can be displayed on low-cost clinician's workstations throughout the medical center. High-resolution diagnostic quality multi-monitor VistA workstations with specialized viewing software can be used for reading radiology images. Two approaches are used to acquire and handle imags within the radiology department. Some sties have a commercial Picture Archiving and Communications System (PACS) interfaced to the VistA HIS, while other sites use the direct image acquisition and integrated diagnostic reading capabilities of VistA itself. A small set of DICOM services have been implemented by VistA to allow patient and study text data to be transmitted to image producing modalities and the commercial PACS, and to enable images and study data to be transferred back. The VistA DICOM capabilities are now used to interface seven different commercial PACS products and over twenty different radiology modalities. The communications capabilities of DICOM and the VA wide area network are begin used to support reading of radiology images form remote sites. DICOM has been the cornerstone in the ability to integrate imaging functionality into the Healthcare Enterprise. Because of its openness, it allows the integration of system component from commercial and non- commercial sources to work together to provide functional cost-effective solutions. As DICOM expands to non-radiology devices, integration must occur with the specialty information subsystems that handle orders and reports, their associated DICOM image capture systems, and the computer- based patient record. The mode and concepts of

Coping and acceptance: the greatest challenge for veterans with intestinal stomas.

Science.gov (United States)

Krouse, Robert S; Grant, Marcia; Rawl, Susan M; Mohler, M Jane; Baldwin, Carol M; Coons, Stephen Joel; McCorkle, Ruth; Schmidt, C Max; Ko, Clifford Y

2009-03-01

Intestinal stomas (ostomies) create challenges for veterans. The goal of this qualitative analysis was to understand better patients' perspectives regarding their greatest challenge. Ostomates at three Veterans Affairs locations were surveyed using the modified City of Hope Quality of Life-Ostomy questionnaire that contained an open-ended request for respondents to describe their greatest challenge. The response rate was 51% (239 of 467); 68% (163 of 239) completed the open-ended item. Content analysis was performed by an experienced qualitative research team. Coping and acceptance were the most commonly addressed themes. The most frequently expressed issues and advice were related to a need for positive thinking and insight regarding adjustment over time. Coping strategies included the use of humor, recognition of positive changes resulting from the stoma, and normalization of life with an ostomy. Coping and acceptance are common themes described by veterans with an intestinal stoma. Health-care providers can assist veterans by utilizing ostomate self-management strategies, experience, and advice.

Evidence of greater health care needs among older veterans of the Vietnam War.

Science.gov (United States)

Brooks, Matthew S; Laditka, Sarah B; Laditka, James N

2008-08-01

This study examined self-rated health, impairments in activities of daily living, and treatment for eight health conditions among Vietnam War-era veterans, comparing those who served in Vietnam with those who served elsewhere. Data were from the nationally representative 2001 National Survey of Veterans (N = 7,907; 3,923 veterans served in Vietnam). Age-stratified ( or =60 years) analyses included multivariate logistic regression. In adjusted analyses, among those Vietnam had notably poorer self-rated health and higher stroke risk (odds ratio, 1.51; 95% confidence interval, 1.48-1.53); odds of most other conditions were lower. Among those > or =60 years of age, those who served in Vietnam had poorer self-rated health, higher cancer risk (odds ratio, 1.33; 95% confidence interval, 1.32-1.35), and more treatment for hypertension, lung conditions, stroke, and hearing loss. Results suggest greater resource use among older veterans who served in Vietnam. Clinicians and the Department of Veterans Affairs should especially note their substantially higher cancer risk.

Ambulatory Medical Follow-Up in the Year After Surgery and Subsequent Survival in a National Cohort of Veterans Health Administration Surgical Patients.

Science.gov (United States)

Schonberger, Robert B; Dai, Feng; Brandt, Cynthia; Burg, Matthew M

2016-06-01

Among a national cohort of surgical patients, the authors analyzed the association between medical follow-up during the first postsurgical year and survival during the second postsurgical year. Retrospective cohort study. US Veterans Hospitals. The study included adults who received surgical care in any Veterans Health Administration facility from 2006 to 2011 who were discharged within 10 days of surgery and who survived for at least 1 year postoperatively. None. The association between the receipt of nonsurgical ambulatory medical care during the first postoperative year and the hazard of death during postsurgical year 2 was measured. Among 236,200 veterans, 93.2% received a nonsurgical medical follow-up visit in postsurgical year 1; of those, 5.1% died during postsurgical year 2. This compares with 9.4% year-2 mortality among patients lacking year-1 medical follow-up (p<0.0001). After adjustment for confounders, medical follow-up in postoperative year 1 again was associated with a significantly lower hazard of death in postoperative year 2 (hazard ratio 0.71; 95% confidence interval 0.66-0.78). Sensitivity analyses examining patient subgroups stratified by procedural specialty demonstrated comparable findings. The results were robust under a variety of simulated scenarios of unmeasured confounding. Within a national cohort of US veterans who presented for surgery, those who received nonsurgical ambulatory follow-up during the first postoperative year demonstrated lower all-cause mortality in the subsequent postoperative year than those who did not receive the same type of follow-up care. Interventions focused on postoperative care coordination of outpatient medical follow-up may have the potential to improve long-term postoperative survival. Copyright © 2016. Published by Elsevier Inc.

Dysthymia and depression increase risk of dementia and mortality among older veterans.

Science.gov (United States)

Byers, Amy L; Covinsky, Kenneth E; Barnes, Deborah E; Yaffe, Kristine

2012-08-01

To determine whether less severe depression spectrum diagnoses such as dysthymia, as well as depression, are associated with risk of developing dementia and mortality in a "real-world" setting. Retrospective cohort study conducted using the Department of Veterans Affairs (VA) National Patient Care Database (1997-2007). VA medical centers in the United States. A total of 281,540 veterans aged 55 years and older without dementia at study baseline (1997-2000). Depression status and incident dementia were ascertained from International Classification of Diseases, Ninth Revision codes during study baseline (1997-2000) and follow-up (2001-2007), respectively. Mortality was ascertained by time of death dates in the VA Vital Status File. Ten percent of veterans had baseline diagnosis of depression and nearly 1% had dysthymia. The unadjusted incidence of dementia was 11.2% in veterans with depression, 10.2% with dysthymia and 6.4% with neither. After adjusting for demographics and comorbidities, patients diagnosed with dysthymia or depression were twice as likely to develop incident dementia compared with those with no dysthymia/depression (adjusted dysthymia hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.71-2.25; and depression HR: 2.18, 95% CI: 2.08-2.28). Dysthymia and depression also were associated with increased risk of death (31.6% dysthymia and 32.9% depression versus 28.5% neither; adjusted dysthymia HR: 1.41, 95% CI: 1.31-1.53; and depression HR: 1.47, 95% CI: 1.43-1.51). Findings suggest that older adults with dysthymia or depression need to be monitored closely for adverse outcomes. Future studies should determine whether treatment of depression spectrum disorders may reduce risk of these outcomes.

Strategic planning to reduce the burden of stroke among veterans: using simulation modeling to inform decision making.

Science.gov (United States)

Lich, Kristen Hassmiller; Tian, Yuan; Beadles, Christopher A; Williams, Linda S; Bravata, Dawn M; Cheng, Eric M; Bosworth, Hayden B; Homer, Jack B; Matchar, David B

2014-07-01

Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative's strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke care in the US Veteran population to inform policy and practice. A System Dynamics stroke model of the Veteran population was constructed to evaluate the relative impact of 15 intervention scenarios including both broad and targeted primary and secondary prevention and acute care/rehabilitation on cumulative (20 years) outcomes including quality-adjusted life years (QALYs) gained, strokes prevented, stroke fatalities prevented, and the number-needed-to-treat per QALY gained. At the population level, a broad hypertension control effort yielded the largest increase in QALYs (35,517), followed by targeted prevention addressing hypertension and anticoagulation among Veterans with prior cardiovascular disease (27,856) and hypertension control among diabetics (23,100). Adjusting QALYs gained by the number of Veterans needed to treat, thrombolytic therapy with tissue-type plasminogen activator was most efficient, needing 3.1 Veterans to be treated per QALY gained. This was followed by rehabilitation (3.9) and targeted prevention addressing hypertension and anticoagulation among those with prior cardiovascular disease (5.1). Probabilistic sensitivity analysis showed that the ranking of interventions was robust to uncertainty in input parameter values. Prevention strategies tend to have larger population impacts, though interventions targeting specific high-risk groups tend to be more efficient in terms of number-needed-to-treat per QALY gained. © 2014 American Heart Association, Inc.

Disruptive Innovation: Implementation of Electronic Consultations in a Veterans Affairs Health Care System.

Science.gov (United States)

Gupte, Gouri; Vimalananda, Varsha; Simon, Steven R; DeVito, Katerina; Clark, Justice; Orlander, Jay D

2016-02-12

Electronic consultations (e-consults) offer rapid access to specialist input without the need for a patient visit. E-consult implementation began in 2011 at VA Boston Healthcare System (VABHS). By early 2013, e-consults were available for all clinical services. In this implementation, the requesting clinician selects the desired consultation within the electronic health record (EHR) ordering menu, which creates an electronic form that is pre-populated with patient demographic information and allows free-text entry of the reason for consult. This triggers a message to the requesting clinician and requested specialty, thereby enabling bidirectional clinician-clinician communication. The aim of this study is to examine the utilization of e-consults in a large Veterans Affairs (VA) health care system. Data from the electronic health record was used to measure frequency of e-consult use by provider type (physician or nurse practitioner (NP) and/or physician assistant), and by the requesting and responding specialty from January 2012 to December 2013. We conducted chart reviews for a purposive sample of e-consults and semi-structured interviews with a purposive sample of clinicians and hospital leaders to better characterize the process, challenges, and usability of e-consults. A total of 7097 e-consults were identified, 1998 from 2012 and 5099 from 2013. More than one quarter (27.56%, 1956/7097) of the e-consult requests originated from VA facilities in New England other than VABHS and were excluded from subsequent analysis. Within the VABHS e-consults (72.44%, 5141/7097), variability in frequency and use of e-consults across provider types and specialties was found. A total of 64 NPs requested 2407 e-consults (median 12.5, range 1-415). In contrast, 448 physicians (including residents and fellows) requested 2349 e-consults (median 2, range 1-116). More than one third (37.35%, 1920/5141) of e-consults were sent from primary care to specialists. While most e

Veterans Medical Care: FY2010 Appropriations

Science.gov (United States)

2010-01-21

including eyeglasses and hearing aids; home health services, hospice care, palliative care, and institutional respite care; and noninstitutional...claimed and an administrative determination was made regarding the veteran’s ability to bear the cost of such transportation.89 The Veterans

Veteran participation in the integrative health and wellness program: Impact on self-reported mental and physical health outcomes.

Science.gov (United States)

Hull, Amanda; Brooks Holliday, Stephanie; Eickhoff, Christine; Sullivan, Patrick; Courtney, Rena; Sossin, Kayla; Adams, Alyssa; Reinhard, Matthew

2018-04-05

Complementary and integrative health (CIH) services are being used more widely across the nation, including in both military and veteran hospital settings. Literature suggests that a variety of CIH services show promise in treating a wide range of physical and mental health disorders. Notably, the Department of Veterans Affairs is implementing CIH services within the context of a health care transformation, changing from disease based health care to a personalized, proactive, patient-centered approach where the veteran, not the disease, is at the center of care. This study examines self-reported physical and mental health outcomes associated with participation in the Integrative Health and Wellness Program, a comprehensive CIH program at the Washington DC VA Medical Center and one of the first wellbeing programs of its kind within the VA system. Using a prospective cohort design, veterans enrolled in the Integrative Health and Wellness Program filled out self-report measures of physical and mental health throughout program participation, including at enrollment, 12 weeks, and 6 months. Analyses revealed that veterans reported significant improvements in their most salient symptoms of concern (primarily pain or mental health symptoms), physical quality of life, wellbeing, and ability to participate in valued activities at follow-up assessments. These results illustrate the potential of CIH services, provided within a comprehensive clinic focused on wellbeing not disease, to improve self-reported health, wellbeing, and quality of life in a veteran population. Additionally, data support recent VA initiatives to increase the range of CIH services available and the continued growth of wellbeing programs within VA settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Statin Utilization and Recommendations Among HIV- and HCV-infected Veterans: A Cohort Study.

Science.gov (United States)

Clement, Meredith E; Park, Lawrence P; Navar, Ann Marie; Okeke, Nwora Lance; Pencina, Michael J; Douglas, Pamela S; Naggie, Susanna

2016-08-01

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are associated with increased risk of cardiovascular disease (CVD). The potential impact of recently updated cholesterol guidelines on treatment of HIV- and HCV-infected veterans is unknown. We performed a retrospective cohort study to assess statin use and recommendations among 13 579 HIV-infected, 169 767 HCV-infected, and 6628 HIV/HCV-coinfected male veterans aged 40-75 years. Prior 2004 Adult Treatment Panel (ATP-III) guidelines were compared with current 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines and 2014 US Department of Veterans Affairs (VA)/US Department of Defense (DoD) joint clinical practice guidelines using laboratory, medication, and comorbidity data from the VA Clinical Case Registry from 2008 through 2010. Using risk criteria delineated by the ATP-III guidelines, 50.6% of HIV-infected, 45.9% of HCV-infected, and 33.8% of HIV/HCV-coinfected veterans had an indication for statin therapy. However, among those eligible, 22.7%, 30.5%, and 31.5%, respectively, were not receiving ATP-III recommended statin therapy. When current cholesterol guidelines were applied by VA/DoD and ACC/AHA criteria, increases in recommendations for statins were found in all groups (57.3% and 66.1% of HIV-infected, 64.4% and 73.7% of HCV-infected, 49.1% and 58.5% of HIV/HCV-coinfected veterans recommended). Statins were underutilized among veterans infected with HIV, HCV, and HIV/HCV according to previous ATP-III guidelines. Current VA/DoD and ACC/AHA guidelines substantially expand statin recommendations and widen the gap of statin underutilization in all groups. These gaps in care present an opportunity to improve CVD prevention efforts in these at-risk populations. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Effectiveness of Cognitive Processing Therapy and Prolonged Exposure in the Department of Veterans Affairs.

Science.gov (United States)

Rutt, Benjamin T; Oehlert, Mary E; Krieshok, Thomas S; Lichtenberg, James W

2018-04-01

Objective This study evaluated the effectiveness of cognitive processing therapy and prolonged exposure in conditions reflective of current clinical practice within the Veterans Health Administration. Method This study involved a retrospective review of 2030 charts. A total of 750 veterans from 10 U.S. states who received cognitive processing therapy or prolonged exposure in individual psychotherapy were included in the study (participants in cognitive processing therapy, N = 376; participants in prolonged exposure, N = 374). The main dependent variable was self-reported posttraumatic stress disorder symptoms as measured by total scores on the Posttraumatic Stress Disorder Checklist. The study used multilevel modeling to evaluate the absolute and relative effectiveness of both treatments and determine the relationship between patient-level variables and total Posttraumatic Stress Disorder Checklist scores during treatment. Results Cognitive processing therapy and prolonged exposure were equally effective at reducing total Posttraumatic Stress Disorder Checklist scores. Veterans who completed therapy reported significantly larger reductions in the Posttraumatic Stress Disorder Checklist than patients who did not complete therapy. There were no significant differences in the improvement of posttraumatic stress disorder symptoms with respect to age and three racial/ethnic groups (Caucasian, African American, and Hispanic). Conclusions Cognitive processing therapy and prolonged exposure were shown to be effective in conditions highly reflective of clinical practice and with a highly diverse sample of veterans. Challenges related to dropout from trauma focused therapy should continue to be researched.

Improving healthcare systems' disclosures of large-scale adverse events: a Department of Veterans Affairs leadership, policymaker, research and stakeholder partnership.

Science.gov (United States)

Elwy, A Rani; Bokhour, Barbara G; Maguire, Elizabeth M; Wagner, Todd H; Asch, Steven M; Gifford, Allen L; Gallagher, Thomas H; Durfee, Janet M; Martinello, Richard A; Schiffner, Susan; Jesse, Robert L

2014-12-01

The Department of Veterans Affairs (VA) mandates disclosure of large-scale adverse events to patients, even if risk of harm is not clearly present. Concerns about past disclosures warranted further examination of the impact of this policy. Through a collaborative partnership between VA leaders, policymakers, researchers and stakeholders, the objective was to empirically identify critical aspects of disclosure processes as a first step towards improving future disclosures. Semi-structured interviews were conducted with participants at nine VA facilities where recent disclosures took place. Ninety-seven stakeholders participated in the interviews: 38 employees, 28 leaders (from facilities, regions and national offices), 27 Veteran patients and family members, and four congressional staff members. Facility and regional leaders were interviewed by telephone, followed by a two-day site visit where employees, patients and family members were interviewed face-to-face. National leaders and congressional staff also completed telephone interviews. Interviews were analyzed using rapid qualitative assessment processes. Themes were mapped to the stages of the Crisis and Emergency Risk Communication model: pre-crisis, initial event, maintenance, resolution and evaluation. Many areas for improvement during disclosure were identified, such as preparing facilities better (pre-crisis), creating rapid communications, modifying disclosure language, addressing perceptions of harm, reducing complexity, and seeking assistance from others (initial event), managing communication with other stakeholders (maintenance), minimizing effects on staff and improving trust (resolution), and addressing facilities' needs (evaluation). Through the partnership, five recommendations to improve disclosures during each stage of communication have been widely disseminated throughout the VA using non-academic strategies. Some improvements have been made; other recommendations will be addressed through

76 FR 65563 - Genomic Medicine Program Advisory Committee; Notice of Meeting

Science.gov (United States)

2011-10-21

... oversight and protecting the privacy of Veterans. The meeting focus will be on current and upcoming... recommendations to the Secretary of Veterans Affairs on using genetic information to optimize medical care of...

VA Disability Compensation and Money Spent on Substance Use Among Homeless Veterans: A Controversial Association.

Science.gov (United States)

Tsai, Jack; Rosenheck, Robert A

2015-06-01

There has long been concern that public support payments are used to support addictive behaviors. This study examined the amount of money homeless veterans spend on alcohol and drugs and the association between public support income, including VA disability compensation, and expenditures on alcohol and drugs. Data were from 1,160 veterans from 19 sites on entry into the Housing and Urban Development-Veterans Affairs Supportive Housing program. Descriptive statistics and nonparametric analyses were conducted. About 33% of veterans reported spending money on alcohol and 22% reported spending money on drugs in the past month. No significant association was found between public support income, VA disability compensation, and money spent on alcohol and drugs. A substantial proportion of homeless veterans spend some income on alcohol and drugs, but disability income, including VA compensation, does not seem to be related to substance use or money spent on addictive substances.

Factors associated with receipt of pension and compensation benefits for homeless veterans in the VBA/VHA Homeless Outreach Initiative.

Science.gov (United States)

Chen, Joyce H; Rosenheck, Robert A; Greenberg, Greg A; Seibyl, Catherine

2007-03-01

Public support payments may facilitate exit from homelessness for persons with mental illness. We examined data from 10,641 homeless veterans contacted from October 1, 1995 to September 30, 2002 in a collaborative outreach program designed to facilitate access to Department of Veterans Affairs (VA) disability benefits. Those who were awarded benefits (22% of contacted veterans) were more likely to report disability, poor to fair self-rated health, and were more likely to have used VA services in the past. Thus, this program achieved only modest success and was most successful with veterans who were already receiving VA services and who might have received benefits even without the outreach effort.

Sexual assault during the time of Gulf War I: a cross-sectional survey of U.S. service men who later applied for Department of Veterans Affairs PTSD disability benefits.

Science.gov (United States)

Murdoch, Maureen; Polusny, Melissa A; Street, Amy; Noorbaloochi, Siamak; Simon, Alisha B; Bangerter, Ann; Grill, Joseph; Voller, Emily

2014-03-01

To estimate the cumulative incidence of sexual assault during the time of Gulf War I among male Gulf War I Veterans who later applied for Department of Veterans Affairs (VA) post-traumatic stress disorder disability benefits and to identify potential risk and protective factors for sexual assault within the population. Mailed, national, cross-sectional survey supplemented with VA administrative and clinical data. Of 2,415 Veterans sampled, 1,700 (70%) responded. After adjusting for nonignorable missing data, the cumulative incidence of sexual assault during Gulf War I in this population ranged from 18% [95% confidence intervals (CI): 5.0%-51.9%] to 21% (95% CI: 20.0-22.0). Deployment was not associated with sexual assault [Odds Ratio (OR), 0.96; 95% CI: 0.75-1.23], but combat exposure was (OR, 1.80; 95% CI: 1.52-2.10). Other correlates of sexual assault within the population included working in a unit with greater tolerance of sexual harassment (OR, 1.80; 95% CI: 1.52-2.10) and being exposed to more sexual identity challenges (OR, 1.76; 95% CI: 1.55-2.00). The 9-month cumulative incidence of sexual assault in this particular population exceeded the lifetime cumulative incidence of sexual assault in U.S. civilian women. Although Persian Gulf deployment was not associated with sexual assault in this population, combat exposure was. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs).

Science.gov (United States)

Edwards, Samuel T; Helfrich, Christian D; Grembowski, David; Hulen, Elizabeth; Clinton, Walter L; Wood, Gordon B; Kim, Linda; Rose, Danielle E; Stewart, Greg

2018-01-01

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. 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. PCPs reported the extent to which they relied on other team members to complete 15 common primary care tasks; paired nurses reported how much they were relied on to complete the same tasks. A composite score of task delegation/reliance was developed by taking the average of the responses to the 15 questions. We performed multivariable regression to explore predictors of task delegation and burnout. Among 777 PCP-nurse dyads, PCPs reported delegating tasks less than nurses reported being relied on (PCP mean ± standard deviation composite delegation score, 2.97± 0.64 [range, 1-4]; nurse composite reliance score, 3.26 ± 0.50 [range, 1-4]). Approximately 48% of PCPs and 35% of nurses reported burnout. PCPs who reported more task delegation reported less burnout (odds ratio [OR], 0.62 per unit of delegation; 95% confidence interval [CI], 0.49-0.78), whereas nurses who reported being relied on more reported more burnout (OR, 1.83 per unit of reliance; 95% CI, 1.33-2.5). Task delegation was associated with less burnout for PCPs, whereas task reliance was associated with greater burnout for nurses. Strategies to improve work life in primary care by increasing PCP task delegation must consider the impact on nurses. © Copyright 2018 by the American Board of Family Medicine.

Mixed methods study examining work reintegration experiences from perspectives of Veterans with mental health disorders.

Science.gov (United States)

Kukla, Marina; Rattray, Nicholas A; Salyers, Michelle P

2015-01-01

Recent findings have demonstrated that reintegration for Veterans is often challenging. One difficult aspect of reintegration—transitioning into the civilian workplace—has not been fully explored in the literature. To address this gap and examine work reintegration, this mixed methods study examined the perspectives of Veterans with mental health disorders receiving Department of Veterans Affairs healthcare. Forty Veterans rated factors that affect work success; participants also provided narratives on their most and least successful work experiences. We used t-tests and qualitative analysis to compare participants who did and did not serve in combat. Several themes relevant to work reintegration emerged in the narratives, particularly for Veterans who served in combat. An array of work difficulties were reported in the months following military discharge. In addition, Veterans who served in combat reported significantly more work barriers than Veterans who did not serve in combat, particularly health-related barriers. In conclusion, Veterans with mental health disorders who served in combat experienced more work reintegration difficulty than their counterparts who did not serve in combat. The role of being a Veteran affected how combat Veterans formed their self-concept, which also shaped their work success and community reintegration, especially during the early transition period.

Gender differences in service utilization among Operations Enduring Freedom, Iraqi Freedom, and New Dawn Veterans Affairs patients with severe mental illness and substance use disorders.

Science.gov (United States)

Painter, Janelle M; Brignone, Emily; Gilmore, Amanda K; Lehavot, Keren; Fargo, Jamison; Suo, Ying; Simpson, Tracy; Carter, Marjorie E; Blais, Rebecca K; Gundlapalli, Adi V

2018-02-01

Severe mental illness (SMI) and substance use disorders (SUD) are among the more chronic and costly mental health conditions treated in the Department of Veterans Affairs (VA). Service use patterns of returning veterans with SMI and SUD have received little attention. We examined gender differences in the utilization of VA services among a national sample of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) VA patients with SMI, SUD, and their comorbidity (SMI/SUD) in their first year of established VA care (N = 24,166). Outpatient services and acute-residential stays were modeled using negative binomial and logistic regression, respectively. Among all diagnostic categories, men used outpatient services less often than did women, including primary care (adjusted rate ratio [ARR] = .71, 95% confidence interval CI [.68, .74]), mental health (ARR = .85, 95% CI [.80, .91]), and addiction (ARR = .91, 95% CI [.83, .99]) services. For emergency department (ED) and psychiatric inpatient services, gender interacted significantly with diagnosis. The combination of SMI/SUD compared to either SMI or SUD conferred greater risk of ED utilization among men than women (adjusted odds ratio [AOR] = 2.09, 95% CI [1.24, 3.51], and 1.95, 95% CI [1.17, 3.26], respectively). SMI versus SUD conferred greater risk of psychiatric inpatient utilization among men than women (AOR = 1.83, 95% CI [1.43, 2.34]). Our findings point to gender differences in outpatient and acute service utilization among OEF/OIF/OND VA patients with some of the more chronic and costly mental health conditions. Further investigation of health care utilization patterns is needed to understand factors driving these gender differences to ensure that veterans have appropriate access to the services they need. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Perspectives on electronic medical records adoption: electronic medical records (EMR in outcomes research

Directory of Open Access Journals (Sweden)

Dan Belletti

2010-04-01

Full Text Available Dan Belletti1, Christopher Zacker1, C Daniel Mullins21Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 2University of Maryland School of Pharmacy, Baltimore, MD, USAAbstract: Health information technology (HIT is engineered to promote improved quality and efficiency of care, and reduce medical errors. Healthcare organizations have made significant investments in HIT tools and the electronic medical record (EMR is a major technological advance. The Department of Veterans Affairs was one of the first large healthcare systems to fully implement EMR. The Veterans Health Information System and Technology Architecture (VistA began by providing an interface to review and update a patient’s medical record with its computerized patient record system. However, since the implementation of the VistA system there has not been an overall substantial adoption of EMR in the ambulatory or inpatient setting. In fact, only 23.9% of physicians were using EMRs in their office-based practices in 2005. A sample from the American Medical Association revealed that EMRs were available in an office setting to 17% of physicians in late 2007 and early 2008. Of these, 17% of physicians with EMR, only 4% were considered to be fully functional EMR systems. With the exception of some large aggregate EMR databases the slow adoption of EMR has limited its use in outcomes research. This paper reviews the literature and presents the current status of and forces influencing the adoption of EMR in the office-based practice, and identifies the benefits, limitations, and overall value of EMR in the conduct of outcomes research in the US.Keywords: electronic medical records, health information technology, medical errors

76 FR 24573 - Genomic Medicine Program Advisory Committee; Notice of Meeting

Science.gov (United States)

2011-05-02

... appropriate ethical oversight and protecting the privacy of Veterans. The meeting focus will be on current and... recommendations to the Secretary of Veterans Affairs on using genetic information to optimize medical care of...

Association between women veterans' experiences with VA outpatient health care and designation as a women's health provider in primary care clinics.

Science.gov (United States)

Bastian, Lori A; Trentalange, Mark; Murphy, Terrence E; Brandt, Cynthia; Bean-Mayberry, Bevanne; Maisel, Natalya C; Wright, Steven M; Gaetano, Vera S; Allore, Heather; Skanderson, Melissa; Reyes-Harvey, Evelyn; Yano, Elizabeth M; Rose, Danielle; Haskell, Sally

2014-01-01

Women veterans comprise a small percentage of Department of Veterans Affairs (VA) health care users. Prior research on women veterans' experiences with primary care has focused on VA site differences and not individual provider characteristics. In 2010, the VA established policy requiring the provision of comprehensive women's health care by designated women's health providers (DWHPs). Little is known about the quality of health care delivered by DWHPs and women veterans' experience with care from these providers. Secondary data were obtained from the VA Survey of Healthcare Experience of Patients (SHEP) using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient-centered medical home (PCMH) survey from March 2012 through February 2013, a survey designed to measure patient experience with care and the DWHPs Assessment of Workforce Capacity that discerns between DWHPs versus non-DWHPs. Of the 28,994 surveys mailed to women veterans, 24,789 were seen by primary care providers and 8,151 women responded to the survey (response rate, 32%). A total of 3,147 providers were evaluated by the SHEP-CAHPS-PCMH survey (40%; n = 1,267 were DWHPs). In a multivariable model, patients seen by DWHPs (relative risk, 1.02; 95% CI, 1.01-1.04) reported higher overall experiences with care compared with patients seen by non-DWHPs. The main finding is that women veterans' overall experiences with outpatient health care are slightly better for those receiving care from DWHPs compared with those receiving care from non-DWHPs. Our findings have important policy implications for how to continue to improve women veterans' experiences. Our work provides support to increase access to DWHPs at VA primary care clinics. Published by Elsevier Inc.

38 CFR 17.504 - Disclosure methods.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Disclosure methods. 17.504 Section 17.504 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review Records § 17.504 Disclosure methods. (a) Disclosure of...

38 CFR 17.801 - Definitions.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Definitions. 17.801 Section 17.801 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Transitional Housing Loan Program § 17.801 Definitions. (a) Applicant: A non-profit organization making application for...

Agent Orange exposure and attributed health effects in Vietnam veterans.

Science.gov (United States)

Young, Alvin L; Cecil, Paul F

2011-07-01

Serum dioxin studies of Vietnam (VN) veterans, military historical records of tactical herbicide use in Vietnam, and the compelling evidence of the photodegradation of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and other aspects of environmental fate and low bioavailability of TCDD are consistent with few, if any, ground troop veterans being exposed to Agent Orange. That conclusion, however, is contrary to the presumption by the Department of Veterans Affairs (DVA) that military service in Vietnam anytime from January 9, 1962 to May 7, 1975 is a proxy for exposure to Agent Orange. The DVA assumption is inconsistent with the scientific principles governing determinations of disease causation. The DVA has nonetheless awarded Agent Orange-related benefits and compensation to an increasing number of VN veterans based on the presumption of exposure and the published findings of the Institute of Medicine that there is sufficient evidence of a "statistical association" (a less stringent standard than "causal relationship") between exposure to tactical herbicides or TCDD and 15 different human diseases. A fairer and more valid approach for VN veterans would have been to enact a program of "Vietnam experience" benefits for those seriously ill, rather than benefits based on the dubious premise of injuries caused by Agent Orange.

Atmospheric fluidized-bed combustion (AFBC) co-firing of coal and hospital waste

International Nuclear Information System (INIS)

1993-02-01

The proposed project involves co-firing of coal and medical waste (including infectious medical waste) in an atmospheric fluidized-bed combustor (AFBC) to safely dispose of medical waste and produce steam for hospital needs. Combustion at the design temperature and residence time (duration) in the AFBC has been proven to render infectious medical waste free of disease producing organisms. The project would be located at the Veterans Affairs (VA) Medical Center in Lebanon, Pennsylvania. The estimated cost of the proposed AFBC facility is nearly $4 million. It would be jointly funded by DOE, Veterans Affairs, and Donlee Technologies, Inc., of York, Pennsylvania, under a cooperative agreement between DOE and Donlee. Under the terms of this agreement, $3.708 million in cost-shared financial assistance would be jointly provided by DOE and the Veterans Affairs (50/50), with $278,000 provided by Donlee. The purposes of the proposed project are to: (1) provide the VA Medical Center and the Good Samaritan Hospital (GSH), also of Lebanon, Pennsylvania, with a solution for disposal of their medical waste; and (2) demonstrate that a new coal-burning technology can safely incinerate infectious medical waste, produce steam to meet hospital needs, and comply with environmental regulations

The Overseas Service Veteran At Home Pilot: How Choice of Care May Affect Use of Nursing Home Beds and Waiting Lists. Brief Report

Science.gov (United States)

Pedlar, David; Walker, John

2004-01-01

In 1999 Veterans Affairs Canada (VAC) implemented the Overseas Service Veterans (OSV) At Home Pilot Project in response to the problem that a growing number of clients were on waiting lists for beds in long-term care facilities. The At Home pilot offered certain clients on waiting lists, who met nursing-level care and military-service…

Comparing Mobile Health Strategies to Improve Medication Adherence for Veterans With Coronary Heart Disease (Mobile4Meds): Protocol for a Mixed-Methods Study.

Science.gov (United States)

Park, Linda G; Collins, Eileen G; Shim, Janet K; Whooley, Mary A

2017-07-18

Adherence to antiplatelet medications is critical to prevent life threatening complications (ie, stent thrombosis) after percutaneous coronary interventions (PCIs), yet rates of nonadherence range from 21-57% by 12 months. Mobile interventions delivered via text messaging or mobile apps represent a practical and inexpensive strategy to promote behavior change and enhance medication adherence. The Mobile4Meds study seeks to determine whether text messaging or a mobile app, compared with an educational website control provided to all Veterans, can improve adherence to antiplatelet therapy among patients following acute coronary syndrome (ACS) or PCI. The three aims of the study are to: (1) determine preferences for content and frequency of text messaging to promote medication adherence through focus groups; (2) identify the most patient-centered app that promotes adherence, through a content analysis of all commercially available apps for medication adherence and focus groups centered on usability; and (3) compare adherence to antiplatelet medications in Veterans after ACS/PCI via a randomized clinical trial (RCT). We will utilize a mixed-methods design that uses focus groups to achieve the first and second aims (N=32). Patients will be followed for 12 months after being randomly assigned to one of three arms: (1) customized text messaging, (2) mobile app, or (3) website-control groups (N=225). Medication adherence will be measured with electronic monitoring devices, pharmacy records, and self-reports. Enrollment for the focus groups is currently in progress. We expect to enroll patients for the RCT in the beginning of 2018. Determining the efficacy of mobile technology using a Veteran-designed protocol to promote medication adherence will have a significant impact on Veteran health and public health, particularly for individuals with chronic diseases that require strict medication adherence. ClinicalTrials.gov NCT03022669. ©Linda G Park, Eileen G Collins, Janet K

US veterans use vitamins and supplements as substitutes for prescription medication.

Science.gov (United States)

Goldstein, Jennifer N; Long, Judith A; Arevalo, Doris; Ibrahim, Said A; Mao, Jun J

2014-12-01

Vitamins and supplements are the most commonly used form of complementary and alternative medicine in the United States. Growing research suggests that patients substitute vitamins and supplements for their prescription medications. The reasons might include cost of prescription medications and discordant patient and doctor health belief systems. To investigate the prevalence of substitution of vitamins and supplements for prescription medications among veterans who receive care in the VA health care system and whether substitution is associated with prescription rationing due to cost, treatment beliefs, or distrust of the health system. Cross-sectional observational survey. Primary care patients (n=275) at the Philadelphia VA Medical Center. Medication substitution, prescription medication rationing, treatment beliefs, and health system distrust were measured with structured instruments. Multivariate logistic regression was performed with substitution as the dependent variable. A significant number of primary care patients in the VA system use vitamins and supplements 206 (75%). The prevalence of medication substitution is high 48 (18%). Medication substitution is strongly associated with prescription rationing due to cost (adjusted odds ratio 6.3, 95% confidence interval: 2.0-19.5, P=0.001). Similarly, greater belief in complementary and alternative approaches to care positively predicts medication substitution (adjusted odds ratio 1.08, 95% confidence interval: 1.01-1.15, P=0.011). There is no significant association between health system distrust and likelihood of medication substitution. Medication substitution is prevalent in this sample of inner city primary care patients who receive care in the VA system. Cost of prescriptions and belief in the value of complementary and alternative approaches to care appear to be associated with this patient-driven treatment decision.

Race and incarceration in an aging cohort of Vietnam veterans in treatment for post-traumatic stress disorder (PTSD).

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Coker, Kendell L; Rosenheck, Robert

2014-03-01

Cross sectional studies have addressed the incarceration of Vietnam veterans with post-traumatic stress disorder (PTSD), but no studies have examined changes in incarceration as they age. This study examines patterns of incarceration among Vietnam veterans treated in specialized veterans affairs (VA) intensive PTSD programs over time. Data was drawn from admission data from the initial episode of treatment of Caucasian and African American Vietnam veterans entering VA specialized intensive PTSD programs between 1993 and 2011 (N = 31,707). Bivariate correlations and logistic regression were used to examine associations among race and incarceration over time and the potentially confounding influence of demographic and clinical covariates on this relationship. Rates of reported incarceration declined from 63 to 43%. Over time, African American veterans were 34% more likely than Caucasian veterans to have a lifetime history of incarceration while interaction analysis showed steeper declines for Caucasians than African Americans. Rates of incarceration among these Vietnam veterans declined as they aged. Furthermore, African American veterans were substantially more likely than Caucasian veterans to have been incarcerated and showed less decline as the cohort aged. While reduced, needs for clinical PTSD services remain among aging combat veterans.

Smoking cessation among African American and white smokers in the Veterans Affairs health care system.

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Burgess, Diana J; van Ryn, Michelle; Noorbaloochi, Siamak; Clothier, Barbara; Taylor, Brent C; Sherman, Scott; Joseph, Anne M; Fu, Steven S

2014-09-01

We examined whether a proactive care smoking cessation intervention designed to overcome barriers to treatment would be especially effective at increasing cessation among African Americans receiving care in the Veterans Health Administration. We analyzed data from a randomized controlled trial, the Veterans Victory over Tobacco study, involving a population-based electronic registry of current smokers (702 African Americans, 1569 whites) and assessed 6-month prolonged smoking abstinence at 1 year via a follow-up survey of all current smokers. We also examined candidate risk adjustors for the race effect on smoking abstinence. The interaction between patient race and intervention condition (proactive care vs. usual care) was not significant. Overall, African Americans had higher quit rates than Whites (13% vs. 9%; P Whites. These findings may be a result of the large number of veterans receiving smoking cessation services and the lack of racial differences in receipt of these services as well as racial differences in smoking history, self-efficacy, and motivation to quit that favor African Americans.

Complementary and alternative medicine use among veterans with chronic noncancer pain.

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Denneson, Lauren M; Corson, Kathryn; Dobscha, Steven K

2011-01-01

We describe prior use and willingness to try complementary and alternative medicine (CAM) among 401 veterans experiencing chronic noncancer pain and explore differences between CAM users and nonusers. Participants in a randomized controlled trial of a collaborative intervention for chronic pain from five Department of Veterans Affairs (VA) primary care clinics self-reported prior use and willingness to try chiropractic care, massage therapy, herbal medicines, and acupuncture. Prior CAM users were compared with nonusers on demographic characteristics, pain-related clinical characteristics, disease burden, and treatment satisfaction. A majority of veterans ( n = 327, 82%) reported prior use of at least one CAM modality, and nearly all (n = 399, 99%) were willing to try CAM treatment for pain. Chiropractic care was the least preferred option, whereas massage therapy was the most preferred (75% and 96%, respectively). CAM users were less likely to have service-connection disabilities (54% vs 68%; chi square = 4.64, p = 0.03) and reported having spent a larger percentage of their lives in pain (26% vs 20%; Z = 1.40, p = 0.04) than nonusers. We detected few differences between veterans who had tried CAM and those who had not, suggesting that CAM may have broad appeal among veterans with chronic pain. Implications for VA policy and practice and for clinicians treating veterans with chronic pain are discussed.

Long-Term Effects of Chemical Warfare on Post-traumatic Stress Disorder, Depression, and Chronic Medical Conditions in Veterans.

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Safi-Aghdam, Hamideh; Shafie, Mehrzad; Khoshdel, Alireza; Moazen-Zadeh, Ehsan; Avakh, Farhad; Rahmani, Arash

2018-04-24

We investigated the association between exposure to chemical warfare and chronic mental/physical conditions. This was a secondary analysis of data from a case-control study on Iranian male veterans. Participants with neuropsychiatric disorders other than depressive/anxiety disorders, anatomical defects, or malignancies were excluded. Compared to non-exposed veterans, exposed veterans demonstrated significantly higher odds of PTSD [OR (95% CI) = 5.23 (1.98-13.85)], hypertension [OR (95% CI) = 5.57 (1.68-18.48)], coronary heart disease [OR (95% CI) = 6.8 (1.62-28.49)], and diabetes [OR (95% CI) = 3.88 (1.35-11.16)], and marginally higher odds of moderate to severe depressive symptoms [OR (95% CI) = 2.21 (0.93-5.28)]. This study provides preliminary evidence on association of exposure to chemical warfare with long-term mental disorders as well as chronic medical conditions.

Body mass index, exercise capacity, and mortality risk in male veterans with hypertension.

Science.gov (United States)

Faselis, Charles; Doumas, Michael; Panagiotakos, Demosthenes; Kheirbek, Raya; Korshak, Lauren; Manolis, Athanasios; Pittaras, Andreas; Tsioufis, Costas; Papademetriou, Vasilios; Fletcher, Ross; Kokkinos, Peter

2012-04-01

Overweight and obesity are associated with increased risk of chronic diseases and mortality. Exercise capacity is inversely associated with mortality risk. However, little is known on the interaction between fitness, fatness, and mortality risk in hypertensive individuals. Thus, we assessed the interaction between exercise capacity, fatness, and all-cause mortality in hypertensive males. A graded exercise test was performed in 4,183 hypertensive veterans (mean age ± s.d.; 63.3 ± 10.5 years) at the Veterans Affairs Medical Center, Washington, DC. We defined three body weight categories based on body mass index (BMI): normal weight (BMI 7.5 METs). During a median follow-up period of 7.2 years, there were 1,000 deaths. The association between exercise capacity and mortality risk was strong, inverse, and graded. For each 1-MET increase in exercise capacity the adjusted risk was 20% for normal weight, 12% for overweight, and 25% for obese (P exercise capacity is associated with lower mortality risk in hypertensive males regardless of BMI. The risk for overweight and obese but fit individuals was significantly lower when compared to normal weight but unfit. These findings suggest that in older hypertensive men, it may be healthier to be fit regardless of standard BMI category than unfit and normal weight.

38 CFR 21.21 - Election of benefits under education programs administered by the Department of Veterans Affairs.

Science.gov (United States)

2010-07-01

... § 21.21 Election of benefits under education programs administered by the Department of Veterans... education programs administered by VA must make an election of benefits between chapter 31 and any other VA... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Election of benefits...

Serving Our Homeless Veterans: Patient Perpetrated Violence as a Barrier to Health Care Access

Directory of Open Access Journals (Sweden)

Luz M. Semeah

2017-07-01

Full Text Available In 2009, the Department of Veterans Affairs (VA set a goal to end veteran homelessness by 2015. Since then there has been a 36% reduction in homelessness due, in part, to the VA Supportive Housing (HUD-VASH program. These services include the receipt of home-based services to the veterans’ home. However, safety concerns and the threat of violence toward health care workers remain problematic in non-institutional care settings. This article discusses the concept of access to care and how safety concerns act as a barrier to services and optimal patient outcomes. Our study provides information on the prevalence of patient violence toward health care workers in the HUD-VASH program in a large veterans’ health system. Results suggest 70% of home-based service providers were exposed to violence and aggression. Providing services to veterans outside of institutional care settings, and the goal of eradicating homelessness among veterans, warrants further examination of access barriers.

In Data We Trust? Comparison of Electronic Versus Manual Abstraction of Antimicrobial Prescribing Quality Metrics for Hospitalized Veterans With Pneumonia.

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Jones, Barbara E; Haroldsen, Candace; Madaras-Kelly, Karl; Goetz, Matthew B; Ying, Jian; Sauer, Brian; Jones, Makoto M; Leecaster, Molly; Greene, Tom; Fridkin, Scott K; Neuhauser, Melinda M; Samore, Matthew H

2018-07-01

Electronic health records provide the opportunity to assess system-wide quality measures. Veterans Affairs Pharmacy Benefits Management Center for Medication Safety uses medication use evaluation (MUE) through manual review of the electronic health records. To compare an electronic MUE approach versus human/manual review for extraction of antibiotic use (choice and duration) and severity metrics. Retrospective. Hospitalizations for uncomplicated pneumonia occurring during 2013 at 30 Veterans Affairs facilities. We compared summary statistics, individual hospitalization-level agreement, facility-level consistency, and patterns of variation between electronic and manual MUE for initial severity, antibiotic choice, daily clinical stability, and antibiotic duration. Among 2004 hospitalizations, electronic and manual abstraction methods showed high individual hospitalization-level agreement for initial severity measures (agreement=86%-98%, κ=0.5-0.82), antibiotic choice (agreement=89%-100%, κ=0.70-0.94), and facility-level consistency for empiric antibiotic choice (anti-MRSA r=0.97, P<0.001; antipseudomonal r=0.95, P<0.001) and therapy duration (r=0.77, P<0.001) but lower facility-level consistency for days to clinical stability (r=0.52, P=0.006) or excessive duration of therapy (r=0.55, P=0.005). Both methods identified widespread facility-level variation in antibiotic choice, but we found additional variation in manual estimation of excessive antibiotic duration and initial illness severity. Electronic and manual MUE agreed well for illness severity, antibiotic choice, and duration of therapy in pneumonia at both the individual and facility levels. Manual MUE showed additional reviewer-level variation in estimation of initial illness severity and excessive antibiotic use. Electronic MUE allows for reliable, scalable tracking of national patterns of antimicrobial use, enabling the examination of system-wide interventions to improve quality.

Veterans Affairs Information Technology: Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems

Science.gov (United States)

2017-02-07

department’s three major components—the Veterans Health Administration (VHA), the Veterans Benefits Administration ( VBA ), and the National Cemetery...care and specialized care, and it performs research and development to improve veterans’ needs. VBA provides a variety of benefits to veterans and...the determination of benefits, benefits claims processing, patient admission to hospitals and clinics, and access to health records, among other

38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Dental services for... Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.166 Dental services for... domiciliary care pursuant to the provisions of §§ 17.46 and 17.47, will be furnished such dental services as...

The Relationship Between Traumatic Brain Injury and Rates of Chronic Symptomatic Illness in 202 Gulf War Veterans.

Science.gov (United States)

Chao, Linda L

2018-05-18

Although not a "signature injury" of Operation Desert Shield/Desert Storm (i.e., Gulf War, GW), some GW veterans have a history traumatic brain injury (TBI). For example, a previous study found that 12.2% of the GW veterans from the Fort Devens Cohort Study had self-reported TBIs. The present study sought to build upon this finding by examining the relationship between TBI and chronic symptomatic illness in a different sample of GW veterans. Participants were 202 GW veterans recruited from 2014 to 2018 at the San Francisco Veterans Affairs Medical Center as part of a VA-funded study on the effects of predicted exposure to low levels of sarin and cyclosarin on brain structure and function. The Ohio State University TBI identification method was used to determine lifetime history of TBI. The Kansas Gulf War Military History and Health Questionnaire was used to assess symptoms and to determine cases of Kansas Gulf War Illness (GWI) and Centers for Disease Control and Prevention (CDC) Chronic Multisymptom Illness (CMI). Nearly half (47%) the sample had a history of TBI, but only 7% of the TBIs were sustained in injuries that occurred during the GW. Most of the TBIs were sustained in injuries that occurred prior to (73%) or after (34%) the GW. History of TBI was not associated with higher rates of symptomatic illness when it was narrowly defined (i.e., Kansas GWI cases or cases of severe CMI). History of TBI was only associated with higher rates of symptomatic illness when it is broadly defined (i.e., CDC CMI or mild-moderate CMI). There was suggestive evidence that veterans who sustained TBIs during the GW (only seven in the present sample) have poorer functional outcomes compared with GW veterans with non-GW related TBIs. While TBIs were uncommon during the GW, many GW veterans sustained TBIs prior or after the GW. Because TBI and GWI/CMI share some overlapping symptoms, history of TBI may appear to be associated with increased rates of chronic symptomatic illness in

Posttraumatic stress disorder among black Vietnam veterans.

Science.gov (United States)

Allen, I M

1986-01-01

Because of racism in the military and racial and social upheaval in the United States during the Vietnam War years, as well as limited opportunities for blacks in the postwar period, black veterans of the Vietnam War often harbor conflicting feelings about their wartime experiences and have difficulty rationalizing brutality against the Vietnamese. As a result, black veterans suffer from posttraumatic stress disorder (PTSD) at a higher rate than white veterans. Diagnosis and treatment of PTSD in black veterans is complicated by the tendency to misdiagnose black patients, by the varied manifestations of PTSD, and by patients' frequent alcohol and drug abuse and medical, legal, personality, and vocational problems. The author presents his and others' recommendations about ways to treat black veterans with PTSD.

Creating a sampling frame for population-based veteran research: representativeness and overlap of VA and Department of Defense databases.

Science.gov (United States)

Washington, Donna L; Sun, Su; Canning, Mark

2010-01-01

Most veteran research is conducted in Department of Veterans Affairs (VA) healthcare settings, although most veterans obtain healthcare outside the VA. Our objective was to determine the adequacy and relative contributions of Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), and Department of Defense (DOD) administrative databases for representing the U.S. veteran population, using as an example the creation of a sampling frame for the National Survey of Women Veterans. In 2008, we merged the VHA, VBA, and DOD databases. We identified the number of unique records both overall and from each database. The combined databases yielded 925,946 unique records, representing 51% of the 1,802,000 U.S. women veteran population. The DOD database included 30% of the population (with 8% overlap with other databases). The VHA enrollment database contributed an additional 20% unique women veterans (with 6% overlap with VBA databases). VBA databases contributed an additional 2% unique women veterans (beyond 10% overlap with other databases). Use of VBA and DOD databases substantially expands access to the population of veterans beyond those in VHA databases, regardless of VA use. Adoption of these additional databases would enhance the value and generalizability of a wide range of studies of both male and female veterans.

38 CFR 17.150 - Prosthetic and similar appliances.

Science.gov (United States)

2010-07-01

... appliances. 17.150 Section 17.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Prosthetic, Sensory, and Rehabilitative Aids § 17.150 Prosthetic and similar appliances... appliances including invalid lifts and therapeutic and rehabilitative devices, and special clothing made...

Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans.

Science.gov (United States)

Bovin, Michelle J; Marx, Brian P; Weathers, Frank W; Gallagher, Matthew W; Rodriguez, Paola; Schnurr, Paula P; Keane, Terence M

2016-11-01

This study examined the psychometric properties of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5; Weathers, Litz, et al., 2013b) in 2 independent samples of veterans receiving care at a Veterans Affairs Medical Center (N = 468). A subsample of these participants (n = 140) was used to define a valid diagnostic cutoff score for the instrument using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers, Blake, et al., 2013) as the reference standard. The PCL-5 test scores demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity. Consistent with previous studies (Armour et al., 2015; Liu et al., 2014), confirmatory factor analysis revealed that the data were best explained by a 6-factor anhedonia model and a 7-factor hybrid model. Signal detection analyses using the CAPS-5 revealed that PCL-5 scores of 31 to 33 were optimally efficient for diagnosing PTSD (κ(.5) = .58). Overall, the findings suggest that the PCL-5 is a psychometrically sound instrument that can be used effectively with veterans. Further, by determining a valid cutoff score using the CAPS-5, the PCL-5 can now be used to identify veterans with probable PTSD. However, findings also suggest the need for research to evaluate cluster structure of DSM-5. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Are comparisons of patient experiences across hospitals fair? A study in Veterans Health Administration hospitals.

Science.gov (United States)

Cleary, Paul D; Meterko, Mark; Wright, Steven M; Zaslavsky, Alan M

2014-07-01

Surveys are increasingly used to assess patient experiences with health care. Comparisons of hospital scores based on patient experience surveys should be adjusted for patient characteristics that might affect survey results. Such characteristics are commonly drawn from patient surveys that collect little, if any, clinical information. Consequently some hospitals, especially those treating particularly complex patients, have been concerned that standard adjustment methods do not adequately reflect the challenges of treating their patients. To compare scores for different types of hospitals after making adjustments using only survey-reported patient characteristics and using more complete clinical and hospital information. We used clinical and survey data from a national sample of 1858 veterans hospitalized for an initial acute myocardial infarction (AMI) in a Department of Veterans Affairs (VA) medical center during fiscal years 2003 and 2004. We used VA administrative data to characterize hospitals. The survey asked patients about their experiences with hospital care. The clinical data included 14 measures abstracted from medical records that are predictive of survival after an AMI. Comparisons of scores across hospitals adjusted only for patient-reported health status and sociodemographic characteristics were similar to those that also adjusted for patient clinical characteristics; the Spearman rank-order correlations between the 2 sets of adjusted scores were >0.97 across 9 dimensions of inpatient experience. This study did not support concerns that measures of patient care experiences are unfair because commonly used models do not adjust adequately for potentially confounding patient clinical characteristics.

Military Sexual Trauma Among Recent Veterans: Correlates of Sexual Assault and Sexual Harassment.

Science.gov (United States)

Barth, Shannon K; Kimerling, Rachel E; Pavao, Joanne; McCutcheon, Susan J; Batten, Sonja V; Dursa, Erin; Peterson, Michael R; Schneiderman, Aaron I

2016-01-01

Military sexual trauma (MST) includes sexual harassment or sexual assault that occurs during military service and is of increasing public health concern. The population prevalence of MST among female and male veterans who served during Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) has not been estimated to our knowledge. The purpose of this study is to assess the population prevalence and identify military correlates of MST, sexual harassment, and sexual assault among OEF/OIF veterans. MST was assessed in the 2009-2011 National Health Study for a New Generation of U.S. Veterans, a survey of 60,000 veterans who served during the OEF/OIF eras (response rate, 34%, n=20,563). Weighted prevalence estimates and AORs of MST, sexual harassment, and sexual assault among women and men were calculated. Gender-stratified logistic regression models controlled for military and demographic characteristics. Data analyses were conducted in 2013-2014. Approximately 41% of women and 4% of men reported experiencing MST. Deployed men had lower risk for MST compared with non-deployed men, though no difference was found among women. However, veterans reporting combat exposure during deployment had increased risk for MST compared with those without, while controlling for OEF/OIF deployment. Among women, Marines and Navy veterans had increased risk for MST compared with Air Force veterans. MST was significantly higher among veterans who reported using Veterans Affairs healthcare services. These prevalence estimates underscore the importance of public awareness and continued investigation of the public health impact of MST. Published by Elsevier Inc.

Medication-use evaluation with a Web application.

Science.gov (United States)

Burk, Muriel; Moore, Von; Glassman, Peter; Good, Chester B; Emmendorfer, Thomas; Leadholm, Thomas C; Cunningham, Francesca

2013-12-15

A Web-based application for coordinating medication-use evaluation (MUE) initiatives within the Veterans Affairs (VA) health care system is described. The MUE Tracker (MUET) software program was created to improve VA's ability to conduct national medication-related interventions throughout its network of 147 medical centers. MUET initiatives are centrally coordinated by the VA Center for Medication Safety (VAMedSAFE), which monitors the agency's integrated databases for indications of suboptimal prescribing or drug therapy monitoring and adverse treatment outcomes. When a pharmacovigilance signal is detected, VAMedSAFE identifies "trigger groups" of at-risk veterans and uploads patient lists to the secure MUET application, where locally designated personnel (typically pharmacists) can access and use the data to target risk-reduction efforts. Local data on patient-specific interventions are stored in a centralized database and regularly updated to enable tracking and reporting for surveillance and quality-improvement purposes; aggregated data can be further analyzed for provider education and benchmarking. In a three-year pilot project, the MUET program was found effective in promoting improved prescribing of erythropoiesis-stimulating agents (ESAs) and enhanced laboratory monitoring of ESA-treated patients in all specified trigger groups. The MUET initiative has since been expanded to target other high-risk drugs, and efforts are underway to refine the tool for broader utility. The MUET application has enabled the increased standardization of medication safety initiatives across the VA system and may serve as a useful model for the development of pharmacovigilance tools by other large integrated health care systems.

Cataract Surgery Outcomes in Glaucomatous Eyes: Results From the Veterans Affairs Ophthalmic Surgery Outcomes Data Project.

Science.gov (United States)

Turalba, Angela; Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Cakiner-Egilmez, Tulay; Chomsky, Amy S; Vollman, David E; Baze, Elizabeth F; Lawrence, Mary; Daly, Mary K

2015-10-01

To compare visual acuity outcomes, vision-related quality of life, and complications related to cataract surgery in eyes with and without glaucoma. Retrospective cohort study. Cataract surgery outcomes in cases with and without glaucoma from the Veterans Affairs Ophthalmic Surgical Outcomes Data Project were compared. We identified 608 glaucoma cases and 4306 controls undergoing planned cataract surgery alone. After adjusting for age, pseudoexfoliation, small pupil, prior ocular surgery, and anterior chamber depth, we found that glaucoma cases were more likely to have posterior capsular tear with vitrectomy (odds ratio [OR] 1.8, P = .03) and sulcus intraocular lens placement (OR 1.65, P = .03) during cataract surgery. Glaucoma cases were more likely to have postoperative inflammation (OR 1.73, P < .0001), prolonged elevated intraocular pressure (OR 2.96, P = .0003), and additional surgery within 30 days (OR 1.92, P = .03). Mean best-corrected visual acuity (BCVA) and Visual Function Questionnaire (VFQ) scores significantly improved after cataract surgery in both groups (P < .0001), but there were larger improvements in BCVA (P = .01) and VFQ composite scores (P < .0001) in the nonglaucoma vs the glaucoma group. A total of 3621 nonglaucoma cases (94.1%) had postoperative BCVA 20/40 or better, compared to 466 glaucoma cases (89.6%) (P = .0003). Eyes with glaucoma are at increased risk for complications and have more modest visual outcomes after cataract surgery compared to eyes without glaucoma. Despite this, glaucoma patients still experience significant improvement in vision-related outcomes after cataract extraction. Further study is needed to explore potential factors that influence cataract surgery outcomes in glaucomatous eyes. Published by Elsevier Inc.

Comparing the quality of antidepressant pharmacotherapy in the Department of Veterans Affairs and the private sector.

Science.gov (United States)

Busch, Susan H; Leslie, Douglas L; Rosenheck, Robert A

2004-12-01

Comparing quality of care between large health care systems is important for health systems management. This study compared measures of the quality of pharmacotherapy for patients with major depression across a sample of patients from the Department of Veterans Affairs (VA) and the private sector. In this observational study, all patients who were given a new prescription for an antidepressant and a diagnosis of major depression in the VA during fiscal year 2000 were identified by using administrative data (N=27,713). In the private sector, a similar sample of patients were identified by using Medstat's MarketScan database (N=4,852). For both groups, measures of the quality of antidepressant pharmacotherapy were constructed. These measures were compared across the two groups by using logistic regression models. Controls for age, gender, comorbid disorders, and initial antidepressant drug prescribed were included in some models. Although the populations had different demographic and clinical characteristics, differences in the quality measures between the two systems were few, with the VA slightly outperforming the private sector in the prescription of antidepressants during the acute phase of treatment, the first 84 days (84.7 compared with 81 percent) and during the maintenance phase of treatment, the first 181 days (53.9 compared with 50.9 percent). Patient characteristics that were associated with quality measures included being older, being female, and having a comorbid diagnosis of substance use disorder, bipolar disorder, or anxiety or adjustment disorder. Both systems had relatively high rates of adherence to pharmacotherapy guidelines. Even though the populations in the two systems were different, adjusting the analyses for clinical characteristics did little to change the measured differences between the two systems.

77 FR 76170 - Presumption of Exposure to Herbicides for Blue Water Navy Vietnam Veterans Not Supported

Science.gov (United States)

2012-12-26

... during the Vietnam War. After careful review of the IOM report, the Secretary determines that the... served in deep-water naval vessels off the coast of Vietnam during the Vietnam War are referred to as... DEPARTMENT OF VETERANS AFFAIRS Presumption of Exposure to Herbicides for Blue Water Navy Vietnam...

The predictive power of depression screening procedures for veterans with coronary artery disease

Directory of Open Access Journals (Sweden)

Shankman SA

2012-04-01

Full Text Available Stewart A Shankman1*, Jeffrey Nadelson2*, Sarah Kate McGowan1, Ali A Sovari2, Mladen I Vidovich21Department of Psychiatry and Psychology, University of Illinois, 2Department of Cardiology, Jesse Brown VA Medical Center, Chicago, IL, USA*These authors contributed equally to this workAbstract: Depression leads to a worse outcome for patients with coronary artery disease (CAD. Thus, accurately identifying depression in CAD patients is imperative. In many veterans affairs (VA hospitals, patients are screened for depression once a year using the patient health questionnaire (PHQ-9. Although the PHQ-9 is generally considered a specific and sensitive measure of depression, there is reason to believe that these screening procedures may miss a large number of cases of depression within CAD patients and cardiology patients more generally. The goal of this study was to provide data as to the predictive power of this depression screening procedure by (a comparing the prevalence rate of depression identified by the PHQ-9 to known prevalence rates and (b examining whether patients identified as “depressed” also had conditions that consistently co-occur with depression (eg, post-traumatic stress disorder [PTSD], other medical issues. Participants were 813 consecutive patients who received an angiogram in the cardiac catheterization laboratory at a large VA Medical Center. Prevalence of depression was 6.9% in the overall sample and less than 6% when the sample was restricted to CAD patients with significant stenosis. Depression was significantly associated with PTSD, smoking, and alcohol problems. However, depression was not associated with other medical problems such as diabetes, renal failure, peripheral vascular disease, or anemia. In conclusion, the low prevalence rate of depression and lack of associations with comorbid medical problems may suggest that the VA’s depression screening procedures have low sensitivity for identifying depression in CAD

38 CFR 17.106 - Authority for disciplinary action.

Science.gov (United States)

2010-07-01

... disciplinary action. 17.106 Section 17.106 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Disciplinary Control of Beneficiaries Receiving Hospital, Domiciliary Or Nursing Home Care § 17.106 Authority for disciplinary action. The good conduct of beneficiaries receiving hospitalization...

38 CFR 17.100 - Refusal of treatment by unnecessarily breaking appointments.