WorldWideScience

Sample records for veterans affairs department

  1. 75 FR 78807 - Agency Information Collection (Notice to Department of Veterans Affairs of Veteran or Beneficiary...

    Science.gov (United States)

    2010-12-16

    ... Incarcerated in Penal Institution) Activity Under OMB Review AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: In compliance with the Paperwork Reduction Act (PRA... Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution, VA Form 21-4193. OMB Control...

  2. 38 CFR 3.108 - State Department as agent of Department of Veterans Affairs.

    Science.gov (United States)

    2010-07-01

    ... Administrative § 3.108 State Department as agent of Department of Veterans Affairs. Diplomatic and consular officers of the Department of State are authorized to act as agents of the Department of Veterans Affairs... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false State Department as agent...

  3. Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)

    Data.gov (United States)

    Department of Veterans Affairs — Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health care benefit program designed for the dependents of certain Veterans....

  4. 38 CFR 3.201 - Exchange of evidence; Social Security and Department of Veterans Affairs.

    Science.gov (United States)

    2010-07-01

    ...; Social Security and Department of Veterans Affairs. 3.201 Section 3.201 Pensions, Bonuses, and Veterans... Compensation Evidence Requirements § 3.201 Exchange of evidence; Social Security and Department of Veterans... Social Security Administration or to have the Department of Veterans Affairs obtain such evidence from...

  5. 48 CFR 852.203-71 - Display of Department of Veterans Affairs hotline poster.

    Science.gov (United States)

    2010-10-01

    ... Veterans Affairs hotline poster. 852.203-71 Section 852.203-71 Federal Acquisition Regulations System... Provisions and Clauses 852.203-71 Display of Department of Veterans Affairs hotline poster. As prescribed in 803.7001, insert the following clause: Display of Department of Veterans Affairs Hotline Poster (DEC...

  6. Assessment of Service Members Knowledge and Trust of the Department of Veterans Affairs

    Science.gov (United States)

    2015-06-12

    OIF Operation Iraqi Freedom VA Department of Veterans Affairs VA OIG Department of Veterans Affairs Office of Inspector General VBA Veterans Benefits...reorganization into the three administrations: Veterans Health Administration (VHA), Veterans Benefits Administration ( VBA ) and National Cemetery...features. VBA also implemented a similar program in coordination with DoD called eBenefits which allows Veterans, Service Members and their families to

  7. 38 CFR 3.1611 - Official Department of Veterans Affairs representation at funeral.

    Science.gov (United States)

    2010-07-01

    ... representation at funeral. When requested by the person entitled to the custody of the body of a deceased beneficiary of the Department of Veterans Affairs, official representation at the funeral will be granted... Veterans Affairs representation at funeral. 3.1611 Section 3.1611 Pensions, Bonuses, and Veterans' Relief...

  8. 38 CFR 14.514 - Suits by or against United States or Department of Veterans Affairs officials; indemnification of...

    Science.gov (United States)

    2010-07-01

    ... United States or Department of Veterans Affairs officials; indemnification of Department of Veterans... States or Department of Veterans Affairs officials. When a suit involving any activities of the Department of Veterans Affairs is filed against the United States or the Secretary or a suit is filed against...

  9. Veterans Affairs Suicide Prevention Synthetic Dataset

    Data.gov (United States)

    Department of Veterans Affairs — The VA's Veteran Health Administration, in support of the Open Data Initiative, is providing the Veterans Affairs Suicide Prevention Synthetic Dataset (VASPSD). The...

  10. The Post-9/11 GI Bill: Insights from Veterans Using Department of Veterans Affairs Educational Benefits

    Science.gov (United States)

    Bell, Geri L.; Boland, Elizabeth A.; Dudgeon, Brian; Johnson, Kurt

    2013-01-01

    Because the Post-9/11 GI Bill was implemented in August of 2009, increasing numbers of veterans returning from the Global War on Terror (GWT) have drawn on Department of Veterans Affairs (VA) educational benefits. Based on the findings of a mixed-methods study, quantitative and qualitative survey responses from veterans enrolled at a major…

  11. 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...

  12. 38 CFR 17.509 - Authorized disclosure: Non-Department of Veterans Affairs requests.

    Science.gov (United States)

    2010-07-01

    ... quality assurance records and documents. (2) Accreditation agencies charged with more narrowly focused...' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Confidentiality of Healthcare Quality Assurance Review... confidential and privileged quality assurance records and documents from organizations or individuals outside...

  13. 38 CFR 1.553a - Time limits for Department of Veterans Affairs response to requests for records.

    Science.gov (United States)

    2010-07-01

    ... of Veterans Affairs Records Other Than Claimant Records § 1.553a Time limits for Department of... jurisdiction and allow the Department of Veterans Affairs additional time to complete its review of the records... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Time limits for...

  14. Veterans' use of Department of Veterans Affairs care and perceptions of outsourcing inpatient care.

    Science.gov (United States)

    Wakefield, Bonnie J; Tripp-Reimer, Toni; Rosenbaum, Marcy E; Rosenthal, Gary E

    2007-06-01

    The objective of the study was to examine veterans' perceptions of problems and benefits of outsourcing inpatient care from Veterans Affairs (VA) hospitals to private sector hospitals. Primary data were collected from a cross-section of 42 veterans who were VA users and nonusers using focus groups. Focus group discussion examined reasons patients use VA care, differences between VA and civilian care, positive and negative impacts of outsourcing, and special needs of veterans. Analyses revealed five domains related both to use of VA services and perceptions of outsourcing: costs, access, quality of care, contract (i.e., a covenant between veterans and the U.S. government), veteran milieu, and special needs. Participants identified a variety of potential positive and negative impacts. In general, veterans perceived more advantages than disadvantages to outsourcing VA care but still expressed significant concerns related to outsourcing. These issues should be considered in the development of future policy toward outsourcing VA care to the private sector.

  15. 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.

  16. 76 FR 72047 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

    Science.gov (United States)

    2011-11-21

    ... placement for senior, disabled, homeless and/or at-risk Veterans and their families. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans Affairs, 810...

  17. 76 FR 71441 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

    Science.gov (United States)

    2011-11-17

    ... placement for senior Veterans, homeless Veterans and Veterans at risk of homelessness and their families... self-sufficiency. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 461...

  18. Migration by Veterans Who Received Homeless Services From the Department of Veterans Affairs.

    Science.gov (United States)

    Metraux, Stephen; Treglia, Dan; O'Toole, Thomas P

    2016-10-01

    We examined migration patterns among 113,400 homeless veterans, focusing on the prevalence and the basic geographic patterns of this migration. Data were for all veterans who initiated use of Veterans Affairs homeless services in 2011 or 2012; and we followed them using Veterans Affairs administrative records for up to 2 years following this initial contact. Results showed that 15.3% of the veterans migrated across regions while homeless. Those who were homeless for longer periods were more likely to migrate, and migration, were it to occur, was most likely earlier on in veterans' homelessness episodes. There were no clear geographic correlates that explained the dynamics of this migration as, overall, in-migration tended to roughly balance out-migration in a region. These findings suggest that concerns about the extent of migration and its impact on localities are exaggerated, but also sets forth an agenda for more in-depth study of these data to gain a deeper and more expansive understanding of this phenomenon. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  19. 2 CFR 801.995 - Principal (Department of Veterans Affairs supplement to government-wide definition at 2 CFR 180...

    Science.gov (United States)

    2010-01-01

    ... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Principal (Department of Veterans Affairs supplement to government-wide definition at 2 CFR 180.995.) 801.995 Section 801.995 Grants and Agreements Federal Agency Regulations for Grants and Agreements DEPARTMENT OF VETERANS AFFAIRS NONPROCUREMENT...

  20. 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 Agreements Federal Agency Regulations for Grants and Agreements DEPARTMENT OF VETERANS AFFAIRS NONPROCUREMENT...

  1. 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 Agreements Federal Agency Regulations for Grants and Agreements DEPARTMENT OF VETERANS AFFAIRS NONPROCUREMENT...

  2. An Examination of the External and Internal Forces that have Shaped the Department of Veterans Affairs

    Science.gov (United States)

    2014-05-22

    OF THIS MONOGRAPH IS TO RESEARCH THE INTERNAL AND EXTERNAL SHAPING FORCES THAT HAVE CHANGED THE DEPARTMENT OF VETERANS AFFAIRS ( DVA ) AT THE...STRATEGIC AND OPERATIONAL LEVEL. THE HISTORY OF DVA , MAJOR LEGISLATIVE, EXECUTIVE, AND JUDICIAL SHAPING FORCES HAVE MOLDED THE DEPARTMENT. HOWEVER, THE...SCANDALS OF CHARLES FORBES AND THE ARMY ACTIONS AGAINST THE BONUS ARMY MADE LASTING IMPRESSIONS ON THE DEPARTMENT. THE MODERN DVA WAS CREATED WHEN A

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

    Science.gov (United States)

    2010-09-29

    overall exposure of troops to Leishmania tropica? 3. What were the exposure concentrations to various petroleum products, and their combustion products...have been identified in Veterans of the 1990 – 1991 Gulf War. 3. What were the exposure concentrations to various petroleum products, and their...Research Program within CDMRP (DoD). A clinical study to examine the effects of aspirin and Clopidogrel on biomarkers of Gulf War Veterans

  4. Availability of gynecologic services in the department of veterans affairs.

    Science.gov (United States)

    Seelig, Michelle D; Yano, Elizabeth M; Bean-Mayberry, Bevanne; Lanto, Andy B; Washington, Donna L

    2008-01-01

    The optimum approach to providing the Congressionally mandated gender-specific services for which women veterans are eligible is unknown. We evaluated onsite availability of gynecologic services, clinic type and staffing arrangements, and the impact of having a gynecology clinic (GYN) and/or an obstetrician gynecologist (OBGYN) routinely available. We analyzed data from the 2001 national VHA Survey of Women Veterans Health Programs and Practices (n = 136 sites; response rate, 83%). We assessed availability of gynecologic services, and evaluated differences in availability by clinic type (designated women's health provider in primary care [PC], separate women's health clinic for primary care [WHC], and/or separate GYN) and staffing arrangements (OBGYN routinely involved versus not). Out of 133 sites, 77 sites (58%) offered services through a GYN and 56 sites (42%) did not have GYN. Seventy-two (54%) sites had a WHC. More sites with an OBGYN provided endometrial biopsies (91% vs. 20%), IUD insertion (85% vs. 14%), infertility evaluation (56% vs. 23%), infertility treatment (25% vs. none), gynecologic surgery (65 vs. 28%), p gynecologic surgery 2.3 (1.0-5.4). As the VA develops strategic plans for accommodating the growing number of women veterans, leaders should consider focusing on establishing WHC for primary care and routine availability of OBGYN or other qualified clinicians, rather than establishing separate GYN.

  5. 75 FR 7648 - Privacy Act of 1974, as Amended; Computer Matching Program (SSA/Department of Veterans Affairs...

    Science.gov (United States)

    2010-02-22

    .../Veterans Benefits Administration (VA/ VBA))--Match Number 1309 AGENCY: Social Security Administration (SSA... announces a renewal of an existing computer matching program that we are currently conducting with VA/VBA... Matching Program, SSA With the Department of Veterans Affairs/Veterans Benefits Administration (VA/VBA) A...

  6. 76 FR 71439 - Amendment to an Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for...

    Science.gov (United States)

    2011-11-17

    ... preference and priority placement for homeless Veterans and Veterans at risk of homelessness and their...-term self-sufficiency. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 461...

  7. 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

    2016-05-09

    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 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.

  8. Veterans Affairs Central Cancer Registry (VACCR)

    Data.gov (United States)

    Department of Veterans Affairs — The Veterans Affairs Central Cancer Registry (VACCR) receives and stores information on cancer diagnosis and treatment constraints compiled and sent in by the local...

  9. 38 CFR 14.518 - Litigation involving beneficiaries in custody of Department of Veterans Affairs employees acting...

    Science.gov (United States)

    2010-07-01

    ... with a writ of habeas corpus involving a beneficiary of the Department of Veterans Affairs in the... steps as in his or her judgment are necessary for self protection. (b) Habeas corpus writs. (1) If a...

  10. The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight

    Science.gov (United States)

    2013-09-18

    E M B E R 1 8 , 2 0 1 3 The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More...Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight 5a. CONTRACT NUMBER...Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight Objective Our audit objective was to determine whether the

  11. 76 FR 72045 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

    Science.gov (United States)

    2011-11-21

    ... required to provide preference and priority placement for Veterans at risk for homelessness, and provide on-site supportive services. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 461...

  12. Overlapping buprenorphine, opioid, and benzodiazepine prescriptions among veterans dually enrolled in Department of Veterans Affairs and Medicare Part D.

    Science.gov (United States)

    Gellad, Walid F; Zhao, Xinhua; Thorpe, Carolyn T; Thorpe, Joshua M; Sileanu, Florentina E; Cashy, John P; Mor, Maria; Hale, Jennifer A; Radomski, Thomas; Hausmann, Leslie R M; Fine, Michael J; Good, Chester B

    2017-01-01

    Buprenorphine is a key tool in the management of opioid use disorder, but there are growing concerns about abuse, diversion, and safety. These concerns are amplified for the Department of Veterans Affairs (VA), whose patients may receive care concurrently from multiple prescribers within and outside VA. To illustrate the extent of this challenge, we examined overlapping prescriptions for buprenorphine, opioids, and benzodiazepines among veterans dually enrolled in VA and Medicare Part D. We constructed a cohort of all veterans dually enrolled in VA and Part D who filled an opioid prescription in 2012. We identified patients who received tablet or film buprenorphine products from either source. We calculated the proportion of buprenorphine recipients with any overlapping prescription (based on days supply) for a nonbuprenorphine opioid or benzodiazepine, focusing on veterans who received overlapping prescriptions from a different system than their buprenorphine prescription (Part D buprenorphine recipients receiving overlapping opioids or benzodiazepines from VA and vice versa). There were 1790 dually enrolled veterans with buprenorphine prescriptions, including 760 (43%) from VA and 1091 (61%) from Part D (61 veterans with buprenorphine from both systems were included in each group). Among VA buprenorphine recipients, 199 (26%) received an overlapping opioid prescription and 11 (1%) received an overlapping benzodiazepine prescription from Part D. Among Part D buprenorphine recipients, 208 (19%) received an overlapping opioid prescription and 178 (16%) received an overlapping benzodiazepine prescription from VA. Among VA and Part D buprenorphine recipients with cross-system opioid overlap, 25% (49/199) and 35% (72/208), respectively, had >90 days of overlap. Many buprenorphine recipients receive overlapping prescriptions for opioids and benzodiazepines from a different health care system than the one in which their buprenorphine was filled. These findings highlight

  13. 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

  14. 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.

  15. Ethnic Disparities in Emergency Severity Index Scores among U.S. Veteran's Affairs Emergency Department Patients

    National Research Council Canada - National Science Library

    Vigil, Jacob M; Alcock, Joe; Coulombe, Patrick; McPherson, Laurie; Parshall, Mark; Murata, Allison; Brislen, Heather

    2015-01-01

    ... characteristics, and whether these differences varied among male and female Veterans Affairs (VA) ED patients. We used a large national database of electronic medical records of ED patients from twenty-two...

  16. 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

  17. Associations between the Department of Veterans Affairs' suicide prevention campaign and calls to related crisis lines.

    Science.gov (United States)

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

    2014-01-01

    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. 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. 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. 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.

  18. Infertility Care Among OEF/OIF/OND Women Veterans in the Department of Veterans Affairs

    Science.gov (United States)

    Mattocks, Kristin; Kroll-Desrosiers, Aimee; Zephyrin, Laurie; Katon, Jodie; Weitlauf, Julie; Bastian, Lori; Haskell, Sally; Brandt, Cynthia

    2015-01-01

    Background An increasing number of young women Veterans seek reproductive health care through the VA, yet little is known regarding the provision of infertility care for this population. The VA provides a range of infertility services for Veterans including artificial insemination, but does not provide in vitro fertilization. This study will be the first to characterize infertility care among OEF/OIF/OND women Veterans using VA care. Methods We analyzed data from the OEF/OIF/OND roster file from the Defense Manpower Data Center (DMDC)—Contingency Tracking System Deployment file of military discharges from October 1, 2001–December 30, 2010, which includes 68,442 women Veterans between the ages of 18 and 45 who utilized VA health care after separating from military service. We examined the receipt of infertility diagnoses and care using ICD-9 and CPT codes. Results Less than 2% (n = 1323) of OEF/OIF/OND women Veterans received an infertility diagnosis during the study period. Compared with women VA users without infertility diagnosis, those with infertility diagnosis were younger, obese, black, or Hispanic, have a service-connected disability rating, a positive screen for military sexual trauma, and a mental health diagnosis. Overall, 22% of women with an infertility diagnosis received an infertility assessment or treatment. Thirty-nine percent of women Veterans receiving infertility assessment or treatment received this care from non-VA providers. Conclusions Overall, a small proportion of OEF/OIF/OND women Veterans received infertility diagnoses from the VA during the study period, and an even smaller proportion received infertility treatment. Nearly 40% of those who received infertility treatments received these treatments from non-VA providers, indicating that the VA may need to examine the training and resources needed to provide this care within the VA. Understanding women’s use of VA infertility services is an important component of understanding VA

  19. Infertility care among OEF/OIF/OND women Veterans in the Department of Veterans Affairs.

    Science.gov (United States)

    Mattocks, Kristin; Kroll-Desrosiers, Aimee; Zephyrin, Laurie; Katon, Jodie; Weitlauf, Julie; Bastian, Lori; Haskell, Sally; Brandt, Cynthia

    2015-04-01

    An increasing number of young women Veterans seek reproductive health care through the VA, yet little is known regarding the provision of infertility care for this population. The VA provides a range of infertility services for Veterans including artificial insemination, but does not provide in vitro fertilization. This study will be the first to characterize infertility care among OEF/OIF/OND women Veterans using VA care. We analyzed data from the OEF/OIF/OND roster file from the Defense Manpower Data Center (DMDC)-Contingency Tracking System Deployment file of military discharges from October 1, 2001-December 30, 2010, which includes 68,442 women Veterans between the ages of 18 and 45 who utilized VA health care after separating from military service. We examined the receipt of infertility diagnoses and care using ICD-9 and CPT codes. Less than 2% (n=1323) of OEF/OIF/OND women Veterans received an infertility diagnosis during the study period. Compared with women VA users without infertility diagnosis, those with infertility diagnosis were younger, obese, black, or Hispanic, have a service-connected disability rating, a positive screen for military sexual trauma, and a mental health diagnosis. Overall, 22% of women with an infertility diagnosis received an infertility assessment or treatment. Thirty-nine percent of women Veterans receiving infertility assessment or treatment received this care from non-VA providers. Overall, a small proportion of OEF/OIF/OND women Veterans received infertility diagnoses from the VA during the study period, and an even smaller proportion received infertility treatment. Nearly 40% of those who received infertility treatments received these treatments from non-VA providers, indicating that the VA may need to examine the training and resources needed to provide this care within the VA. Understanding women's use of VA infertility services is an important component of understanding VA's commitment to comprehensive medical care for

  20. Trends in Timing of Dialysis Initiation within Versus Outside the Department of Veterans Affairs

    Science.gov (United States)

    O’Hare, Ann M.; Batten, Adam; Sulc, Christine A.; Neely, Emily L.; Liu, Chuan-Fen; Hebert, Paul L.

    2015-01-01

    Background and objectives The secular trend toward dialysis initiation at progressively higher levels of eGFR is not well understood. This study compared temporal trends in eGFR at dialysis initiation within versus outside the Department of Veterans Affairs (VA)—the largest non–fee-for-service health system in the United States. Design, setting, participants, & measurements The study used linked data from the US Renal Data System, VA, and Medicare to compare temporal trends in eGFR at dialysis initiation between 2000 and 2009 (n=971,543). Veterans who initiated dialysis within the VA were compared with three groups who initiated dialysis outside the VA: (1) veterans whose dialysis was paid for by the VA, (2) veterans whose dialysis was not paid for by the VA, and (3) nonveterans. Logistic regression was used to estimate average predicted probabilities of dialysis initiation at an eGFR≥10 ml/min per 1.73 m2. Results The adjusted probability of starting dialysis at an eGFR≥10 ml/min per 1.73 m2 increased over time for all groups but was lower for veterans who started dialysis within the VA (0.31; 95% confidence interval [95% CI], 0.30 to 0.32) than for those starting outside the VA, including veterans whose dialysis was (0.36; 95% CI, 0.35 to 0.38) and was not (0.40; 95% CI, 0.40 to 0.40) paid for by the VA and nonveterans (0.39; 95% CI, 0.39 to 0.39). Differences in eGFR at initiation within versus outside the VA were most pronounced among older patients (P for interaction dialysis initiation within the VA mirrored those in the wider United States dialysis population, but eGFR at initiation was consistently lowest among those who initiated within the VA. Differences in eGFR at initiation within versus outside the VA were especially pronounced in older patients and those with higher 1-year mortality risk. PMID:26206891

  1. 77 FR 14600 - Public Availability of the Department of Veterans Affairs Fiscal Year (FY) 2011 Service Contract...

    Science.gov (United States)

    2012-03-12

    ... Management Service, in the Office of Acquisition, Logistics, and Construction at (202) 461-6918, or email... Inventory AGENCY: Department of Veterans Affairs. ACTION: Notice of Public Availability of FY 2011 Service Contract Inventories. SUMMARY: In accordance with Section 743 of Division C of the Consolidated...

  2. Ethnic Disparities in Emergency Severity Index Scores among U.S. Veteran's Affairs Emergency Department Patients.

    Directory of Open Access Journals (Sweden)

    Jacob M Vigil

    Full Text Available The goal of these analyses was to determine whether there were systematic differences in Emergency Severity Index (ESI scores, which are intended to determine priority of treatment and anticipate resource needs, across categories of race and ethnicity, after accounting for patient-presenting vital signs and examiner characteristics, and whether these differences varied among male and female Veterans Affairs (VA ED patients.We used a large national database of electronic medical records of ED patients from twenty-two U.S. Department of Veterans Affairs ED stations to determine whether ESI assignments differ systematically by race or ethnicity. Multi-level, random effects linear modeling was used to control for demographic characteristics and patient's vital signs (heart rate, respiratory rate, and pain level, as well as age, gender, and experience of triage nurses. The dataset included 129,991 VA patients presenting for emergency care between 2008 and 2012 (91% males; 61% non-Hispanic White, 28% Black, 7% Hispanic, 2% Asian, <1% American Indian/Alaska Native, 1% mixed ethnicity and 774 nurses for a total of 359,642 patient/examiner encounters. Approximately 13% of the variance in ESI scores was due to patient characteristics and 21% was due to the nurse characteristics. After controlling for characteristics of nurses and patients, Black patients were assigned less urgent ESI scores than White patients, and this effect was more prominent for Black males compared with Black females. A similar interaction was found for Hispanic males. It remains unclear how these results may generalize to EDs and patient populations outside of the U.S. VA Health Care system.The findings suggest the possibility that subgroups of VA patients receive different ESI ratings in triage, which may have cascading, downstream consequences for patient treatment quality, satisfaction with care, and trust in the health equity of emergency care.

  3. Assessing Hospital Disaster Readiness Over Time at the US Department of Veterans Affairs.

    Science.gov (United States)

    Der-Martirosian, Claudia; Radcliff, Tiffany A; Gable, Alicia R; Riopelle, Deborah; Hagigi, Farhad A; Brewster, Pete; Dobalian, Aram

    2017-02-01

    Introduction There have been numerous initiatives by government and private organizations to help hospitals become better prepared for major disasters and public health emergencies. This study reports on efforts by the US Department of Veterans Affairs (VA), Veterans Health Administration, Office of Emergency Management's (OEM) Comprehensive Emergency Management Program (CEMP) to assess the readiness of VA Medical Centers (VAMCs) across the nation. Hypothesis/Problem This study conducts descriptive analyses of preparedness assessments of VAMCs and examines change in hospital readiness over time. To assess change, quantitative analyses of data from two phases of preparedness assessments (Phase I: 2008-2010; Phase II: 2011-2013) at 137 VAMCs were conducted using 61 unique capabilities assessed during the two phases. The initial five-point Likert-like scale used to rate each capability was collapsed into a dichotomous variable: "not-developed=0" versus "developed=1." To describe changes in preparedness over time, four new categories were created from the Phase I and Phase II dichotomous variables: (1) rated developed in both phases; (2) rated not-developed in Phase I but rated developed in Phase II; (3) rated not-developed in both phases; and (4) rated developed in Phase I but rated not- developed in Phase II. From a total of 61 unique emergency preparedness capabilities, 33 items achieved the desired outcome - they were rated either "developed in both phases" or "became developed" in Phase II for at least 80% of VAMCs. For 14 items, 70%-80% of VAMCs achieved the desired outcome. The remaining 14 items were identified as "low-performing" capabilities, defined as less than 70% of VAMCs achieved the desired outcome. Measuring emergency management capabilities is a necessary first step to improving those capabilities. Furthermore, assessing hospital readiness over time and creating robust hospital readiness assessment tools can help hospitals make informed decisions

  4. 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

    ... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Who in the Department of Veterans Affairs may grant an exception to allow an excluded person to participate in a covered transaction? 801.137... Veterans Affairs may grant an exception to allow an excluded person to participate in a covered transaction...

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

    Science.gov (United States)

    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.

  6. Differences in cause of death of Washington State veterans who did and did not use Department of Veterans Affairs healthcare services.

    Science.gov (United States)

    Maynard, Charles; Boyko, Edward J

    2006-01-01

    Relatively little is known about the cause of death in the veteran population, although more is known about the cause of death in Vietnam veterans or veterans receiving mental health services. This article compares characteristics and causes of death in Washington State veterans who did and did not use Department of Veterans Affairs (VA) healthcare services in the 5 years prior to death. This study included 62,080 veterans who died between 1998 and 2002, of whom 21% were users of VA healthcare services. The veterans who used VA healthcare services were younger, more often men, less educated, more often divorced, and more often smokers than the veterans who did not use VA healthcare services. Both female and male veterans who used VA healthcare services were more likely to die from drug- and/or alcohol-related causes. These findings suggest that the VA patient population is socially disadvantaged and more severely affected by substance-use disorders compared with veterans who do not use VA healthcare services.

  7. 76 FR 61151 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

    Science.gov (United States)

    2011-10-03

    ... INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans... homeless Veterans and Veterans at risk of homelessness and their families; and provide a supportive...

  8. Suicide Mortality Following Nursing Home Discharge in the Department of Veterans Affairs Health System

    Science.gov (United States)

    Szymanski, Benjamin R.; Karlin, Bradley E.; Katz, Ira R.

    2013-01-01

    Objectives. We assessed suicide rates up to 6 months following discharge from US Department of Veterans Affairs (VA) nursing homes. Methods. In VA Minimum Data Set (MDS) records, we identified 281 066 live discharges from the 137 VA nursing homes during fiscal years 2002 to 2008. We used MDS and administrative data to assess resident age, gender, behaviors, pain, and indications of psychoses, bipolar disorder, dementia, and depression. We identified vital status and suicide mortality within 6 months of discharge through National Death Index searches. Results. Suicide rates within 6 months of discharge were 88.0 per 100 000 person-years for men and 89.4 overall. Standardized mortality ratios relative to age- and gender-matched individuals in the VA patient population were 2.3 for men (95% confidence interval [CI] = 1.9, 2.8) and 2.4 overall (95% CI = 2.0, 2.9). In multivariable proportional hazards regression analyses, resident characteristics, diagnoses, behaviors, and pain were not significantly associated with suicide risk. Conclusions. Suicide risk was elevated following nursing home discharge. This underscores the importance of ongoing VA efforts to enhance discharge planning and timely postdischarge follow-up. PMID:24134359

  9. Advanced earthquake monitoring system for U.S. Department of Veterans Affairs medical buildings--instrumentation

    Science.gov (United States)

    Kalkan, Erol; Banga, Krishna; Ulusoy, Hasan S.; Fletcher, Jon Peter B.; Leith, William S.; Reza, Shahneam; Cheng, Timothy

    2012-01-01

    In collaboration with the U.S. Department of Veterans Affairs (VA), the National Strong Motion Project (NSMP; http://nsmp.wr.usgs.gov/) of the U.S. Geological Survey has been installing sophisticated seismic systems that will monitor the structural integrity of 28 VA hospital buildings located in seismically active regions of the conterminous United States, Alaska, and Puerto Rico during earthquake shaking. These advanced monitoring systems, which combine the use of sensitive accelerometers and real-time computer calculations, are designed to determine the structural health of each hospital building rapidly after an event, helping the VA to ensure the safety of patients and staff. This report presents the instrumentation component of this project by providing details of each hospital building, including a summary of its structural, geotechnical, and seismic hazard information, as well as instrumentation objectives and design. The structural-health monitoring component of the project, including data retrieval and processing, damage detection and localization, automated alerting system, and finally data dissemination, will be presented in a separate report.

  10. 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,...

  11. 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

  12. Variation in Formulary Management Practices Within the Department of Veterans Affairs Health Care System.

    Science.gov (United States)

    Radomski, Thomas R; Good, Chester B; Thorpe, Carolyn T; Zhao, Xinhua; Marcum, Zachary A; Glassman, Peter A; Lowe, John; Mor, Maria K; Fine, Michael J; Gellad, Walid F

    2016-02-01

    All Department of Veterans Affairs Medical Centers (VAMCs) operate under a single national drug formulary, yet substantial variation in prescribing and spending exists across facilities. Local management of the national formulary may differ across VAMCs and may be one cause of this variation. To characterize variation in the management of nonformulary medication requests and pharmacy and therapeutics (P&T) committee member perceptions of the formulary environment at VAMCs nationwide. We performed an online survey of the chief of pharmacy and an additional staff pharmacist and physician on the P&T committee at all VAMCs. Respondents were asked questions regarding criteria for use for nonformulary medications, specific procedures for ordering nonformulary medications in general and specific lipid-lowering and diabetes agents, the appeals process, and the formulary environment at their VAMCs. We compared responses across facilities and between chiefs of pharmacy, pharmacists, and physicians. A total of 212 chief pharmacists (n = 80), staff pharmacists (n = 78), and physicians (n = 54) responded, for an overall response rate of 49%. In total, 107/143 (75%) different VAMCs were represented. The majority of VAMCs reported adhering to national criteria for use, with 38 (36%) being very adherent and 69 (65%) being mostly adherent. There was substantial variation between VAMCs regarding how nonformulary drugs were ordered, evaluated, and appealed. The nonformulary lipid-lowering drugs ezetimibe, rosuvastatin, and atorvastatin were viewable to providers in the order entry screen at 67 (63%), 67 (63%), and 64 (60%) VAMCs, respectively. The nonformulary diabetes medication pioglitazone was only viewable at 58 (55%) VAMCs. In the remaining VAMCs, providers could not order these nonformulary drugs through the normal order-entry process. For questions about the formulary environment, physician respondent perceptions differed from those of staff pharmacists and chief pharmacists

  13. Measuring the intensity of resident supervision in the department of veterans affairs: the resident supervision index.

    Science.gov (United States)

    Byrne, John M; Kashner, Michael; Gilman, Stuart C; Aron, David C; Cannon, Grant W; Chang, Barbara K; Godleski, Linda; Golden, Richard M; Henley, Steven S; Holland, Gloria J; Kaminetzky, Catherine P; Keitz, Sheri A; Kirsh, Susan; Muchmore, Elaine A; Wicker, Annie B

    2010-07-01

    To develop a survey instrument designed to quantify supervision by attending physicians in nonprocedural care and to assess the instrument's feasibility and reliability. In 2008, the Department of Veterans Affairs (VA) Office of Academic Affiliations convened an expert panel to adopt a working definition of attending supervision in nonprocedural patient care and to construct a survey to quantify it. Feasibility was field-tested on residents and their supervising attending physicians at primary care internal medicine clinics at the VA Loma Linda Healthcare System in their encounters with randomly selected outpatients diagnosed with either major depressive disorder or diabetes. The authors assessed both interrater concurrent reliability and test-retest reliability. The expert panel adopted the VA's definition of resident supervision and developed the Resident Supervision Index (RSI) to measure supervision in terms of residents' case understanding, attending physicians' contributions to patient care through feedback to the resident, and attending physicians' time (minutes). The RSI was field-tested on 60 residents and 37 attending physicians for 148 supervision episodes from 143 patient encounters. Consent rates were 94% for residents and 97% for attending physicians; test-retest reliability intraclass correlations (ICCs) were 0.93 and 0.88, respectively. Concurrent reliability between residents' and attending physicians' reported time was an ICC of 0.69. The RSI is a feasible and reliable measure of resident supervision that is intended for research studies in graduate medical education focusing on education outcomes, as well as studies assessing quality of care, patient health outcomes, care costs, and clinical workload.

  14. Benchmarking US Department of Veterans Affairs dermatologic services: results from a national survey.

    Science.gov (United States)

    Krause, L Kendall; Townsend, Leilani; Orser, Michael L; Mulhausen, Jennifer; Duke, Jodi; Waxweiler, Weston T; Dellavalle, Robert P

    2012-03-01

    How well Department of Veterans Affairs (VA) dermatology services provide clinical care, medical education, and innovative research is a largely unexplored topic in the literature. We sought to benchmark VA dermatology services by surveying VA dermatologists about their environment, resources, and the pros and cons of working in the VA. Printed surveys were mailed to VA dermatologists and responses were compiled and analyzed. Of 105 dermatology services surveyed, 48% returned surveys completed by board-certified dermatologists (n = 50); 20 surveys completed by nondermatologists were excluded from the analysis. Most services trained dermatology residents (72%) and medical students (80%). One third of services reported significant research involvement. Qualitative analysis revealed the academic environment, patient population, and decreased business management responsibilities as the 3 most commonly cited advantages to VA employment. The most commonly listed disadvantages included low salaries, bureaucracy, and lack of resources. The survey data were self-reported and not independently verified. Not all services returned the survey. Outpatient VA dermatology services accomplish significant primary care and preventive services (eg, sun safety counseling, skin cancer screening, and treatment). However, the small number of dedicated dermatology services, their irregular geographic distribution, and the lack of staffing and resources may adversely affect optimal patient care. Dermatologist responses regarding the positive and negative aspects of working in the VA system may lead to improved management strategies to better retain and recruit dermatologists to provide patient care, medical education, and medical research despite dramatically lower dermatologist salaries within the VA system compared with private practice. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  15. Department of Veterans Affairs Cooperative Studies Program Network of Dedicated Enrollment Sites: Implications for Surgical Trials.

    Science.gov (United States)

    Bakaeen, Faisal G; Reda, Domenic J; Gelijns, Annetine C; Cornwell, Lorraine; Omer, Shuab; Al Jurdi, Rayan; Kougias, Panos; Anaya, Daniel; Berger, David H; Huang, Grant D

    2014-06-01

    Surgical clinical trials have played a critical role in shaping clinical practice, yet their launch and conduct remain challenging. Innovative approaches to carrying out such studies can not only help transform how trials produce definitive evidence but also move the field toward increased participation in trials. To review a recently launched pilot program aimed at enhancing patient enrollment and improving surgical trial operations at individual sites and nationally. After a solicitation to create a national network focused on making the conduct of clinical trials more efficient, 10 Department of Veterans Affairs (VA) sites were selected. These sites, collectively called the Cooperative Studies Program (CSP) Network of Dedicated Enrollment Sites (NODES), were evaluated with regard to their previous participation in CSP multisite trials, the strength of the local clinical research environment, and presentation of innovative plans to coordinate and enhance the operations of local CSP studies and share best practices with other centers. Node accountability was also emphasized and involved metrics that tracked productivity and efficiency. Building from available CSP experience in a range of clinical trials, including ones involving surgical interventions, NODES provides VA surgeons with resources for facilitating timely study initiation, determining patient availability, and addressing enrollment barriers. Such resources are particularly important for surgical studies, which often face challenges in patient recruitment and retention. In addition, NODES can maintain qualified and trained personnel at sites to support surgeons with limited time to fulfill the numerous administrative and regulatory responsibilities that often fall to the investigators. The VA's approach to enhancing trial efficiency may reinvigorate interest in surgical trials by offering a redesigned cooperative framework that builds on a core of high-yield sites and could mitigate traditional

  16. Increasing access and quality in Department of Veterans Affairs care at the end of life: a lesson in change.

    Science.gov (United States)

    Edes, Thomas; Shreve, Scott; Casarett, David

    2007-10-01

    The pursuit of a "good death" remains out of reach for many despite numerous piecemeal solutions to address the growing need for access to quality care at the end of life. In 2002, U.S. veteran deaths were at an all-time high, few Department of Veterans Affairs (VA) hospitals had inpatient palliative care services, and there was no reliable approach to meet home hospice needs. The VA embarked on a course of major change to improve veterans' care at the end of life. A coordinated plan to increase access to hospice and palliative care services was established, addressing policy development, program and staff development, collaboration with community hospices, outcomes measurement, and proving value to the organization. To determine progress and monitor resource allocation, workload and outcome measures were established in all settings. Within 3 years, the number of veterans receiving VA-paid home hospice had tripled, all VA hospitals had a palliative care team, 42% of all veterans who died as VA inpatients received a palliative care consultation, and a nationwide network of VA partnerships with community hospice agencies was established. Through a multifaceted strategic plan and a mission of honoring veterans' preferences for care at the end of life, the VA has made rapid progress in improved access to palliative care services for inpatients and outpatients. The VA's experience serves as a powerful example of the magnitude of change possible in a complex health system and a model for improving access and quality of palliative care services in other health systems.

  17. Development of a Sleep Telementorship Program for Rural Department of Veterans Affairs Primary Care Providers: Sleep Veterans Affairs Extension for Community Healthcare Outcomes.

    Science.gov (United States)

    Parsons, Elizabeth C; Mattox, Elizabeth A; Beste, Lauren A; Au, David H; Young, Bessie A; Chang, Michael F; Palen, Brian N

    2017-02-01

    Primary care providers (PCPs) frequently encounter sleep complaints, especially in regions with limited specialty care access. The U.S. Department of Veterans Affairs Extension for Community Healthcare Outcomes (VA-ECHO) program (based on Project ECHO) has successfully provided rural PCP education in subspecialty areas, including hepatitis C. We describe the feasibility of an ECHO program for sleep medicine. ECHO creates a virtual learning community through video-teleconferencing, combining didactics with individualized clinical case review. We invited multidisciplinary providers to attend up to 10 stand-alone, 1-hour sessions. Invitees completed a needs assessment, which guided curriculum development. After program completion, we examined participant characteristics and self-reported changes in practice and comfort with managing sleep complaints. We surveyed participation barriers among invitees with low/no attendance. Of the 39 program participants, 38% worked in rural healthcare. Participants included nurse practitioners (26%), registered nurses (21%), and physicians (15%). Seventeen (44%) completed the summative program evaluation. Respondents anticipated practice change from the program, especially in patient education about sleep disorders (93% of respondents). Respondents reported improved comfort managing sleep complaints, especially sleep-disordered breathing, insomnia, and sleep in post-traumatic stress disorder (80% of respondents each). A follow-up survey of program invitees who attended zero to two sessions reported scheduling conflicts (62%) and lack of protected time (52%) as major participation barriers. Participants in a pilot sleep medicine VA-ECHO program report practice change and increased comfort managing common sleep complaints. Future work is needed to identify objective measures of return on investment and address participation barriers.

  18. 76 FR 61150 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property at the VA...

    Science.gov (United States)

    2011-10-03

    ... INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044C), Department of Veterans... priority placement for homeless Veterans and Veterans at risk of homelessness; and provide a supportive...

  19. 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.

  20. 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.

  1. A study of ambulatory care education in medical schools and U.S. Department of Veterans Affairs health care facilities.

    Science.gov (United States)

    Robbins, A S; Lussier, R R; Koser, K

    1989-10-01

    A study of ambulatory care and education was conducted by sending questionnaires to U.S. Department of Veterans Affairs hospitals (75) and medical schools (65) prior to the Conference on Ambulatory Care and Education. Responses from 48% of medical schools indicated that there was little required clinical time in ambulatory care (15-20%), as well as faculty resistance and lack of medical school commitment to ambulatory care education. VA respondents (35% sample) also documented relatively little training in ambulatory care at the undergraduate and graduate levels. Numerous barriers to ambulatory care education are mentioned and strategies for overcoming the problems found are discussed.

  2. 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

  3. Implementing and Evaluating a Telephone-Based Centralized Maternity Care Coordination Program for Pregnant Veterans in the Department of Veterans Affairs.

    Science.gov (United States)

    Mattocks, Kristin M; Kuzdeba, Judy; Baldor, Rebecca; Casares, Jose; Lombardini, Lisa; Gerber, Megan R

    The purpose of this study was to develop and evaluate a comprehensive, telephonic maternity care coordination (MCC) program for all pregnant veterans enrolled for care at New England Department of Veterans Affairs (VA) facilities that comprise the Veterans Integrated Service Network 1. Telephone interviews were conducted with postpartum women veterans who had participated in the MCC program during their pregnancies. The program evaluation instrument assessed satisfaction and use of MCC services, prenatal education classes, and infant and maternal outcomes (e.g., newborn birthweight, insurance status, maternal depression) using both closed-ended and open-ended questions. A substantial majority (95%) of women enrolled in the MCC program expressed satisfaction with the services they received in the program. Women were most satisfied with help understanding VA maternity benefits and acquiring VA services and equipment, such as breast pumps and pregnancy-related medications. More than one-third of women noted their infants had experienced health problems since delivery, including neonatal intensive care unit hospitalizations. A majority of women planned to return to VA care in the future. Our findings suggest that MCC services play an important role for women veterans as they navigate both VA and non-VA care systems. MCC staff members coordinated maternity, medical, and mental health care services for women veterans. Additionally, by maintaining contact with the veteran during the postpartum period, MCC staff were able to assess the health of the mother and the infant, and refer women and their infants to medical and psychosocial services in the community as needed. Published by Elsevier Inc.

  4. When health insurance is not a factor: national comparison of homeless and nonhomeless US veterans who use Veterans Affairs Emergency Departments.

    Science.gov (United States)

    Tsai, Jack; Doran, Kelly M; Rosenheck, Robert A

    2013-12-01

    We examined the proportion of homeless veterans among users of Veterans Affairs (VA) emergency departments (EDs) and compared sociodemographic and clinical characteristics of homeless and nonhomeless VA emergency department users nationally. We used national VA administrative data from fiscal year 2010 for a cross-sectional study comparing homeless (n = 64,091) and nonhomeless (n = 866,621) ED users on sociodemographics, medical and psychiatric diagnoses, and other clinical characteristics. Homeless veterans had 4 times the odds of using EDs than nonhomeless veterans. Multivariate analyses found few differences between homeless and nonhomeless ED users on the medical conditions examined, but homeless ED users were more likely to have been diagnosed with a drug use disorder (odds ratio [OR] = 4.12; 95% confidence interval [CI] = 3.97, 4.27), alcohol use disorder (OR = 3.67; 95% CI = 3.55, 3.79), or schizophrenia (OR = 3.44; 95% CI = 3.25, 3.64) in the past year. In a national integrated health care system with no specific requirements for health insurance, the major differences found between homeless and nonhomeless ED users were high rates of psychiatric and substance abuse diagnoses. EDs may be an important location for specialized homeless outreach (or "in" reach) services to address mental health and addictive disorders.

  5. 76 FR 71442 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

    Science.gov (United States)

    2011-11-17

    ... homeless and at-risk Veterans and their families; and provide a supportive services program. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans...

  6. The Veterans Choice Act: A Qualitative Examination of Rapid Policy Implementation in the Department of Veterans Affairs.

    Science.gov (United States)

    Mattocks, Kristin M; Mengeling, Michelle; Sadler, Anne; Baldor, Rebecca; Bastian, Lori

    2017-07-01

    Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 [Veterans Choice Act (VCA)] to improve access to timely, high-quality health care for Veterans. Although Congress mandated that VCA must begin within 90 days of passage of the legislation, no guidelines were provided in the legislation to ensure that Veterans had access to an adequate number of community providers across different specialties of care or distinct geographic areas, including rural areas of the country. To examine VCA policy implementation across a sampling of Veterans Health Administration (VHA) Medical Centers. We conducted a qualitative study of 43 VHA staff and providers by conducting in-person interviews at 5 VA medical centers in the West, South, and Midwest United States. Interview questions focused on perceptions and experiences with VCA and challenges related to implementation for VHA staff and providers. We identified 3 major themes to guide description of choice implementation: (1) VCA implemented too rapidly with inadequate preparation; (2) community provider networks insufficiently developed; and (3) communication and scheduling problems with subcontractors may lead to further delays in care. Our evaluation suggests that VCA was implemented far too rapidly, with little consideration given to the adequacy of community provider networks available to provide care to Veterans. Given the challenges we have highlighted in VCA implementation, it is imperative that the VHA continue to develop care coordination systems that will allow the Veterans to receive seamless care in the community.

  7. National Dissemination of Cognitive Behavioral Therapy for Depression in the Department of Veterans Affairs Health Care System: Therapist and Patient-Level Outcomes

    Science.gov (United States)

    Karlin, Bradley E.; Brown, Gregory K.; Trockel, Mickey; Cunning, Darby; Zeiss, Antonette M.; Taylor, C. Barr

    2012-01-01

    Objective: The Department of Veterans Affairs (VA) health care system is nationally disseminating and implementing cognitive behavioral therapy for depression (CBT-D). The current article evaluates therapist and patient-level outcomes associated with national training in and implementation of CBT-D in the VA health care system. Method: Therapist…

  8. 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.

  9. 38 CFR 3.159 - Department of Veterans Affairs assistance in developing claims.

    Science.gov (United States)

    2010-07-01

    ... such as medical and scientific articles and research reports or analyses. (2) Competent lay evidence... and military unit of a person who served with the veteran; or the name and address of a medical care... local governments, private medical care providers, current or former employers, and other non-Federal...

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

    Science.gov (United States)

    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.

  11. Ethical issues regarding caring for dermatology patients in the U.S. Department of Veterans Affairs Health Care System.

    Science.gov (United States)

    Reich, Reuben; Stevens, Emily; Dellavalle, Robert P

    2012-01-01

    The U.S. Department of Veterans Affairs (VA) operates the largest integrated health care system within the United States. VA budgets continue to escalate in an environment of heightened financial prudence and accountability. Despite having received many awards in areas from patient satisfaction and safety to product innovations, like any health care system, the VA is not immune to ethical conflict that requires exploration and evaluation. Several VA dermatologists, including section chiefs, were interviewed, and their responses to ethical complexities encountered or anticipated were analyzed in fictional case scenarios. Five morally concerning issues were highlighted. These include (1) providing care in a teaching setting with limited resources to a patient population with few other health care alternatives; (2) stereotyping patients, altogether an uncommon act, is possibly easier to do in the VA and has the potential to negatively affect patient care; (3) service-related disability claim cases often include medical opinion and findings documented in the medical record when judgments are made, thus the VA physician can have a significant effect on the outcome of these claims; (4) whether the VA provides a setting for apathetic physicians to thrive or instead allows for a more meaningful work experience and then how to manage the subpar performer; (5) except for the treatment of HIV lipodystrophy with injectables, primary cosmetic procedures are prohibited at the VA and can lead to difficulties for the VA dermatologist attempting to comply in a era where dermatology is being more closely associated with cosmesis. Published by Elsevier Inc.

  12. Treatment of dupuytren disease with injectable collagenase in a veteran population: a case series at the department of veterans affairs new jersey health care system.

    Science.gov (United States)

    Sood, Aditya; Therattil, Paul J; Paik, Angie M; Simpson, Mary F; Lee, Edward S

    2014-01-01

    Clinical trials seeking to establish long-term efficacy of injectable collagenase clostridium histolyticum for treatment of Dupuytren disease are ongoing. In this quality improvement study, the efficacy, recurrence rate, and complications of collagenase injection for Dupuytren disease are reviewed in a population of Veteran patients. A retrospective chart review was performed for patients who underwent treatment with injectable collagenase for Dupuytren disease from 2010 to 2013 at our regional Department of Veterans Affairs medical center. Data points of interest included the degree of joint contracture preoperatively, immediately after treatment, and at follow-up, complications, and patient satisfaction. Sixteen patients received 27 injections (18 metacarpophalangeal and 9 proximal interphalangeal injections). The mean time of follow-up was 12.3 months. There was a 50% or greater reduction of the original extension deficit in 74.1% (n = 27) of the joints treated. Metacarpophalangeal joint recurrence was "high" (≥50°) in 0% (n = 18) of joints, and "low" (5°-50°) in 33.3% (n = 18) of joints with a mean follow-up of 12 months. Proximal interphalangeal joint recurrence was "high" (≥40°) in 18.5% (n = 9) of joints and "low" (5°-40°) in 7.4% (n = 9) of joints with a mean follow-up of 12.9 months. Minor complications were experienced in 93.8% (n = 16) of patients who underwent collagenase injection and included ecchymosis, skin laceration, injection-site swelling, injection-site hemorrhage, tenderness, and pruritus. Seventy-five percent (n = 12) of patients in our study reported they would undergo treatment with collagenase again. The case series presented demonstrates that injectable collagenase clostridium histolyticum produced a clinical success rate of 74.1% and is a safe method to treat Dupuytren disease.

  13. Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care System

    Directory of Open Access Journals (Sweden)

    Piñeros Sandy

    2009-08-01

    Full Text Available Abstract Background Mortality from acute myocardial infarction (AMI is declining worldwide. We sought to determine if mortality in the Veterans Health Administration (VHA has also been declining. Methods We calculated 30-day mortality rates between 2004 and 2006 using data from the VHA External Peer Review Program (EPRP, which entails detailed abstraction of records of all patients with AMI. To compare trends within VHA with other systems of care, we estimated relative mortality rates between 2000 and 2005 for all males 65 years and older with a primary diagnosis of AMI using administrative data from the VHA Patient Treatment File and the Medicare Provider Analysis and Review (MedPAR files. Results Using EPRP data on 11,609 patients, we observed a statistically significant decline in adjusted 30-day mortality following AMI in VHA from 16.3% in 2004 to 13.9% in 2006, a relative decrease of 15% and a decrease in the odds of dying of 10% per year (p = .011. Similar declines were found for in-hospital and 90-day mortality. Based on administrative data on 27,494 VHA patients age 65 years and older and 789,400 Medicare patients, 30-day mortality following AMI declined from 16.0% during 2000-2001 to 15.7% during 2004-June 2005 in VHA and from 16.7% to 15.5% in private sector hospitals. After adjusting for patient characteristics and hospital effects, the overall relative odds of death were similar for VHA and Medicare (odds ratio 1.02, 95% C.I. 0.96-1.08. Conclusion Mortality following AMI within VHA has declined significantly since 2003 at a rate that parallels that in Medicare-funded hospitals.

  14. 32 CFR Appendix D to Part 45 - State Directors of Veterans Affairs

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false State Directors of Veterans Affairs D Appendix D..., App. D Appendix D to Part 45—State Directors of Veterans Affairs Alabama Director, Department of... 06067. Indiana Director, Department of Veterans Affairs, 707 State Office Building, 100 N. Senate Avenue...

  15. Characteristics and use of treatment modalities of patients with binge-eating disorder in the Department of Veterans Affairs.

    Science.gov (United States)

    Bellows, Brandon K; DuVall, Scott L; Kamauu, Aaron W C; Supina, Dylan; Pawaskar, Manjiri; Babcock, Thomas; LaFleur, Joanne

    2016-04-01

    In 2013 binge-eating disorder (BED) was recognized as a formal diagnosis, but was historically included under the diagnosis code for eating disorder not otherwise specified (EDNOS). This study compared the characteristics and use of treatment modalities in BED patients to those with EDNOS without BED (EDNOS-only) and to matched-patients with no eating disorders (NED). Patients were identified for this study from electronic health records in the Department of Veterans Affairs from 2000 to 2011. Patients with BED were identified using natural language processing and patients with EDNOS-only were identified by ICD-9 code (307.50). First diagnosis defined index date for these groups. NED patients were frequency matched to BED patients up to 4:1, as available, on age, sex, BMI, depression, and index month encounter. Baseline characteristics and use of treatment modalities during the post-index year were compared using t-tests or chi-square tests. There were 593 BED, 1354 EDNOS-only, and 1895 matched-NED patients identified. Only 68 patients with BED had an EDNOS diagnosis. BED patients were younger (48.7 vs. 49.8years, p=0.04), more were male (72.2% vs. 62.8%, p<0.001) and obese (BMI 40.2 vs. 37.0, p<0.001) than EDNOS-only patients. In the follow-up period fewer BED (68.0%) than EDNOS-only patients (87.6%, p<0.001), but more BED than NED patients (51.9%, p<0.001) used at least one treatment modality. The characteristics of BED patients were different from those with EDNOS-only and NED as was their use of treatment modalities. These differences highlight the need for a separate identifier of BED. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Transcatheter aortic valve replacement: establishing a comprehensive program model for hybrid cardiac catheterization laboratories in the Department of Veterans Affairs.

    Science.gov (United States)

    Speiser, Bernadette; Dutra-Brice, Cynthia

    2014-01-01

    Aortic valve disease, especially aortic stenosis, becomes progressively debilitating and carries a high mortality risk if it is categorized as severe and symptomatic (J Thorac Cardiovas Surg. 2012;144(3):e29-e84). In the past, the only treatment for aortic stenosis was surgical aortic valve replacement. Surgical treatment may require several hours of cardioplegia, and if the patient has comorbidities, such as renal failure or chronic obstructive pulmonary disease, their operative mortality percentage increases.In 2011, the US Food and Drug Administration approved the use of a transcatheter aortic valve replacement (TAVR) procedure for patients who were deemed high risk or inoperative for the routine surgical aortic valve replacement surgery. More than 20, 000 TAVRs have been performed in patients worldwide since 2002 when Dr Alain Cribier performed the first-in-man TAVR (Arch Cardiovasc Dis. 2012;105(3):145-152). The Edwards Lifesciences SAPIEN XT valve and the Medtronic CoreValve are commercially available.The clinical findings and economic statistic have supported the expansion of the TAVR procedure. However, there has been considerable controversy over where the procedure is to occur and who is directly responsible for directing the TAVR care. This debate has identified barriers to the implementation of a TAVR program. The operating rooms and a cardiac catheterization laboratory are underprepared for the hybrid valve replacement therapy. Because of the barriers identified, the Department of Veterans Affairs determined a need for a systematic approach to review the programs that applied for this structural heart disease program. A centralized team was developed to ensure room readiness and staff competency. The use of the Health Failure Mode and Effects Analysis can define high-risk clinical processes and conduct a hazard analysis. Worksheets can show potential failure modes and their probabilities, along with actions and outcome measures, team collaboration

  17. 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.

  18. 76 FR 5432 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property at the Charlie...

    Science.gov (United States)

    2011-01-31

    ...-sufficiency. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044...; provide preference and priority placement for homeless Veterans and Veterans at risk of homelessness; and...

  19. 76 FR 60965 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

    Science.gov (United States)

    2011-09-30

    ...-sufficiency. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044... priority placement for homeless Veterans and Veterans at risk of homelessness and their families; and...

  20. 76 FR 67023 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

    Science.gov (United States)

    2011-10-28

    ...-sufficiency. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044... placement for homeless Veterans and Veterans at risk of homelessness and their families; and provide a...

  1. 75 FR 72871 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

    Science.gov (United States)

    2010-11-26

    ...-sufficiency. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044C...; provide preference and priority placement for homeless Veterans and Veterans at risk of homelessness; and...

  2. Towards a Heterogeneous, Polystore-like Data Architecture for the US Department of Veteran Affairs (VA) Enterprise Analytics

    Energy Technology Data Exchange (ETDEWEB)

    Begoli, Edmon [ORNL; Bates, Jack [Veterans Administration; Kistler, Derek E [ORNL

    2016-01-01

    The Polystore architecture revisits the federated approach to access and querying of the standalone, independent databases in the uniform and optimized fashion, but this time in the context of heterogeneous data and specialized analyses. In the light of this architectural philosophy, and in the light of the major data architecture development efforts at the US Department of Veterans Administration (VA), we discuss the need for the heterogeneous data store consisting of the large relational data warehouse, an image and text datastore, and a peta-scale genomic repository. The VA's heterogeneous datastore would, to a larger or smaller degree, follow the architectural blueprint proposed by the polystore architecture. To this end, we discuss the current state of the data architecture at VA, architectural alternatives for development of the heterogeneous datastore, the anticipated challenges, and the drawbacks and benefits of adopting the polystore architecture.

  3. 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

    ... INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044), Department of Veterans... permanent housing facility for homeless and at-risk Veterans and their families where the lessee will give...

  4. House Committee on Veterans' Affairs

    Science.gov (United States)

    ... following events are open to the press: WHO: House Committee on Veterans’ Affairs WHAT: Legislative Hearing on ... From Shielding Dangerous Doctors 13 Oct On Thursday, House Committee on Veterans’ Affairs Committee Chairman Phil Roe ( ...

  5. Factors related to rapidity of housing placement in Housing and Urban Development-Department of Veterans Affairs Supportive Housing program of 1990s.

    Science.gov (United States)

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

    2011-01-01

    The Housing and Urban Development-Department of Veterans Affairs Supportive Housing (HUD-VASH) program is the largest supported housing program in the country for homeless veterans who are seeking rapid entry into permanent independent housing. This study examined factors related to how rapidly clients were housed in the early years of the program and how long they stayed in the program. Mental health, substance abuse, work/income, criminal history, and site were examined as predictors of process times. Regression analyses based on 627 HUD-VASH clients who entered the program between 1992 and 2003 showed that client characteristics were not rate-limiting factors for obtaining HUD-VASH housing; i.e., clients who had greater substance abuse problems or more extensive criminal histories did not take longer to obtain housing. The large differences associated with site of entry partly reflected a curvilinear relationship between the duration of operation of the HUD-VASH program and process times; i.e., at relatively younger and older programs, clients entered housing slightly faster than at programs in the middle range. Lastly, HUD-VASH clients whose case managers reported good therapeutic alliances stayed in the program longer. These findings have implications for the continued expansion of the HUD-VASH program.

  6. 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

    ... provide preference and priority placement for homeless and at-risk Veterans, and provide on-site supportive services. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management...

  7. 76 FR 61150 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

    Science.gov (United States)

    2011-10-03

    ... will be set aside to provide transitional housing and supportive services for homeless and at-risk Veterans. FOR FURTHER INFORMATION CONTACT: Edward L. Bradley, III, Office of Asset Enterprise Management...

  8. 76 FR 71443 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

    Science.gov (United States)

    2011-11-17

    ... placement for homeless and/or at-risk Veterans and their families; and provide a supportive services program. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044...

  9. 76 FR 71439 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

    Science.gov (United States)

    2011-11-17

    ... placement for homeless and/or at-risk Veterans and their families; and provide a supportive services program. FOR FURTHER INFORMATION CONTACT: Edward Bradley, Office of Asset Enterprise Management (044...

  10. Application of the U.S. Army’s Integrated Planning to the Department of Veterans Affairs

    Science.gov (United States)

    2014-05-22

    Art and Science MDMP Military Decision Making Process SOP Standard Operating Procedure SAMS School of Advanced Military Studies VBA Veterans...technological elements in the course of action. Furthermore the staff had access to Veterans Benefits Administration ( VBA ) data showing that factors...later than 1 January 2015, the VBA will have no unprocessed claims older than 125 days. The VBA will place processes into action which will ensure

  11. 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

    ... contain a factual description of the employee's duties and responsibilities at the time of the incident... by a physician, dentist, nurse, physician's assistant, dentist's assistant, pharmacist or paramedical... personnel, while furnishing medical care and treatment in the exercise of duties in or for the Veterans...

  12. Decisions about Renal Replacement Therapy in Patients with Advanced Kidney Disease in the US Department of Veterans Affairs, 2000–2011

    Science.gov (United States)

    Hebert, Paul L.; Laundry, Ryan J.; Hammond, Kenric W.; Liu, Chuan-Fen; Burrows, Nilka R.; O’Hare, Ann M.

    2016-01-01

    Background and objectives It is not known what proportion of United States patients with advanced CKD go on to receive RRT. In other developed countries, receipt of RRT is highly age dependent and the exception rather than the rule at older ages. Design, setting, participants, & measurements We conducted a retrospective study of a national cohort of 28,568 adults who were receiving care within the US Department of Veteran Affairs and had a sustained eGFR <15 ml/min per 1.73 m2 between January 1, 2000 to December 31, 2009. We used linked administrative data from the US Renal Data System, US Department of Veteran Affairs, and Medicare to identify cohort members who received RRT during follow-up through October 1, 2011 (n=19,165). For a random 25% sample of the remaining 9403 patients, we performed an in-depth review of their VA–wide electronic medical records to determine the treatment status of their CKD. Results Two thirds (67.1%) of cohort members received RRT on the basis of administrative data. On the basis of the results of chart review, we estimate that an additional 7.5% (95% confidence interval, 7.2% to 7.8%) of cohort members had, in fact, received dialysis, that 10.9% (95% confidence interval, 10.6% to 11.3%) were preparing for and/or discussing dialysis but had not started dialysis at most recent follow-up, and that a decision had been made not to pursue dialysis in 14.5% (95% confidence interval, 14.1% to 14.9%). The percentage of cohort members who received or were preparing to receive RRT ranged from 96.2% (95% confidence interval, 94.4% to 97.4%) for those <45 years old to 53.3% (95% confidence interval, 50.7% to 55.9%) for those aged ≥85 years old. Results were similar after stratification by tertile of Gagne comorbidity score. Conclusions In this large United States cohort of patients with advanced CKD, the majority received or were preparing to receive RRT. This was true even among the oldest patients with the highest burden of comorbidity

  13. 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

  14. Evaluation of a command-line parser-based order entry pathway for the Department of Veterans Affairs electronic patient record.

    Science.gov (United States)

    Lovis, C; Chapko, M K; Martin, D P; Payne, T H; Baud, R H; Hoey, P J; Fihn, S D

    2001-01-01

    To improve and simplify electronic order entry in an existing electronic patient record, the authors developed an alternative system for entering orders, which is based on a command- interface using robust and simple natural-language techniques. The authors conducted a randomized evaluation of the new entry pathway, measuring time to complete a standard set of orders, and users' satisfaction measured by questionnaire. A group of 16 physician volunteers from the staff of the Department of Veterans Affairs Puget Sound Health Care System-Seattle Division participated in the evaluation. Thirteen of the 16 physicians (81%) were able to enter medical orders more quickly using the natural-language-based entry system than the standard graphical user interface that uses menus and dialogs (mean time spared, 16.06 +/- 4.52 minutes; P=0.029). Compared with the graphical user interface, the command--based pathway was perceived as easier to learn (P<0.01), was considered easier to use and faster (P<0.01), and was rated better overall (P<0.05). Physicians found the command- interface easier to learn and faster to use than the usual menu-driven system. The major advantage of the system is that it combines an intuitive graphical user interface with the power and speed of a natural-language analyzer.

  15. Institutional Incentives for Mentoring at the U.S. Department of Veterans Affairs and Universities: Associations With Mentors' Perceptions and Time Spent Mentoring.

    Science.gov (United States)

    Maisel, Natalya C; Halvorson, Max A; Finney, John W; Bi, Xiaoyu; Hayashi, Ko P; Blonigen, Daniel M; Weitlauf, Julie C; Timko, Christine; Cronkite, Ruth C

    2017-04-01

    Limited empirical attention to date has focused on best practices in advanced research mentoring in the health services research domain. The authors investigated whether institutional incentives for mentoring (e.g., consideration of mentoring in promotion criteria) were associated with mentors' perceptions of mentoring benefits and costs and with time spent mentoring. The authors conducted an online survey in 2014 of a national sample of mentors of U.S. Department of Veterans Affairs (VA) Health Services Research and Development Service (HSR&D) mentored career development award recipients who received an award during 2000-2012. Regression analyses were used to examine institutional incentives as predictors of perceptions of benefits and costs of mentoring and time spent mentoring. Of the 145 mentors invited, 119 (82%) responded and 110 (76%) provided complete data for the study items. Overall, mentors who reported more institutional incentives also reported greater perceived benefits of mentoring (P = .03); however, more incentives were not significantly associated with perceived costs of mentoring. Mentors who reported more institutional incentives also reported spending a greater percentage of time mentoring (P = .02). University incentives were associated with perceived benefits of mentoring (P = .02), whereas VA incentives were associated with time spent mentoring (P = .003). Institutional policies that promote and support mentorship of junior investigators, specifically by recognizing and rewarding the efforts of mentors, are integral to fostering mentorship programs that contribute to the development of early-career health services researchers into independent investigators.

  16. VA-INPC: Linking Department of Veterans Affairs (VA) and Indiana Network for Patient Care (INPC) data to assess surveillance testing among veterans with colorectal cancer.

    Science.gov (United States)

    Haggstrom, David A; Rosenman, Marc; Myers, Laura J; Teal, Evgenia; Doebbeling, Bradley N

    2010-11-13

    The goal of this project was to provide empiric evidence about the benefit to US veterans and the VA of capturing data from a citywide clinical informatics network (INPC) to assess care received outside the VA. We identified 468 veterans diagnosed with colorectal cancer from 2000-2007 in the Indianapolis VA cancer registry. Electronic VA healthcare data were linked with electronic health records from the regional health information organization (RHIO) INPC; 341 matches were found. Both the VA and INPC systems were queried regarding receipt of surveillance tests. The proportion with additional data from INPC varied by test: colonoscopy (3%), CT scan/abdomen (13%), CT scan/chest (79%), carcinoembryonic antigen test (8%), and other laboratory tests (25%-53%). An incremental benefit of linking VA and INPC data was present and may increase when expanded beyond patients with a single condition. New, important information about care outside the VA is obtained through RHIO data linkage.

  17. Predictive Modeling and Concentration of the Risk of Suicide: Implications for Preventive Interventions in the US Department of Veterans Affairs.

    Science.gov (United States)

    McCarthy, John F; Bossarte, Robert M; Katz, Ira R; Thompson, Caitlin; Kemp, Janet; Hannemann, Claire M; Nielson, Christopher; Schoenbaum, Michael

    2015-09-01

    The Veterans Health Administration (VHA) evaluated the use of predictive modeling to identify patients at risk for suicide and to supplement ongoing care with risk-stratified interventions. Suicide data came from the National Death Index. Predictors were measures from VHA clinical records incorporating patient-months from October 1, 2008, to September 30, 2011, for all suicide decedents and 1% of living patients, divided randomly into development and validation samples. We used data on all patients alive on September 30, 2010, to evaluate predictions of suicide risk over 1 year. Modeling demonstrated that suicide rates were 82 and 60 times greater than the rate in the overall sample in the highest 0.01% stratum for calculated risk for the development and validation samples, respectively; 39 and 30 times greater in the highest 0.10%; 14 and 12 times greater in the highest 1.00%; and 6.3 and 5.7 times greater in the highest 5.00%. Predictive modeling can identify high-risk patients who were not identified on clinical grounds. VHA is developing modeling to enhance clinical care and to guide the delivery of preventive interventions.

  18. Hurricanes Katrina and Rita and the Department of Veterans Affairs: a conceptual model for understanding the evacuation of nursing homes.

    Science.gov (United States)

    Dobalian, Aram; Claver, Maria; Fickel, Jacqueline J

    2010-01-01

    Hurricanes Katrina and Rita exposed significant flaws in US preparedness for catastrophic events and the nation's capacity to respond to them. These flaws were especially evident in the affected disaster areas' nursing homes, which house a particularly vulnerable population of frail older adults. Although evacuation of a healthcare facility is a key preparedness activity, there is limited research on factors that lead to effective evacuation. Our review of the literature on evacuation is focused on developing a conceptual framework to study future evacuations rather than as a comprehensive assessment of prior work. This paper summarizes what is known thus far about disaster response activities of nursing homes following natural and human-caused disasters, describes a conceptual model to guide future inquiry regarding this topic, and suggests future areas of research to further understand the decision-making process of nursing home facilitators regarding evacuating nursing home residents. To demonstrate the utility of the conceptual model and to provide guidance about effective practices and procedures, this paper focuses on the responses of Veterans Health Administration (VHA) nursing homes to the 2 hurricanes. Quarantelli's conceptual framework, as modified by Perry and Mushkatel, is useful in guiding the development of central hypotheses related to the decision-making that occurred in VA nursing homes and other healthcare facilities following Hurricanes Katrina and Rita. However, we define evacuation somewhat differently to account for the fact that evacuation may, in some instances, be permanent. Thus, we propose modifying this framework to improve its applicability beyond preventive evacuation. We need to better understand how disaster plans can be adapted to meet the needs of frail elders and other residents in nursing homes. Moreover, we must address identified gaps in the scientific literature with respect to health outcomes by tracking outcomes over time

  19. Lower-Limb Amputation and Effect of Posttraumatic Stress Disorder on Department of Veterans Affairs Outpatient Cost Trends

    Science.gov (United States)

    2015-07-01

    data obtained from other U.S. Department of Defense data- bases [19]. Records from each level of care are reviewed by certified nurse coders at NHRC...M, Quinn K, Galarneau M. Glasgow Coma Scale scores, early opioids , and 4-year psychological outcomes among combat amputees. J Rehabil Res Dev

  20. Passing the baton: a grounded practical theory of handoff communication between multidisciplinary providers in two Department of Veterans Affairs outpatient settings.

    Science.gov (United States)

    Koenig, Christopher J; Maguen, Shira; Daley, Aaron; Cohen, Greg; Seal, Karen H

    2013-01-01

    Handoffs are communication processes that enact the transfer of responsibility between providers across clinical settings. Prior research on handoff communication has focused on inpatient settings between provider teams and has emphasized patient safety. This study examines handoff communication within multidisciplinary provider teams in two outpatient settings. To conduct an exploratory study that describes handoff communication among multidisciplinary providers, to develop a theory-driven descriptive framework for outpatient handoffs, and to evaluate the strengths and weaknesses of different handoff types. Qualitative, in-depth, semi-structured interviews with 31 primary care, mental health, and social work providers in two Department of Veterans Affairs (VA) Medical Center outpatient clinics. Audio-recorded interviews were transcribed and analyzed using Grounded Practical Theory to develop a theoretical model of and a descriptive framework for handoff communication among multidisciplinary providers. Multidisciplinary providers reported that handoff decisions across settings were made spontaneously and without clear guidelines. Two situated values, clinic efficiency and patient-centeredness, shaped multidisciplinary providers' handoff decisions. Providers reported three handoff techniques along a continuum: the electronic handoff, which was the most clinically efficient; the provider-to-provider handoff, which balanced clinic efficiency and patient-centeredness; and the collaborative handoff, which was the most patient-centered. Providers described handoff choice as a practical response to manage constituent features of clinic efficiency (time, space, medium of communication) and patient-centeredness (information continuity, management continuity, relational continuity, and social interaction). We present a theoretical and descriptive framework to help providers evaluate differential handoff use, reflect on situated values guiding clinic communication, and guide

  1. Healthcare costs and resource utilization of patients with binge-eating disorder and eating disorder not otherwise specified in the Department of Veterans Affairs.

    Science.gov (United States)

    Bellows, Brandon K; DuVall, Scott L; Kamauu, Aaron W C; Supina, Dylan; Babcock, Thomas; LaFleur, Joanne

    2015-12-01

    The objective of this study was to compare the one-year healthcare costs and utilization of patients with binge-eating disorder (BED) to patients with eating disorder not otherwise specified without BED (EDNOS-only) and to matched patients without an eating disorder (NED). A natural language processing (NLP) algorithm identified adults with BED from clinical notes in the Department of Veterans Affairs (VA) electronic health record database from 2000 to 2011. Patients with EDNOS-only were identified using ICD-9 code (307.50) and those with NLP-identified BED were excluded. First diagnosis date defined the index date for both groups. Patients with NED were randomly matched 4:1, as available, to patients with BED on age, sex, BMI, depression diagnosis, and index month. Patients with cost data (2005-2011) were included. Total healthcare, inpatient, outpatient, and pharmacy costs were examined. Generalized linear models were used to compare total one-year healthcare costs while adjusting for baseline patient characteristics. There were 257 BED, 743 EDNOS-only, and 823 matched NED patients identified. The mean (SD) total unadjusted one-year costs, in 2011 US dollars, were $33,716 ($38,928) for BED, $37,052 ($40,719) for EDNOS-only, and $19,548 ($35,780) for NED patients. When adjusting for patient characteristics, BED patients had one-year total healthcare costs $5,589 higher than EDNOS-only (p = 0.06) and $18,152 higher than matched NED patients (p < 0.001). This study is the first to use NLP to identify BED patients and quantify their healthcare costs and utilization. Patients with BED had similar one-year total healthcare costs to EDNOS-only patients, but significantly higher costs than patients with NED. © 2015 Wiley Periodicals, Inc.

  2. 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,...

  3. Veterans Affairs Geographic Distribution of Expenditures FY06 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,...

  4. 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,...

  5. Veterans Affairs Geographic Distribution of Expenditures FY07 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,...

  6. Veterans Affairs Geographic Distribution of Expenditures FY06 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,...

  7. Veterans Affairs Geographic Distribution of Expenditures FY09 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,...

  8. 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,...

  9. 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,...

  10. 38 CFR 12.21 - Action upon death of veteran.

    Science.gov (United States)

    2010-07-01

    ... veteran at a Department of Veterans Affairs hospital, center or domiciliary activity while receiving care... of the Department of Veterans Affairs hospital, center, or domiciliary activity having jurisdiction...

  11. Timing of Initiation of Maintenance Dialysis: A Qualitative Analysis of the Electronic Medical Records of a National Cohort of Patients From the Department of Veterans Affairs.

    Science.gov (United States)

    Wong, Susan P Y; Vig, Elizabeth K; Taylor, Janelle S; Burrows, Nilka R; Liu, Chuan-Fen; Williams, Desmond E; Hebert, Paul L; O'Hare, Ann M

    2016-02-01

    There is often considerable uncertainty about the optimal time to initiate maintenance dialysis in individual patients and little medical evidence to guide this decision. To gain a better understanding of the factors influencing the timing of initiation of dialysis in clinical practice. A qualitative analysis was conducted using the electronic medical records from the Department of Veterans Affairs (VA) of a national random sample of 1691 patients for whom the decision to initiate maintenance dialysis occurred in the VA between January 1, 2000, and December 31, 2009. Data analysis took place from June 1 to November 30, 2014. Central themes related to the timing of initiation of dialysis as documented in patients' electronic medical records. Of the 1691 patients, 1264 (74.7%) initiated dialysis as inpatients and 1228 (72.6%) initiated dialysis with a hemodialysis catheter. Cohort members met with a nephrologist during an outpatient clinic visit a median of 3 times (interquartile range, 0-6) in the year prior to initiation of dialysis. The mean (SD) estimated glomerular filtration rate at the time of initiation for cohort members was 10.4 (5.7) mL/min/1.73 m(2). The timing of initiation of dialysis reflected the complex interplay of at least 3 interrelated and dynamic processes. The first was physician practices, which ranged from practices intended to prepare patients for dialysis to those intended to forestall the need for dialysis by managing the signs and symptoms of uremia with medical interventions. The second process was sources of momentum. Initiation of dialysis was often precipitated by clinical events involving acute illness or medical procedures. In these settings, the imperative to treat often seemed to override patient choice. The third process was patient-physician dynamics. Interactions between patients and physicians were sometimes adversarial, and physician recommendations to initiate dialysis sometimes seemed to conflict with patient priorities

  12. 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...

  13. Initial Results from the Survey of Organizational Research Climates (SOuRCe in the U.S. Department of Veterans Affairs Healthcare System.

    Directory of Open Access Journals (Sweden)

    Brian C Martinson

    Full Text Available In service to its core mission of improving the health and well-being of veterans, Veterans Affairs (VA leadership is committed to supporting research best practices in the VA. Recognizing that the behavior of researchers is influenced by the organizational climates in which they work, efforts to assess the integrity of research climates and share such information with research leadership in VA may be one way to support research best practices. The Survey of Organizational Research Climate (SOuRCe is the first validated survey instrument specifically designed to assess the organizational climate of research integrity in academic research organizations. The current study reports on an initiative to use the SOuRCe in VA facilities to characterize the organizational research climates and pilot test the effectiveness of using SOuRCe data as a reporting and feedback intervention tool.We administered the SOuRCe using a cross-sectional, online survey, with mailed follow-up to non-responders, of research-engaged employees in the research services of a random selection of 42 VA facilities (e.g., Hospitals/Stations believed to employ 20 or more research staff. We attained a 51% participation rate, yielding more than 5,200 usable surveys.We found a general consistency in organizational research climates across a variety of sub-groups in this random sample of research services in the VA. We also observed similar SOuRCe scale score means, relative rankings of these scales and their internal reliability, in this VA-based sample as we have previously documented in more traditional academic research settings. Results also showed more substantial variability in research climate scores within than between facilities in the VA research service as reflected in meaningful subgroup differences. These findings suggest that the SOuRCe is suitable as an instrument for assessing the research integrity climates in VA and that the tool has similar patterns of results that

  14. Initial Results from the Survey of Organizational Research Climates (SOuRCe) in the U.S. Department of Veterans Affairs Healthcare System.

    Science.gov (United States)

    Martinson, Brian C; Nelson, David; Hagel-Campbell, Emily; Mohr, David; Charns, Martin P; Bangerter, Ann; Thrush, Carol R; Ghilardi, Joseph R; Bloomfield, Hanna; Owen, Richard; Wells, James A

    2016-01-01

    In service to its core mission of improving the health and well-being of veterans, Veterans Affairs (VA) leadership is committed to supporting research best practices in the VA. Recognizing that the behavior of researchers is influenced by the organizational climates in which they work, efforts to assess the integrity of research climates and share such information with research leadership in VA may be one way to support research best practices. The Survey of Organizational Research Climate (SOuRCe) is the first validated survey instrument specifically designed to assess the organizational climate of research integrity in academic research organizations. The current study reports on an initiative to use the SOuRCe in VA facilities to characterize the organizational research climates and pilot test the effectiveness of using SOuRCe data as a reporting and feedback intervention tool. We administered the SOuRCe using a cross-sectional, online survey, with mailed follow-up to non-responders, of research-engaged employees in the research services of a random selection of 42 VA facilities (e.g., Hospitals/Stations) believed to employ 20 or more research staff. We attained a 51% participation rate, yielding more than 5,200 usable surveys. We found a general consistency in organizational research climates across a variety of sub-groups in this random sample of research services in the VA. We also observed similar SOuRCe scale score means, relative rankings of these scales and their internal reliability, in this VA-based sample as we have previously documented in more traditional academic research settings. Results also showed more substantial variability in research climate scores within than between facilities in the VA research service as reflected in meaningful subgroup differences. These findings suggest that the SOuRCe is suitable as an instrument for assessing the research integrity climates in VA and that the tool has similar patterns of results that have been

  15. Initial Results from the Survey of Organizational Research Climates (SOuRCe) in the U.S. Department of Veterans Affairs Healthcare System

    Science.gov (United States)

    Martinson, Brian C.; Nelson, David; Hagel-Campbell, Emily; Mohr, David; Charns, Martin P.; Bangerter, Ann; Thrush, Carol R.; Ghilardi, Joseph R.; Bloomfield, Hanna; Owen, Richard; Wells, James A.

    2016-01-01

    Background In service to its core mission of improving the health and well-being of veterans, Veterans Affairs (VA) leadership is committed to supporting research best practices in the VA. Recognizing that the behavior of researchers is influenced by the organizational climates in which they work, efforts to assess the integrity of research climates and share such information with research leadership in VA may be one way to support research best practices. The Survey of Organizational Research Climate (SOuRCe) is the first validated survey instrument specifically designed to assess the organizational climate of research integrity in academic research organizations. The current study reports on an initiative to use the SOuRCe in VA facilities to characterize the organizational research climates and pilot test the effectiveness of using SOuRCe data as a reporting and feedback intervention tool. Methods We administered the SOuRCe using a cross-sectional, online survey, with mailed follow-up to non-responders, of research-engaged employees in the research services of a random selection of 42 VA facilities (e.g., Hospitals/Stations) believed to employ 20 or more research staff. We attained a 51% participation rate, yielding more than 5,200 usable surveys. Results We found a general consistency in organizational research climates across a variety of sub-groups in this random sample of research services in the VA. We also observed similar SOuRCe scale score means, relative rankings of these scales and their internal reliability, in this VA-based sample as we have previously documented in more traditional academic research settings. Results also showed more substantial variability in research climate scores within than between facilities in the VA research service as reflected in meaningful subgroup differences. These findings suggest that the SOuRCe is suitable as an instrument for assessing the research integrity climates in VA and that the tool has similar patterns of

  16. 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.

  17. 78 FR 70088 - Advisory Committee on Veterans Business Affairs

    Science.gov (United States)

    2013-11-22

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Advisory Committee on Veterans Business Affairs AGENCY: U.S. Small Business Administration. ACTION... Business Affairs. The meeting will be open to the public. DATES: December 5, 2013 from 9 a.m. to 3 p.m...

  18. The influence of veteran race and psychometric testing on veterans affairs posttraumatic stress disorder (PTSD) disability exam outcomes.

    Science.gov (United States)

    Marx, Brian P; Engel-Rebitzer, Eden; Bovin, Michelle J; Parker-Guilbert, Kelly S; Moshier, Samantha; Barretto, Kenneth; Szafranski, Derek; Gallagher, Matthew W; Holowka, Darren W; Rosen, Raymond C; Keane, Terence M

    2017-06-01

    This study examined the influence of veterans' race and examiners' use of psychometric testing during a Department of Veterans Affairs posttraumatic stress disorder (PTSD) disability examination on diagnostic and service connection status outcomes. Participants were 764 veterans enrolled in a national longitudinal registry. Current and lifetime PTSD diagnostic status was determined with the Structured Clinical Interview for DSM-IV (SCID) and was compared with PTSD diagnosis conferred upon veterans by their compensation and pension (C&P) examiners as well as with ultimate Veterans Affairs (VA) PTSD service connected status. The concordance rate between independent SCID current PTSD diagnosis and PTSD disability examination diagnosis was 70.4%, and between SCID lifetime PTSD diagnosis and PTSD disability examination diagnosis was 77.7%. Among veterans with current SCID diagnosed PTSD, Black veterans were significantly less likely than White veterans to receive a PTSD diagnosis from their C&P examiner (odds ratio [OR] = .39, p = .003, confidence interval [CI] = .20-.73). Among veterans without current SCID diagnosed PTSD, White veterans were significantly more likely than Black veterans to receive a PTSD diagnosis from their C&P examiner (OR = 4.07, p = .005, CI = 1.51-10.92). Splitting the sample by use of psychometric testing revealed that examinations that did not include psychometric testing demonstrated the same relation between veteran race and diagnostic concordance. However, for examinations in which psychometric testing was used, the racial disparity between SCID PTSD status and disability exam PTSD status was no longer significant. Results suggest that psychometric testing may reduce disparities in VA PTSD disability exam outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  19. 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...

  20. The Department of Veterans Affairs Nutritional Status Classification Scheme Allows for Rapid Assessment of Nutritional Status Prior to Autologous Peripheral Blood Stem Cell Transplantation and Identifies Patients at High Risk of Transplant-Related Complications

    National Research Council Canada - National Science Library

    Toro, Juan J; Haile, David J; Chao, Ju-Hsien; Schneider, Deanna; Jewell, Pamela S; Lee, Shuko; Freytes, César O

    2009-01-01

    ... of Veterans Affairs (VA) developed a Nutritional Status Classification Scheme (NSCS) to identify nutritionally compromised inpatients rapidly and reliably. The VA-NSCS takes into account a combination of body weight, routine laboratory tests, and clinical and dietary history. The VA-NSCS is routinely utilized for the nutritional evaluation ...

  1. Use of Veterans Affairs and Medicaid Services for Dually Enrolled Veterans.

    Science.gov (United States)

    Yoon, Jean; Vanneman, Megan E; Dally, Sharon K; Trivedi, Amal N; Phibbs, Ciaran S

    2017-06-13

    To examine how dual coverage for nonelderly, low-income veterans by Veterans Affairs (VA) and Medicaid affects their demand for care. Veterans Affairs utilization data and Medicaid Analytic Extract Files. A retrospective, longitudinal study of VA users prior to and following enrollment in Medicaid 2006-2010. Veterans Affairs reliance, or proportion of care provided by VA, was estimated with beta-binomial models, adjusting for patient and state Medicaid program factors. In a cohort of 19,890 nonelderly veterans, VA utilization levels were similar before and after enrolling in Medicaid. VA outpatient reliance was 0.65, and VA inpatient reliance was 0.53 after Medicaid enrollment. Factors significantly associated with greater VA reliance included sociodemographic factors, having a service-connected disability, comorbidity, and higher state Medicaid reimbursement. Factors significantly associated with less VA reliance included months enrolled in Medicaid, managed care enrollment, Medicaid eligibility type, longer drive time to VA care, greater Medicaid eligibility generosity, and better Medicaid quality. Veterans Affairs utilization following new Medicaid enrollment remained relatively unchanged, and the VA continued to provide the large majority of care for dually enrolled veterans. There was variation among patients as Medicaid eligibility and other program factors influenced their use of Medicaid services. © Health Research and Educational Trust.

  2. 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...

  3. Effects of hospital procedure volume and resident training on clinical outcomes and resource use in radical retropubic prostatectomy surgery in the Department of Veterans Affairs.

    Science.gov (United States)

    Ku, Tse-Sun; Kane, Christopher J; Sen, Saunak; Henderson, William G; Dudley, R Adams; Cason, Brian A

    2008-01-01

    In this retrospective cohort study we used data from the National Surgical Quality Improvement Program of the Veterans Health Administration to examine the effect of case volume and resident participation on radical retropubic prostatectomy outcomes. The study population included 5,736 patients who underwent radical retropubic prostatectomy in Veterans Administration hospitals between October 1, 2001 and September 30, 2004. Resource related outcomes included operative times and length of stay. Clinical outcomes included blood transfusion, complications, readmissions and reoperations. Hierarchical multivariate regression models were developed to predict outcomes. Risk adjustment was performed using patient chronic health factors and results of preoperative laboratory testing. A total of 5,070 radical retropubic prostatectomy surgeries met inclusion criteria. After adjustment for case mix, academic training institutions had longer operative times (3.2 vs 2.4 hours, p <0.01) but shorter length of stay (3.4 vs 4.2 days, p <0.01). Surgery at academic institutions was not associated with greater risk of transfusion (p = 0.36), reoperation (p = 0.93), complications (p = 0.53) or readmissions (p = 0.97). However, among the academic institutions low vs high hospital radical retropubic prostatectomy volume was associated with longer length of stay (3.7 vs 3.1 days, p = 0.02) and higher transfusion rate (29.6% vs 18.2%, p = 0.02). Substantial clustering of outcomes at the hospital level was observed. Within the Veterans Administration system academic training institutions have longer operative times for radical retropubic prostatectomy, but shorter length of stay. Among the same institutions, high volume hospitals tend to have lower transfusion rates and shorter length of stay. Clustering of outcomes at the hospital level suggests that unmeasured institutional factors are key determinants of clinical and resource related outcomes.

  4. The department of veterans affairs nutritional status classification scheme allows for rapid assessment of nutritional status prior to autologous peripheral blood stem cell transplantation and identifies patients at high risk of transplant-related complications.

    Science.gov (United States)

    Toro, Juan J; Haile, David J; Chao, Ju-Hsien; Schneider, Deanna; Jewell, Pamela S; Lee, Shuko; Freytes, César O

    2009-09-01

    The nutritional assessment of patients prior to autologous peripheral blood stem cell transplantation (APBSCT) is labor intensive. A simple method of nutritional assessment prior to APSCT would be extremely helpful, especially if this method could identify patients at high risk of transplant-related complications. The Department of Veterans Affairs (VA) developed a Nutritional Status Classification Scheme (NSCS) to identify nutritionally compromised inpatients rapidly and reliably. The objective of this study was to determine if the use of the VA-NSCS could be utilized as a tool for the evaluation of patients prior to APBSCT and to determine if this tool could be used to identify patients at high risk of transplant-related complications. The nutritional status of 128 patients who underwent APBSCT was assessed by a registered dietician, utilizing the VA-NSCS, upon admission to the hospital and prior to conditioning regimen. Patients with moderately compromised nutritional status pretransplantation experienced a higher incidence of infections, longer duration of diarrhea, and longer length of hospital stay when compared to patients with normal or mildly compromised nutritional status. Our study demonstrates that the VA-NSCS, a simple and inexpensive tool to assess nutritional status, was useful in determining the pretransplant nutritional status of patients with lymphogenous malignancies who underwent APBSCT. In addition, this method was able to identify patients at a higher risk of posttransplant complications. Future studies should be undertaken to determine the optimal method for the nutritional assessment of autologous stem cell transplant candidates.

  5. 2001 National Survey of Veterans (NSV)

    Data.gov (United States)

    Department of Veterans Affairs — The 2001 National Survey of Veterans (NSV) is the fifth in a series of comprehensivenationwide surveys designed to help the Department of Veterans Affairs (VA) plan...

  6. Veterans Affairs Contracting: Improved Oversight Needed for Certain Contractual Arrangements

    Science.gov (United States)

    2015-07-01

    Contracting Letter 1 Background 3 The Extent to Which VA Used IAAs Is Unknown Due to Incomplete Information 10 Management of the Award and Oversight...of IAAs Varied, and in Some Cases Did Not Comply with Policy 13 VA Obligated Over $244 Million to FFRDCs with Significant Increases for Two VA...Documentation among Selected IAA Orders 14 Table 2: Veterans Affairs Obligations to Federally Funded Research and Development Centers, Fiscal

  7. The Health and Social Isolation of American Veterans Denied Veterans Affairs Disability Compensation.

    Science.gov (United States)

    Fried, Dennis Adrian; Passannante, Marian; Helmer, Drew; Holland, Bart K; Halperin, William E

    2017-02-01

    Authors comparatively analyzed health and social isolation between U.S. military veterans denied Veterans Affairs (VA) disability compensation and veterans awarded VA disability compensation. The 2001 National Survey of Veterans was used to create a sample of 4,522 veterans denied or awarded VA disability compensation. Using the Andersen health services utilization model as a conceptual framework, multivariate logistic regression was applied to assess relationships between VA disability compensation award status, three separate domains of health, and correlates of social isolation. Results indicate that denied applicants were more likely than those awarded to have poor overall health (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.23, 1.70), and limitations in activities of daily living (OR = 1.12, 95% CI: 1.03, 1.21). Denied applicants' physical functioning (40.3) and mental functioning (41.2) composite summary scores were not clinically different from those of awarded applicants (39.0 and 40.1, respectively), indicating that both were comparably impaired. Veterans denied VA disability compensation had poor health and functional impairments. They also experienced poverty and isolation, suggesting that they may be in need of additional supportive services. Connecting veterans to community resources could be a vital service to provide to all veterans applying for disability compensation. © 2016 National Association of Social Workers.

  8. 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...

  9. 77 FR 18307 - Gulf War Veterans' Illnesses Task Force Report

    Science.gov (United States)

    2012-03-27

    ... addressing 1990-1991 Gulf War Veterans' illnesses. The GWVI-TF published its first annual report in September... AFFAIRS Gulf War Veterans' Illnesses Task Force Report AGENCY: Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Secretary Department of Veterans Affairs (VA) established the Gulf War Veterans...

  10. Families' perceptions of end-of-life care in Veterans Affairs versus non-Veterans Affairs facilities.

    Science.gov (United States)

    Lu, Hien; Trancik, Emily; Bailey, F Amos; Ritchie, Christine; Rosenfeld, Kenneth; Shreve, Scott; Furman, Christian; Smith, Dawn; Wolff, Catherine; Casarett, David

    2010-08-01

    The Veterans Affairs (VA) has made significant investments in care for veterans. However, it is not known whether these investments have produced improvements in end-of-life care in the VA compared to other settings. Therefore, the goal of this study was to compare families' perceptions of end-of-life care among patients who died in VA and non-VA facilities. Retrospective 32-item telephone surveys were conducted with family members of patients who died in VA and non-VA facilities. Five Veterans Affairs medical centers and their affiliated nursing homes and outpatient clinics. Patients were eligible if they received any care from a participating VA facility in the last month of life and if they died in an inpatient setting. One family member per patient completed the survey. In bivariate analysis, patients who died in VA facilities (n = 520) had higher mean satisfaction scores compared to those who died in non-VA facilities (n = 89; 59 versus 51; rank sum test p = 0.002). After adjusting for medical center, the overall score was still significantly higher for those dying in the VA (beta = 0.07; confidence interval [CI] = 0.02-0.11; p = 0.004), as was the domain measuring care around the time of death (beta = 0.11; CI = 0.04-0.17; p = 0.001). Families of patients who died in VA facilities rated care as being better than did families of those who died in non-VA facilities. These results provide preliminary evidence that the VA's investment in end-of-life care has contributed to improvements in care in VA facilities compared to non-VA facilities.

  11. 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

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

    Science.gov (United States)

    Schirmer, Patricia L; Lucero-Obusan, Cynthia A; Benoit, Stephen R; Santiago, Luis M; Stanek, Danielle; Dey, Achintya; Martinez, Mirsonia; Oda, Gina; Holodniy, Mark

    2013-01-01

    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. 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. 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. 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 emphasize use of diagnostic testing to better understand the

  13. National Cemetery Administration Summary of Veteran and Non-Veteran Interments: FY2000 to FY2012

    Data.gov (United States)

    Department of Veterans Affairs — Total Veteran and Non-Veteran Interments at National Cemetery, and shown by Interment Type of Casket or Cremain, FY2000 to FY2012. Non-Veteran includes dependents,...

  14. 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.

  15. Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: Protocol for a Randomized Study Funded by the US Department of Veterans Affairs Health Services Research and Development Program.

    Science.gov (United States)

    Piette, John D; Krein, Sarah L; Striplin, Dana; Marinec, Nicolle; Kerns, Robert D; Farris, Karen B; Singh, Satinder; An, Lawrence; Heapy, Alicia A

    2016-04-07

    Cognitive behavioral therapy (CBT) is one of the most effective treatments for chronic low back pain. However, only half of Department of Veterans Affairs (VA) patients have access to trained CBT therapists, and program expansion is costly. CBT typically consists of 10 weekly hour-long sessions. However, some patients improve after the first few sessions while others need more extensive contact. We are applying principles from "reinforcement learning" (a field of artificial intelligence or AI) to develop an evidence-based, personalized CBT pain management service that automatically adapts to each patient's unique and changing needs (AI-CBT). AI-CBT uses feedback from patients about their progress in pain-related functioning measured daily via pedometer step counts to automatically personalize the intensity and type of patient support. The specific aims of the study are to (1) demonstrate that AI-CBT has pain-related outcomes equivalent to standard telephone CBT, (2) document that AI-CBT achieves these outcomes with more efficient use of clinician resources, and (3) demonstrate the intervention's impact on proximal outcomes associated with treatment response, including program engagement, pain management skill acquisition, and patients' likelihood of dropout. In total, 320 patients with chronic low back pain will be recruited from 2 VA healthcare systems and randomized to a standard 10 sessions of telephone CBT versus AI-CBT. All patients will begin with weekly hour-long telephone counseling, but for patients in the AI-CBT group, those who demonstrate a significant treatment response will be stepped down through less resource-intensive alternatives including: (1) 15-minute contacts with a therapist, and (2) CBT clinician feedback provided via interactive voice response calls (IVR). The AI engine will learn what works best in terms of patients' personally tailored treatment plans based on daily feedback via IVR about their pedometer-measured step counts, CBT skill

  16. 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...

  17. Dengue Surveillance in Veterans Affairs Healthcare Facilities, 2007–2010

    Science.gov (United States)

    Schirmer, Patricia L.; Lucero-Obusan, Cynthia A.; Benoit, Stephen R.; Santiago, Luis M.; Stanek, Danielle; Dey, Achintya; Martinez, Mirsonia; Oda, Gina; Holodniy, Mark

    2013-01-01

    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 emphasize use

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

    Data.gov (United States)

    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...

  19. A Health Assessment Survey of Veteran Students: Utilizing a Community College-Veterans Affairs Medical Center Partnership.

    Science.gov (United States)

    Misra-Hebert, Anita D; Santurri, Laura; DeChant, Richard; Watts, Brook; Sehgal, Ashwini R; Aron, David C

    2015-10-01

    To assess health status among student veterans at a community college utilizing a partnership between a Veterans Affairs Medical Center and a community college. Student veterans at Cuyahoga Community College in Cleveland, Ohio, in January to April 2013. A health assessment survey was sent to 978 veteran students. Descriptive analyses to assess prevalence of clinical diagnoses and health behaviors were performed. Logistic regression analyses were performed to assess for independent predictors of functional limitations. 204 students participated in the survey (21% response rate). Self-reported depression and unhealthy behaviors were high. Physical and emotional limitations (45% and 35%, respectively), and pain interfering with work (42%) were reported. Logistic regression analyses confirmed the independent association of self-reported depression with functional limitation (odds ratio [OR] = 3.3, 95% confidence interval [CI] 1.4-7.8, p student veterans at a community college. A partnership between a Veterans Affairs Medical Center and a community college can be utilized to help understand the health needs of veteran students. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  20. 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...

  1. 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...

  2. 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...

  3. 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,...

  4. 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.

  5. 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.

  6. 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...

  7. Clinical practice guideline implementation strategy patterns in Veterans Affairs primary care clinics.

    Science.gov (United States)

    Hysong, Sylvia J; Best, Richard G; Pugh, Jacqueline A

    2007-02-01

    The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. MEASURES; Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels.

  8. Effect of the Veterans Affairs Medical System on plastic surgery residency training.

    Science.gov (United States)

    Ravin, Adam G; Gottlieb, Neil B; Wang, Howard T; Meade, Ricardo A; Humphrey, J Stewart; Schwarz, Karl W; Levin, L Scott; Tyler, Douglas S; Erdmann, Detlev

    2006-02-01

    Teaching hospitals within the Veterans Affairs Health System perform the majority of complex and high-risk surgical procedures in the veteran patient population. Residency positions in the Veterans Affairs Medical System are usually part of a rotational educational system within a university-based residency, and plastic surgeons in training are a major work force and health care provider. The purpose of this study was to evaluate the current effect of the Veterans Affairs Medical System on plastic surgery residency training. A 6-year (January of 1998 to December of 2003) review was performed of procedures completed at the Durham Veterans Affairs Medical Center, Section of Plastic Surgery. Procedures were divided into the following categories: extremities and trunk; breast and cosmetic; head and neck, including excision of skin lesions; hand surgery; craniomaxillofacial surgery; and other. Only procedures performed in the main operating room were reviewed and analyzed. In addition, a detailed review was performed of major head and neck reconstructions with free tissue transfer. A total of 1655 operative procedures were performed in 1290 patients. The ratio of men to women was 6:1 (1112 men and 178 women). Patients ranged in age from 26 to 97 years (average age, 62.7 years). Procedures in the extremities and trunk (n = 193, 11.7 percent), breast and cosmetic (n = 228, 13.8 percent), hand surgery (n = 155, 9.4 percent), and other (n = 275, 16.6 percent) categories were comparably distributed. Although the head and neck category accounted for the highest number of procedures (n = 766, 46.3 percent), the majority of these procedures were simple excisions of skin tumors (n = 612). There were significantly fewer major craniomaxillofacial cases (n = 38, 2.3 percent). Data from the retrospective analysis reveal that a broad spectrum of plastic surgical procedures is performed within the Veterans Affairs Health System, serving as a tremendous resource for resident training

  9. Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults.

    Science.gov (United States)

    Heath, Barbara; Bernhardt, Jaime; Michalski, Thomas J; Crnich, Christopher J; Moehring, Rebekah; Schmader, Kenneth E; Olds, Danielle; Higgins, Patricia A; Jump, Robin L P

    2016-03-01

    We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. We found that the course addressed an important knowledge gap. Our outcomes suggest opportunities to engage nursing staff in advancing antimicrobial stewardship, particularly in the long-term care setting. Published by Elsevier Inc.

  10. Epidemiology of Ocular Surface Squamous Neoplasia in a Veterans Affairs Population.

    Science.gov (United States)

    McClellan, Andrew J; McClellan, Allison L; Pezon, Candido F; Karp, Carol L; Feuer, William; Galor, Anat

    2013-10-01

    To evaluate the epidemiology of ocular surface squamous neoplasia (OSSN) and its associated risk factors in a South Florida Veterans Affairs Hospital population. Retrospective case-control study. Twenty-eight confirmed cases of OSSN from 24,179 veterans who received care at the Miami Veterans Affairs Healthcare System and affiliated satellite eye clinics between March 1, 2007, and March 1, 2012. Data extracted from the veterans administration database that comprised demographic information and medical diagnosis information [based on International Classification of Disease (ICD-9) codes]. The main outcome measures were the period prevalence of OSSN and identification of factors associated with the presence of disease. The period prevalence of OSSN in our population was 0.1%. The risk factors studied included UV-related dermatologic diseases (melanoma, squamous and basal cell cancer, and actinic keratosis), UV-related ocular conditions (pterygium), HIV seropositivity, human papilloma virus-related diseases, and tobacco use. The presence of skin malignancy (squamous cell carcinoma and/or basal cell carcinoma) and pterygium was found to be significantly associated with the presence of OSSN [odds ratio, 4.40; 95% confidence interval, 2.03-9.55; P ocular conditions related to sun exposure was the most important risk factor for the occurrence of OSSN in a South Florida Veterans Affairs Healthcare System population consistent with previous epidemiological reports worldwide.

  11. 76 FR 4152 - Proposed Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...

    Science.gov (United States)

    2011-01-24

    ... AFFAIRS Proposed Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV... Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA), Department of... application and servicing processes for the VBA Compensation and Pension (C&P) Service, Education (EDU...

  12. 78 FR 37278 - Proposed Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...

    Science.gov (United States)

    2013-06-20

    ... AFFAIRS Proposed Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV... Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA), Department of... application and servicing processes for the VBA Compensation Service (CS), Pension Service (P&F), Education...

  13. 38 CFR 17.251 - The Subcommittee on Academic Affairs.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false The Subcommittee on Academic Affairs. 17.251 Section 17.251 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants for Exchange of Information § 17.251 The Subcommittee on Academic Affairs. There is...

  14. 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...

  15. The Veteran Population Projection 2014

    Data.gov (United States)

    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...

  16. 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...

  17. 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...

  18. Rapid HIV testing experience at Veterans Affairs North Texas Health Care System's Homeless Stand Downs.

    Science.gov (United States)

    Hooshyar, Dina; Surís, Alina M; Czarnogorski, Maggie; Lepage, James P; Bedimo, Roger; North, Carol S

    2014-01-01

    In the USA, 21% of the estimated 1.1 million people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) are unaware they are HIV-infected. In 2011, Veterans Health Administration (VHA)'s Office of Public Health in conjunction with VHA's Health Care for Homeless Veterans Program funded grants to support rapid HIV testing at homeless outreach events because homeless populations are more likely to obtain emergent rather than preventive care and have a higher HIV seroprevalence as compared to the general population. Because of a Veterans Affairs North Texas Health Care System (VANTHCS)'s laboratory testing requirement, VANTHCS partnered with community agencies to offer rapid HIV testing for the first time at VANTHCS' 2011 Homeless Stand Downs in Dallas, Fort Worth, and Texoma, Texas. Homeless Stand Downs are outreach events that connect Veterans with services. Veterans who declined testing were asked their reasons for declining. Comparisons by Homeless Stand Down site used Pearson χ², substituting Fisher's Exact tests for expected cell sizes Veterans attending the Homeless Stand Downs, 261 Veterans reported reasons for declining HIV testing, and 133 Veterans were tested, where 92% of the tested Veterans obtained their test results at the events - all tested negative. Veterans' reported reasons for declining HIV testing included previous negative result (n=168), no time to test (n=49), no risk factors (n=36), testing is not a priority (n=11), uninterested in knowing serostatus (n=6), and HIV-infected (n=3). Only "no time to test" differed significantly by Homeless Stand Down site. Nonresponse rate was 54%. Offering rapid HIV testing at Homeless Stand Downs is a promising testing venue since 15% of Veterans attending VANTHCS' Homeless Stand Downs were tested for HIV, and majority obtained their HIV test results at point-of-care while further research is needed to determine how to improve these rates.

  19. Review of the Report of the Commission To Assess Veterans' Education Policy and the Response of the DVA. Hearing before the Subcommittee on Education, Training and Employment of the Committee on Veterans' Affairs, House of Representatives, One Hundred First Congress, First Session.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. House Committee on Veterans' Affairs.

    This document describes a hearing to review a report of the Commission to Assess Veterans' Education Policy, which was established by Congress in 1986, and the initial response from the Department of Veterans Affairs (DVA), which administers education and training programs. Following the opening statements by Congressmen Timothy J. Penny and…

  20. Local Area Unemployment and the Demand for Inpatient Care Among Veterans Affairs Enrollees.

    Science.gov (United States)

    Wong, Edwin S; Hebert, Paul L; Nelson, Karin M; Hernandez, Susan E; Sylling, Philip W; Fihn, Stephan D; Liu, Chuan-Fen

    2015-08-01

    Prior research examining the relationship between economic conditions and health service demand has focused primarily on outpatient use. This study examines whether local area unemployment, as an indicator of economic conditions, was associated with use of inpatient care, which is theoretically less subject to discretionary use. Using a random sample of 131,603 patients dually enrolled in the Veterans Affairs (VA) Health System and fee-for-service Medicare, we measured VA, Medicare, and total (VA and Medicare) hospitalizations. Overall, local unemployment was not associated with VA, Medicare, or total hospitalization probability. Among low-income veterans exempt from VA copayments, higher local unemployment was moderately associated with a lower probability of hospitalization through Medicare. For veterans subject to VA copayments, higher local unemployment was moderately associated with a higher likelihood of VA hospitalization. These results suggest inpatient use is less sensitive to the economy, although worse economic conditions slightly affected inpatient demand for select veterans. © The Author(s) 2015.

  1. Employment of Veterans in the Federal Executive Branch

    Data.gov (United States)

    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,...

  2. 77 FR 13390 - Veterans' Rural Health Advisory Committee, Notice of Meeting

    Science.gov (United States)

    2012-03-06

    ... AFFAIRS Veterans' Rural Health Advisory Committee, Notice of Meeting The Department of Veterans Affairs... Affairs on health care issues affecting enrolled Veterans residing in rural areas. The Committee examines programs and policies that impact the provision of VA health care to enrolled Veterans residing in rural...

  3. Advocating for Standards in Student Affairs Departments in African ...

    African Journals Online (AJOL)

    However, the latest developments have seen the role of Student Affairs Departments grow from 'in‑loco parentis' to educators who are expected to strategically position the image of their institutions to ensure that students are equipped with relevant, tried and tested skills in preparation for their studies, work, and civic ...

  4. 77 FR 52135 - Advisory Committee on Homeless Veterans, Notice of Meeting

    Science.gov (United States)

    2012-08-28

    ... AFFAIRS Advisory Committee on Homeless Veterans, Notice of Meeting The Department of Veterans Affairs (VA... Committee on Homeless Veterans will be held on September 5-7, 2012, in the Onondaga 3 Room at the Embassy... Veterans. The Committee shall assemble and review information relating to the needs of homeless Veterans...

  5. 76 FR 21107 - Veterans' Rural Health Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2011-04-14

    ... AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The Department of Veterans Affairs... VA health care to enrolled Veterans residing in rural areas and discusses ways to improve and enhance... Secretary, VA Veteran Centers services, rural women Veteran health care, and the meeting agenda and planning...

  6. 75 FR 24514 - Supportive Services for Veteran Families Program

    Science.gov (United States)

    2010-05-05

    ... eligible homeless veterans, such as the Health Care for Homeless Veterans (HCHV) Program, the Grant and Per... AFFAIRS 38 CFR Part 62 RIN 2900-AN53 Supportive Services for Veteran Families Program AGENCY: Department... concerning the Supportive Services for Veteran Families Program (SSVF Program) of the Department of Veterans...

  7. 76 FR 20823 - Agency Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...

    Science.gov (United States)

    2011-04-13

    ... AFFAIRS Agency Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV... U.S.C. 3501-21), this notice announces that the Veterans Benefits Administration (VBA), Department... INFORMATION: Title: Veterans Benefits Administration (VBA) Voice of the Veteran (VOV) Pilot Surveys. a...

  8. Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center.

    Science.gov (United States)

    Valsangkar, Nakul P; Eppstein, Andrew C; Lawson, Rick A; Taylor, Amber N

    2017-01-01

    There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center. All patients evaluated by the general surgery department through outpatient clinics, clinical video teleconferencing, and e-consultations from October 2011 through September 2014 were included. Patients evaluated through the emergency department or as inpatient consults were excluded. The surgery service and systems redesign service held a value stream analysis in FY 2013, culminating in multiple rapid process improvement workshops. Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows. High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-FY 2013. Planned outcome measures included wait time, clinic and telehealth volume, number of no-shows, and operative volume. Paired t tests were used to identify differences in outcome measures after the institution of reforms. Following rapid process improvement workshop project rollouts, mean

  9. Comparative safety of benzodiazepines and opioids among veterans affairs patients with posttraumatic stress disorder.

    Science.gov (United States)

    Hawkins, Eric J; Malte, Carol A; Grossbard, Joel; Saxon, Andrew J; Imel, Zac E; Kivlahan, Daniel R

    2013-01-01

    Although Veterans Affairs (VA) patients with posttraumatic stress disorder (PTSD) are prescribed benzodiazepines and opioids in addition to recommended pharmacotherapies, little is known about the safety of these medications. This study compared the 2-year incidence of adverse events among VA patients with PTSD exposed to combinations of selective serotonin reuptake inhibitors (SSRIs) or serotonin/norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and opioids. This retrospective cohort study used VA administrative data from 2004 to 2010 to identify and follow 5236 VA patients with PTSD with new episodes of (1) SSRIs/SNRIs only; (2) concurrent SSRIs/SNRIs and benzodiazepines; and (3) concurrent SSRIs/SNRIs, benzodiazepines, and opioids. Outcome measures were the 2-year incidence and adjusted hazard ratios (AHR) of mental health and medicine/surgery hospitalizations, emergency department visits, harmful events (eg, injuries and death), and any adverse event after adjustment for demographics, clinical covariates, and adverse event history. Compared with SSRIs/SNRIs only, the adjusted risk of mental health hospitalizations (AHR: 1.87; 95% confidence interval [CI]: 1.37-2.53) was greater among patients prescribed SSRIs/SNRIs and benzodiazepines concurrently. The AHR of mental health hospitalizations (AHR: 2.00; 95% CI: 1.35-2.98), medicine/surgery hospitalizations (AHR: 4.86; 95% CI: 3.30-7.14), emergency department visits (AHR: 2.01; 95% CI: 1.53-2.65), any harmful event (2.92; 95% CI: 2.21-3.84), and any adverse event (AHR: 2.65; 95% CI: 2.18-3.23) were all significantly greater among patients prescribed SSRIs/SNRIs, benzodiazepines, and opioids than among those prescribed SSRIs/SNRIs only. Concurrently prescribing SSRIs/SNRIs, benzodiazepines, and opioids among patients with PTSD is associated with adverse events. Although efforts are warranted to monitor patients who are prescribed combinations of these medications to prevent adverse events, these results

  10. Conflict of interest issues pertinent to Veterans Affairs Medical Centers.

    Science.gov (United States)

    Hanna, Jennifer; Simiele, Ernest; Lawson, D Curtis; Tyler, Douglas

    2011-09-01

    Conflicts of interest exist when an arrangement potentially exerts inappropriate influence on decision making or professional judgment, or is perceived to do so, and can thus damage the public trust and undermine the integrity of those decisions. Concerns regarding financial conflicts of interest in the medical arena have reached their height as of late, given that physicians now function in a milieu of complex and delicate relationships with pharmaceutical, biotechnology, and medical device industries. Even when such relationships do not correlate with actual compromise of judgment or patient care, it threatens the credibility of both the health care professional and the institution because of the social perception of the effect of these relationships. Although most institutions in the Western world set forth a code of ethics and conflict-of-interest policies to be followed under threat of termination, the Veterans Health Administration (VHA) presents itself as a unique environment in which conflicts of interest are subject to governmental laws, violation of which may not only result in employment-related discipline, but may be sanctioned by civil and criminal penalties. Moreover, these provisions are developed by a national authoritative organization rather than being institution-specific guidelines. Given that many academic physicians working within the VHA may also have a component of their practice in a University setting, it becomes important to understand the differences in policy between these contexts so as not to threaten the public trust in the veracity of decisions made and, therefore, maintain the integrity of the relationship between physician and patient. This article will review aspects of conflict-of-interest policies in the realm of research, financial relationships, foreign travel, and vendor contracting that are particular to the VHA and make it a unique environment to function in as a physician and scientist. Copyright © 2011 Society for

  11. 78 FR 6405 - Advisory Committee on Homeless Veterans, Notice of Meeting

    Science.gov (United States)

    2013-01-30

    ... AFFAIRS Advisory Committee on Homeless Veterans, Notice of Meeting The Department of Veterans Affairs (VA... Committee on Homeless Veterans will be held on February 13-15, 2013. On February 13, the Committee will meet... Department in assisting homeless Veterans. The Committee shall assemble and review information relating to...

  12. 76 FR 56881 - Advisory Committee on Homeless Veterans; Notice of Meeting

    Science.gov (United States)

    2011-09-14

    ... AFFAIRS Advisory Committee on Homeless Veterans; Notice of Meeting The Department of Veterans Affairs (VA... Committee on Homeless Veterans will be held on September 20- 21, 2011. On September 20, the Committee will... services of the Department in assisting homeless Veterans. The Committee shall assemble and review...

  13. 78 FR 53820 - Advisory Committee on Homeless Veterans, Notice of Meeting

    Science.gov (United States)

    2013-08-30

    ... AFFAIRS Advisory Committee on Homeless Veterans, Notice of Meeting The Department of Veterans Affairs (VA... Committee on Homeless Veterans will be held on September 11- 13, 2013, in the William Phillip King Room at..., organizational structures, and services of the Department in assisting homeless Veterans. The Committee shall...

  14. 75 FR 4453 - Advisory Committee on Homeless Veterans; Notice of Meeting

    Science.gov (United States)

    2010-01-27

    ... AFFAIRS Advisory Committee on Homeless Veterans; Notice of Meeting The Department of Veterans Affairs (VA... Committee on Homeless Veterans will be held February 24-26, 2010, in the Lafayette Park Room at the Hamilton... services of the Department in assisting homeless Veterans. The Committee shall assemble and review...

  15. 76 FR 24087 - Advisory Committee on Homeless Veterans; Notice of Meeting

    Science.gov (United States)

    2011-04-29

    ... AFFAIRS Advisory Committee on Homeless Veterans; Notice of Meeting The Department of Veterans Affairs (VA... Committee on Homeless Veterans will be held May 18-20, 2011, in the Harbor View Room at the Best Western Bay... services of the Department in assisting homeless Veterans. The Committee shall assemble and review...

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

    Science.gov (United States)

    2014-09-01

    Reserve, who is undergoing medical treatment, recuperation , or therapy and is in an outpatient status while recovering from a serious injury or...Copies of GAO Reports and Testimony Order by Phone Connect with GAO To Report Fraud, Waste , and Abuse in Federal Programs Congressional Relations Public Affairs Please Print on Recycled Paper.

  17. Employment of Veterans in Executive Branch

    Data.gov (United States)

    Department of Veterans Affairs — This quick facts summarizes the Veteran new hires into the Federal government by disabled and by 30 percent and higher disabled groups for 2008 to 2015. It shows the...

  18. 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 ...

  19. Veterans Affairs: Data Needed to Help Improve Decisions Concerning Veterans’ Access to Burial Options

    Science.gov (United States)

    2014-09-01

    Appendix II Objectives, Scope, and Methodology 45 Appendix III Printer Friendly Version of National Service Area Map 50 Appendix IV Leading...Unserved Veterans by the end of Fiscal Year 2017, Calculated Using Different Methodologies 15 Figure 4: National Service Area Map 17 Figure 5...different ways using the national service area map we created. 20 2. Methodology 2, proportional distribution of county populations: We multiplied the

  20. Veterans Affairs: Health Care and Benefits for Veterans Exposed to Agent Orange

    Science.gov (United States)

    2010-09-22

    1) Achondroplasia; (2) Cleft lip and cleft palate ; (3) Congenital heart disease; (4) Congenital talipes equinovarus (clubfoot); (5) Esophageal and...cell); breast cancer; cancers of reproductive organs (cervix, uterus, ovary, testes , and penis; excluding prostate); urinary bladder cancer; renal... tests . Each veteran is also required to answer a set of questions relevant to exposure. In September 2000, the Agent Orange Registry was expanded to

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

    Data.gov (United States)

    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...

  2. 77 FR 20886 - Agency Information Collection (Conversion From Servicemembers' Group Life Insurance to Veterans...

    Science.gov (United States)

    2012-04-06

    ... AFFAIRS Agency Information Collection (Conversion From Servicemembers' Group Life Insurance to Veterans' Group Life Insurance); Activity Under OMB Review AGENCY: Veterans Benefits Administration, Department of... Evaluation of the Conversion Privilege from Servicemembers' Group Life Insurance (SGLI) to Veterans' Group...

  3. Employment of Veterans in the Federal Executive Branch: Fiscal Year (FY) 2008 to 2013

    Data.gov (United States)

    Department of Veterans Affairs — This chart summarizes Veteran employment in the federal government using data from the Office of Personnel Management's (OPM) report, Employment of Veterans in the...

  4. 78 FR 57457 - Notice of Funds Availability Inviting Applications for Grants for Transportation of Veterans in...

    Science.gov (United States)

    2013-09-18

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Notice of Funds Availability Inviting Applications for Grants for Transportation of Veterans in... Wallace, National Coordinator, Highly Rural Transportation Grants, Veterans Transportation Program, Chief...

  5. Ethnic differences in blood pressure control among men at Veterans Affairs clinics and other health care sites.

    Science.gov (United States)

    Rehman, Shakaib U; Hutchison, Florence N; Hendrix, Katharine; Okonofua, Eni C; Egan, Brent M

    2005-05-09

    Differential access to health care may contribute to lower blood pressure (BP) control rates to under 140/90 mm Hg in African American compared with white hypertensive patients, especially men (26.5% vs 36.5% of all hypertensive patients in the National Health and Nutrition Examination Survey 1999-2000). The Department of Veterans Affairs (VA) system, which provides access to health care and medications across ethnic and economic boundaries, may reduce disparities in BP control. To test this hypothesis, BP treatment and control groups were compared between African American (VA, n = 4379; non-VA, n = 2754) and white (VA, n = 7987; non-VA, n = 4980) hypertensive men. In both groups, whites were older than African Americans (Pcardiovascular risk.

  6. Smoking mediates the effect of conscientiousness on mortality: The Veterans Affairs Normative Aging Study.

    Science.gov (United States)

    Turiano, Nicholas A; Hill, Patrick L; Roberts, Brent W; Spiro, Avron; Mroczek, Daniel K

    2012-12-01

    This study examined the relationship between conscientiousness and mortality over 18 years and whether smoking behavior mediated this relationship. We utilized data from the Veterans Affairs Normative Aging Study on 1349 men who completed the Goldberg (1992) adjectival markers of the Big Five. Over the 18-year follow-up, 547 (41%) participants died. Through proportional hazards modeling in a structural equation modeling framework, we found that higher levels of conscientiousness significantly predicted longer life, and that this effect was mediated by current smoking status at baseline. Methodologically, we also demonstrate the effectiveness of using a structural equation modeling framework to evaluate mediation when using a censored outcome such as mortality.

  7. 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...

  8. Mentoring health information professionals in the Department of Veterans Affairs.

    Science.gov (United States)

    Lloyd, Susan S; Fenton, Susan H

    2008-04-07

    As a major employer of health information professionals, the VA faces significant recruitment and retention challenges. The authors evaluated mentoring as a retention tool through a review of existing literature and the retrospective review of a VA health information management mentoring program. The literature review showed a link between employer mentorship and employee retention, regardless of the nature and structure of the mentoring relationship. Most organizations support employees who are willing to serve as mentors through increased compensation, recognition, and other types of support. No literature was found that studied retention rates for more than three years after a mentoring experience. The review of the VA mentoring program showed increased retention in the three years following enrollment in the program, but the increase was not statistically significant. The review did not demonstrate improvement in retention over a seven-year period. The combined evaluation gives mixed findings for mentorship as a retention tool and demonstrates the need for more research on the topic.

  9. Veterans Health Administration (VHA)

    Data.gov (United States)

    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...

  10. Veterans Choice Program

    Data.gov (United States)

    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...

  11. Assessing health status differences between Veterans Affairs home-based primary care and state Medicaid Waiver Program clients.

    Science.gov (United States)

    Wharton, Tracy C; Nnodim, Joseph; Hogikyan, Robert; Mody, Lona; James, Mary; Montagnini, Marcos; Fries, Brant E

    2013-04-01

    Comprehensive health care for older adults is complex, involving multiple comorbidities and functional impairments of varying degrees and numbers. In response to this complexity and associated barriers to care, home-based care models have become prevalent. The home-based primary care (HBPC) model, based at a Michigan Department of Veterans Affairs Medical Center, and the Michigan Waiver Program (MWP) that includes home-based care are 2 of these. Although both models are formatted to address barriers to effective and efficient health care, there are differences in disease prevalence and functional performance between groups. The objective of this study was to explore the differences between the 2 groups, to shed some light on potential trends that could suggest areas for resource allocation by service providers. Using a retrospective analysis of data collected using the interRAI-home care, we examined a cross-sectional representation of clients enrolled in HBPC and MWP in 2008. The HBPC sample had 89 participants. The MWP database contained 9324 participants from across the State of Michigan and were weighted to be comparable to the HBPC population in sex and age, and to simulate the HBPC sample size. Veterans were more independent in basic activities of daily living performance, but there was no difference in the rate of reported falls between the 2 groups. Veterans had more pain and a higher prevalence of coronary artery disease (z = 7.0; P Affairs Medical Center were more burdened by chronic disease and had higher degrees of loneliness than their MWP counterparts- factors, which may increase their likelihood of hospitalizations. MWP participants had more cases of cerebrovascular accident (z = 2.1; P = .039), as well as a higher rate of diagnosed dementias (z = 2.7; P = .006). Though not different, stress among caregivers in both groups, and depression in clients of both groups were substantial. Overall, sleep, pain, coronary artery disease, chronic obstructive

  12. Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center

    Science.gov (United States)

    Detweiler, Mark B.; Pagadala, Bhuvaneshwar; Candelario, Joseph; Boyle, Jennifer S.; Detweiler, Jonna G.; Lutgens, Brian W.

    2016-01-01

    The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0–6.0 mg), clonidine (63%, 0.1–2.0 mg), quetiapine (50%, 12.5–800.0 mg), mirtazapine (50%; 7.5–30.0 mg), and terazosin (64%, 50.0–300.0 mg). Notably, olanzapine (2.5–10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares. PMID:27999253

  13. 76 FR 30244 - Veterans' Rural Health Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2011-05-24

    ... AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The Department of Veterans Affairs... provision of VA health care to enrolled Veterans residing in rural areas, and discusses ways to improve and... Healthcare Coordinator, Montana and surrounding region rural health project managers, the Veterans Rural...

  14. 75 FR 39333 - Veterans' Rural Health Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2010-07-08

    ... AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The Department of Veterans Affairs... health care issues affecting enrolled Veterans residing in rural areas. The Committee examines programs and policies that impact the provision of VA health care to enrolled Veterans residing in rural areas...

  15. 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

    -resistant E. coli UTI after TBP included diabetes mellitus, fluoroquinolone exposure, prior hospitalization, and prior cultures with fluoroquinolone-resistant gram-negative bacilli. Conclusion: In the Veterans Affairs Healthcare System, the incidence of E. coli infection after TBP has increased significantly since 2000 due to a dramatic rise in infections with fluoroquinolone-resistant E. coli. Keywords: bacteremia; case-control studies; cohort studies; early detection of cancer; Escherichia coliinfections; microbial drug resistance; postoperative complications; prostate; retrospective studies; United States Department of Veterans Affairs; urinary tract infections.

  16. 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 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.

  17. Nationwide veterans affairs quality measure for cancer: the family assessment of treatment at end of life.

    Science.gov (United States)

    Finlay, Esme; Shreve, Scott; Casarett, David

    2008-08-10

    The Veterans Affairs (VA) health care system has created a national initiative to measure quality of care at the end of life. This article describes the first phase of this national initiative, the Family Assessment of Treatment at End of Life (FATE), in evaluating the quality of end-of-life care for veterans dying with cancer. In the initial phase, next of kin of patients from five VA Medical Centers were contacted 6 weeks after patients' deaths and invited to participate in a telephone interview, and surrogates for 262 cancer patients completed FATE interviews. Decedents were 98% male with an average age of 72 years. There was substantial variation among sites. Higher FATE scores, consistent with family reports of higher satisfaction with care, were associated with palliative care consultation and hospice referral and having a Do Not Resuscitate order at the time of death, whereas an intensive care unit death was associated with lower scores. Early experience with FATE suggests that it will be a helpful tool to characterize end-of-life cancer care and to identify targets for quality improvement.

  18. Impact of ocular surface symptoms on quality of life in a United States veterans affairs population.

    Science.gov (United States)

    Pouyeh, Bozorgmehr; Viteri, Eduardo; Feuer, William; Lee, David J; Florez, Hermes; Fabian, James A; Perez, Victor L; Galor, Anat

    2012-06-01

    To evaluate the impact of ocular surface symptoms on quality of life in a veteran population receiving eye care services. Cross-sectional survey study. setting: Miami Veterans Affairs Medical Center (VAMC). patient population: Patients seen at the eye clinic between June and August 2010 were asked to fill out the Dry Eye Questionnaire 5 (DEQ5) and the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire. main outcome measures: Correlation between ocular surface symptoms and functionality. Four hundred eighty-nine patients elected to fill out the DEQ5 questionnaire (36% response rate). The mean age of respondents was 66 years (standard deviation 12). Ninety-four percent were male; 62% were white and 37% were black. Using the DEQ5 as a surrogate measure of ocular surface symptoms, 65% of respondents reported at least mild ocular surface symptoms (DEQ5 ≥6) and 27% of them reported severe symptoms (DEQ5 ≥12). Black subjects had a 2-fold increased risk of severe symptoms compared to white subjects (odds ratio 2.06, 95% confidence interval 1.33-3.19). Several medications were associated with a significantly increased risk of severe symptoms, including glaucoma medications (1.7-fold increase), antidepressants (2.3-fold increase), and antihistamines (2.1-fold increase). There was an inverse correlation between DEQ5 and IDEEL scores with regard to ability to perform activities of daily living (n = 391, r = -0.54, P life of Miami VAMC veterans. Eye care professionals should be vigilant in eliciting ocular surface complaints from their patients. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. 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

  20. Mediation of smoking-associated postoperative mortality by perioperative complications in veterans undergoing elective surgery: data from Veterans Affairs Surgical Quality Improvement Program (VASQIP)?a cohort study

    OpenAIRE

    Singh, Jasvinder A; Hawn, Mary; Campagna, Elizabeth J; Henderson, William G; Richman, Joshua; Houston, Thomas K

    2013-01-01

    Objective To assess the mediation of smoking-associated postoperative mortality by postoperative complications. Design Observational cohort study. Setting Using data from the Veterans Affairs (VA) Surgical Quality Improvement Programme, a quality assurance programme for major surgical procedures in the VA healthcare system, we assessed the association of current smoking at the time of the surgery with 6-month and 1-year mortality. Primary and secondary outcome measures Using mediation analyse...

  1. Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress.

    Science.gov (United States)

    Mayer, Stephanie B; Levy, James R; Farrell-Carnahan, Leah; Nichols, Michelle G; Raman, Shekar

    2016-07-15

    This cross-sectional study aimed to characterize sleep patterns, the quality and duration of sleep, and estimate the prevalence of common sleep disorders and posttraumatic stress disorder (PTSD) in a hospital-based Veterans Affairs MOVE! (Managing Overweight Veterans Everywhere) clinic. Participants completed five instruments: the Pittsburgh Sleep Quality Index (PSQI), Smith's Measure of Morningness/Eveningness, Restless Legs Syndrome Rating Scale, the STOP Questionnaire, and the Posttraumatic Stress Disorder (PTSD) Checklist - Civilian Version (PCL-C). Enrolled Veterans (n = 96) were mostly male (78%), African American (49%), mean age 58 (standard deviation [SD] 10.6) years, and mean body mass index (BMI) 38.4 kg/m(2) (SD 8.4). By PSQI, 89% rated sleep quality as "poor" (mean = 11.1, SD = 5.1), consistent with severely impaired sleep. Most were at high risk for sleep disorders including restless leg syndrome (53%), obstructive sleep apnea (66%), and circadian sleep disorders (72%). Forty-seven percent endorsed clinically significant symptoms of PTSD. Hypotheses-generating regression models suggest sleep latency (minutes before falling asleep) was associated with BMI (p = 0.018). Bedtime, getting up time, hours of sleep, waking up in the middle of the night or early morning, having to get up to use the bathroom, inability to breathe comfortably, cough or snore loudly, feeling too cold or too hot, having bad dreams, pain, and frequency of having trouble sleeping, were not significantly associated with BMI. Our cross-sectional study suggests that sleep difficulties are common among Veterans referred to a weight loss program at a Veterans Affairs Hospital. Controlled studies are needed to investigate whether the results are generalizable and whether obesity among veterans is a risk factor for sleep disorders and PTSD. A commentary on this article appears in this issue on page 943. © 2016 American Academy of Sleep Medicine.

  2. 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...

  3. 38 CFR 21.400 - Veterans' Advisory Committee on Rehabilitation.

    Science.gov (United States)

    2010-07-01

    ... Committee on Rehabilitation. 21.400 Section 21.400 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Vocational Rehabilitation and Employment Under 38 U.S.C. Chapter 31 Veterans' Advisory Committee on Rehabilitation § 21.400 Veterans...

  4. Enhancing the Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUiPPED): Preliminary Results from Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department, a Novel Multicomponent Interdisciplinary Quality Improvement Initiative.

    Science.gov (United States)

    Stevens, Melissa B; Hastings, Susan Nicole; Powers, James; Vandenberg, Ann E; Echt, Katharina V; Bryan, William E; Peggs, Kiffany; Markland, Alayne D; Hwang, Ula; Hung, William W; Schmidt, Anita J; McGwin, Gerald; Ikpe-Ekpo, Edidiong; Clevenger, Carolyn; Johnson, Theodore M; Vaughan, Camille P

    2015-05-01

    Suboptimal medication prescribing for older adults has been described in a number of emergency department (ED) studies. Despite this, few studies have examined ED-targeted interventions aimed at reducing the use of potentially inappropriate medications (PIMs). Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the ED (EQUiPPED) is an ongoing multicomponent, interdisciplinary quality improvement initiative in eight Department of Veterans Affairs EDs. The project aims to decrease the use of PIMs, as identified by the Beers criteria, prescribed to veterans aged 65 and older at the time of ED discharge. Interventions include provider education; informatics-based clinical decision support with electronic medical record-embedded geriatric pharmacy order sets and links to online geriatric content; and individual provider education including academic detailing, audit and feedback, and peer benchmarking. Poisson regression was used to compare the number of PIMs that staff providers prescribed to veterans aged 65 and older discharged from the ED before and after the initiation of the EQUiPPED intervention. Initial data from the first implementation site show that the average monthly proportion of PIMs that staff providers prescribed was 9.4±1.5% before the intervention and 4.6±1.0% after the initiation of EQUiPPED (relative risk=0.48, 95% confidence interval=0.40-0.59, PJournal compilation © 2015, The American Geriatrics Society.

  5. The state of Veterans Affairs sleep medicine programs: 2012 inventory results.

    Science.gov (United States)

    Sarmiento, Kathleen; Rossettie, John; Stepnowsky, Carl; Atwood, Charles; Calvitti, Alan

    2016-03-01

    The Veterans Health Administration (VHA) represents one of the largest integrated health-care systems in the country. In 2012, the Veterans Affairs Sleep Network (VASN) sought to identify available sleep resources at VA medical centers (VAMCs) across the country through a national sleep inventory. The sleep inventory was administered at the annual 2012 VA Sleep Practitioners meeting and by email to sleep contacts at each VAMC. National prosthetics contacts were used to identify personnel at VAMCs without established sleep programs. Follow-up emails and telephone calls were made through March 2013. One hundred eleven VA medical centers were included for analysis. Thirty-nine programs did not respond, and 10 were considered "satellites," referring all sleep services to a larger neighboring VAMC. Sleep programs were stratified based on extent of services offered (i.e., in-lab and home testing, sleep specialty clinics, cognitive behavioral therapy for insomnia (CBT-i)): 28 % were complex sleep programs (CSPs), 46 % were intermediate (ISPs), 9 % were standard (SSPs), and 17 % offered no formal sleep services. Overall, 138,175 clinic visits and 90,904 sleep testing encounters were provided in fiscal year 2011 by 112.1 physicians and clinical psychologists, 100.4 sleep technologists, and 115.3 respiratory therapists. More than half of all programs had home testing and CBT-i programs, and 26 % utilized sleep telehealth. The 2012 VA sleep inventory suggests considerable variability in sleep services within the VA. Demand for sleep services is high, with programs using home testing, sleep telehealth, and a growing number of mid-level providers to improve access to care.

  6. Identification of rheumatoid arthritis patients using an administrative database: a Veterans Affairs study.

    Science.gov (United States)

    Ng, Bernard; Aslam, Fawad; Petersen, Nancy J; Yu, Hong-Jen; Suarez-Almazor, Maria E

    2012-10-01

    The accuracy of the diagnosis is vital when administrative databases are used for pharmacoepidemiologic and outcome studies. Data pertaining to the utility of databases for rheumatoid arthritis (RA) are sparse and variable. We assessed the utility of various diagnostic algorithms to identify RA patients within the Veterans Health Administration (VHA) databases. Using the International Classification of Diseases, Ninth Revision code for RA at 2 visits at least 6 months apart, we identified 1,779 patients between October 1, 1998 and September 30, 2009 in our local Veterans Affairs Medical Center (VAMC) administrative database. Disease-modifying antirheumatic drug (DMARD) use was ascertained from the pharmacy database. Cases were analyzed based on DMARD therapy and RA codes at clinic visits. A total of 543 patients' medical records, selected by stratification and random selection on the basis of their visits, were reviewed to ascertain the clinicians' diagnoses and clinical criteria documentation. Positive predictive values (PPVs) were calculated for various database case identification algorithms using diagnosis of RA by medical record review as the gold standard. The PPV for identification of RA with 2 RA codes 6 months apart was 30.9%. Addition of DMARD therapy increased the PPV to 60.4%. The PPV further increased to 91.4% when having an RA code at the last VAMC rheumatology clinic visit criterion was added. An algorithm using only 2 administrative RA codes 6 months apart had a low PPV for correctly identifying patients with RA in the VHA database. Including DMARD therapy and requiring an RA code at the last visit with a rheumatologist increased the performance of the data extraction algorithm. Copyright © 2012 by the American College of Rheumatology.

  7. Design of a prostate cancer patient navigation intervention for a Veterans Affairs hospital

    Directory of Open Access Journals (Sweden)

    Nonzee Narissa J

    2012-09-01

    Full Text Available Abstract Background Patient navigation programs have been launched nationwide in an attempt to reduce racial/ethnic and socio-demographic disparities in cancer care, but few have evaluated outcomes in the prostate cancer setting. The National Cancer Institute-funded Chicago Patient Navigation Research Program (C-PNRP aims to implement and evaluate the efficacy of a patient navigation intervention for predominantly low-income minority patients with an abnormal prostate cancer screening test at a Veterans Affairs (VA hospital in Chicago. Methods/Design From 2006 through 2010, C-PNRP implemented a quasi-experimental intervention whereby trained social worker and lay health navigators worked with veterans with an abnormal prostate screen to proactively identify and resolve personal and systems barriers to care. Men were enrolled at a VA urology clinic and were selected to receive navigated versus usual care based on clinic day. Patient navigators performed activities to facilitate timely follow-up such as appointment reminders, transportation coordination, cancer education, scheduling assistance, and social support as needed. Primary outcome measures included time (days from abnormal screening to diagnosis and time from diagnosis to treatment initiation. Secondary outcomes included psychosocial and demographic predictors of non-compliance and patient satisfaction. Dates of screening, follow-up visits, and treatment were obtained through chart audit, and questionnaires were administered at baseline, after diagnosis, and after treatment initiation. At the VA, 546 patients were enrolled in the study (245 in the navigated arm, 245 in the records-based control arm, and 56 in a subsample of surveyed control subjects. Discussion Given increasing concerns about balancing better health outcomes with lower costs, careful examination of interventions aimed at reducing healthcare disparities attain critical importance. While analysis of the C-PNRP data is

  8. Training satisfaction for subspecialty fellows in internal medicine: Findings from the Veterans Affairs (VA Learners' Perceptions Survey

    Directory of Open Access Journals (Sweden)

    Byrne John M

    2011-05-01

    Full Text Available Abstract Background Learner satisfaction assessment is critical in the design and improvement of training programs. However, little is known about what influences satisfaction and whether trainee specialty is correlated. A national comparison of satisfaction among internal medicine subspecialty fellows in the Department of Veterans Affairs (VA provides a unique opportunity to examine educational factors associated with learner satisfaction. We compared satisfaction across internal medicine fellows by subspecialty and compared factors associated with satisfaction between procedural versus non-procedural subspecialty fellows, using data from the Learners' Perceptions Survey (LPS, a validated survey tool. Methods We surveyed 2,221 internal medicine subspecialty fellows rotating through VA between 2001 and 2008. Learners rated their overall training satisfaction on a 100-point scale, and on a five-point Likert scale ranked satisfaction with items within six educational domains: learning, clinical, working and physical environments; personal experience; and clinical faculty/preceptor. Results Procedural and non-procedural fellows reported similar overall satisfaction scores (81.2 and 81.6. Non-procedural fellows reported higher satisfaction with 79 of 81 items within the 6 domains and with the domain of physical environment (4.06 vs. 3.85, p Conclusions Internal medicine fellows are highly satisfied with their VA training. Nonprocedural fellows reported higher satisfaction with most items. For both procedural and non-procedural fellows, clinical faculty/preceptor and personal experience have the strongest impact on overall satisfaction.

  9. Validity of code based algorithms to identify primary open angle glaucoma (POAG) in Veterans Affairs (VA) administrative databases.

    Science.gov (United States)

    Biggerstaff, K S; Frankfort, B J; Orengo-Nania, S; Garcia, J; Chiao, E; Kramer, J R; White, D

    2017-09-25

    The validity of the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9) code for primary open angle glaucoma (POAG) in the Department of Veterans Affairs (VA) electronic medical record has not been examined. We determined the accuracy of the ICD-9 code for POAG and developed diagnostic algorithms for the detection of POAG. We conducted a retrospective study of abstracted data from the Michael E. DeBakey VA Medical Center's medical records of 334 unique patients with at least one visit to the Eye Clinic between 1999 and 2013. Algorithms were developed to validly identify POAG using ICD-9 codes and pharmacy data. The positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and percent agreement of the various algorithms were calculated. For the ICD-9 code 365.1x, the PPV was 65.9%, NPV was 95.2%, sensitivity was 100%, specificity was 82.6%, and percent agreement was 87.8%. The algorithm with the highest PPV was 76.3%, using pharmacy data in conjunction with two or more ICD-9 codes for POAG, but this algorithm also had the lowest NPV at 88.2%. Various algorithms for identifying POAG in the VA administrative databases have variable validity. Depending on the type of research being done, the ICD-9 code 365.1x can be used for epidemiologic or health services database research.

  10. Mastering improvement science skills in the new era of quality and safety: the Veterans Affairs National Quality Scholars Program.

    Science.gov (United States)

    Estrada, Carlos A; Dolansky, Mary A; Singh, Mamta K; Oliver, Brant J; Callaway-Lane, Carol; Splaine, Mark; Gilman, Stuart; Patrician, Patricia A

    2012-04-01

    Healthcare professionals need a new skill set to ensure the success of quality improvement in healthcare. The Department of Veterans Affairs (VA) initiated the VA National Quality Scholars fellowship in 1998; its mission is to improve the quality of care, ensure safety, accelerate healthcare re-design, and advance the improvement science by educating the next generation of leaders in quality and safety. We describe the critical need for leadership in quality and safety and interprofessional education, illustrate the curriculum, provide lessons learned by fellows, summarize key lessons learned from the implementation of an interprofessional education approach, and present most recent accomplishments. Narrative review. As of 2011, 106 program alumni are embedded in the health care delivery system across the United States. Since 2009, when nurse fellows joined the program, of the first nine graduating interdisciplinary fellows, the tailored curriculum has resulted in five advanced academic degrees, 42 projects, 29 teaching activities, 44 presentations, 36 publications, six grants funded or submitted, and two awards. The VA National Quality Scholars program continues to nurture and develop leaders for the new millennium focusing on interprofessional education. The nations' health care systems need strong interdisciplinary leaders in advanced quality improvement science who are dedicated to improving the overall quality of health and health care. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.

  11. 78 FR 55338 - Advisory Committee on Homeless Veterans, Notice of Meeting Amendment

    Science.gov (United States)

    2013-09-10

    ... AFFAIRS Advisory Committee on Homeless Veterans, Notice of Meeting Amendment The Department of Veterans... Committee on Homeless Veterans meeting on September 11-13, 2013, in the William Phillip King room at The... services of the Department in assisting homeless Veterans. The Committee shall assemble and review...

  12. 77 FR 26069 - Advisory Committee on Homeless Veterans, Notice of Meeting

    Science.gov (United States)

    2012-05-02

    ...: 2012-10524] DEPARTMENT OF VETERANS AFFAIRS Advisory Committee on Homeless Veterans, Notice of Meeting... Committee Act) that a meeting of the Advisory Committee on Homeless Veterans will be held on June 1-2, 2012..., organizational structures, and services of the Department in assisting homeless Veterans. The Committee shall...

  13. Use of the surgical Apgar score to enhance Veterans Affairs Surgical Quality Improvement Program surgical risk assessment in veterans undergoing major intra-abdominal surgery.

    Science.gov (United States)

    Masi, Antonio; Amodeo, Salvatore; Hatzaras, Ioannis; Pinna, Antonio; Rosman, Alan S; Cohen, Steven; Saunders, John K; Berman, Russell; Newman, Elliot; Ballantyne, Garth H; Pachter, Leon H; Melis, Marcovalerio

    2017-04-01

    We investigated whether the surgical Apgar score (SAS) may enhance the Veterans Affairs Surgical Quality Improvement Program (VASQIP) risk assessment for prediction of early postoperative outcomes. We retrospectively evaluated demographics, medical history, procedure, SAS, VASQIP assessment, and postoperative data for patients undergoing major/extensive intra-abdominal surgery at the Manhattan Veterans Affairs between October 2006 and September 2011. End points were overall morbidity and 30-, 60- , and 90-day mortality. Pearson's chi-square, ANOVA, and multivariate regression modeling were employed. Six hundred twenty-nine patients were included. Apgar groups did not differ in age, sex, and race. Low SASs were associated with worse functional status, increased postoperative morbidity, and 30-, 60- , and 90-day mortality rates. SAS did not significantly enhance VASQIP prediction of postoperative outcomes, although a trend was detected. Multivariate analysis confirmed SAS as an independent predictor of morbidity and mortality. SAS effectively identifies veterans at high risk for poor postoperative outcome. Additional studies are necessary to evaluate the role of SAS in enhancing VASQIP risk prediction. Published by Elsevier Inc.

  14. Trabeculectomy Outcomes by Supervised Trainees in a Veterans Affairs Medical Center.

    Science.gov (United States)

    Biggerstaff, Kristin S; Vincent, Ryan D; Lin, Albert P; Orengo-Nania, Silvia; Frankfort, Benjamin J

    2016-08-01

    To evaluate the outcomes of trabeculectomy performed in an ophthalmology training program. Retrospective study. A total of 160 patients undergoing trabeculectomy performed by a resident or fellow under attending supervision. Trabeculectomy surgeries performed by a supervised resident or fellow surgeon between October 2000 and April 2010 were reviewed. Success was considered to be complete or partial if intraocular pressure (IOP)-lowering medications were not or were required to achieve IOP≤21 mm Hg, respectively. Failure was defined as IOP>21 mm Hg on 2 consecutive visits, loss of light perception vision, IOP≤5 on 2 consecutive visits with associated visual acuity loss of ≥2 lines, or need for surgical intervention. Trabeculectomy survival was determined using Kaplan-Meier analysis through 60 months of follow-up. Final IOP, success/failure rate. Complete success was achieved in 65 patients (41%). The average final IOP of this group was 9.1±3.7 mm Hg. Qualified success was achieved in 56 patients (35%). The average final IOP of this group was 11.5±6.4 mm Hg. At 60 months, the estimated cumulative probability of survival for complete and qualified successes was 28.9% and 63.7%, respectively. Among patients undergoing trabeculectomy by supervised residents or glaucoma fellows in a large Veterans Affairs Medical Center, IOP reduction was significant and similar to published studies. Trabeculectomy remains a successful intervention to lower IOP, with satisfactory success rates in the hands of trainee surgeons.

  15. Longitudinal changes in hearing sensitivity among men: the Veterans Affairs Normative Aging Study.

    Science.gov (United States)

    Echt, Katharina V; Smith, Sherri L; Burridge, Andrea Backscheider; Spiro, Avron

    2010-10-01

    Over 35 years (1962-1996), participants of the Veterans Affairs Normative Aging Study (NAS), a study of healthy aging in men, completed up to eight audiometric assessments. This report describes the age-related hearing trajectories of screened men (n=953) aged 23 to 81 years at enrollment, estimates the typical rate of change per decade in hearing sensitivity, and compares longitudinal and cross-sectional estimates of change in hearing sensitivity. The men were followed 14 years on average. The hearing trajectories, based on a mixed-effects model analytical approach to the data, provide converging evidence that hearing loss in aging is pervasive and progressive even among men initially selected for good physical health. Typically the men accrued early losses (>25 dB HL) in hearing sensitivity at the higher frequencies beginning in the early 40s, but maintained hearing thresholds better than 25 dB HL for lower frequencies into old age. The average rate of change per year across frequencies and age was 0.69 dB. Predicted cross-sectional estimates of change in hearing sensitivity reliably approximated longitudinal trajectories, with slight misestimations in the 8th decade.

  16. Advocating for Standards in Student Affairs Departments in African ...

    African Journals Online (AJOL)

    in African Institutions: University of Botswana experience. Barbra M. ... Graduating students are expected to exhibit employability skills and ... University of Botswana, the institutional mission emphasises graduates who have been ... creation of the International Association of Student Affairs Services (IASAS), and annual.

  17. 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

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Medical care for veterans... Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Vocational Training and Health-Care Eligibility Protection for Pension Recipients § 17.90 Medical care for veterans receiving vocational training under 38 U...

  18. Higher Education Benefits for Post-9/11 Military Service Members and Veterans. Testimony. CT-428

    Science.gov (United States)

    Gonzalez, Gabriella C.; Miller, Laura L.; Buryk, Peter; Wenger, Jennie W.

    2015-01-01

    This testimony was presented before the House Veterans' Affairs Committee, Subcommittee on Economic Opportunity on March 17, 2015. To inform the Subcommittee hearing on the Department of Veterans Affairs' administration of its education programs, and the educational and training needs of post-9/11 veterans, the presenters offered the statement in…

  19. 78 FR 48543 - Veterans Health Administration Fund Availability Under the VA's Homeless Providers Grant and Per...

    Science.gov (United States)

    2013-08-08

    ... AFFAIRS Veterans Health Administration Fund Availability Under the VA's Homeless Providers Grant and Per... continue to deliver services to the homeless Special Need veteran population as outlined in their FY 2009.... Quarles, Director, VA's Homeless Providers GPD Program, Department of Veterans Affairs, 10770 N. 46th...

  20. 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...

  1. 77 FR 58913 - Veterans' Rural Health Advisory Committee, Notice of Meeting

    Science.gov (United States)

    2012-09-24

    ... AFFAIRS Veterans' Rural Health Advisory Committee, Notice of Meeting The Department of Veterans Affairs... provision of VA health care to enrolled Veterans residing in rural areas, and discusses ways to improve and... Office of Rural Health (ORH) Telehealth Projects funded; Louis A. Johnson Medical Center Women's Health...

  2. 77 FR 30593 - Veterans' Rural Health Advisory Committee, Notice of Meeting

    Science.gov (United States)

    2012-05-23

    ... AFFAIRS Veterans' Rural Health Advisory Committee, Notice of Meeting The Department of Veterans Affairs... Friday, June 22, 2012, in Room GL20 of the Office of Rural Health (ORH), 1722 I Street NW., Washington... on health care issues affecting enrolled Veterans residing in rural areas. The Committee examines...

  3. 77 FR 77185 - Veterans' Rural Health Advisory Committee, Notice of Meeting

    Science.gov (United States)

    2012-12-31

    ... AFFAIRS Veterans' Rural Health Advisory Committee, Notice of Meeting The Department of Veterans Affairs... Tuesday, January ] 29, 2013, in Room GL20 of the Office of Rural Health (ORH), 1722 I Street, NW... on health care issues affecting enrolled Veterans residing in rural areas. The Committee examines...

  4. 76 FR 60965 - Veterans' Rural Health Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2011-09-30

    ... AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The Department of Veterans Affairs... VA health care to enrolled Veterans residing in rural areas, and discusses ways to improve and...HealthyVet; and Office of Rural Health. In the afternoon, the Committee ] will receive a briefing on the...

  5. 76 FR 44091 - Veterans' Rural Health Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2011-07-22

    ... AFFAIRS Department of Veterans Affairs Veterans' Rural Health Advisory Committee; Notice of Meeting The...) that the Veterans' Rural Health Advisory Committee will conduct a teleconference call meeting on Tuesday, August 2, 2011, from 2 p.m. to 4 p.m., in Room GL20 of the Office of Rural Health, 1722 I Street...

  6. 75 FR 61574 - Veterans' Rural Health Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2010-10-05

    ... AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The Department of Veterans Affairs... policies that impact the provision of VA health care to enrolled Veterans residing in rural areas, and... Committee will hear from its Chairman, ] the Director of the VA Office of Rural Health and the VA Under...

  7. 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.

  8. 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.

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

    Science.gov (United States)

    2014-06-13

    8 VBA Budget ................................................................................................................ 8... VBA Leadership and Personnel .................................................................................. 9 Employee Promotion within VBA ...14 VBA Goals and Key Programs

  10. 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.

  11. Rosiglitazone treatment and cardiovascular disease in the Veterans Affairs Diabetes Trial

    Science.gov (United States)

    Florez, H; Reaven, P D; Bahn, G; Moritz, T; Warren, S; Marks, J; Reda, D; Duckworth, W; Abraira, C; Hayward, R; Emanuele, N

    2015-01-01

    Aims To evaluate the relationship between patterns of rosiglitazone use and cardiovascular (CV) outcomes in the Veterans Affairs Diabetes Trial (VADT). Methods Time-dependent survival analyses, case–control and 1 : 1 propensity matching approaches were used to examine the relationship between patterns of rosiglitazone use and CV outcomes in the VADT, a randomized controlled study that assessed the effect of intensive glycaemic control on CV outcomes in 1791 patients with type 2 diabetes (T2D) whose mean age was 60.4 ± 9 years. Participants were recruited between 1 December 2000 and 31 May 2003, and were followed for 5–7.5 years (median 5.6) with a final visit by 31 May 2008. Rosiglitazone (4 mg and 8 mg daily) was initiated per protocol in both the intensive-therapy and standard-therapy groups. Main outcomes included a composite CV outcome, CV death and myocardial infarction (MI). Results Both daily doses of rosiglitazone were associated with lower risk for the primary composite CV outcome [4 mg: hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.49–0.81 and 8 mg: HR 0.60, 95% CI 0.49–0.75] after adjusting for demographic and clinical covariates. A reduction in CV death was also observed (HR 0.25, p < 0.001, for both 4 and 8 mg/day rosiglitazone); however, the effect on MI was less evident for 8 mg/day and not significant for 4 mg/day. Conclusions In older patients with T2D the use of rosiglitazone was associated with decreased risk of the primary CV composite outcome and CV death. Rosiglitazone use did not lead to a higher risk of MI. PMID:25964070

  12. A Link Between Hypoglycemia and Progression of Atherosclerosis in the Veterans Affairs Diabetes Trial (VADT)

    Science.gov (United States)

    Bahn, Gideon D.

    2016-01-01

    OBJECTIVE To determine whether a link exists between serious hypoglycemia and progression of atherosclerosis in a substudy of the Veterans Affairs Diabetes Trial (VADT) and to examine whether glycemic control during the VADT modified the association between serious hypoglycemia and coronary artery calcium (CAC) progression. RESEARCH DESIGN AND METHODS Serious hypoglycemia was defined as severe episodes with loss of consciousness or requiring assistance or documented glucose <50 mg/dL. Progression of CAC was determined in 197 participants with baseline and follow-up computed tomography scans. RESULTS During an average follow-up of 4.5 years between scans, 97 participants reported severe hypoglycemia (n = 23) or glucose <50 mg/dL (n = 74). Serious hypoglycemia occurred more frequently in the intensive therapy group than in the standard treatment group (74% vs. 21%, P < 0.01). Serious hypoglycemia was not associated with progression of CAC in the entire cohort, but the interaction between serious hypoglycemia and treatment was significant (P < 0.01). Participants with serious hypoglycemia in the standard therapy group, but not in the intensive therapy group, had ∼50% greater progression of CAC than those without serious hypoglycemia (median 11.15 vs. 5.4 mm3, P = 0.02). Adjustment for all baseline differences, including CAC, or time-varying risk factors during the trial, did not change the results. Examining the effect of serious hypoglycemia by on-trial HbA1c levels (cutoff 7.5%) yielded similar results. In addition, a dose-response relationship was found between serious hypoglycemia and CAC progression in the standard therapy group only. CONCLUSIONS Despite a higher frequency of serious hypoglycemia in the intensive therapy group, serious hypoglycemia was associated with progression of CAC in only the standard therapy group. PMID:26786575

  13. 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.

  14. Complications and Failure to Rescue After Inpatient Noncardiac Surgery in the Veterans Affairs Health System.

    Science.gov (United States)

    Massarweh, Nader N; Kougias, Panagiotis; Wilson, Mark A

    2016-12-01

    The quality of surgical care in the Veterans Health Administration improved markedly in the 1990s after implementation of the Veterans Affairs (VA) National Surgical Quality Improvement Program (now called the VA Surgical Quality Improvement Program). Although there have been many recent evaluations of surgical care in the private sector, to date, a contemporary global evaluation has not been performed within the VA health system. To provide a contemporaneous report of noncardiac postoperative outcomes in the VA health system during the past 15 years. A retrospective cohort study was conducted using data from the VA Surgical Quality Improvement Program among veterans who underwent inpatient general, vascular, thoracic, genitourinary, neurosurgical, orthopedic, or spine surgery from October 1, 1999, through September 30, 2014. Rates of 30-day morbidity, mortality, and failure to rescue (FTR) over time. Among 704 901 patients (mean [SD] age, 63.7 [11.8] years; 676 750 [96%] male) undergoing noncardiac surgical procedures at 143 hospitals, complications occurred in 97 836 patients (13.9%), major complications occurred in 66 816 (9.5%), FTR occurred in 12 648 of the 97 836 patients with complications (12.9%), FTR after major complications occurred in 12 223 of the 66 816 patients with major complications (18.3%), and 18 924 patients (2.7%) died within 30 days of surgery. There were significant decreases from 2000 to 2014 in morbidity (8202 of 59 421 [13.8%] vs 3368 of 32 785 [10.3%]), major complications (5832 of 59 421 [9.8%] vs 2284 of 32 785 [7%]), FTR (1445 of 8202 [17.6%] vs 351 of 3368 [10.4%]), and FTR after major complications (1388 of 5832 [23.8%] vs 343 of 2284 [15%]) (trend test, P < .001 for all). Although there were no clinically meaningful differences in rates of complications and major complications across hospital risk-adjusted mortality quintiles (any complications: lowest quintile, 20 945 of 147 721 [14.2%] vs highest

  15. Health care for homeless veterans. Final rule.

    Science.gov (United States)

    2011-08-23

    This final rule establishes regulations for contracting with community-based treatment facilities in the Health Care for Homeless Veterans (HCHV) program of the Department of Veterans Affairs (VA). The HCHV program assists certain homeless veterans in obtaining treatment from non-VA community-based providers. The final rule formalizes VA's policies and procedures in connection with this program and clarifies that veterans with substance use disorders may qualify for the program.

  16. 78 FR 72753 - Notice of Funds Availability for Grants for Transportation of Veterans in Highly Rural Areas...

    Science.gov (United States)

    2013-12-03

    ... AFFAIRS Notice of Funds Availability for Grants for Transportation of Veterans in Highly Rural Areas; Extension of Application Deadline AGENCY: Department of Veterans Affairs. ACTION: Notice; extension of NOFA... deadline for funds available under the Grants for Transportation of Veterans in Highly Rural Areas program...

  17. 2015 Veteran Economic Opportunity Report

    Science.gov (United States)

    2015-01-01

    and data analysis to the VBA and stakeholders. PA&I developed the VBA Enterprise Data Warehouse to enable the generation of recurring and ad hoc...reports in response to VBA decision-making and business needs. PA&I will be a primary source of information on Veteran education, vocational...Servicemembers UI Unemployment Insurance URL Uniform Resource Locator USB Under Secretary for Benefits VA Department of Veterans Affairs VBA Veterans

  18. 38 CFR 3.712 - Improved pension elections; surviving spouses of Spanish-American War veterans.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Improved pension elections; surviving spouses of Spanish-American War veterans. 3.712 Section 3.712 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Pension, Compensation, and Dependency and...

  19. 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...

  20. 38 CFR 3.23 - Improved pension rates-Veterans and surviving spouses.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Improved pension rates-Veterans and surviving spouses. 3.23 Section 3.23 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Pension, Compensation, and Dependency and Indemnity Compensation General § 3...

  1. 38 CFR 21.402 - Responsibilities of the Veterans' Advisory Committee on Rehabilitation.

    Science.gov (United States)

    2010-07-01

    ... Veterans' Advisory Committee on Rehabilitation. 21.402 Section 21.402 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Vocational Rehabilitation and Employment Under 38 U.S.C. Chapter 31 Veterans' Advisory Committee on Rehabilitation § 21.402...

  2. 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)...

  3. BP and Renal Outcomes in Diabetic Kidney Disease: The Veterans Affairs Nephropathy in Diabetes Trial.

    Science.gov (United States)

    Leehey, David J; Zhang, Jane H; Emanuele, Nicholas V; Whaley-Connell, Adam; Palevsky, Paul M; Reilly, Robert F; Guarino, Peter; Fried, Linda F

    2015-12-07

    Proteinuric diabetic kidney disease frequently progresses to ESRD. Control of BP delays progression, but the optimal BP to improve outcomes remains unclear. The objective of this analysis was to evaluate the relationship between BP and renal outcomes in proteinuric diabetic kidney disease. BP data from all 1448 randomized participants in the Veterans Affairs Nephropathy in Diabetes Trial were included in a post hoc analysis. The associations of mean on-treatment BP with the primary end point (decline in eGFR, ESRD, or death), renal end point (decline in eGFR or ESRD), rate of eGFR decline, and mortality were measured. The median (25th, 75th percentile) follow-up time was 2.2 (1.2, 3.0) years. There were 284 primary end points. In univariate analyses, both mean systolic and mean diastolic BPs were strongly associated (P150 mmHg (P=0.02), with a significantly higher hazard ratio for 140-149 versus 120-129 mmHg (1.51 [1.06, 2.15]; P=0.02). There was also a significant association of mean diastolic BP with the hazard of developing the primary end point (P<0.01), with a significantly higher hazard ratio when mean diastolic BP was 80-89 versus 70-79 mmHg (1.54 [1.05, 2.25]; P=0.03); there was also a strong trend when mean diastolic BP was <60 mmHg. Associations between BP and both renal end point and rate of eGFR decline were similar to those with the primary end point. No association of BP with mortality was observed, possibly because of the limited number of mortality events. In patients with proteinuric diabetic kidney disease, mean systolic BP ≥ 140 mmHg and mean diastolic BP ≥ 80 mmHg were associated with worse renal outcomes. Copyright © 2015 by the American Society of Nephrology.

  4. Hearing aid patients in private practice and public health (Veterans Affairs) clinics: are they different?

    Science.gov (United States)

    Cox, Robyn M; Alexander, Genevieve C; Gray, Ginger A

    2005-12-01

    In hearing aid research, it is commonplace to combine data across subjects whose hearing aids were provided in different service delivery models. There is reason to question whether these types of patients are always similar enough to justify this practice. To explore this matter, this investigation evaluated similarities and differences in self-report data obtained from hearing aid patients derived from public health (Veterans Affairs, VA) and private practice (PP) settings. The study was a multisite, cross-sectional survey in which 230 hearing aid patients from VA and PP audiology clinic settings provided self-report data on a collection of questionnaires both before and after the hearing aid fitting. Subjects were all older adults with mild to moderately severe hearing loss. About half of them had previous experience wearing hearing aids. All subjects were fitted with wide-dynamic-range-compression instruments and received similar treatment protocols. Numerous statistically significant differences were observed between the VA and PP subject groups. Before the fitting, VA patients reported higher expectations from the hearing aids and more severe unaided problems compared with PP patients with similar audiograms. Three wks after the fitting, VA patients reported more satisfaction with their hearing aids. On some measures VA patients reported more benefit, but different measures of benefit did not give completely consistent results. Both groups reported using the hearing aids an average of approximately 8 hrs per day. VA patients reported age-normal physical and mental health, but PP patients tended to report better than typical health for their age group. These data indicate that hearing aid patients seen in the VA public health hearing services are systematically different in self-report domains from those seen in private practice services. It is therefore risky to casually combine data from these two types of subjects or to generalize research results from one

  5. Predictors of Cognitive Decline in Older Adult Type 2 Diabetes from the Veterans Affairs Diabetes Trial.

    Science.gov (United States)

    Zimering, Mark B; Knight, Jeffrey; Ge, Ling; Bahn, Gideon

    2016-01-01

    Cognitive decline disproportionately affects older adult type 2 diabetes. We tested whether randomized intensive (INT) 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. A battery of neuropsychological tests [digit span, digit symbol substitution (DSym), and Trails-making Test-Part B (TMT-B)] was administered at baseline in ~1700 participants and repeated at year 5. Thirty-seven risk factors were evaluated as predictors of cognitive decline in multivariable regression analyses. The mean age-adjusted DSym or TMT-B declined significantly in all study participants (P < 0.001). Randomized INT 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 (BP; beta = 0.028; P = 0.002), 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 BPs. 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 BP-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. A 5-year period of randomized INT glucose-lowering did not significantly reduce the rate of cognitive decline in older-aged adults with type 2 diabetes. Systolic and diastolic BPs as well as plasma triglycerides

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

    Directory of Open Access Journals (Sweden)

    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

  7. Plastic surgery within the Veterans Affairs Medical System: proposed modified indications for operative procedures.

    Science.gov (United States)

    Erdmann, Detlev; Pradka, Sarah P; Similie, Ernest; Marcus, Jeffrey R; Moyer, Kurtis E; Shelburne, John D; Tyler, Douglas S; Levin, Scott L

    2009-07-01

    Many plastic surgery procedures span the divide between aesthetic ("cosmetic") and reconstructive surgery. However, definitions and guidelines may be inconsistent, which may decrease patients' access to legitimate procedures. The article aims to assist Veterans' Health Administration-affiliated plastic surgeons in continuing to provide optimal care to the Nation's Veterans and family members, and should be regarded as an open discussion.

  8. State of affairs of emergency medicine in the Veterans Health Administration.

    Science.gov (United States)

    Kessler, Chad; Chen, Jennifer; Dill, Curt; Tyndall, Gary; Olszyk, Mark D

    2010-10-01

    The Veterans Health Administration (VHA) has reformed its emergency medical services. This study updates an overview of emergency medicine within VHA. This is a cross-sectional survey of VHA medical facilities offering emergency medical care. Sixty-eight percent (95/140) of facilities had emergency departments (EDs) only, 12% (16/140) had both ED and urgent care centers (UCCs), and 16% (23/140) had only UCCs. The mean (SD) ED/UCC census was 13 371 (7664). A mean (SD) of 53% (27%) of facility admissions were admitted through ED/UCCs. The median of all ED/UCC admissions admitted to intensive care unit level care was 11% (interquartile range, 7-16). Of physicians with any board certification, 16% (209/1331) of physicians had emergency medicine board certification. Emergency medical care is now available at most VHA facilities. The specialty of emergency medicine has an important but minority presence within clinical emergency medical care at VHA. Published by Elsevier Inc.

  9. 77 FR 54367 - Sharing Information Between the Department of Veterans Affairs and the Department of Defense

    Science.gov (United States)

    2012-09-05

    ... or activity (including education, training, treatment, rehabilitation, or research) relating to drug..., Archives and records, Cemeteries, Claims, Courts, Crime, Flags, Freedom of information, Government contracts, Government employees, Government property, Infants and children, Penalties, Privacy, Reporting...

  10. 76 FR 65133 - Sharing Information Between the Department of Veterans Affairs and the Department of Defense

    Science.gov (United States)

    2011-10-20

    ... activity (including education, training, treatment, rehabilitation, or research) relating to drug abuse..., Courts, Crime, Flags, Freedom of information, Government contracts, Government employees, Government property, Infants and children, Penalties, Privacy, Reporting and recordkeeping requirements, Security...

  11. Analysis of a Joint Department of Veterans Affairs and Department of Defense Intensive Care Unit

    National Research Council Canada - National Science Library

    Malone, Danna

    2004-01-01

    ...) for a jointly staffed six-bed intensive care unit (ICU) at WHMC. The STVHCS can recruit and hire critical care nurses but has inadequate ICU bed capacity while WHMC has available ICU beds but insufficient nursing staff due to military deployments...

  12. Racial and Ethnic Health Care Disparities Among Women in the Veterans Affairs Healthcare System: A Systematic Review.

    Science.gov (United States)

    Carter, Andrea; Borrero, Sonya; Wessel, Charles; Washington, Donna L; Bean-Mayberry, Bevanne; Corbelli, Jennifer

    2016-01-01

    Women are a rapidly growing segment of patients who seek care in the Veterans Affairs (VA) Healthcare System, yet many questions regarding their health care experiences and outcomes remain unanswered. Racial and ethnic disparities have been well-documented in the general population and among veterans; however, prior disparities research conducted in the VA focused primarily on male veterans. We sought to characterize the findings and gaps in the literature on racial and ethnic disparities among women using the VA. We systematically reviewed the literature on racial and ethnic health care disparities exclusively among women using the VA Healthcare System. We included studies that examined health care use, satisfaction, and/or quality, and stratified data by race or ethnicity. Nine studies of the 2,591 searched met our inclusion criteria. The included studies examined contraception provision/access (n = 3), treatment of low bone mass (n = 1), hormone therapy (n = 1), use of mental health or substance abuse-related services (n = 2), trauma exposure and use of various services (n = 1), and satisfaction with primary care (n = 1). Five of nine studies showed evidence of a significant racial or ethnic difference. In contrast with the wealth of literature examining disparities both among the male veterans and women in non-VA settings, only nine studies examine racial and ethnic disparities specifically among women in the VA Healthcare System. These results demonstrate that there is an unmet need to further assess health care disparities among female VA users. Published by Elsevier Inc.

  13. 38 CFR 17.351 - Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Grants for the..., Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants to the Republic of the Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center...

  14. 38 CFR 74.4 - Who does CVE consider to control a veteran-owned small business?

    Science.gov (United States)

    2010-07-01

    ... of business operations. An applicant or participant's management and daily business operations must... control a veteran-owned small business? 74.4 Section 74.4 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VETERANS SMALL BUSINESS REGULATIONS General Guidelines § 74.4 Who...

  15. Advocating for Standards in Student Affairs Departments in African Institutions: University of Botswana experience

    Directory of Open Access Journals (Sweden)

    Barbra M. Pansiri

    2017-07-01

    Full Text Available The Student Affairs Departments have seen immense growth over the years, from a discourse which had no academic relevance in higher education, to that which is expected to add value to the attraction, retention, and graduation of students. However, the latest developments have seen the role of Student Affairs Departments grow from ‘in‑loco parentis’ to educators who are expected to strategically position the image of their institutions to ensure that students are equipped with relevant, tried and tested skills in preparation for their studies, work, and civic engagement. The level of personal growth of students as they transition from secondary to tertiary institutions is now also traced to the effectiveness of Student Affairs personnel, policies, and structures. Thus the need for the visibility of such departments and the need to add value to higher education in the 21st century has escalated. More innovative ways of engaging students and academics in this social discourse has a bearing on a professional approach that places emphasis on standards. The argument is made for advancing standards in the sphere of Student Affairs as a method of enhancing needed visibility and adding value to African higher education, the focus of which is leading the continent’s transformation agenda towards socio-economic development.

  16. Development and Validation of a Methodology to Reduce Mortality Using the Veterans Affairs Surgical Quality Improvement Program Risk Calculator.

    Science.gov (United States)

    Keller, Deborah S; Kroll, Donald; Papaconstantinou, Harry T; Ellis, C Neal

    2017-04-01

    To identify patients with a high risk of 30-day mortality after elective surgery, who may benefit from referral for tertiary care, an institution-specific process using the Veterans Affairs Surgical Quality Improvement Program (VASQIP) Risk Calculator was developed. The goal was to develop and validate the methodology. Our hypothesis was that the process could optimize referrals and reduce mortality. A VASQIP risk score was calculated for all patients undergoing elective noncardiac surgery at a single Veterans Affairs (VA) facility. After statistical analysis, a VASQIP risk score of 3.3% predicted mortality was selected as the institutional threshold for referral to a tertiary care center. The model predicted that 16% of patients would require referral, and 30-day mortality would be reduced by 73% at the referring institution. The main outcomes measures were the actual vs predicted referrals and mortality rates at the referring and receiving facilities. The validation included 565 patients; 90 (16%) had VASQIP risk scores greater than 3.3% and were identified for referral; 60 consented. In these patients, there were 16 (27%) predicted mortalities, but only 4 actual deaths (p = 0.007) at the receiving institution. When referral was not indicated, the model predicted 4 mortalities (1%), but no actual deaths (p = 0.1241). These data validate this methodology to identify patients for referral to a higher level of care, reducing mortality at the referring institutions and significantly improving patient outcomes. This methodology can help guide decisions on referrals and optimize patient care. Further application and studies are warranted. Copyright © 2017 American College of Surgeons. All rights reserved.

  17. 78 FR 73926 - Veterans' Rural Health Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2013-12-09

    ... AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The Department of Veterans Affairs... Health Advisory Committee will hold a meeting on January 14-15, 2014, in Room 1G12, Building 1, at the George E. Whalen VA Medical Center (VAMC), 500 Foothill Drive, Salt Lake City, Utah, from 9 a.m. to 5 p.m...

  18. 75 FR 8789 - Veterans' Rural Health Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2010-02-25

    ... AFFAIRS Veterans' Rural Health Advisory Committee; Notice of Meeting The Department of Veterans Affairs... rural areas. The Committee examines programs and policies that impact the provision of VA health care to... hear from its chairman, the acting director of the VA Office of Rural Health, and the directors of the...

  19. Long-term follow-up of intensive glycaemic control on renal outcomes in the Veterans Affairs Diabetes Trial (VADT).

    Science.gov (United States)

    Agrawal, Lily; Azad, Nasrin; Bahn, Gideon D; Ge, Ling; Reaven, Peter D; Hayward, Rodney A; Reda, Domenic J; Emanuele, Nicholas V

    2017-11-03

    We conducted an analysis of data collected during the Veterans Affairs Diabetes Trial (VADT) and the follow-up study (VADT-F) to determine whether intensive (INT) compared with standard (STD) glycaemic control during the VADT resulted in better long-term kidney outcomes. VADT randomly assigned 1791 veterans from 20 Veterans Affairs (VA) medical centres who had type 2 diabetes mellitus and a mean HbA1c of 9.4 ± 2% (79.2 mmol/mol) at baseline to receive either INT or STD glucose control for a median of 5.6 years (randomisation December 2000 to May 2003; intervention ending in May 2008). After the trial, participants received routine care through their own physicians within the VA. This is an interim analysis of the VADT-F (June 2008 to December 2013). We collected data using VA and National databases and report renal outcomes based on serum creatinine, eGFR and urine albumin to creatinine ratio (ACR) in 1033 people who provided informed consent to participate in the VADT-F. By the end of the VADT-F, significantly more people who received INT treatment during the VADT maintained an eGFR >60 ml min(-1) 1.73 m(-2) (OR 1.34 [95% CI 1.05, 1.71], p = 0.02). This benefit was most evident in those who were classified as at moderate risk (INT vs STD, RR 1.3, p = 0.03) or high risk (RR 2.3, p = 0.04) of chronic kidney disease on the Kidney Disease Improving Global Outcomes (KDIGO-CKD) at the beginning of VADT. At the end of VADT-F, significantly more people from the INT group improved to a low KDIGO risk category (RR 6.1, p = 0.002). During the VADT-F there were no significant differences between INT and STD for average HbA1c, blood pressure or lipid levels. After just over 11 years of follow-up, there was a 34% greater odds of maintaining an eGFR of >60 ml min(-1) 1.73 m(-2) and of improving the KDIGO category in individuals with type 2 diabetes who had received INT for a median of 5.6 years. VADT clinical trials.gov number: NCT 00032487.

  20. Identifying US veterans who access services from health care for the homeless clinics.

    Science.gov (United States)

    Knopf-Amelung, Sarah M; Jenkins, Darlene M

    2013-12-01

    Research on veterans experiencing homelessness is predominantly focused on the US Department of Veterans Affairs setting, despite the fact that substantial numbers receive services from Health Care for the Homeless (HCH) clinics. We explored how HCH clinics identified veteran patients through a survey of administrators (49% response rate). The majority (98%) identified veterans but used varied language and approaches. Implementing a streamlined, culturally competent identification process is vital to collecting accurate data, connecting veterans with benefits, and informing treatment plans.

  1. 38 CFR 8.30 - Appeal to Board of Veterans Appeals.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Appeal to Board of Veterans Appeals. 8.30 Section 8.30 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS NATIONAL SERVICE LIFE INSURANCE Appeals § 8.30 Appeal to Board of Veterans Appeals. (a) The provisions of Part 19 of this chapter will be followed i...

  2. Spousal labor market effects from government health insurance: Evidence from a veterans affairs expansion.

    Science.gov (United States)

    Boyle, Melissa A; Lahey, Joanna N

    2016-01-01

    Measuring the total impact of health insurance receipt on household labor supply is important in an era of increased access to publicly provided and subsidized insurance. Although government expansion of health insurance to older workers leads to direct labor supply reductions for recipients, there may be spillover effects on the labor supply of uncovered spouses. While the most basic model predicts a decrease in overall household work hours, financial incentives such as credit constraints, target income levels, and the need for own health insurance suggest that spousal labor supply might increase. In contrast, complementarities of spousal leisure would predict a decrease in labor supply for both spouses. Utilizing a mid-1990s expansion of health insurance for U.S. veterans, we provide evidence on the effects of public insurance availability on the labor supply of spouses. Using data from the Current Population Survey and Health and Retirement Study, we employ a difference-in-differences strategy to compare the labor market behavior of the wives of older male veterans and non-veterans before and after the VA health benefits expansion. Although husbands' labor supply decreases, wives' labor supply increases, suggesting that financial incentives dominate complementarities of spousal leisure. This effect is strongest for wives with lower education levels and lower levels of household wealth and those who were not previously employed full-time. These findings have implications for government programs such as Medicare and Social Security and the Affordable Care Act. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Profile of Sheltered Homeless Veterans for Fiscal Years 2009 and 2010

    Data.gov (United States)

    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...

  4. 78 FR 36309 - Research Advisory Committee on Gulf War Veterans' Illnesses, Notice of Meeting

    Science.gov (United States)

    2013-06-17

    ... diagnosing and treating Gulf War Veterans, and a drug treatment trial which is underway. On June 18, the... AFFAIRS Research Advisory Committee on Gulf War Veterans' Illnesses, Notice of Meeting The Department of... Research Advisory Committee on Gulf War Veterans' Illnesses will meet on June 17 and 18, 2013, in room 230...

  5. 77 FR 3327 - Veterans' Rural Health Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2012-01-23

    ... No: 2012-1173] DEPARTMENT OF VETERANS AFFAIRS Veterans' Rural Health Advisory Committee; Notice of... Committee Act) that the Veterans' Rural Health Advisory Committee will conduct a telephone conference call meeting from 11 a.m. to 12:30 p.m. on Monday, January 30, 2012, in Room GL20 of the Office of Rural Health...

  6. Homeless and Unemployed Veterans. Hearing before the Subcommittee on Education, Training and Employment of the Committee on Veterans' Affairs. House of Representatives, Ninety-Ninth Congress, Second Session.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. House Committee on Veterans' Affairs.

    This congressional report contains the testimony that was presented at a hearing to examine the needs of homeless and unemployed veterans. Testimony was provided by representatives of the following agencies and organizations: the Vietnam Veterans Ensemble; the National Coalition for the Homeless; the various Veterans' Administration (VA)…

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

    Science.gov (United States)

    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.

  8. Role of prolonged surveillance in the eradication of nosocomial scabies in an extended care Veterans Affairs medical center.

    Science.gov (United States)

    Jimenez-Lucho, V E; Fallon, F; Caputo, C; Ramsey, K

    1995-02-01

    Although general guidelines for control of institutional outbreaks of scabies have been published, little information is available on the long-term efficacy of these measures in extended care facilities. An epidemic of scabies occurred in a comprehensive care Veterans Affairs facility as a result of an unrecognized case of crusted scabies, with a total of 112 persons affected during a 12-month period. The initial outbreak occurred in the acute care units, with highest attack rates among roommates of the index patient (11/14, 78%) and nursing staff (27/55, 49%). Despite sustained infection control measures, secondary outbreaks continued to occur in the extended care units. Factors contributing to the persistence of the epidemic were transfer of patients with unrecognized infestation within the facility, prolonged latency period and atypical manifestations in elderly patients, and failure of scabicide treatment. In addition, a role may be played by carriage of scabies mites by infested staff members before they have symptoms. Control of the epidemic was only achieved with the following: increased awareness and better scabies recognition, restriction of staff rotation in the facility, and improved communication among primary providers and infection control personnel. Prolonged surveillance may be required for eradication of nosocomial scabies in extended care settings.

  9. Department of Defense TRICARE (DOD TRICARE)

    Data.gov (United States)

    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...

  10. 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.

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

    OpenAIRE

    Olson, Jonathan

    2009-01-01

    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,...

  12. Higher Education Military and Veteran Student Program Success: A Qualitative Study of Program Administration Best Practice Application

    Science.gov (United States)

    Murillo, Rose L.

    2017-01-01

    Purpose: The purpose of this study was to determine how Southern California community colleges have implemented best practices based on the 8 Keys to Veterans' Success as identified by the U.S. Departments of Education, Defense, and Veterans Affairs to effectively support and retain military and veteran students in higher education programs. The…

  13. Supporting School Success for Homeless Children of Veterans and Active Duty Military Members. Best Practices in Interagency Collaboration

    Science.gov (United States)

    National Center for Homeless Education at SERVE, 2011

    2011-01-01

    This brief is designed for local staff of the Department of Veterans Affairs (VA), state McKinney-Vento coordinators and school district McKinney-Vento liaisons, educators, and other providers of services to active members of the military and veterans, and their children. It provides basic information to assist homeless children of veterans or…

  14. Special home adaptation grants for members of the Armed Forces and veterans with certain vision impairment. Final rule.

    Science.gov (United States)

    2014-09-12

    The Department of Veterans Affairs (VA) is issuing a final rule to amend its adjudication regulations regarding special home adaptation grants for members of the Armed Forces and veterans with certain vision impairment. This regulatory amendment is necessary to conform the regulations to changes mandated in the Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012.

  15. Perioperative use of anti-rheumatic agents does not increase early postoperative infection risks: a Veteran Affairs' administrative database study.

    Science.gov (United States)

    Abou Zahr, Zaki; Spiegelman, Andrew; Cantu, Maria; Ng, Bernard

    2015-02-01

    The aim of this study was to validate a novel technique that predicts stopping of disease-modifying anti-rheumatic drugs (DMARDs) and biologic agents (BA) from the Veterans Affairs (VA) database and compare infection risks of rheumatoid arthritis patients who stopped versus continued DMARDs/BA perioperatively. We identified 6,024 patients on 1 DMARD or BA in the perioperative period between 1999 and 2009. Time gap between medication stop date and the next start date predicted drug stoppage (X). Time gap between surgery date and stop date predicted whether stoppage was before surgery (Y). Chart review from Houston VA was used for validation. ROC analyses were performed on chart review data to obtain X and Y cutoffs. The primary endpoints were wound infections and other infections within 30 days. ROC analyses found X ≥ 33 (AUC = 0.954) and Y ≥ -11 (AUC = 0.846). Risk of postoperative infections was not different when stopping and continuing DMARDs/BA preoperatively. Stopping BA after surgery was associated with higher odds of postoperative wound (OR 14.15, 95 % CI 1.76-113.76) and general infection (OR 9.2, 95 % CI 1.99-42.60) compared to not stopping. Stopping DMARDs after surgery was associated with increased risk of postoperative general infection (OR 1.84, 95 % CI 1.07-3.16) compared with not stopping. There was positive association between stopping DMARDs after surgery and postoperative wound infection but failed to achieve statistical significance (OR 1.67, 95 % CI 0.96-2.91). There was no significant difference in postoperative infection risk when stopping or continuing DMARD/BA. Our new validated method can be utilized in the VA and other databases to predict drug stoppage.

  16. Who Gets Testosterone? Patient Characteristics Associated with Testosterone Prescribing in the Veteran Affairs System: a Cross-Sectional Study.

    Science.gov (United States)

    Jasuja, Guneet K; Bhasin, Shalender; Reisman, Joel I; Hanlon, Joseph T; Miller, Donald R; Morreale, Anthony P; Pogach, Leonard M; Cunningham, Francesca E; Park, Angela; Berlowitz, Dan R; Rose, Adam J

    2017-03-01

    There has been concern about the growing off-label use of testosterone. Understanding the context within which testosterone is prescribed may contribute to interventions to improve prescribing. To evaluate patient characteristics associated with receipt of testosterone. Cross-sectional. A national cohort of male patients, who had received at least one outpatient prescription within the Veterans Affairs (VA) system during Fiscal Year 2008- Fiscal Year 2012. The study sample consisted of 682,915 non-HIV male patients, of whom 132,764 had received testosterone and a random 10% sample, 550,151, had not. Conditions and medications associated with testosterone prescription. Only 6.3% of men who received testosterone from the VA during the study period had a disorder of the testis, pituitary or hypothalamus associated with male hypogonadism. Among patients without a diagnosed disorder of hypogonadism, the use of opioids and obesity were the strongest predictors of testosterone prescription. Patients receiving >100 mg/equivalents of oral morphine daily (adjusted odds ratio = 5.75, p 40 kg/m2 (adjusted odds ratio = 3.01, p testosterone than non-opioid users and men with BMI testosterone receipt, all with an adjusted odds ratio less than 2 (p testosterone did not have a diagnosed condition of the testes, pituitary, or hypothalamus. The strongest predictors of testosterone receipt (e.g., obesity, receipt of opioids), which though are associated with unapproved, off-label use, may be valid reasons for therapy. Interventions should aim to increase the proportion of testosterone recipients who have a valid indication.

  17. Joint replacement surgery in homeless veterans

    Directory of Open Access Journals (Sweden)

    Chase G. Bennett, MD

    2017-12-01

    Full Text Available Total joint arthroplasty (TJA in a homeless patient is generally considered contraindicated. Here, we report our known medical and social (housing and employment results of homeless veterans who had TJA. Thirty-seven TJAs were performed on 33 homeless patients (31 men at our hospital between November 2000 and March 2014. This was 1.2% of all TJAs. Average age was 54 years. Average hospital stay was 4.1 days. There were no major inpatient complications. Thirty-four cases had at least 1-year follow-up in any clinic within the Veterans Affairs health care system. There were no known surgery-related reoperations or readmissions. At final follow-up, 24 patients had stable housing and 9 were employed. The extensive and coordinated medical and social services that were provided to veterans from the Department of Veterans Affairs contributed to our positive results. Keywords: Homeless, Veteran, Joint replacement, Total hip, Total knee, Employment

  18. Universal screening for homelessness and risk for homelessness in the Veterans Health Administration.

    Science.gov (United States)

    Montgomery, Ann Elizabeth; Fargo, Jamison D; Byrne, Thomas H; Kane, Vincent R; Culhane, Dennis P

    2013-12-01

    We examined data for all veterans who completed the Veterans Health Administration's national homelessness screening instrument between October 1, 2012, and January 10, 2013. Among veterans who were not engaged with the US Department of Veterans Affairs homeless system and presented for primary care services, the prevalence of recent housing instability or homelessness was 0.9% and homelessness risk was 1.2%. Future research will refine outreach strategies, targeting of prevention resources, and development of novel interventions.

  19. Addressing the Needs of Transgender Military Veterans: Better Access and More Comprehensive Care

    OpenAIRE

    Dietert, Michelle; Dentice, Dianne; Keig, Zander

    2017-01-01

    Abstract Purpose: There is a gap in social science literature addressing issues of access and quality of care for transgender military veterans. Psychologists, medical doctors, and other health professionals are beginning to address some of the barriers present in the Department of Veterans Affairs (VA) system that affect veterans who are also transgender and intersex. Over a 7-year period, between 2006 and 2013, 2600 transgender veterans were served by the VA. Data from several surveys revea...

  20. 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.

  1. Veterans’s Medical Care: FY2014 Appropriations

    Science.gov (United States)

    2013-08-14

    B and flu vaccinations . 25 Department of Veterans Affairs, FY2014 Budget Submission, Medical Programs and Information Technology Programs, Volume 2...veterans of World War II allied nations, and employees receiving preventative occupational immunizations such as Hepatitis A&B and flu vaccinations . The...based counseling centers that provide a wide range of social and psychological services such as professional readjustment counseling to veterans who

  2. 76 FR 16043 - Agency Information Collection (Department of Veterans Affairs Acquisition Regulations Clause 852...

    Science.gov (United States)

    2011-03-22

    ... care services. It requires the bidder/offeror prior to contract award to furnish evidence of....207-3, Right of First Refusal of Employment. An agency may not conduct or sponsor, and a person is not...

  3. 76 FR 2761 - Proposed Information Collection (Department of Veterans Affairs Acquisition Regulations Clause...

    Science.gov (United States)

    2011-01-14

    ... acquisition of non-personal health care services. It requires the bidder/offeror prior to contract award to....207-3, Right of First Refusal of Employment. Affected Public: Business or other for-profit and Not-for...

  4. 76 FR 51890 - Release of Information From Department of Veterans Affairs Records

    Science.gov (United States)

    2011-08-19

    ... proposed rule to correct typographical or grammatical errors and to make the language of the text more... final rule is exempt, pursuant to 5 U.S.C. 605(b), from the final regulatory flexibility analysis...

  5. Building a Leadership Pipeline: A Focus on Succession Planning with the Department of Veterans Affairs

    Science.gov (United States)

    2015-06-12

    should possess sufficient interpersonal skills to foster meaningful relationships , possess the ability to communicate effectively both orally and in...been a part of the team. I appreciate your friendship and your selfless service to our nation. vi TABLE OF CONTENTS Page MASTER OF MILITARY... Relationship Management, which is a platform that allows VBA to securely communicate and share information with external stakeholders such as DVA

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

    National Research Council Canada - National Science Library

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

    2014-01-01

    .... 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...

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

    Science.gov (United States)

    ... Guide Purpose and Scope Find Assessment Measures Instrument Authority List Research and Biology Research on PTSD Biology ... Mental Health Mental Health Home Suicide Prevention Substance Abuse Military Sexual Trauma PTSD Research (MIRECC) Military Exposures ...

  8. Geriatric-Focused Educational Offerings in the Department of Veterans Affairs from 1999 to 2009

    Science.gov (United States)

    Thielke, Stephen; Tumosa, Nina; Lindenfeld, Rivkah; Shay, Kenneth

    2011-01-01

    The scope of geriatrics-related educational offerings in large health care systems, in either the target audiences or topics covered, has not previously been analyzed or reported in the professional literature. The authors reviewed the geriatrics-related educational sessions that were provided between 1999 and 2009 by the Geriatrics Research,…

  9. 75 FR 63120 - Release of Information From Department of Veterans Affairs Records

    Science.gov (United States)

    2010-10-14

    ... alcohol abuse, infection with the human immunodeficiency virus, and sickle cell anemia. We propose to... advise requesters that other regulations also apply to requests for particular types of records, such as... types of determinations that are adverse to requesters, restate the requirement to include the name of...

  10. Department of Veterans Affairs, Journal of Rehabilitation Research and Development, Volume 30, Number 2, 1993

    Science.gov (United States)

    1992-01-01

    Michigan19. Reliability of Hlndfoot Goniometry When Using Medical Center, Ann Arbor, MI 48109-0506 a Flexible Electrogonlometer. Ball P, Johnson GR, Clin...equipment used (Figure 1). The measurement was performed between the two pho- 10-19 27 27 54 tocells. Goniometry was not used in the present 20-29 15 15 30... reliability analysis of power wheelchair frames. (Thesis). Charlottesville, VA: Univer-locations and load conditions that may be examined. sity of

  11. Development of a Veterans Affairs hybrid operating room for transcatheter aortic valve replacement in the cardiac catheterization laboratory.

    Science.gov (United States)

    Shunk, Kendrick A; Zimmet, Jeffrey; Cason, Brian; Speiser, Bernadette; Tseng, Elaine E

    2015-03-01

    Transcatheter aortic valve replacement (TAVR) revolutionized the treatment of aortic stenosis. Developing a TAVR program with a custom-built hybrid operating room (HOR) outside the surgical operating room area poses unique challenges in Veterans Affairs (VA) institutions. To present the process by which the San Francisco VA Medical Center developed a VA-approved TAVR program, in which an HOR exists in a cardiac catheterization laboratory, as a guideline for future programs. Retrospective review of each required approval process for developing an HOR in a cardiac catheterization laboratory in a VA designated for complex surgery. Participants included San Francisco VA Medical Center health care professionals and individuals responsible for new program initiation in VA institutions. External reviews by industry vendors, the VA Central Office, and the Office for Construction, Facilities, and Management and an internal Healthcare Failure Mode and Effect Analysis. The timeline for each process. Developing a TAVR program required vetting and approval from industry vendors, who provided training and expertise. Architectural plans for construction of the HOR began in 2010-2011, followed by approval from Edwards Lifesciences, Inc, in 2012 and fundamentals training on February 8 and 9, 2013. Following a pilot launch of the first VA TAVR program at the Houston VA Medical Center, subsequent programs were required to submit a plan to the VA Central Office for proposed restructuring of their clinical programs. After the San Francisco VA Medical Center proposal submission on February 3, 2013, a site visit consisting of a National Chief of Catheterization Laboratory Managers, a cardiac surgeon, and an interventional cardiologist with TAVR experience was conducted on April 12, 2013. During construction, HOR plans were inspected by the Office for Construction, Facilities, and Management followed by on-site inspection on August 8, 2013, to assess the adequacy of the HOR, newly built

  12. Veterans' Education Benefits: Enhanced Guidance and Collaboration Could Improve Administration of the Post-9/11 GI Bill Program. GAO-11-356R

    Science.gov (United States)

    Scott, George A.

    2011-01-01

    With the passage of the Post-9/11 Veterans Educational Assistance Act of 2008 (Post- 9/11 GI Bill), Congress created a comprehensive education benefit program for veterans, service members, and their dependents pursuing postsecondary education. Since implementation, the Department of Veterans Affairs (VA) has provided just over $5.7 billion for…

  13. 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/m2 (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

  14. Critical pathway for the management of acute heart failure at the Veterans Affairs San Diego Healthcare System: transforming performance measures into cardiac care.

    Science.gov (United States)

    Gardetto, Nancy J; Greaney, Karen; Arai, Lisa; Brenner, April; Carroll, Karen C; Howerton, Nancy M; Lee, Melinda; Pada, Laureen; Tseng, Marilynne; Maisel, Alan S

    2008-09-01

    Acute decompensated heart failure (ADHF) is a major public health problem and leading cause for hospitalization in people 65 years and older. Admission rates for ADHF, accounted for more than 1 million heart failure (HF) hospitalizations in 2004, and more than 6.5 million inpatient hospital days. Despite significant advances in HF management, including pharmacotherapy and devices; and extensive collaborative efforts of the American College of Cardiology, and American Heart Association to disseminate evidence-based practice guidelines for management of chronic HF in adults; 3 patients continue to present to the emergency departments in ADHF. The hospital treatment of HF frequently does not follow published guidelines, potentially contributing to the high morbidity, mortality, and economic cost of this disorder. This highlights an ongoing need for development of quality improvement programs that focus on delivering reliable, evidence-based care for patients with ADHF. Consequently, the development of clinical pathways has the potential to reduce the current variability in care, enhance guideline adherence, and improve outcomes for patients. The Veterans Affairs San Diego Healthcare System (VASDHCS) formed a multidisciplinary HF performance improvement team. The team set forth on the task of developing standard order sets for patients with ADHF. After analyzing local care processes, reviewing evidence of best care practices, and defining appropriate goals to satisfy the multidimensional needs of HF patient; the team developed a computerized pathway in a user-friendly format that is simple, yet comprehensive; and focuses on early stages of HF evaluation and treatment for patients presenting to the emergency department. Successful strategies to improve care for HF patients need to assist health care providers with rapid recognition and early aggressive treatment, while creating a reliable process that ensures continuity of care. This critical pathway for management of

  15. Systemic Vulnerabilities to Suicide among Veterans from the Iraq and Afghanistan Conflicts: Review of Case Reports from a National Veterans Affairs Database

    Science.gov (United States)

    Mills, Peter D.; Huber, Samuel J.; Watts, Bradley Vince; Bagian, James P.

    2011-01-01

    While suicide among recently returned veterans is of great concern, it is a relatively rare occurrence within individual hospitals and clinics. Root cause analysis (RCA) generates a detailed case report that can be used to identify system-based vulnerabilities following an adverse event. Review of a national database of RCA reports may identify…

  16. 38 CFR 3.401 - Veterans.

    Science.gov (United States)

    2010-07-01

    ... domiciliary. (Authority: 38 U.S.C. 501) (3) Spouse, additional compensation for aid and attendance: Date of...) Director of a Department of Veterans Affairs medical center or domiciliary. From day following date of last... from hospitalization (regular or release to non-bed care). (i) Increased disability pension based on...

  17. A Decade’s Experience With Quality Improvement in Cardiac Surgery Using the Veterans Affairs and Society of Thoracic Surgeons National Databases

    Science.gov (United States)

    Grover, Frederick L.; Shroyer, A. Laurie W.; Hammermeister, Karl; Edwards, Fred H.; Ferguson, T. Bruce; Dziuban, Stanley W.; Cleveland, Joseph C.; Clark, Richard E.; McDonald, Gerald

    2001-01-01

    Objective To review the Department of Veteran Affairs (VA) and the Society of Thoracic Surgeons (STS) national databases over the past 10 years to evaluate their relative similarities and differences, to appraise their use as quality improvement tools, and to assess their potential to facilitate improvements in quality of cardiac surgical care. Summary Background Data The VA developed a mandatory risk-adjusted database in 1987 to monitor outcomes of cardiac surgery at all VA medical centers. In 1989 the STS developed a voluntary risk-adjusted database to help members assess quality and outcomes in their individual programs and to facilitate improvements in quality of care. Methods A short data form on every veteran operated on at each VA medical center is completed and transmitted electronically for analysis of unadjusted and risk-adjusted death and complications, as well as length of stay. Masked, confidential semiannual reports are then distributed to each program’s clinical team and the associated administrator. These reports are also reviewed by a national quality oversight committee. Thus, VA data are used both locally for quality improvement and at the national level with quality surveillance. The STS dataset (217 core fields and 255 extended fields) is transmitted for each patient semiannually to the Duke Clinical Research Institute (DCRI) for warehousing, analysis, and distribution. Site-specific reports are produced with regional and national aggregate comparisons for unadjusted and adjusted surgical deaths and complications, as well as length of stay for coronary artery bypass grafting (CABG), valvular procedures, and valvular/CABG procedures. Both databases use the logistic regression modeling approach. Data for key processes of care are also captured in both databases. Research projects are frequently carried out using each database. Results More than 74,000 and 1.6 million cardiac surgical patients have been entered into the VA and STS databases

  18. Performance of a Natural Language Processing (NLP) Tool to Extract Pulmonary Function Test (PFT) Reports from Structured and Semistructured Veteran Affairs (VA) Data.

    Science.gov (United States)

    Sauer, Brian C; Jones, Barbara E; Globe, Gary; Leng, Jianwei; Lu, Chao-Chin; He, Tao; Teng, Chia-Chen; Sullivan, Patrick; Zeng, Qing

    2016-01-01

    Pulmonary function tests (PFTs) are objective estimates of lung function, but are not reliably stored within the Veteran Health Affairs data systems as structured data. The aim of this study was to validate the natural language processing (NLP) tool we developed-which extracts spirometric values and responses to bronchodilator administration-against expert review, and to estimate the number of additional spirometric tests identified beyond the structured data. All patients at seven Veteran Affairs Medical Centers with a diagnostic code for asthma Jan 1, 2006-Dec 31, 2012 were included. Evidence of spirometry with a bronchodilator challenge (BDC) was extracted from structured data as well as clinical documents. NLP's performance was compared against a human reference standard using a random sample of 1,001 documents. In the validation set NLP demonstrated a precision of 98.9 percent (95 percent confidence intervals (CI): 93.9 percent, 99.7 percent), recall of 97.8 percent (95 percent CI: 92.2 percent, 99.7 percent), and an F-measure of 98.3 percent for the forced vital capacity pre- and post pairs and precision of 100 percent (95 percent CI: 96.6 percent, 100 percent), recall of 100 percent (95 percent CI: 96.6 percent, 100 percent), and an F-measure of 100 percent for the forced expiratory volume in one second pre- and post pairs for bronchodilator administration. Application of the NLP increased the proportion identified with complete bronchodilator challenge by 25 percent. This technology can improve identification of PFTs for epidemiologic research. Caution must be taken in assuming that a single domain of clinical data can completely capture the scope of a disease, treatment, or clinical test.

  19. Nicotine Dependence and Its Risk Factors Among Users of Veterans Health Services, 2008-2009

    OpenAIRE

    Tsai, Jack; Edens, Ellen L.; Rosenheck, Robert A.

    2011-01-01

    Introduction Tobacco use is the leading preventable cause of death in the United States and is disproportionately higher among veterans than nonveterans. We examined the prevalence of nicotine dependence and its associated risk factors among veterans who used health services in the US Department of Veterans Affairs (VA) system. Methods Using a case-control design, we compared all VA health service users in fiscal year 2008-2009 (N = 5,031,381) who received a nicotine dependence diagnosis with...

  20. IN-HOME EXPOSURE THERAPY FOR VETERANS WITH POST TRAUMATIC STRESS DISORDER

    Science.gov (United States)

    2016-10-01

    PE that is office -based telehealth (OBT; Veterans come to the clinic to meet with the therapist over telehealth), (2) PE delivered via home -based...randomized to receive In- Home , In-Person (IHIP); 51 (33.1%) were randomized to receive Office -Based Telehealth (OBT); and 52 (33.8%) were randomized to...Statement of Work Project Title: “In- Home Exposure Therapy for Veterans with PTSD” Primary Institution: Department of Veteran Affairs VA San Diego

  1. Leadership Studies: A New Partnership between Academic Departments and Student Affairs.

    Science.gov (United States)

    Burns, John S.

    1995-01-01

    Reports on Washington State University's effort to formalize, coordinate, and further develop its leadership education, tapping the expertise of student affairs professionals and discipline-based faculty to establish an interdisciplinary minor in leadership studies. Provides objectives, expected student outcomes, and curriculum for the minor. (JBJ)

  2. 75 FR 61621 - Charges Billed to Third Parties for Prescription Drugs Furnished by VA to a Veteran for a...

    Science.gov (United States)

    2010-10-06

    ... reasonable charges for medical care or services (including the provision of prescription drugs) from a third... AFFAIRS 38 CFR Part 17 RIN 2900-AN15 Charges Billed to Third Parties for Prescription Drugs Furnished by...: Final rule. SUMMARY: This document amends the medical regulations of the Department of Veterans Affairs...

  3. Use of the Adaptive LASSO Method to Identify PM2.5 Components Associated with Blood Pressure in Elderly Men: The Veterans Affairs Normative Aging Study.

    Science.gov (United States)

    Dai, Lingzhen; Koutrakis, Petros; Coull, Brent A; Sparrow, David; Vokonas, Pantel S; Schwartz, Joel D

    2016-01-01

    PM2.5 (particulate matter ≤ 2.5 μm) has been associated with adverse cardiovascular outcomes, but it is unclear whether specific PM2.5 components, particularly metals, may be responsible for cardiovascular effects. We aimed to determine which PM2.5 components are associated with blood pressure in a longitudinal cohort. We fit linear mixed-effects models with the adaptive LASSO penalty to longitudinal data from 718 elderly men in the Veterans Affairs Normative Aging Study, 1999-2010. We controlled for PM2.5 mass, age, body mass index, use of antihypertensive medication (ACE inhibitors, non-ophthalmic beta blockers, calcium channel blockers, diuretics, and angiotensin receptor antagonists), smoking status, alcohol intake, years of education, temperature, and season as fixed effects in the models, and additionally applied the adaptive LASSO method to select PM2.5 components associated with blood pressure. Final models were identified by the Bayesian Information Criterion (BIC). For systolic blood pressure (SBP), nickel (Ni) and sodium (Na) were selected by the adaptive LASSO, whereas only Ni was selected for diastolic blood pressure (DBP). An interquartile range increase (2.5 ng/m3) in 7-day moving-average Ni was associated with 2.48-mmHg (95% CI: 1.45, 3.50 mmHg) increase in SBP and 2.22-mmHg (95% CI: 1.69, 2.75 mmHg) increase in DBP, respectively. Associations were comparable when the analysis was restricted to study visits with PM2.5 below the 75th percentile of the distribution (12 μg/m3). Our study suggested that exposure to ambient Ni was associated with increased blood pressure independent of PM2.5 mass in our study population of elderly men. Further research is needed to confirm our findings, assess generalizability to other populations, and identify potential mechanisms for Ni effects. Dai L, Koutrakis P, Coull BA, Sparrow D, Vokonas PS, Schwartz JD. 2016. Use of the adaptive LASSO method to identify PM2.5 components associated with blood pressure in

  4. An innovative approach to treating combat veterans with PTSD at risk for suicide.

    Science.gov (United States)

    Hendin, Herbert

    2014-10-01

    Suicide rates among military personnel had a significant drop in 2013, but there is no evidence of a drop among veterans. The problem of suicide among combat veterans with posttraumatic stress disorder (PTSD) remains a source of concern. The Department of Defense and the Department of Veterans Affairs are now calling for innovative treatment approaches to the problem. A short-term psychodynamic therapy presented here may be able to fill that need by dissipating the guilt from veterans' combat-related actions that leads to suicidal behavior. The treatment showed promise of success with veterans of the war in Vietnam. Preliminary work with combat veterans of the wars in Iraq and Afghanistan indicates that it may be equally successful in treating them. Basic aspects of the psychodynamic approach could be incorporated into current therapies and should improve their ability to treat veterans with PTSD at risk for suicide. © 2014 The American Association of Suicidology.

  5. Despite variation in volume, Veterans Affairs hospitals show consistent outcomes among patients with non-postoperative mechanical ventilation.

    Science.gov (United States)

    Cooke, Colin R; Kennedy, Edward H; Wiitala, Wyndy L; Almenoff, Peter L; Sales, Anne E; Iwashyna, Theodore J

    2012-09-01

    To assess the relationship between volume of nonoperative mechanically ventilated patients receiving care in a specific Veterans Health Administration hospital and their mortality. Retrospective cohort study. One-hundred nineteen Veterans Health Administration medical centers. We identified 5,131 hospitalizations involving mechanically ventilated patients in an intensive care unit during 2009, who did not receive surgery. None. We extracted demographic and clinical data from the VA Inpatient Evaluation Center. For each hospital, we defined volume as the total number of nonsurgical admissions receiving mechanical ventilation in an intensive care unit during 2009. We examined the hospital contribution to 30-day mortality using multilevel logistic regression models with a random intercept for each hospital. We quantified the extent of interhospital variation in 30-day mortality using the intraclass correlation coefficient and median odds ratio. We used generalized estimating equations to examine the relationship between volume and 30-day mortality and risk-adjusted all models using a patient-level prognostic score derived from clinical data representing the risk of death conditional on treatment at a high-volume hospital. Mean age for the sample was 65 (SD 11) yrs, 97% were men, and 60% were white. The median VA hospital cared for 40 (interquartile range 19-62) mechanically ventilated patients in 2009. Crude 30-day mortality for these patients was 36.9%. After reliability and risk adjustment to the median patient, adjusted hospital-level mortality varied from 33.5% to 40.6%. The intraclass correlation coefficient for the hospital-level variation was 0.6% (95% confidence interval 0.1, 3.4%), with a median odds ratio of 1.15 (95% confidence interval 1.06, 1.38). The relationship between hospital volume of mechanically ventilated and 30-day mortality was not statistically significant: each 50-patient increase in volume was associated with a nonsignificant 2% decrease in

  6. 38 CFR 12.1 - Designee cases; competent veterans.

    Science.gov (United States)

    2010-07-01

    ... Facility Upon Death, Or Discharge, Or Unauthorized Absence, and of Funds and Effects Found on Facility § 12... Department of Veterans Affairs to deliver his or her funds and effects in event of death. He or she may also designate an alternate to whom delivery will be made if the first designee fails or refuses to accept...

  7. A retrospective review of insulin requirements in patients using U-500 insulin hospitalized to a Veterans Affairs Hospital.

    Science.gov (United States)

    Kedia, Rohit; Desouza, Cyrus; Smith, Lynette M; Shivaswamy, Vijay

    2017-05-01

    The aim of this study was to compare the changes in the total daily dose (TDD) of insulin of patients on U-500 insulin; before hospitalization, during hospitalization and six weeks after discharge. A retrospective chart review of veterans with type 2 diabetes receiving U-500 insulin in the ambulatory setting and who were admitted between 2012 and 2015 was performed. During hospitalization, patients were transitioned to receive U-100 insulin (detemir or glargine for basal and aspart for bolus). Paired t-tests were conducted to compare TDD of insulin during hospitalization to prior to admission and at six week of follow-up. The average hemoglobin A1c at the time of hospital admission was 8.3±1.5% (n=20). The average TDD of insulin during hospitalization (124±67units) was significantly less than prior to admission (295±123units) and at six week follow-up (310±105units). The average glucose during hospitalization was 180±36mg/dL. Hypoglycemia was less than 0.5%. We showed that patients received significantly less total daily insulin while hospitalized compared to their insulin doses in the ambulatory setting, and we demonstrate that patients receiving U-500 insulin can be safely transitioned to U-100 insulin while hospitalized, with minimal hypoglycemia. Published by Elsevier Inc.

  8. 78 FR 59769 - Agency Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...

    Science.gov (United States)

    2013-09-27

    ... AFFAIRS Agency Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...) of 1995 (44 U.S.C. 3501-21), this notice announces that the Veterans Benefits Administration (VBA...-0782.'' SUPPLEMENTARY INFORMATION: Title: Veterans Benefits Administration (VBA) Voice of the Veteran...

  9. Veterans' Group Life Insurance (VGLI) no-health period extension. Final rule.

    Science.gov (United States)

    2012-11-01

    The Department of Veterans Affairs (VA) is issuing this final rule that amends the regulations governing eligibility for Veterans' Group Life Insurance (VGLI) to extend to 240 days the current 120-day "no-health" period during which veterans can apply for VGLI without proving that they are in good health for insurance purposes. The purpose of this rule is to increase the opportunities for disabled veterans to enroll in VGLI, some of whom would not qualify for VGLI coverage under existing provisions. This document adopts as a final rule, without change, the proposed rule published in the Federal Register on June 25, 2012.

  10. Grants for transportation of veterans in highly rural areas. Final rule.

    Science.gov (United States)

    2013-04-02

    The Department of Veterans Affairs (VA) amends its regulations to establish a new program to provide grants to eligible entities to assist veterans in highly rural areas through innovative transportation services to travel to VA medical centers, and to otherwise assist in providing transportation services in connection with the provision of VA medical care to these veterans, in compliance with section 307 of title III of the Caregivers and Veterans Omnibus Health Services Act of 2010. This final rule establishes procedures for evaluating grant applications under the new grant program, and otherwise administering the new grant program.

  11. Evidence of poorer life-course mental health outcomes among veterans of the Korean War cohort.

    Science.gov (United States)

    Brooks, Matthew Stephen; Fulton, Lawrence

    2010-03-01

    Comparing the outcomes of veterans who served in Korea and those who served elsewhere, we examined the treatment of post-traumatic stress disorder (PTSD), other mental health conditions, psychiatric treatment locations, and six mental health well-being measures. The analytic sample consisted of nationally representative data from the 2001 National Survey of Veterans (NSV). Analyses included multiple logistic regressions that controlled for sociodemographic characteristics. Korean era veterans in the NSV (n = 4030): 1498 served in Korea; 2532 elsewhere during the era. Veterans who served in Korea have notably poorer mental health than those who served elsewhere. These results suggest higher resource needs among aging Korean era veterans. Clinicians, policy makers and the Department of Veterans Affairs should focus on mental health services to older veterans.

  12. Mood disorders and risk of lung cancer in the EAGLE case-control study and in the U.S. Veterans Affairs inpatient cohort.

    Directory of Open Access Journals (Sweden)

    David E Capo-Ramos

    Full Text Available Mood disorders may affect lung cancer risk. We evaluated this hypothesis in two large studies.We examined 1,939 lung cancer cases and 2,102 controls from the Environment And Genetics in Lung cancer Etiology (EAGLE case-control study conducted in Italy (2002-2005, and 82,945 inpatients with a lung cancer diagnosis and 3,586,299 person-years without a lung cancer diagnosis in the U.S. Veterans Affairs Inpatient Cohort (VA study, composed of veterans with a VA hospital admission (1969-1996. In EAGLE, we calculated odds ratios (ORs and 95% confidence intervals (CI, with extensive adjustment for tobacco smoking and multiple lifestyle factors. In the VA study, we estimated lung cancer relative risks (RRs and 95% CIs with time-dependent Poisson regression, adjusting for attained age, calendar year, hospital visits, time within the study, and related previous medical diagnoses. In EAGLE, we found decreased lung cancer risk in subjects with a personal history of mood disorders (OR: 0.59, 95% CI: 0.44-0.79, based on 121 lung cancer incident cases and 192 controls and family history of mood disorders (OR: 0.62, 95% CI: 0.50-0.77, based on 223 lung cancer cases and 345 controls. The VA study analyses yielded similar results (RR: 0.74, 95% CI: 0.71-0.77, based on 2,304 incident lung cancer cases and 177,267 non-cancer person-years in men with discharge diagnoses for mood disorders. History of mood disorders was associated with nicotine dependence, alcohol and substance use and psychometric scales of depressive and anxiety symptoms in controls for these studies.The consistent finding of a relationship between mood disorders and lung cancer risk across two large studies calls for further research into the complex interplay of risk factors associated with these two widespread and debilitating diseases. Although we adjusted for smoking effects in EAGLE, residual confounding of the results by smoking cannot be ruled out.

  13. TRAINING OF DEVELOPMENT OF SKILLS OF PROFESSIONAL COMMUNICATION THE SECURITY OFFICER OF THE CRIMINAL INVESTIGATION DEPARTMENT OF THE INTERNAL AFFAIRS

    Directory of Open Access Journals (Sweden)

    Yuliya Leonidovna Lampusova

    2015-08-01

    Full Text Available Training is a form of active learning that is aimed at developing knowledge, skills, and attitudes. To improve operational security officers of Internal Affairs Agencies activity, we have schemed out training for the development of communication skills. This paper presents the exercises focusing on the professional communication skills of employees of the Criminal Investigation Department of the Interior development. Eight exercises are described, the main objectives of them are: learning to navigate the feelings of the partner, the ability to change the position of the interlocutor, the formation of the ability to listen to the end and not to interrupt, developing the ability to talk, improving the communicative competence and the development of the ability to accurately convey information.

  14. Long-term electrical survival analysis of Riata and Riata ST silicone leads: National Veterans Affairs experience.

    Science.gov (United States)

    Sung, Raphael K; Massie, Barry M; Varosy, Paul D; Moore, Hans; Rumsfeld, John; Lee, Byron K; Keung, Edmund

    2012-12-01

    A medical device advisory issued by St Jude Medical in November 2011 estimated 0.63% all-cause abrasion rate on their Riata and Riata ST silicone high-voltage lead families (Riata/ST), leading to Food and Drug Administration class I recall. We performed an independent comparative, long-term electrical survival analysis of Riata/ST and 3 other high-voltage lead families in a large national cohort of patients. To evaluate long-term electrical survival of Riata/ST leads relative to other commonly evaluated high-voltage leads. Failure rates of Riata/ST, Sprint Quattro Secure (Quattro), Sprint Fidelis (Fidelis), and Endotak Reliance G/SG (Endotak) leads from the Veterans Administration's National Cardiac Device Surveillance Center database, consisting of 24,145 patients with remote transmissions since 2003, were analyzed. Survival Probabilities were determined with Kaplan-Meier survival analysis and compared using the log-rank test. Of 1,403 Riata/ST, 6,091 Quattro, 5,073 Fidelis, and 2,401 Endotak leads identified, 5-year survival probability of Riata/ST leads (97.5%) was significantly lower than that of Quattro (99.3%) and Endotak (99.4%) leads (P leads (89.6%) (P leads showed a 5-year survival of 95.5% (95% confidence interval 92.4-97.4) compared to 98.4% (95% confidence interval 97.1-99.1) in Riata leads (P = .003). There is decreased survival probability of Riata/ST leads compared to other contemporary high-voltage leads, with decreased survival of Riata ST silicone compared to Riata lead series. Careful long-term follow-up should be maintained in patients with Riata/ST leads in order to prevent inappropriate shocks or failed device interventions. Our results were determined in advance of Food and Drug Administration class I recall, which suggested that large-scale remote monitoring may be an effective tool for continued implantable cardioverter-defibrillator system surveillance. Published by Elsevier Inc.

  15. 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

    Consolidate Data Centers, and Retire Legacy Systems Statement of Statement of David A. Powner, Director Information Technology Management Issues...Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems What GAO Found GAO...department had not assessed user satisfaction, or established user satisfaction goals. In addition, VA’s consolidation and closure of data centers

  16. 76 FR 45282 - Announcement of Funding Awards for the HUD-Veterans Affairs Supportive Housing (HUD-VASH) Program...

    Science.gov (United States)

    2011-07-28

    ... Street S Tacoma WA 98444 $179,013 25 SPOKANE HOUSING AUTHORITY 55 W Mission Avenue........ Spokane WA...-VASH) Program for Fiscal Years (FY) 2010 AGENCY: Office of Public and Indian Housing, HUD. ACTION..., Office of Public and Indian Housing, Department of Housing and Urban Development, 451 7th Street, SW...

  17. Transmission of methicillin-resistant Staphylococcus aureus to health care worker gowns and gloves during care of residents in Veterans Affairs nursing homes.

    Science.gov (United States)

    Pineles, Lisa; Morgan, Daniel J; Lydecker, Alison; Johnson, J Kristie; Sorkin, John D; Langenberg, Patricia; Blanco, Natalia; Lesse, Alan; Sellick, John; Gupta, Kalpana; Leykum, Luci; Cadena, Jose; Lepcha, Nickie; Roghmann, Mary-Claire

    2017-09-01

    This was an observational study designed to estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by health care workers (HCWs) interacting with Veterans Affairs Community Living Center (VA nursing home) residents to inform MRSA prevention policies. Participants included residents and HCWs from 7 VA nursing homes in 4 states and Washington, DC. Residents were cultured for MRSA at the anterior nares, perianal skin, and wound (if present). HCWs wore gowns and gloves during usual care activities. After each activity, a research coordinator swabbed the HCW's gown and gloves. Swabs were cultured for MRSA. There were 200 residents enrolled; 94 (46%) were MRSA colonized. Glove contamination was higher than gown contamination (20% vs 11%, respectively; P  1.0, P < .05) for gown contamination included changing dressings (eg, wound), dressing, providing hygiene (eg, brushing teeth), and bathing. Low-risk care activities (OR < 1.0, P < .05 or no transmission) for gown contamination included glucose monitoring, giving medications, and feeding. MRSA transmission from colonized residents to gloves was higher than transmission to gowns. Transmission to gloves varies by type of care, but all care had a risk of contamination, demonstrating the importance of hand hygiene after all care. Transmission to gowns was significantly higher with certain types of care. Optimizing gown and glove use by targeting high-risk care activities could improve resident-centered care for MRSA-colonized residents by promoting a home-like environment. Published by Elsevier Inc.

  18. An academic hospitalist model to improve healthcare worker communication and learner education: results from a quasi-experimental study at a Veterans Affairs medical center.

    Science.gov (United States)

    Saint, Sanjay; Fowler, Karen E; Krein, Sarah L; Flanders, Scott A; Bodnar, Timothy W; Young, Eric; Moseley, Richard H

    2013-12-01

    Although hospitalists may improve efficiency and quality of inpatient care, their effect on healthcare-worker communication and education has been less well-studied. To test various approaches to improving healthcare-worker communication and learner education within the context of a newly designed academic hospital medicine program. Before-and-after design with concurrent control group. A Midwestern Veterans Affairs medical center. Multimodal systems redesign of 1 of 4 medical teams (Gold team) that included clinical modifications (change in rounding structure, with inclusion of nurses, a Clinical Care Coordinator, and a pharmacist) and educational interventions (providing explicit expectations of learners and providing a reading list for both learners and attending physicians). Number of admissions, length of stay, readmissions, house officer and medical student ratings of attendings' teaching, medical student internal medicine National Board of Medical Examiners Subject Examination ("shelf" exam) scores, and clinical staff surveys. Length of stay was reduced by about 0.3 days on all teams after the initiative began (P = 0.004), with no significant differences between Gold and non-Gold teams. The majority of physicians (83%) and nurses (68%) felt that including nurses during rounds improved healthcare-worker communication; significantly more nurses were satisfied with communication with the Gold team than with the other teams (71% vs 53%; P = 0.02). Gold attendings generally received higher teaching scores compared with non-Gold attendings, and third-year medical students on the Gold team scored significantly higher on the shelf exam compared with non-Gold team students (84 vs 82; P = 0.006). Academic hospitalists working within a systems redesign intervention were able to improve healthcare-worker communication and enhance learner education without increasing patient length of stay or readmission rates. © 2013 Society of The Authors. Journal of Hospital Medicine

  19. 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.

  20. Fertility Counseling and Treatment for Certain Veterans and Spouses. Interim final rule.

    Science.gov (United States)

    2017-01-19

    The Department of Veterans Affairs (VA) amends its regulation regarding fertility counseling and treatment available to certain veterans and spouses. VA currently provides certain infertility services other than in vitro fertilization (IVF) to veterans as part of the medical benefits package. IVF is the process of fertilization by manually fertilizing an egg, and then transferring the embryo to the uterus. This interim final rulemaking adds a new section authorizing IVF for a veteran with a service-connected disability that results in the inability of the veteran to procreate without the use of fertility treatment. In addition, we add a new section stating that VA may provide fertility counseling and treatment using assisted reproductive technologies (ART), including IVF, to a spouse of a veteran with a service-connected disability that results in the inability of the veteran to procreate without the use of fertility treatment. VA will provide ART treatment, including IVF, to these veterans and spouses as specified in the Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act to the extent such services are consistent with the services available to enrolled veterans under the medical benefits package.

  1. 78 FR 24434 - Notice of Inventory Completion: U.S. Department of the Interior, Bureau of Indian Affairs...

    Science.gov (United States)

    2013-04-25

    ..., including geographical, kinship, biological, archeological, anthropological, linguistic, folklore, oral tradition, historical, and expert opinion, officials of the Bureau of Indian Affairs have reasonably...

  2. Validation of self-reported veteran status among two sheltered homeless populations.

    Science.gov (United States)

    Metraux, Stephen; Stino, Magdi; Culhane, Dennis P

    2014-01-01

    We assessed the accuracy of self-reported veteran status among sheltered homeless adults to assess the reliability of using self-report to determine the number of veterans in homeless populations and examine whether there are demographic correlates to inaccurate reporting of veteran status. Records on 5,860 sheltered adults from Columbus, Ohio, and 16,346 sheltered adults from New York City (NYC) were matched with U.S. Department of Veterans Affairs (VA) records. We analyzed the agreement between veteran self-reporting and official records using descriptive measures, diagnostic tests, and logistic regression. The degree of concordance was moderate. Using VA records rather than self-report data to determine veteran status increased homeless veteran prevalence rates by 27% in Columbus and 39% in NYC. Veterans with discordant veteran status (i.e., false positive or false negative) showed lower levels of services use in the VA (both cities) and in the municipal shelter system (NYC only). Younger veterans and women were at higher risk of not being identified as veterans. Administrative records can help to more accurately identify homeless veterans and to connect them to available services and benefits.

  3. Environmental Protection Department Operations and Regulatory Affairs Division LLNL NESHAPs 2005 Annual Report

    Energy Technology Data Exchange (ETDEWEB)

    Larson, J; Peterson, S R; Wilson, K; Bowen, B; MacQueen, D; Wegrecki, A

    2006-06-19

    This annual report is prepared pursuant to the National Emission Standards for Hazardous Air Pollutants (NESHAPs; Title 40 Code of Federal Regulations [CFR] Part 61, Subpart H). Subpart H governs radionuclide emissions to air from Department of Energy (DOE) facilities. NESHAPs limits the emission of radionuclides to the ambient air from DOE facilities to levels resulting in an annual effective dose equivalent (EDE) of 10 mrem (100 {micro}Sv) to any member of the public. The EDEs for the Lawrence Livermore National Laboratory (LLNL) site-wide maximally exposed members of the public from operations in 2005 are summarized here. Livermore site: 0.0065 mrem (0.065 {micro}Sv) (41% from point source emissions, 59% from diffuse source emissions). The point source emissions include gaseous tritium modeled as tritiated water vapor as directed by EPA Region IX; the resulting dose is used for compliance purposes. Site 300: 0.018 mrem (0.18 {micro}Sv) (48% from point source emissions, 52% from diffuse source emissions). The EDEs were calculated using the EPA-approved CAP88-PC air dispersion/dose-assessment model, except for doses for two diffuse sources that were estimated using measured radionuclide concentrations and dose coefficients. Specific inputs to CAP88-PC for the modeled sources included site-specific meteorological data and source emissions data, the latter variously based on continuous stack effluent monitoring data, stack flow or other release-rate information, ambient air monitoring data, and facility knowledge.

  4. Audit of the Transfer of DoD Service Treatment Records to the Department of Veterans Affairs

    Science.gov (United States)

    2014-07-31

    2010, an STR is a record of all essential medical, mental health, and dental care received by service members during their military career . The STR is...care repository that contains results of annual health care assessments and information from private physicians and dentists . Although the Army

  5. Trends in anemia management in lung and colon cancer patients in the US Department of Veterans Affairs, 2002-2008.

    Science.gov (United States)

    Tarlov, Elizabeth; Stroupe, Kevin T; Lee, Todd A; Weichle, Thomas W; Zhang, Qiuying L; Michaelis, Laura C; Ozer, Howard; Browning, Margaret M; Hynes, Denise M

    2012-08-01

    In 2007, growing concerns about adverse impacts of erythropoiesis-stimulating agents (ESAs) in cancer patients led to an FDA-mandated black box warning on product labeling, publication of revised clinical guidelines, and a Medicare coverage decision limiting ESA coverage. We examined ESA therapy in lung and colon cancer patients receiving chemotherapy in the VA from 2002 to 2008 to ascertain trends in and predictors of ESA use. A retrospective study employed national VA databases to "observe" treatment for a 12-month period following diagnosis. Multivariable logistic regression analyses evaluated changes in ESA use following the FDA-mandated black box warning in March 2007 and examined trends in ESA administration between 2002 and 2008. Among 17,014 lung and 4,225 colon cancer patients, those treated after the March 2007 FDA decision had 65% (lung OR 0.35, CI(95%) 0.30-0.42) and 53% (colon OR 0.47, CI(95%) 0.36-0.63) reduced odds of ESA treatment compared to those treated before. Declines in predicted probabilities of ESA use began in 2006. The magnitude of the declines differed across age groups among colon patients (p = 0.01) and levels of hemoglobin among lung cancer patients (p = 0.04). Use of ESA treatment for anemia in VA cancer care declined markedly after 2005, well before the 2007 changes in product labeling and clinical guidelines. This suggests that earlier dissemination of research results had marked impacts on practice patterns with these agents.

  6. 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.

  7. The associations between organizational culture and knowledge, attitudes, and practices in a multicenter Veterans Affairs quality improvement initiative to prevent methicillin-resistant Staphylococcus aureus.

    Science.gov (United States)

    Sinkowitz-Cochran, Ronda L; Burkitt, Kelly H; Cuerdon, Timothy; Harrison, Cassandra; Gao, Shasha; Obrosky, D Scott; Jain, Rajiv; Fine, Michael J; Jernigan, John A

    2012-03-01

    Previous research demonstrates that organizational culture (OC) and knowledge, attitudes, and practices of health care personnel are associated with the overall success of infection control programs; however, little attention has been given to the relationships among these factors in contributing to the success of quality improvement programs. Cross-sectional surveys assessing OC and knowledge, attitudes, and practices related to methicillin-resistant Staphylococcus aureus (MRSA) were distributed to 16 medical centers participating in a Veterans Affairs MRSA prevention initiative in 2 time periods. Factor analysis was performed on the OC survey responses, and factor scores were generated. To assess associations between OC and knowledge, attitudes, and practices of health care personnel, regression analyses were performed overall and then stratified by job type. The final analyzable sample included 2,314 surveys (43% completed by nurses, 9% by physicians, and 48% by other health care personnel). Three OC factors emerged accounting for 53% of the total variance: "Staff Engagement," "Overwhelmed/Stress-Chaos," and "Hospital Leadership." Overall, higher Staff Engagement was associated with greater knowledge scores, better hand hygiene practices, fewer reported barriers, and more positive attitudes. Higher Hospital Leadership scores were associated with better hand hygiene practices, fewer reported barriers, and more positive attitudes. Conversely, higher Overwhelmed/Stress-Chaos scores were associated with poorer reported prevention practices, more barriers, and less positive attitudes. When these associations were stratified by job type, there were significant associations between OC factors and knowledge for nurses only, between OC factors and practice items for nurses and other health care personnel, and between OC factors and the barriers and attitudes items for all job types. OC factors were not associated with knowledge and practices among physicians. Three OC

  8. Engaging, Supporting, and Sustaining the Invisible Partners in Care: Young Caregivers of Veterans From the Post-9/11 Era.

    Science.gov (United States)

    Miller, Katherine M; Kabat, Margaret; Henius, Jennifer; Harold, Courtney; Van Houtven, Harold

    2015-01-01

    Few studies have explored the health effects of caregiving for post-9/11 veterans who have been traumatically injured, have traumatic brain injuries, or have post-traumatic stress disorder. Post-9/11 veterans and their caregivers tend to be younger than veterans who served exclusively prior to 9/11. In response to the needs of caregivers, Public Law 111-163, the Caregivers and Veterans Omnibus Health Services Act of 2010, was passed, providing unprecedented support for informal caregivers of veterans. This support includes a monthly stipend and health insurance for caregivers who meet eligibility criteria. The uptake in these support services, and the resulting cost of services, has far surpassed expectations. As the Department of Veterans Affairs continues to provide caregiver support services, it is essential to determine the value and direct impact of the services provided to caregivers and veterans.

  9. Applying behavior change theory to technology promoting veteran mental health care seeking.

    Science.gov (United States)

    Whealin, Julia M; Kuhn, Eric; Pietrzak, Robert H

    2014-11-01

    Despite the availability of effective mental health interventions, the vast majority of veterans with a mental disorder underutilize psychological services. Contemporary research has revealed that several factors such as low education, stigma, stoicism, lack of knowledge, and negative beliefs about mental health services are associated with veterans' underutilization of services. In this article, the authors provide an overview of factors that affect symptomatic veterans' decisions about whether to seek mental health services. Second, they describe the theory of planned behavior (Ajzen & Fishbein, 1980), a useful model for understanding mental health care seeking that can inform the development of technology-based interventions designed to increase veterans' willingness to seek psychological services. Third, the authors describe the development of Considering Professional Help, a personalized web-based tool developed by the Department of Veterans Affairs, which has been designed to promote mental health care seeking in veterans with mental health problems. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  10. A tale of two veterans: homeless vs domiciled veterans presenting to a psychiatric urgent care clinic.

    Science.gov (United States)

    Lee, Haoyu; Iglewicz, Alana; Golshan, Shah; Zisook, Sidney

    2013-11-01

    The relationship between homelessness among veterans and mental illness and suicidality has not been clearly defined. To further examine this relationship, we compared rates of mental illness and suicidality among homeless and domiciled veterans seeking urgent psychiatric care at a US Department of Veterans Affairs (VA) facility. Information was collected by survey from 482 consecutive veterans seeking care at the Psychiatric Emergency Clinic (PEC) at the VA San Diego Healthcare System. A total of 73 homeless veterans were designated the homeless group and 73 domiciled veterans were randomly selected as the domiciled group. Suicidality and mental illnesses were assessed by self-assessment questionnaires and chart review of diagnoses. The homeless group had significantly higher rates of past suicide attempts (47% vs 27%) and recent reckless or self-harming behavior (33% vs 18%) compared with the domiciled group but significantly lower rates of depressive disorder (25% vs 44%), as diagnosed by a PEC physician. There were no differences between groups on the questionnaires for posttraumatic stress disorder (PTSD), depression, or alcohol abuse. Nor were there differences in diagnoses of bipolar disorder, PTSD, anxiety disorder, schizophrenia/schizoaffective disorder, or alcohol abuse. Veterans seeking help from a VA-based urgent psychiatric care clinic often are burdened by substantial depression, alcohol use disorders, PTSD, and both past and present suicide risk.

  11. Learning Is the Journey: From Process Reengineering to Systemic Customer-Service Design at the United States Department of Veterans Affairs, Veterans Benefits Administration

    Science.gov (United States)

    2013-05-23

    the organization can 1 Peter Senge, “The Leader’s New Work: Building Learning Organizations,” Sloan Management Review (Fall 1990 ): 9-10. Senge uses...1. 9 Henry Mintzberg , “The Fall and Rise of Strategic Planning,” Harvard Business Review, (January-February 1994): 109. 4...Negating,” The Innovation Journal: The Public Sector Innovation Journal, Volume 10(3), 2-4. Henry Mintzberg , noted business author, also alludes to a

  12. 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).

  13. Trauma Spectrum Disorders: Emerging Perspectives on the Impact on Military and Veteran Families

    Science.gov (United States)

    O'Donnell, Lolita; Begg, Lisa; Lipson, Linda; Elvander, Erika

    2011-01-01

    This article summarizes the findings from the Second Annual Trauma Spectrum Disorders Conference, which was held in December 2009 and was sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in conjunction with the Department of Veterans Affairs and the National Institutes of Health. The conference…

  14. Grants for the Rural Veterans Coordination Pilot (RVCP). Final rule.

    Science.gov (United States)

    2013-02-25

    The Department of Veterans Affairs (VA) adopts as a final rule, without change, the proposal to establish a pilot program known as the Rural Veterans Coordination Pilot (RVCP). The RVCP will provide grants to eligible community-based organizations and local and State government entities to be used by these organizations and entities to assist veterans and their families who are transitioning from military service to civilian life in rural or underserved communities. VA will use information obtained through the pilot program to evaluate the effectiveness of using community-based organizations and local and State government entities to improve the provision of services to transitioning veterans and their families. Five RVCP grants will be awarded for a 2-year period in discrete locations pursuant to a Notice of Funds Availability (NOFA) to be published in the Federal Register.

  15. 78 FR 36829 - Proposed Information Collection (Veterans Mortgage Life Insurance Statement) Activity: Comment...

    Science.gov (United States)

    2013-06-19

    ... AFFAIRS Proposed Information Collection (Veterans Mortgage Life Insurance Statement) Activity: Comment... solicits comments for information needed to decline Veterans Mortgage Life Insurance. DATES: Written... techniques or the use of other forms of information technology. Title: Veterans Mortgage Life Insurance...

  16. 76 FR 24571 - Proposed Information Collection (Veterans Mortgage Life Insurance Inquiry); Comment Request

    Science.gov (United States)

    2011-05-02

    ... AFFAIRS Proposed Information Collection (Veterans Mortgage Life Insurance Inquiry); Comment Request AGENCY... information needed to maintain Veterans Mortgage Life Insurance accounts. DATES: Written comments and... techniques or the use of other forms of information technology. Title: Veterans Mortgage Life Insurance...

  17. 76 FR 72243 - Proposed Information Collection (Operation Enduring Freedom/Operation Iraqi Freedom Veterans...

    Science.gov (United States)

    2011-11-22

    ... AFFAIRS Proposed Information Collection (Operation Enduring Freedom/ Operation Iraqi Freedom Veterans... facilities for returning Operation Enduring Freedom/ Operation Iraqi Freedom veterans and their families.... Title: Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs Assessment, VA Form 10...

  18. 76 FR 21768 - Privacy Act of 1974; Department of Homeland Security/Office of Health Affairs-001 Contractor...

    Science.gov (United States)

    2011-04-18

    ... exercise oversight over all medical and public health activities of'' DHS. Section II, DHS Delegation 5001.... 321e by granting the Chief Medical Officer ``the authority to exercise oversight over all medical and..., in support of the Office of Health Affair's responsibilities for medical and health matters. This...

  19. Who is served by programs for the homeless? Admission to a domiciliary care program for homeless veterans.

    Science.gov (United States)

    Rosenheck, R; Leda, C

    1991-02-01

    Demographic and clinical data are presented on 4,138 veterans assessed in the 20-site Department of Veterans Affairs (VA) Domiciliary Care for Homeless Veterans program during its first year of operation. More than two-thirds of the veterans who were screened had been hospitalized in VA medical centers during the year before assessment, and 34 percent were hospitalized at the time of assessment. Compared with veterans who were not admitted for residential treatment, veterans who were admitted were more likely to be previously involved in mental health treatment, literally homeless rather than at risk for homelessness, and without public financial support. Specialized service programs for the homeless such as the VA domiciliary care program may also be called on to play a broader role in the discharge and rehabilitative efforts of public mental health service systems.

  20. Health risk factors and differences in outcomes between younger and older veterans using VA transitional housing.

    Science.gov (United States)

    Brown, Lisa M; Barnett, Scott D; Frahm, Kathryn A; Schinka, John A; Schonfeld, Lawrence; Casey, Roger J

    2015-01-01

    This study examined age-related differences in general medical and mental health risk factors for veterans participating in the U.S. Department of Veterans Affairs (VA) Grant Per Diem (GPD) transitional supportive housing program. The subpopulation of older homeless veterans is growing, and little is known about the implications of this fact for health care providers and for supportive programs intended to meet homeless veterans' needs. Data were obtained from the VA records of all veterans (N=40,820) who used the GPD program during fiscal years 2003 to 2009. Unconditional adjusted and unadjusted odds ratios for general medical and psychiatric characteristics were calculated and were the primary study focus. Significant predictors of homeless program completion assessed from univariate models were then evaluated in multivariate models. Younger (homeless veterans reported an equal number of days homeless before enrollment. Younger veterans averaged 19 fewer days in GPD. Older veterans had more general medical problems and approximately $500 more in program costs. Findings from this study indicate that older homeless veterans are at increased risk of serious medical problems. This group is especially vulnerable to experiencing negative consequences related to homelessness. Addressing these complex needs will allow the VA to provide enhanced care to older homeless veterans.

  1. 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.

  2. Multiclonal methicillin-resistant Staphylococcus aureus (MRSA) outbreak and its control after use of the Veterans Affairs (VA) MRSA bundle in a VA long-term care facility, 2004-2014.

    Science.gov (United States)

    Webb, Risa M; Denton, Carmelita; Spruill, Emily; Henson, Gay; Bruce, Lisa; Woods, Gail L; Swiatlo, Andrea; Walker, Erica D; Peel, Chere; Sullivan, Donna

    2016-06-01

    A multiclonal methicillin-resistant Staphylococcus aureus (MRSA) outbreak with 91 infections occurred in our Veterans Affairs (VA) community living center over 46 months. Both similar and unique strains were shown by repetitive polymerase chain reaction to contribute to the outbreak, including 1 strain causing infections over a 33-month period. Most infections were soft tissue infections (67%). For 21 months after the initiation of the VA MRSA bundle, no infections were identified, and low rates of infection have been sustained an additional 4 years. The average annual rate of MRSA infection decreased by 62% (P < .001) from 0.6 per 1,000 resident days for 4 years prior to the bundle implementation to 0.09 per 1,000 resident days for 4 years after the bundle implementation. Published by Elsevier Inc.

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

    Science.gov (United States)

    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.

  4. Street outreach and other forms of engagement with literally homeless veterans.

    Science.gov (United States)

    Tsai, Jack; Kasprow, Wesley J; Kane, Vincent; Rosenheck, Robert A

    2014-05-01

    Street outreach is one of the most direct methods of engaging homeless individuals, but the characteristics of those most likely to be engaged this way is not well-understood. Data from the Department of Veterans Affairs (VA) Homeless Operations Management and Evaluation System showed that of the 70,778 literally homeless veterans engaged in VA homeless services in 2011-2012, 12% were through street outreach while the majority was through provider referrals (41%) and self-referrals (28%). Veterans engaged through street outreach had more extensive histories of recent homelessness, were more likely to be chronically homeless, and were more likely to be referred and admitted to the VA's supported housing program than other veterans. These findings suggest street outreach is an especially important approach to engaging chronic street homeless veterans in services and linking them to permanent supported housing.

  5. The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015

    Directory of Open Access Journals (Sweden)

    Michael A. Grasso

    2016-06-01

    Full Text Available Introduction: The purpose of the study was to measure national prescribing patterns for hydrocodone/acetaminophen among veterans seeking emergency medical care, and to see if patterns have changed since this medication became a Schedule II controlled substance. Methods: We conducted a retrospective cohort study of emergency department (ED visits within the Veterans Health Administration (VA between January 2009 and June 2015. We looked at demographics, comorbidities, utilization measures, diagnoses, and prescriptions. Results: During the study period, 1,709,545 individuals participated in 6,270,742 ED visits and received 471,221 prescriptions for hydrocodone/acetaminophen (7.5% of all visits. The most common diagnosis associated with a prescription was back pain. Prescriptions peaked at 80,776 in 2011 (8.7% of visits, and declined to 35,031 (5.6% during the first half of 2015 (r=‒0.99, p<0.001. The percentage of hydrocodone/acetaminophen prescriptions limited to 12 pills increased from 22% (13,949 in 2009 to 31% (11,026 in the first half of 2015. A prescription was more likely written for patients with a pain score≥7 (OR 3.199, CI [3.192‒3.205], a musculoskeletal (OR 1.622, CI [1.615‒1.630] or soft tissue (OR 1.656, CI [1.649‒1.664] diagnosis, and those below the first quartile for total ED visits (OR 1.282, CI [1.271‒1.293] and total outpatient ICD 9 codes (OR 1.843, CI [1.833‒1.853]. Conclusion: Hydrocodone/acetaminophen is the most frequently prescribed ED medication in the VA. The rate of prescribing has decreased since 2011, with the rate of decline remaining unchanged after it was classified as a Schedule II controlled substance. The proportion of prescriptions falling within designated guidelines has increased but is not at goal. [West J Emerg Med. 2016;17(4:396-403.

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

    Science.gov (United States)

    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.

  7. Screening for homelessness among individuals initiating medication-assisted treatment for opioid use disorder in the Veterans Health Administration.

    Science.gov (United States)

    Bachhuber, Marcus A; Roberts, Christopher B; Metraux, Stephen; Montgomery, Ann Elizabeth

    2015-01-01

    To determine the prevalence of homelessness and risk for homelessness among veterans with opioid use disorder initiating treatment. Addiction treatment programs operated by the US Department of Veterans Affairs (VA). All veterans initiating treatment with methadone or buprenorphine for opioid use disorder between October 1, 2013 and September 30, 2014 (n = 2,699) who were administered the VA's national homelessness screener. Self-reported homelessness or imminent risk of homelessness. The prevalence of homelessness was 10.2 percent and 5.3 percent were at risk for homelessness. Compared to male veterans, women veterans were less likely to report homelessness (8.9 percent vs 10.3 percent) but more likely to be at risk (11.8 percent vs 4.9 percent). By age group, veterans aged 18-34 and 45-54 years most frequently reported homelessness (12.0 and 11.7 percent, respectively) and veterans aged 45-54 and 55-64 years most frequently reported risk for homelessness (6.5 and 6.8 percent, respectively). The prevalence of homelessness in this population is approximately 10 times that of the general veteran population accessing care at VA. Screening identified a substantial number of veterans who could benefit from VA housing assistance and had not received it recently. Programs to address veteran homelessness should engage with veterans seeking addiction treatment. Integration of homelessness services into addiction treatment settings may, in turn, improve outcomes.

  8. Comparison of Nutrition Profile and Diet Record Between Veteran and Nonveteran End-Stage Renal Disease Patients Receiving Hemodialysis in Veterans Affairs and Community Clinics in Metropolitan South-Central Texas.

    Science.gov (United States)

    Cunningham, Sue E D; Verkaik, Darlene; Gross, Georgiana; Khazim, Khalid; Hirachan, Padam; Agarwal, Gurav; Lorenzo, Carlos; Matteucci, Elena; Bansal, Shweta; Fanti, Paolo

    2015-10-01

    U.S. military veterans have high rates of chronic disease and social disadvantage, which are risk factors for protein-energy wasting (PEW). It is not known whether this translates into high prevalence of PEW in veterans with end-stage renal disease. We compared the clinical, socioeconomic, and nutrition status and the diet of 33 veteran and 38 nonveteran clinically stable patients receiving maintenance hemodialysis (MHD) in south-central Texas. The whole cohort included 82% Mexican Americans (MAs), 72% type 2 diabetics, and 73% males. The body mass index was 28.9 ± 6.2, while energy intake was 21.5 ± 8.2 kcal/kg/d and protein intake was 1.0 ± 0.4 g/kg/d. Serum albumin (bromocresol purple) was 3.5 ± 0.4 g/dL, transferrin was 171.9 ± 27.8 mg/d, C-reactive protein was 2.9 (1.4-6.5) mg/L, interleukin-6 (IL-6) was 8.3 (4.2-17.9) pg/mL, neutrophil gelatinase-associated lipocalin was 729 (552-1256) ng/mL, and the malnutrition-inflammation score was 8.8 ± 3.0. In group comparison that adjusted for sex and ethnicity, the veterans had better household income, less MAs (60% vs 100%), more males (94% vs 55%), more use of a renin-angiotensin-aldosterone system blockade (66% vs 33%), and lower IL-6 levels (4.4 [3.1-5.8] vs 15.4 [8.3-20.5] pg/mL; P = .01) than nonveterans. In regression analysis, the lower serum IL-6 level in veterans was independently explained by dialysis clinic, sex, and, possibly, household income (intermediate significance). In a relatively small cohort of clinically stable MHD patients, the veterans showed equivalent nutrition status and dietary intake and less inflammation than the nonveterans, thus not supporting the possibility that veteran MHD patients may have worse nutrition than the nonveteran counterpart. © 2015 American Society for Parenteral and Enteral Nutrition.

  9. A Comparative Study of Job Burnout in Army Public Affairs Commissioned Officers and Department of the Army Civilians

    Science.gov (United States)

    1993-11-01

    34 David Friesen studied occupational burnout in two samples: 1,191 public school teachers and 190 principals and vice principals. Overall job stress ...drained, used up, fatigued , burned ..t, frustrated, stressed , and being at the end of their rope (Maslach 30). One civilian reported loving her...affairs. Much has been written 3about stress and battle fatigue . The Army spends a great deal of time and effort in preventing and reducing stress S

  10. Increased Mortality Among Older Veterans Admitted to VA Homelessness Programs.

    Science.gov (United States)

    Schinka, John A; Bossarte, Robert M; Curtiss, Glenn; Lapcevic, William A; Casey, Roger J

    2016-04-01

    National Death Index data were examined to describe mortality patterns among older veterans who are homeless. Homelessness and health care records from the U.S. Department of Veterans Affairs were used to identify old (ages 55-59) and older (ages ≥60) veterans who were (N=4,475) or were not (N=20,071) homeless. Survival functions and causes of death of the two samples over an 11-year follow-up period were compared. Substantially more veterans who were homeless (34.9%) died compared with the control sample (18.2%). Veterans who were homeless were approximately 2.5 years younger at time of death compared with the control sample. Older veterans who were homeless had the lowest survival rate (58%). No disease category appeared to be critical in reducing survival time. Suicide was twice as frequent in the homeless (.4%) versus the control (.2%) sample. Older veterans who were homeless experienced excess mortality and increased suicide risk.

  11. 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.

  12. Organizing and conducting career guidance and crime prevention among young people by means of physical culture and sports specialized university departments Internal Affairs of Ukraine.

    Directory of Open Access Journals (Sweden)

    Zakorko I.P

    2011-06-01

    Full Text Available At the present stage of social development takes on special urgency the problem of finding new means and methods of crime prevention among youth in the context of strengthening the nation's health. In our opinion, employees of the Ukrainian Interior Ministry must take a decisive role in solving these problems. One of the most effective ways to solve them is to organize youth sports schools and clubs to professionally-applied sports at the bases of relevant departments of higher educational institutions of Ministry of Internal Affairs of Ukraine, the involvement of the best specialists and trainers.

  13. Health Care for Homeless Veterans program. Final rule.

    Science.gov (United States)

    2015-05-01

    The Department of Veterans Affairs (VA) amends its medical regulations concerning eligibility for the Health Care for Homeless Veterans (HCHV) program. The HCHV program provides per diem payments to non-VA community-based facilities that provide housing, outreach services, case management services, and rehabilitative services, and may provide care and/or treatment to homeless veterans who are enrolled in or eligible for VA health care. The rule modifies VA's HCHV regulations to conform to changes enacted in the Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012. Specifically, the rule removes the requirement that homeless veterans be diagnosed with a serious mental illness or substance use disorder to qualify for the HCHV program. This change makes the program available to all homeless veterans who are enrolled in or eligible for VA health care. The rule also updates the definition of homeless to match in part the one used by the Department of Housing and Urban Development (HUD). The rule further clarifies that the services provided by the HCHV program through non-VA community-based providers must include case management services, including non-clinical case management, as appropriate.

  14. The impact of Agent Orange exposure on prognosis and management in patients with chronic lymphocytic leukemia: a National Veteran Affairs Tumor Registry Study.

    Science.gov (United States)

    Mescher, Craig; Gilbertson, David; Randall, Nicole M; Tarchand, Gobind; Tomaska, Julie; Baumann Kreuziger, Lisa; Morrison, Vicki A

    2017-09-14

    Exposure to Agent Orange (AO) has been associated with the development of chronic lymphocytic leukemia (CLL). We performed a retrospective study of 2052 Vietnam veterans identified in the National VA Tumor Registry to assess the impact of AO exposure on CLL prognosis, treatment and survival. Prognostic factors did not differ based on exposure. Veterans exposed to AO were diagnosed younger (63.2 vs. 70.5 years, p < .0001) and had longer overall survival (median not reached vs. 91 months, p < .001). This prolonged survival was in the subgroups of patients aged 60-69 years (p< .0001) and those with 11q deletion (p < .0001). Those exposed to AO were more likely to be treated with fludarabine, chlorambucil and rituximab (38 vs. 21%, p < .001) and bendamustine plus rituximab (25 vs. 18%, p = 0.039) as first line therapy. Exposure to AO was not associated with either poor prognostic factors or shortened overall survival in our large veteran population with CLL.

  15. Characteristics and Use of Services Among Literally Homeless and Unstably Housed U.S. Veterans With Custody of Minor Children.

    Science.gov (United States)

    Tsai, Jack; Rosenheck, Robert A; Kasprow, Wesley J; Kane, Vincent

    2015-10-01

    The study examined the number of homeless veterans with minor children in their custody ("children in custody"), compared sociodemographic and clinical characteristics among homeless veterans with and without children in custody, and observed differences in referral and admission patterns among veterans with and without children in custody for a variety of U.S. Department of Veterans Affairs (VA) programs for homeless veterans. Data were obtained from the VA Homeless Operations Management and Evaluation System for 89,142 literally homeless and unstably housed veterans. Sociodemographic, housing, health, and psychosocial characteristics of veterans were analyzed. Among literally homeless veterans, 9% of men and 30% of women had children in custody; among unstably housed veterans, 18% of men and 45% of women had children in custody. Both male and female veterans with children in custody were younger and less likely to have chronic general medical conditions and psychiatric disorders compared with other veterans, but, notably, 11% of homeless veterans with children in custody had psychotic disorders. Veterans with children in custody were more likely than other veterans to be referred and admitted to the VA's permanent supported housing program, and women were more likely than men to be admitted to the program. A substantial proportion of homeless veterans served by the VA have severe mental illness and children in custody, which raises concerns about the parenting environment for their children. Particular focus should be directed at VA's supported-housing program, and the practical and ethical implications of serving homeless parents and their children need to be considered.

  16. Veterans Benefits: Burial Benefits and National Cemeteries

    Science.gov (United States)

    2010-10-18

    hospital, nursing home, or domiciliary care facility; and (2) a plot allowance for a veteran eligible for burial in a national cemetery who is not... domiciliary care . The VA was permitted to enter into contracts to provide the burial and funeral services for veterans who died in VA facilities...Veterans Affairs (VA) provides a range of benefits and services to veterans who meet certain eligibility rules; benefits include hospital and medical care

  17. Services utilization among recently homeless veterans: a gender-based comparison.

    Science.gov (United States)

    Montgomery, Ann Elizabeth; Byrne, Thomas H

    2014-03-01

    As women emerge as a significant segment of the Veteran population, there is a need to understand how they enter the homeless system, the impact of homelessness on healthcare, and how this varies by gender. This study provides a gender-based comparison of Veterans' utilization of U.S. Department of Veterans Affairs (VA) health and behavioral health services following the onset of a homeless episode and assesses the relationship between services utilization and Veterans' entry into the homeless system. Male and female veterans were equally as likely to use mainstream and VA homeless services. There were few differences between genders in inpatient services use following a homeless episode. Men used more substance abuse outpatient treatment and emergency services whereas women used outpatient medical treatment. Veterans who sought non-VA homeless services were less likely to use outpatient services but more likely to access emergency services. Veterans experiencing homelessness who do not use VA homeless assistance services are less engaged with preventative VA health and behavioral healthcare. Veterans who are homeless but not identified as such by VA, particularly women, need additional engagement. Ongoing study of gender-based differences in services utilization among homeless and at-risk Veterans is needed. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  18. Age-Related Concerns of Male Veteran Callers to a Suicide Crisis Line

    Science.gov (United States)

    King, Deborah A.; O’Riley, Alisa A.; Thompson, Caitlin; Conwell, Yeates; He, Hua; Kemp, Janet

    2015-01-01

    In July 2007, the United States Department of Veterans Affairs (VA) partnered with the Department of Health and Human Services’ Substance Abuse and Mental Health Service Administration (SAMHSA) to create the Veterans Crisis Line (VCL) in order to meet the unique needs of Veterans in distress. The current study utilized a mixed methods design to examine characteristics of male callers to the VCL. Results from qualitative analyses demonstrated that the majority of callers between April 1 and August 31, 2008 contacted the VCL with concerns related to mental health issues, suicide ideation, and substance abuse issues. Quantitative analyses demonstrated age differences associated with concerns presented by callers such that middle-aged and older callers were more likely to present with loneliness and younger callers were more likely to present with mental health concerns. The results of this study will help to inform future research designed to optimize the effectiveness of the VCL for suicide prevention in Veterans. PMID:24810270

  19. The use of VA Disability Compensation and Social Security Disability Insurance among working-aged veterans.

    Science.gov (United States)

    Wilmoth, Janet M; London, Andrew S; Heflin, Colleen M

    2015-07-01

    Although there is substantial disability among veterans, relatively little is known about working-aged veterans' uptake of Department of Veterans Affairs (VA) Disability Compensation and Social Security Disability Insurance (DI). This study identifies levels of veteran participation in VA disability and/or DI benefit programs, examines transitions into and out of VA and DI programs among veterans, and estimates the size and composition of the veteran population receiving VA and/or DI benefits over time. Data from the 1992, 1993, 1996, 2001, 2004, and 2008 Survey of Income and Program Participation (SIPP) are used to describe VA and DI program participation among veterans under the age of 65. The majority of working-aged veterans do not receive VA or DI benefits and joint participation is low, but use of these programs has increased over time. A higher percentage of veterans receive VA compensation, which ranges from 4.9% in 1992 to 13.2% in 2008, than DI compensation, which ranges from 2.9% in 1992 to 6.7% in 2008. The rate of joint participation ranges from less than 1% in 1992 to 3.6% in 2008. Veterans experience few transitions between VA and DI programs during the 36-48 months they are observed. The number of veterans receiving benefits from VA and/or DI nearly doubled between 1992 and 2008. There have been substantial shifts in the composition of veterans using these programs, as cohorts who served prior to 1964 are replaced by those who served after 1964. The findings suggest potential gaps in veterans' access to disability programs that might be addressed through improved coordination of VA and DI benefits. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Predictors of Incarceration of Veterans Participating in U.S. Veterans' Courts.

    Science.gov (United States)

    Johnson, R Scott; Stolar, Andrea G; McGuire, James F; Mittakanti, Krithika; Clark, Sean; Coonan, Loretta A; Graham, David P

    2017-02-01

    Significant variability exists regarding the criteria and procedures used by different veterans' courts (VCs) across the country. Limited guidance is available regarding which VC model has the most successful outcomes. The purpose of this study was to examine factors associated with incarceration during VC participation. This study used data for 1,224 veterans collected from the HOMES (Homeless Operations Management and Evaluation System) database of the Department of Veterans Affairs, as well as data from a national phone survey inventory of all U.S. VCs. To identify variables associated with incarceration during VC participation, four backward conditional logistic regressions were performed. The following variables were associated with higher rates of incarceration because of a veteran's noncompletion of the VC program: charges of probation or parole violations, longer stays in the VC program, end of VC participation because of incarceration for a new arrest or case transfer by the legal system, and requiring mental health follow-up but not undergoing treatment. The following variables were associated with lower rates of incarceration: stable housing and participating in a VC program that referred veterans for substance abuse treatment. This study offers VCs a thorough review of an extensive set of recidivism data. Further investigation is necessary to understand the impact of VCs.

  1. The Department of Veterans Health Administration Office of Nursing Service, "transforming nursing in a national healthcare system: an example of transformation in action".

    Science.gov (United States)

    Wertenberger, Sydney; Chapman, Kathleen M; Wright-Brown, Salena

    2011-01-01

    The Department of Veterans Health Administration Office of Nursing Service has embarked on a multiyear transformational process, an example of which is the development of an organization-wide nursing handbook. The development of this handbook offered the opportunity to improve collaboration, redefine expectations and behavior, as well as prepare for the future of Nursing within the Veterans Health Administration. The lessons learned from this process have revolved around the themes of leadership skills for managing high-level change often in a virtual environment; constant collaboration; that the practice of nursing will continue to evolve on the basis of new evidence, technology, customer expectations, and resources; and that the process to accomplish this goal is powerful.

  2. Clinician versus Veteran ratings on the Mayo-Portland Participation Index in veterans with a history of mild traumatic brain injury.

    Science.gov (United States)

    McCulloch, Katie; Pastorek, Nicholas J; Miller, Brian I; Romesser, Jennifer; Linck, John; Sim, Anita H; Troyanskaya, Maya; Maestas, Kacey Little

    2015-01-01

    The Department of Veterans Affairs is encouraging administration of the Mayo-Portland Adaptability Inventory-4 Participation Index (M2PI) to identify long-term psychosocial outcomes of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with a history of traumatic brain injury (TBI). To evaluate clinician and Veteran interrater reliability and how response validity influences M2PI item ratings. A total of 122 OEF/OIF/OND Veterans who reported a history consistent with mild TBI during deployment and were referred for neuropsychological evaluation following Comprehensive TBI Evaluation. Interrater reliability study. M2PI; Minnesota Multiphasic Personality Inventory-2 Symptom Validity Scale (FBS). Veterans reported greater perceived restrictions than clinicians across all M2PI items and total score. Interrater correlations ranged from rs = 0.27 (residence) to rs = 0.58 (money management) across items, with a total score correlation of rs = 0.60. When response bias was indicated, both Veterans and clinicians reported greater participation restrictions than those reported by Veterans without evidenced response bias. Low interrater correlation is consistent with previous findings. As ratings of clinicians and Veterans should not be interpreted as equivalent, documenting the rater's identity is important for interpretation. Using objective indicators of functional outcome may assist clinician raters, particularly when self-report may be biased.

  3. Male Veteran Intimate Partner Violence (IPV) Program Outcomes.

    Science.gov (United States)

    Schaffer, Bradley J

    2016-01-01

    The prominence and incidence of intimate partner violence (IPV) with male military veterans vary, but generally there is consensus that screening and intervention does help reduce IPV. Intervention is generally provided in the community via Batterer Intervention Programs. However, at the Department of Veterans Affairs (VA) intervention is provided via the Domestic Relations Clinic. Nationally the VA has limited treatment for male IPV. An aggregate sample (n = 178) of participants was assessed using the Domestic Violence/Abuse Screen to measure covariate pre-test and post-test outcomes, program failure, and recidivism. The treatment approach is psycho-educationally based to meet the challenging and unique needs of the military veteran population. The results contribute to a more comprehensive understanding of IPV and highlight the need for more intervention and prevention approaches.

  4. Veterans Employment Pay for Success Grant Program. Interim final rule.

    Science.gov (United States)

    2016-08-10

    The Department of Veterans Affairs (VA) is establishing a grant program (Veterans Employment Pay for Success (VEPFS)) under the authority of the U.S.C. to award grants to eligible entities to fund projects that are successful in accomplishing employment rehabilitation for Veterans with service-connected disabilities. VA will award grants on the basis of an eligible entity's proposed use of a Pay for Success (PFS) strategy to achieve goals. This interim final rule establishes regulations for awarding a VEPFS grant, including the general process for awarding the grant, criteria and parameters for evaluating grant applications, priorities related to the award of a grant, and general requirements and guidance for administering a VEPFS grant program.

  5. Methylenetetrahydrofolate reductase (MTHFR) polymorphism A1298C (Glu429Ala) predicts decline in renal function over time in the African-American Study of Kidney Disease and Hypertension (AASK) Trial and Veterans Affairs Hypertension Cohort (VAHC).

    Science.gov (United States)

    Fung, Maple M; Salem, Rany M; Lipkowitz, Michael S; Bhatnagar, Vibha; Pandey, Braj; Schork, Nicholas J; O'Connor, Daniel T

    2012-01-01

    Hyperhomocysteinemia is associated with increased venous thrombosis and cardiovascular disease (CVD). Mutations in the human methylenetetrahydrofolate reductase (MTHFR) gene have been associated with increased homocysteine levels and risks of CVD in various populations including those with kidney disease. Here, we evaluated the influence of MTHFR variants on progressive loss of kidney function. We analyzed 821 subjects with hypertensive nephrosclerosis from the longitudinal National Institute of Diabetes and Digestive and Kidney Diseases African-American Study of Kidney Disease and Hypertension (AASK) Trial to determine whether decline in glomerular filtration rate (GFR) over ∼4.2 years was predicted by common genetic variation within MTHFR at non-synonymous positions C677T (Ala222Val) and A1298C (Glu429Ala) or by MTHFR haplotypes. The effect on GFR decline was then supported by a study of 1333 subjects from the San Diego Veterans Affairs Hypertension Cohort (VAHC), followed over ∼4.5 years. Linear effect models were utilized to determine both genotype [single-nucleotide polymorphism (SNP)] and genotype (SNP)-by-time interactions. In AASK, the polymorphism at A1298C predicted the rate of GFR decline: A1298/A1298 major allele homozygosity resulted in a less pronounced decline of GFR, with a significant SNP-by-time interaction. An independent follow-up study in the San Diego VAHC subjects supports that A1298/A1298 homozygotes have the greatest estimated GFR throughout the study. Haplotype analysis with C677T yielded concurring results. We conclude that the MTHFR-coding polymorphism at A1298C is associated with renal decline in African-Americans with hypertensive nephrosclerosis and is supported by a veteran cohort with a primary care diagnosis of hypertension. Further investigation is needed to confirm such findings and to determine what molecular mechanism may contribute to this association.

  6. Methylenetetrahydrofolate reductase (MTHFR) polymorphism A1298C (Glu429Ala) predicts decline in renal function over time in the African-American Study of Kidney Disease and Hypertension (AASK) Trial and Veterans Affairs Hypertension Cohort (VAHC)

    Science.gov (United States)

    Salem, Rany M.; Lipkowitz, Michael S.; Bhatnagar, Vibha; Pandey, Braj; Schork, Nicholas J.; O’Connor, Daniel T.

    2012-01-01

    Background. Hyperhomocysteinemia is associated with increased venous thrombosis and cardiovascular disease (CVD). Mutations in the human methylenetetrahydrofolate reductase (MTHFR) gene have been associated with increased homocysteine levels and risks of CVD in various populations including those with kidney disease. Here, we evaluated the influence of MTHFR variants on progressive loss of kidney function. Methods. We analyzed 821 subjects with hypertensive nephrosclerosis from the longitudinal National Institute of Diabetes and Digestive and Kidney Diseases African-American Study of Kidney Disease and Hypertension (AASK) Trial to determine whether decline in glomerular filtration rate (GFR) over ∼4.2 years was predicted by common genetic variation within MTHFR at non-synonymous positions C677T (Ala222Val) and A1298C (Glu429Ala) or by MTHFR haplotypes. The effect on GFR decline was then supported by a study of 1333 subjects from the San Diego Veterans Affairs Hypertension Cohort (VAHC), followed over ∼4.5 years. Linear effect models were utilized to determine both genotype [single-nucleotide polymorphism (SNP)] and genotype (SNP)-by-time interactions. Results. In AASK, the polymorphism at A1298C predicted the rate of GFR decline: A1298/A1298 major allele homozygosity resulted in a less pronounced decline of GFR, with a significant SNP-by-time interaction. An independent follow-up study in the San Diego VAHC subjects supports that A1298/A1298 homozygotes have the greatest estimated GFR throughout the study. Haplotype analysis with C677T yielded concurring results. Conclusion. We conclude that the MTHFR-coding polymorphism at A1298C is associated with renal decline in African-Americans with hypertensive nephrosclerosis and is supported by a veteran cohort with a primary care diagnosis of hypertension. Further investigation is needed to confirm such findings and to determine what molecular mechanism may contribute to this association. PMID:21613384

  7. 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

  8. The use of data to assist in the design of a new service system for homeless veterans in New York City.

    Science.gov (United States)

    Henderson, Claire; Bainbridge, Jay; Keaton, Kim; Kenton, Martha; Guz, Meghan; Kanis, Becky

    2008-03-01

    Operation Home is an agreement between the City of New York and the US Department of Veterans Affairs to design a new service system to help end veteran homelessness in New York City. The authors' task was to obtain data to inform the design of this new system. A variety of methods were used. The group reviewed relevant literature and data from street homeless survey samples, analyzed shelter data, and consulted with VA homeless program staff on the findings. We then surveyed case managers at a veterans' shelter regarding their clients and determined their housing eligibility using a standardized logic model, and led two focus groups of veterans at this shelter regarding their views of the current shelter system and services for homeless veterans and how these might be improved. Among those resident in shelters during 2006, 37.2% of self-identified veterans compared to 0.9% of others reported their prior residence as supported housing, suggesting the need for more intensive case management at veterans' supported housing sites to help them sustain their tenure. The lack of interconnectedness among the various information systems made it more difficult to collect and analyze pertinent data. To begin to address this, a data match was undertaken to estimate the proportion of veterans resident in the veterans' shelter who were not in receipt of VA benefits to which they may be entitled. The data obtained through collaboration between staff from NYC's Department of Homelessness Services, US Department of Veterans Affairs facilities in the New York/New Jersey region and Common Ground Community led to information that informed the evaluation design of the new system. The identification of gaps in available data on homeless veterans will lead to projects both to improve and share data.

  9. 78 FR 65452 - Proposed Information Collection (Veterans, Researchers, and IRB Members Experiences With...

    Science.gov (United States)

    2013-10-31

    ... understand Veterans' preferences on research recruitment methods. The data will be published in peer-review... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS... Recruitment Restrictions); Comment Request AGENCY: Veterans Health Administration, Department of Veterans...

  10. Anticipating the traumatic brain injury-related health care needs of women veterans after the Department of Defense change in combat assignment policy.

    Science.gov (United States)

    Amara, Jomana; Iverson, Katherine M; Krengel, Maxine; Pogoda, Terri K; Hendricks, Ann

    2014-01-01

    Female service members' presence in combat zones during Operation Enduring Freedom and Operation Iraqi Freedom is unprecedented both in terms of the number of women deployed and the nature of their involvement. In light of changing Department of Defense policy governing the deployment of women in combat zones, this article intends to set the groundwork for estimating future combat-related injuries and subsequent Veterans Health Administration (VHA) utilization while focusing on traumatic brain injury (TBI). The article summarizes and presents the results of a study that examines veterans who present to VHA for TBI evaluation. For a national sample of veterans, a dataset including information on post-screening utilization, diagnoses, and location of care was constructed. The dataset included self-reported health symptoms and other information obtained from a standardized national VHA post-screening clinical evaluation, the comprehensive TBI evaluation (CTBIE). Both women and men utilize high levels of VHA health care after a CTBIE. However, there are gender differences in the volume and types of services used, with women utilizing different services than their male counterparts and incurring higher costs, including higher overall and outpatient costs. As women veterans seek more of their health care from the VHA, there will be a need for more coordinated care to identify and manage deployment-related TBI and common comorbidities such as posttraumatic stress disorder, depression, and chronic pain. Deployment-connected injuries are likely to rise because of the rescinding of the ban on women in combat. This in turn has critical implications for VHA strategic planning and budgeting. Published by Elsevier Inc.

  11. 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.

  12. Introducing INSPIRE: an implementation research collaboration between the Department of Foreign Affairs, Trade and Development Canada and the World Health Organization.

    Science.gov (United States)

    Blais, Pierre; Hirnschall, Gottfried; Mason, Elizabeth; Shaffer, Nathan; Lipa, Zuzanna; Baller, April; Rollins, Nigel

    2014-11-01

    The government of Canada, through the Department of Foreign Affairs, Trade and Development (DFATD) has supported global efforts to reduce the impact of the HIV pandemic. In 2012, WHO and DFATD launched an implementation research initiative to increase access to interventions that were known to be effective in the prevention of mother-to-child transmission of HIV and to learn how these could be successfully integrated with other essential services for mothers and children. In addition to facilitating the implementation research projects, DFATD and WHO promoted four approaches: (1) Country-specific implementation research prioritization exercises, (2) Ministry of Health involvement, (3) Country-led, innovative, high-quality research, and (4) Leveraging regional networks and learning opportunities. While no single aspect of INSPIRE is unique, the process endeavors to promote and support high-quality, rigorous, locally-led implementation research that will have a substantial impact on the health and survival of HIV-infected women and their children.

  13. 77 FR 37839 - Veterans' Group Life Insurance (VGLI) No-Health Period Extension

    Science.gov (United States)

    2012-06-25

    ... AFFAIRS 38 CFR Part 9 RIN 2900-AO24 Veterans' Group Life Insurance (VGLI) No-Health Period Extension... Affairs (VA) proposes to amend its regulations governing eligibility for Veterans' Group Life Insurance... indicate that they are submitted in response to ``RIN 2900-AO24--Veterans' Group Life Insurance (VGLI) No...

  14. Risk factors for hepatitis C infection among Vietnam era veterans versus nonveterans: results from the Chronic Hepatitis Cohort Study (CHeCS).

    Science.gov (United States)

    Boscarino, Joseph A; Sitarik, Alexandra; Gordon, Stuart C; Rupp, Loralee B; Nerenz, David R; Vijayadeva, Vinutha; Schmidt, Mark A; Henkle, Emily; Lu, Mei

    2014-10-01

    Research suggests that Vietnam era veterans have a higher prevalence of hepatitis C virus (HCV) than other veterans and nonveterans. However, the reasons for this are unclear, since this research has been conducted among Department of Veterans Affairs (VA) patients and most veterans do not use the VA. The current study compares HCV risk factors between the Vietnam era veterans and nonveterans seen in 4 large non-VA systems to explain this disparity. A total of 4,636 HCV patients completed surveys in 2011-2012. Vietnam era veterans were defined as those who served in the military any time between 1964 and 1975. Bivariate tests followed by logistic regressions, and multivariable modeling were conducted to study risk factors among Vietnam era veterans and nonveterans. Since few veterans were female (~2 %), they were excluded. Among male respondents (N = 2,638), 22.5 % were classified as Vietnam era veterans. Compared to nonveterans, these patients were older (p risk factor differences for HCV infection by veteran status suggested that while injection drug use approached statistical significance (nonveterans = 46.1 % vs. Vietnam era veterans = 41.4 %, p = 0.06), only reported sex with men was significant (nonveterans = 2.4 % vs. Vietnam era veterans = 0.6 %, p = 0.013). In multivariate logistic regression controlling for age, education, country of birth, marital status and study site, no HCV risk factor was associated with Vietnam era veteran status. However, veterans were more likely to report "other" exposures were the source of infection than nonveterans (p Vietnam era veterans seen in non-VA facilities do not report a higher prevalence of common HCV risk factors, such as injection drug use, they are more likely to report "other" exposures, typically associated with military service, as the source of HCV infection.

  15. A reconsideration of the correlation between veteran status and firearm suicide in the general population.

    Science.gov (United States)

    Hoffmire, Claire A; Bossarte, Robert M

    2014-10-01

    The relationship between veteran status and firearm suicide has been evaluated previously, but multiple sources of bias limit conclusions. This study aimed to clarify the relationship between a history of military service and firearm suicide. Data obtained from suicide death certificates from nine states (1999-2009) were analysed. History of military service was validated using data obtained from the Department of Veterans Affairs and Department of Defense. Modified Poisson Regression with robust SEs was used to compute adjusted prevalence ratios for the common outcome of firearm use among suicide decedents. Male veteran suicide decedents were 6% more likely to use firearms, and female veteran suicide decedents were 18% more likely to use firearms compared with their non-veteran peers. Prior estimates based on logistic regression and death certificate reporting of veteran status may have overestimated the relationship between veteran status and firearm use among suicide decedents. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. 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.

  17. 76 FR 14062 - Notice of Inventory Completion: U.S. Department of the Interior, Bureau of Indian Affairs...

    Science.gov (United States)

    2011-03-15

    ... is a relationship of shared group identity that can be reasonably traced between the Native American... National Park Service Notice of Inventory Completion: U.S. Department of the Interior, Bureau of Indian..., Laramie, WY AGENCY: National Park Service, Interior. ACTION: Notice. Notice is here given in accordance...

  18. 76 FR 58038 - Notice of Inventory Completion: U.S. Department of the Interior, Bureau of Indian Affairs...

    Science.gov (United States)

    2011-09-19

    ... of human remains and associated funerary objects in the control of the U.S. Department of the... notice are the sole responsibility of the museum, institution, or Federal agency that has control of the... fragment, 1 iron bowl fragment, 2 iron keys, 1 iron hinge, 1 iron gun hammer, 2 iron gun pieces, 1 fish...

  19. Nicotine dependence and its risk factors among users of veterans health services, 2008-2009.

    Science.gov (United States)

    Tsai, Jack; Edens, Ellen L; Rosenheck, Robert A

    2011-11-01

    Tobacco use is the leading preventable cause of death in the United States and is disproportionately higher among veterans than nonveterans. We examined the prevalence of nicotine dependence and its associated risk factors among veterans who used health services in the US Department of Veterans Affairs (VA) system. Using a case-control design, we compared all VA health service users in fiscal year 2008-2009 (N = 5,031,381) who received a nicotine dependence diagnosis with those who did not. Independent risk and protective factors associated with receiving a nicotine dependence diagnosis were identified using logistic regression analysis. We conducted subgroup analyses on 2 groups of particular policy concern: homeless veterans and veterans who served in Iraq and Afghanistan. Among all recent VA health service users, 15% (n = 749,353) received a diagnosis of nicotine dependence. Substance abuse, other mental health diagnoses, and homelessness were identified as major risk factors. Veterans who served in Iraq and Afghanistan were not found to be at increased risk compared to veterans from other war eras. Major risk and protective factors within the subgroups of homeless veterans and veterans who served in Iraq and Afghanistan were broadly similar to those in the general VA population. Given that other studies have found higher rates of nicotine dependence among veterans, this risk behavior may be underdiagnosed in VA medical records. Veterans who are homeless or have mental health or substance abuse problems are at highest risk and should be targeted for smoking prevention and cessation interventions. These results support, in principle, efforts to integrate smoking cessation programs with mental health and homeless services.

  20. Rural women veterans demographic report: defining VA users' health and health care access in rural areas.

    Science.gov (United States)

    Brooks, Elizabeth; Dailey, Nancy; Bair, Byron; Shore, Jay

    2014-01-01

    While many women choose to live in rural areas after retiring from active military duty, a paucity of studies examine rural women veterans' health care needs. This report is the first of its kind to describe the population demographics and health care utilization of rural female veteran patients enrolled in the Department of Veterans Affairs (VA). Using the National Patient Care Datasets (n = 327,785), we ran adjusted regression analyses to examine service utilization between (1) urban and rural and (2) urban and highly rural women veterans. Rural and highly rural women veterans were older and more likely to be married than their urban counterparts. Diagnostic rates were generally similar between groups for several mental health disorders, hypertension, and diabetes, with the exception of nonposttraumatic stress anxiety that was significantly lower for highly rural women veterans. Rural and highly rural women veterans were less likely to present to the VA for women's specific care than urban women veterans; highly rural women veterans were less likely to present for mental health care compared to urban women veterans. Among the users of primary care, mental health, women's specific, and all outpatient services, patients' annual utilization rates were similar. Improved service options for women's specific care and mental health visits may help rural women veterans access care. Telehealth technologies and increased outreach, perhaps peer-based, should be considered. Other recommendations for VA policy and planning include increasing caregiver support options, providing consistency for mental health services, and revising medical encounter coding procedures. © 2013 National Rural Health Association.

  1. Trends in Susceptibility Rates and Extended-Spectrum β-Lactamase Production of Klebsiella pneumoniae in Bloodstream Infections Across the United States Veterans Affairs Healthcare System.

    Science.gov (United States)

    Gentry, Chris A; Williams, Riley J

    2015-12-01

    Klebsiella pneumoniae is an important pathogen, increasingly notorious for its ability to become resistant to antimicrobial agents. This study sought to characterize trends in antimicrobial susceptibility rates for K. pneumoniae causing bacteremias across the United States (U.S.) Veterans Healthcare Administration (VHA) from 2007 through 2013 utilizing a national clinical database. K. pneumoniae grew in 9,235 blood cultures from 8,414 patients. Nationally, ampicillin-sulbactam, ceftazidime, cefepime, ertapenem, fluoroquinolones, and amikacin demonstrated statistically significant susceptibility rate increases against K. pneumoniae in the 2010-2013 period versus the 2007-2009 period. No antimicrobial agent had a statistically significant nationwide susceptibility rate decrease. Of the 126 antibiotic-organism pairs tested among 9 U.S. regions, 18 demonstrated statistically significant susceptibility rate increases while 6 demonstrated statistically significant susceptibility rate decreases. The East North Central (eight agents), Mid-Atlantic (five agents), and South Atlantic (four agents) regions demonstrated statistically significant susceptibility rate increases for multiple antimicrobial agents. Of the 70 antibiotic-organism pairs tested among 5 different medical center complexity levels, 11 antibiotics demonstrated statistically significant susceptibility rate increases and 1 demonstrated a statistically significant rate decrease. Extended-spectrum β-lactamase production did not significantly change over the study period across an available nationwide representation of 31 facilities (10.6% in 2007-2009 vs. 9.21% in 2010-2013, p=0.17). The South Atlantic and Mid-Atlantic regions had the highest prevalence of extended-spectrum ß-lactamase production in the two periods, respectively. The recent trend of generally increasing susceptibility rates for K. pneumoniae bloodstream isolates in this nationwide U.S. VHA study contrasts from other U.S. health system reports

  2. Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use.

    Science.gov (United States)

    Nelson, Karin M; Helfrich, Christian; Sun, Haili; Hebert, Paul L; Liu, Chuan-Fen; Dolan, Emily; Taylor, Leslie; Wong, Edwin; Maynard, Charles; Hernandez, Susan E; Sanders, William; Randall, Ian; Curtis, Idamay; Schectman, Gordon; Stark, Richard; Fihn, Stephan D

    2014-08-01

    In 2010, the Veterans Health Administration (VHA) began implementing the patient-centered medical home (PCMH) model. The Patient Aligned Care Team (PACT) initiative aims to improve health outcomes through team-based care, improved access, and care management. To track progress and evaluate outcomes at all VHA primary care clinics, we developed and validated a method to assess PCMH implementation. To create an index that measures the extent of PCMH implementation, describe variation in implementation, and examine the association between the implementation index and key outcomes. We conducted an observational study using data on more than 5.6 million veterans who received care at 913 VHA hospital-based and community-based primary care clinics and 5404 primary care staff from (1) VHA clinical and administrative databases, (2) a national patient survey administered to a weighted random sample of veterans who received outpatient care from June 1 to December 31, 2012, and (3) a survey of all VHA primary care staff in June 2012. Composite scores were constructed for 8 core domains of PACT: access, continuity, care coordination, comprehensiveness, self-management support, patient-centered care and communication, shared decision making, and team-based care. Patient satisfaction, rates of hospitalization and emergency department use, quality of care, and staff burnout. Fifty-three items were included in the PACT Implementation Progress Index (Pi2). Compared with the 87 clinics in the lowest decile of the Pi2, the 77 sites in the top decile exhibited significantly higher patient satisfaction (9.33 vs 7.53; P burnout (Maslach Burnout Inventory emotional exhaustion subscale, 2.29 vs 2.80; P = .02), lower hospitalization rates for ambulatory care-sensitive conditions (4.42 vs 3.68 quarterly admissions for veterans 65 years or older per 1000 patients; P emergency department use (188 vs 245 visits per 1000 patients; P < .001). The extent of PCMH implementation, as

  3. Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans. Welcome

    Science.gov (United States)

    2010-04-01

    pages 90-91 Traumatic Servicemembers’ Group Life Insurance ( TSGLI ) - Module 4, page 85 Intensive Care Unit (ICU) - Module 1, page 31...PNOK – Primary Next of Kin SSN – Social Security Number TSGLI – Traumatic Servicemembers’ Group Life Insurance VA – Department of Veterans Affairs...pages 90-92 TBI Prevalence - Module 1, page 3 TBI Types - Module 1, pages 13-14 TSGLI (Traumatic Servicemembers’ Group Life Insurance

  4. Assailant Identity and Self-Reported Nondisclosure of Military Sexual Trauma in Partnered Women Veterans.

    Science.gov (United States)

    Blais, Rebecca K; Brignone, Emily; Fargo, Jamison D; Galbreath, Nathan W; Gundlapalli, Adi V

    2017-10-09

    Department of Veterans Affairs estimates of military sexual trauma (MST) suggest 27% of female veterans have experienced MST. However, Department of Defense data (Department of Defense, 2014) show that a subgroup of active-duty women do not report sexual assaults to a military authority, suggesting barriers to disclosure exist among military samples. No study of female veterans has examined rates of nondisclosure among those with previous screens for MST; these data could inform screening efforts and establishment of safe havens for candid disclosures. Using an explanatory sequential mixed-methods survey, a history of MST, and postservice MST disclosures during screening and their associations with demographic, assault, and screening-setting characteristics were evaluated in 359 female veterans. Open-ended responses regarding barriers to disclosure were analyzed using editing analysis style. Eighty-one percent (n = 289) reported MST. Of these, 50% (n = 143) reported a prior screening and 25% (n = 35) reported they did not disclose their true MST status. Veterans who experienced MST by a unit-member assailant were significantly less likely to disclose (adjusted odds ratio = 4.75, 95% confidence interval = 1.20-18.30). Disclosure barriers included stigma, experiential avoidance, and discomfort with the screening setting. Creative interventions to reduce nondisclosure among female veterans, with specific attention to those assaulted by a unit member, are urgently needed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  5. 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

  6. Department of Defense Annual Report on Sexual Assault in the Military, Fiscal Year 2012. Volume 1

    Science.gov (United States)

    2012-01-01

    information for use in matters with other agencies, such as with the Department of Veterans Affairs ( DVA ).42 In compliance with this Directive, DoD...National Guard, and the Coast Guard, as well as referral information for legal resources, chaplain support, healthcare services, DVA resources...respond to the growing population of mobile device users. The Department also collaborated with DVA and the Department of Labor to connect

  7. Effectiveness of Sofosbuvir, Ledipasvir/Sofosbuvir, or Paritaprevir/Ritonavir/Ombitasvir and Dasabuvir Regimens for Treatment of Patients With Hepatitis C in the Veterans Affairs National Health Care System.

    Science.gov (United States)

    Ioannou, George N; Beste, Lauren A; Chang, Michael F; Green, Pamela K; Lowy, Elliott; Tsui, Judith I; Su, Feng; Berry, Kristin

    2016-09-01

    We investigated the real-world effectiveness of sofosbuvir, ledipasvir/sofosbuvir, and paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD) in treatment of different subgroups of patients infected with hepatitis C virus (HCV) genotypes 1, 2, 3, or 4. We performed a retrospective analysis of data from 17,487 patients with HCV infection (13,974 with HCV genotype 1; 2131 with genotype 2; 1237 with genotype 3; and 135 with genotype 4) who began treatment with sofosbuvir (n = 2986), ledipasvir/sofosbuvir (n = 11,327), or PrOD (n = 3174), with or without ribavirin, from January 1, 2014 through June 20, 2015 in the Veterans Affairs health care system. Data through April 15, 2016 were analyzed to assess completion of treatments and sustained virologic response 12 weeks after treatment (SVR12). Mean age of patients was 61 ± 7 years, 97% were male, 52% were non-Hispanic white, 29% were non-Hispanic black, 32% had a diagnosis of cirrhosis (9.9% with decompensated cirrhosis), 36% had a Fibrosis-4 index score >3.25 (indicator of cirrhosis), and 29% had received prior antiviral treatment. An SVR12 was achieved by 92.8% (95% confidence interval [CI], 92.3%-93.2%) of subjects with HCV genotype 1 infection (no significant difference between ledipasvir/sofosbuvir and PrOD regimens), 86.2% (95% CI, 84.6%-87.7%) of those with genotype 2 infection (treated with sofosbuvir and ribavirin), 74.8% (95% CI, 72.2%-77.3%) of those with genotype 3 infection (77.9% in patients given ledipasvir/sofosbuvir plus ribavirin, 87.0% in patients given sofosbuvir and pegylated-interferon plus ribavirin, and 70.6% of patients given sofosbuvir plus ribavirin), and 89.6% (95% CI 82.8%-93.9%) of those with genotype 4 infection. Among patients with cirrhosis, 90.6% of patients with HCV genotype 1, 77.3% with HCV genotype 2, 65.7% with HCV genotype 3, and 83.9% with HCV genotype 4 achieved an SVR12. Among previously treated patients, 92.6% with genotype 1; 80.2% with genotype 2; 69.2% with genotype 3

  8. 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.

  9. Preliminary Data from the Caring for Older Adults and Caregivers at Home (COACH) Program: A Care Coordination Program for Home-Based Dementia Care and Caregiver Support in a Veterans Affairs Medical Center.

    Science.gov (United States)

    D'Souza, Maria F; Davagnino, Judith; Hastings, S Nicole; Sloane, Richard; Kamholz, Barbara; Twersky, Jack

    2015-06-01

    Caring for Older Adults and Caregivers at Home (COACH) is an innovative care coordination program of the Durham Veteran's Affairs Medical Center in Durham, North Carolina, that provides home-based dementia care and caregiver support for individuals with dementia and their family caregivers, including attention to behavioral symptoms, functional impairment, and home safety, on a consultation basis. The objectives of this study were to describe the COACH program in its first 2 years of operation, assess alignment of program components with quality measures, report characteristics of program participants, and compare rates of placement outside the home with those of a nontreatment comparison group using a retrospective cohort design. Participants were community-dwelling individuals with dementia aged 65 and older who received primary care in the medical center's outpatient clinics and their family caregivers, who were enrolled as dyads (n = 133), and a control group of dyads who were referred to the program and met clinical eligibility criteria but did not enroll (n = 29). Measures included alignment with Dementia Management Quality Measures and time to placement outside the home during 12 months of follow-up after referral to COACH. Results of the evaluation demonstrated that COACH aligns with nine of 10 clinical process measures identified using quality measures and that COACH delivers several other valuable services to enhance care. Mean time to placement outside the home was 29.6 ± 14.3 weeks for both groups (P = .99). The present study demonstrates the successful implementation of a home-based care coordination intervention for persons with dementia and their family caregivers that is strongly aligned with quality measures. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  10. 78 FR 71591 - Privacy Act of 1974; Computer Matching Program between the U.S. Department of Education (ED) and...

    Science.gov (United States)

    2013-11-29

    ...) (recipient agency) and the U.S. Department of Veterans Affairs (VA) (source agency). After the ED and VA Data..., the Computer Matching and Privacy Protection Act of 1988, 54 FR 25818 (June 19, 1989), and OMB... published in the Federal Register, in text or Adobe Portable Document Format (PDF). To use PDF you must have...

  11. Veterans' Perspectives on Benefits and Drawbacks of Peer Support for Posttraumatic Stress Disorder.

    Science.gov (United States)

    Hundt, Natalie E; Robinson, Andrew; Arney, Jennifer; Stanley, Melinda A; Cully, Jeffrey A

    2015-08-01

    Peer support has been increasingly utilized within the Department of Veterans Affairs and offers an opportunity to augment existing care for posttraumatic stress disorder (PTSD). The current study sought to examine Veterans' perspectives on the potential benefits and drawbacks of peer support for PTSD. A sample of 23 Veterans with substantial treatment experience completed one-time qualitative interviews that were transcribed and coded for thematic content using grounded theory methodology. Results indicated that Veterans identified numerous potential benefits to a peer support program, including social support, purpose and meaning, normalization of symptoms and hope, and therapeutic benefits. Veterans also identified ways that peer support could complement psychotherapy for PTSD by increasing initiation and adherence to treatment and supporting continued use of skills after termination. Results also indicated that Veterans may prefer peer support groups that are separated according to trauma type, gender, and era of service. Other findings highlighted the importance of the leadership and interpersonal skills of a peer support group leader. Overall, Veterans found peer support to be a highly acceptable complement to existing PTSD treatments with few drawbacks. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  12. 75 FR 78806 - Agency Information Collection (Residency Verification Report-Veterans and Survivors) Activity...

    Science.gov (United States)

    2010-12-16

    ... AFFAIRS Agency Information Collection (Residency Verification Report-- Veterans and Survivors) Activity.... 2900-0655.'' SUPPLEMENTARY INFORMATION: Title: Residency Verification Report--Veterans and Survivors... submit the collection of information abstracted below to the Office of Management and Budget (OMB) for...

  13. 38 CFR 21.6420 - Coordination with the Veterans Service Center.

    Science.gov (United States)

    2010-07-01

    ... VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Temporary Program of Vocational... Coordination with the Veterans Service Center. It is the responsibility of the VR&E Division to inform the...

  14. 77 FR 3842 - Proposed Information Collection (Conversion from Servicemembers' Group Life Insurance to Veterans...

    Science.gov (United States)

    2012-01-25

    ... (SGLI) to Veterans' Group Life Insurance (VGLI) for Disabled Service Members. OMB Control Number: 2900... members, especially service members with disabilities are informed about their life insurance option... AFFAIRS Proposed Information Collection (Conversion from Servicemembers' Group Life Insurance to Veterans...

  15. 77 FR 70210 - Agency Information Collection (Veteran's Application for Compensation and/or Pension): Activity...

    Science.gov (United States)

    2012-11-23

    ... AFFAIRS Agency Information Collection (Veteran's Application for Compensation and/or Pension): Activity... Pension, VA Form 21-526. b. Veteran's Supplemental Claim Application, VA Form 21-526b. c. Authorization.... Veterans complete VA Form 21-526 to initially apply for compensation and/or pension benefits. b. Veterans...

  16. 78 FR 58611 - Agency Information Collection (Veterans Mortgage Life Insurance Statement) Activity Under OMB Review

    Science.gov (United States)

    2013-09-24

    ... AFFAIRS Agency Information Collection (Veterans Mortgage Life Insurance Statement) Activity Under OMB... ``OMB Control No. 2900-0212.'' SUPPLEMENTARY INFORMATION: Title: Veterans Mortgage Life Insurance... collection. Abstract: Veterans complete VA Form 29-8636 to decline Veterans Mortgage Life Insurance (VMLI) or...

  17. 76 FR 27384 - Agency Information Collection Activity (Veteran Suicide Prevention Online Quantitative Surveys...

    Science.gov (United States)

    2011-05-11

    ... AFFAIRS Agency Information Collection Activity (Veteran Suicide Prevention Online Quantitative Surveys.... Veterans Online Survey, VA Form 10-0513. b. Veterans Family Online Survey, VA Form 10-0513a. c. Veterans Primary Care Provider Online Survey, VA Form 10-0513b. OMB Control Number: 2900-New (VA Form 10-0513...

  18. 76 FR 9637 - Proposed Information Collection (Veteran Suicide Prevention Online Quantitative Surveys) Activity...

    Science.gov (United States)

    2011-02-18

    ... AFFAIRS Proposed Information Collection (Veteran Suicide Prevention Online Quantitative Surveys) Activity.... Veterans Online Survey, VA Form 10-0513: b. Veterans Family Online Survey, VA Form 10-0513a. c. Veterans Primary Care Provider Online Survey, VA Form 10-0513b. OMB Control Number: 2900-New (VA Form 10-0513...

  19. New to care: demands on a health system when homeless veterans are enrolled in a medical home model.

    Science.gov (United States)

    O'Toole, Thomas P; Bourgault, Claire; Johnson, Erin E; Redihan, Stephen G; Borgia, Matthew; Aiello, Riccardo; Kane, Vincent

    2013-12-01

    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. 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. 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. Homeless adults had substantial health needs when presenting for care. High-intensity primary care and access to specialty care services could reduce ED use.

  20. Development and Validation of an Instrument to Assess Imminent Risk of Homelessness Among Veterans

    Science.gov (United States)

    Fargo, Jamison D.; Kane, Vincent; Culhane, Dennis P.

    2014-01-01

    Objectives Veterans are overrepresented within the homeless population compared with their non-veteran counterparts, particularly when controlling for poverty. The U.S. Department of Veterans Affairs (VA) aims to prevent new episodes of homelessness by targeting households at greatest risk; however, there are no instruments that systematically assess veterans' risk of homelessness. We developed and tested a brief screening instrument to identify imminent risk of homelessness among veterans accessing VA health care. Methods The study team developed initial assessment items, conducted cognitive interviews with veterans experiencing homelessness, refined pilot items based on veterans' and experts' feedback and results of psychometric analyses, and assigned weights to items in the final instrument to indicate a measure of homelessness risk. Results One-third of veterans who responded to the field instrument reported imminent risk of homelessness (i.e., housing instability in the previous 90 days or expected in the next 90 days). The reliability coefficient for the instrument was 0.85, indicating good internal consistency. Veterans who had a recent change in income, had unpaid housing expenses, were living temporarily with family and friends, needed help to get or keep housing, and had poor rental and credit histories were more likely to report a risk of homelessness than those who did not. Conclusion This study provides the field with an instrument to identify individuals and households at risk of or experiencing homelessness, which is necessary to prevent and end homelessness. In addition, it supports VA's investment in homelessness prevention and rapid rehousing services for veterans who are experiencing or are at risk for homelessness. PMID:25177054

  1. Addressing the Needs of Transgender Military Veterans: Better Access and More Comprehensive Care.

    Science.gov (United States)

    Dietert, Michelle; Dentice, Dianne; Keig, Zander

    2017-01-01

    Purpose: There is a gap in social science literature addressing issues of access and quality of care for transgender military veterans. Psychologists, medical doctors, and other health professionals are beginning to address some of the barriers present in the Department of Veterans Affairs (VA) system that affect veterans who are also transgender and intersex. Over a 7-year period, between 2006 and 2013, 2600 transgender veterans were served by the VA. Data from several surveys revealed that most transgender veterans perceive the Veterans Health Administration (VHA) to be less than accommodating for their special needs. The goal of this study was to investigate the experiences of a sample of transgender veterans with regard to their experiences with healthcare services provided by the VHA. Methods: Using snowball sampling techniques, we were able to recruit 22 transgender military veterans to participate in our study. A combination of telephone interviews and questionnaires provided data from veterans in various branches of the military throughout the United States. Results: Findings indicate that even though the VHA is working to address issues of inequality for transgender veterans, our participants indicated that there are still some problems with administration of care, proper training of staff and physicians, and availability of comprehensive services for the unique healthcare needs of transgender individuals. Conclusion: Since our data were collected, the VA has worked to bridge the gap by focusing on increased training for VHA providers and staff and establishing LGBT programs at VA facilities. However, we suggest that one key area of importance should continue to focus on how mental health and medical providers and ancillary staff are trained to interact with and provide care for their transgender patients.

  2. Residential treatment for dually diagnosed homeless veterans: a comparison of program types.

    Science.gov (United States)

    Kasprow, W J; Rosenheck, R; Frisman, L; DiLella, D

    1999-01-01

    This study compared two types of residential programs that treat dually diagnosed homeless veterans. Programs specializing in the treatment of substance abuse disorders (SA) and those programs addressing both psychiatric disorders and substance abuse problems within the same setting (DDX) were compared on (1) program characteristics, (2) clients' perceived environment, and (3) outcomes of treatment. The study was based on surveys and discharge reports from residential treatment facilities that were under contract to the Department of Veterans Affairs Health Care for Homeless Veterans program, a national outreach and case management program operating at 71 sites across the nation. Program characteristics surveys were completed by program administrators, perceived environment surveys were completed by veterans in treatment, and discharge reports were completed by VA case managers. DDX programs were characterized by lower expectations for functioning, more acceptance of problem behavior, and more accommodation for choice and privacy, relative to SA programs after adjusting for baseline differences. Dually diagnosed veterans in DDX programs perceived these programs as less controlling than SA programs, but also as having lower involvement and less practical and personal problem orientations. At discharge, a lower percentage of veterans from DDX than SA programs left without staff consultation. A higher percentage of veterans from DDX than SA programs were discharged to community housing rather than to further institutional treatment. Program effects were not different for psychotic and non-psychotic veterans. Although differences were modest, integration of substance abuse and psychiatric treatment may promote a faster return to community living for dually diagnosed homeless veterans. Such integration did not differentially benefit dually diagnosed veterans whose psychiatric problems included a psychotic disorder.

  3. You won't know if you're improving unless you measure: recommendations for evaluating Hospice-Veteran Partnerships.

    Science.gov (United States)

    Jones, Diane; Edes, Thomas; Shreve, Scott; Casarett, David J

    2006-11-01

    Growing evidence indicates that there are abundant opportunities to improve the care that patients receive near the end of life. Hospice care has been associated with improvements in these and other outcomes, but hospice is underused by most patient populations. Therefore, the Department of Veterans Affairs (VA) has made hospice access a priority in its plan to improve end-of-life care for all veterans. In addition to committing funding for hospice care, the VA has also established a national network of Hospice-Veteran Partnerships (HVPs) whose goal is to improve access to hospice for veterans. This article describes the results of a nationwide consensus project to develop measures of the success of HVPs and recommends key measures that should be used to track improvements and to identify opportunities for highly successful collaborative strategies.

  4. Residential treatment for homeless female veterans with psychiatric and substance use disorders: effect on 1-year clinical outcomes.

    Science.gov (United States)

    Harpaz-Rotem, Ilan; Rosenheck, Robert A; Desai, Rani

    2011-01-01

    Limited evidence shows that time-limited residential treatment (RT) is beneficial for homeless people with serious mental illness. The Department of Veterans Affairs has established 11 specialty programs for homeless female veterans. We present data comparing 1-year clinical outcomes in a group of veterans who did and did not receive at least 30 days of RT. Clients of the Homeless Women Veterans Programs were invited to participate in a follow-up study. They were interviewed every 3 months for 1 year. Those who received at least 30 days of RT in the 3 months after program entry (RT group) were compared with other program participants (no or homeless women. This study, in conjunction with others, suggests that provision of stable housing may be an important element of recovery for homeless women with psychiatric problems, excluding substance use.

  5. Health and functioning among four war eras of U.S. veterans: examining the impact of war cohort membership, socioeconomic status, mental health, and disease prevalence.

    Science.gov (United States)

    Villa, Valentine M; Harada, Nancy D; Washington, Donna; Damron-Rodriguez, JoAnn

    2002-09-01

    This analysis examines the self-rated health and functioning of World War II, Vietnam era, Korean Conflict, and Persian Gulf War veterans participating in the Veteran Identity Program Survey 2001. The results indicate that although World War II veterans are more likely to report poor health status and functioning, Vietnam-era veterans report more difficulty with specific activities of daily living and instrumental activities of daily living than any other era of veterans. These relationships remain when controlling for race/ethnicity, socioeconomic status, disease prevalence, and mental health status. These findings suggest that there are characteristics unique to the Vietnam experience that negatively affect this cohort of veterans. We suggest that further analysis examine the specific pathways through which the experience of being a Vietnam veteran affects health. In the meantime, health and social service planning within the Department of Veterans Affairs should explore the services that should be developed and targeted to this cohort of veterans so that they may remain independent in the community.

  6. Unified Medical Command and Control in the Department of Defense

    Science.gov (United States)

    2012-03-22

    they will also depend on the MHS. There are cost / benefit issues associated with deferring patients to the Department of Veterans Affairs ( DVA ...whether efficiencies can be gained by better integrating the two largest government institutional health systems. Should, for instance, the DVA take...over institutional health care in its entirety; operating Military and DVA Medical Treatment Facilities and training physicians, nurses, medics and

  7. Grants for adaptive sports programs for disabled veterans and disabled members of the Armed Forces. Final rule.

    Science.gov (United States)

    2015-05-04

    This final rule amends Department of Veterans Affairs (VA) regulations to establish a new program to provide grants to eligible entities to provide adaptive sports activities to disabled veterans and disabled members of the Armed Forces. This rulemaking is necessary to implement a change in the law that authorizes VA to make grants to entities other than the United States Olympic Committee for adaptive sports programs. It establishes procedures for evaluating grant applications under this grant program, and otherwise administering the grant program. This rule implements section 5 of the VA Expiring Authorities Extension Act of 2013.

  8. Grants for adaptive sports programs for disabled veterans and disabled members of the Armed Forces. Interim final rule.

    Science.gov (United States)

    2014-07-01

    This interim final rule amends Department of Veterans Affairs (VA) regulations to establish a new program to provide grants to eligible entities to provide adaptive sports activities to disabled veterans and disabled members of the Armed Forces. This rulemaking is necessary to implement a change in the law that authorizes VA to make grants to entities other than the United States Olympic Committee for adaptive sports programs. It establishes procedures for evaluating grant applications under this grant program, and otherwise administering the grant program. This rule implements section 5 of the VA Expiring Authorities Extension Act of 2013.

  9. Public affairs plan

    Energy Technology Data Exchange (ETDEWEB)

    1994-09-01

    The purpose of the Uranium Mill Tailings Remedial Action (UMTRA) Project Public Affairs Plan is to establish goals for the Fiscal Year 1995 UMTRA public affairs program and identify specific activities to be conducted during the year. It also describes the roles of various agencies involved in the conduct of the public affairs program and defines the functions of the Technical Assistance Contractor (TAC) Public Affairs Department. It integrates and replaces the Public Participation Plan (DOE/AL/62350-47D) and Public Information Plan (DOE/AL/623590-71). The plan describes the US Department of Energy`s (DOE) plans to keep stakeholders and other members of the public informed about project policies, plans, and activities, and provide opportunities for stakeholders and interested segments of the public to participate in project decision-making processes. The plan applies to the UMTRA Project Office; the DOE Albuquerque Operations Office, Office of Intergovernmental and External Affairs (OIEA); the UMTRA TAC; the UMTRA Remedial Action Contractor (RAC); and other cooperating agencies.

  10. Characteristics and service use of homeless veterans and nonveterans residing in a low-demand emergency shelter.

    Science.gov (United States)

    Petrovich, James C; Pollio, David E; North, Carol S

    2014-06-01

    This study examined use of U.S. Department of Veterans Affairs (VA) and non-VA services and predictors of service use among veterans and nonveterans who resided in a low-demand emergency shelter. Equal numbers (N=110) of veterans and nonveterans recruited between January and June 2008 at a low-demand emergency shelter were interviewed about demographic characteristics, histories of military service and homelessness, general medical and mental functioning, current alcohol and drug problems and substance use, and use of medical, psychiatric, and substance abuse services. The Behavioral Model for Vulnerable Populations was used to identify need-based, enabling, and predisposing variables for analysis. Both groups reported high rates of arrest and incarceration, very low incomes, extensive histories of homelessness, and a similar need for services. However, significantly more veterans than nonveterans used psychiatric services, nonemergency medical services, and inpatient substance use services. Similar proportions of veterans and nonveterans used public non-VA health care services. Need-based variables appropriately predicted service use, but veterans and individuals with insurance were also more likely to access services. The veterans and nonveterans residing in a low-demand shelter faced several barriers to escaping homelessness. Both groups made similar use of non-VA services, but veterans used more services overall because of their access to VA services. The predictive power of insurance indicated that veterans may experience barriers to care despite the availability of VA services. The presence of veterans in this low-demand shelter may represent evidence of barriers to veteran and other public housing services.

  11. Acknowledging the Risk for Traumatic Brain Injury in Women Veterans.

    Science.gov (United States)

    Amoroso, Timothy; Iverson, Katherine M

    2017-04-01

    Since the Iraq and Afghanistan wars began, an unprecedented number of women have been engaging in combat operations. Likewise, the number of women using Department of Veterans Affairs (VA) services has doubled since 2001. Military service, and deployment to combat in particular, poses certain risks for traumatic brain injury (TBI)-for all service members. However, women may have additional military and nondeployment risk factors such as intimate partner violence (IPV). We briefly review the definition and classification issues related to TBI, as well as common acute and chronic health symptoms after TBI. Specific sex differences in prognosis after TBI, in particular the neurobehavioral symptoms, are also reviewed. We then focus on the emerging literature regarding TBI in women veterans including the etiologies, outcomes, and unique challenges this population faces. The article concludes with suggestions for enhanced screening by VA and non-VA providers alike, as well as directions for future research and clinical inquiry.

  12. The prevalence of sacroilitis in psoriatic arthritis: new perspectives from a large, multicenter cohort. A Department of Veterans Affairs Cooperative Study

    Energy Technology Data Exchange (ETDEWEB)

    Battistone, M.J.; Clegg, D.O. [Division of Rheumatology, University of Utah Medical Center, Salt Lake City, UT (United States)]|[Department of Medicine, Division of Rheumatology, Veterans Affairs Medical Center, Salt Lake City, UT (United States); Manaster, B.J. [Department of Radiology, Division of Musculoskeletal Imaging, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA (United States); Reda, D.J. [Cooperative Studies Program Coordinating Center, VA Hospital, Hines, IL (United States)

    1999-04-01

    Objective. To determine the prevalence of radiographic evidence of sacroiliitis in a large population of patients with psoriatic arthritis. Patients and design. Patients were recruited from 15 clinical centers. This was part of a large, multicenter study of patients with an established diagnosis of ankylosing spondylitis, psoriatic arthritis, or reactive arthritis. For this cohort, an established diagnosis of psoriatic arthritis was required, with cutaneous manifestations and involvement of at least three appendicular joints. At entry, patients were not selected for the presence of axial involvement. Radiographs - one anteroposterior view of the pelvis and one oblique view of each sacroiliac joint - were graded using the New York classification scale by a musculoskeletal radiologist masked to the specific diagnosis and clinical symptoms. Re-evaluation of 10% of the films 3 years later quantified intraobserver variability. Results. Two hundred and two patients with psoriatic arthritis were studied. Duration of the disease averaged 12 years; all patients had psoriasis and peripheral arthritis. The prevalence of radiographic evidence of sacroiliitis (grade 2 or higher) was 78%; 71% of these had grade 3 disease. Conclusions. Previously reported prevalence of sacroiliitis in patients with psoriatic arthritis ranges from 30% to 50%. The prevalence of radiographic evidence of sacroiliitis in this large multicenter cohort of patients with appendicular psoriatic arthritis was substantially higher. (orig.) With 3 figs., 4 tabs., 29 refs.

  13. A Randomized Clinical Trial of Alcohol Care Management Delivered in Department of Veterans Affairs Primary Care Clinics Versus Specialty Addiction Treatment

    National Research Council Canada - National Science Library

    Oslin, David W; Lynch, Kevin G; Maisto, Stephen A; Lantinga, Larry J; McKay, James R; Possemato, Kyle; Ingram, Erin; Wierzbicki, Michael

    Alcohol use disorder is one of the leading causes of disability worldwide. Despite the availability of efficacious treatments, few individuals with an alcohol use disorder are actively engaged in treatment...

  14. A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcohol screening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center.

    Science.gov (United States)

    Broyles, Lauren Matukaitis; Rodriguez, Keri L; Kraemer, Kevin L; Sevick, Mary Ann; Price, Patrice A; Gordon, Adam J

    2012-05-02

    Unhealthy alcohol use includes the spectrum of alcohol consumption from risky drinking to alcohol use disorders. Routine alcohol screening, brief intervention (BI) and referral to treatment (RT) are commonly endorsed for improving the identification and management of unhealthy alcohol use in outpatient settings. However, factors which might impact screening, BI, and RT implementation in inpatient settings, particularly if delivered by nurses, are unknown, and must be identified to effectively plan randomized controlled trials (RCTs) of nurse-delivered BI. The purpose of this study was to identify the potential barriers and facilitators associated with nurse-delivered alcohol screening, BI and RT for hospitalized patients. We conducted audio-recorded focus groups with nurses from three medical-surgical units at a large urban Veterans Affairs Medical Center. Transcripts were analyzed using modified grounded theory techniques to identify key themes regarding anticipated barriers and facilitators to nurse-delivered screening, BI and RT in the inpatient setting. A total of 33 medical-surgical nurses (97% female, 83% white) participated in one of seven focus groups. Nurses consistently anticipated the following barriers to nurse-delivered screening, BI, and RT for hospitalized patients: (1) lack of alcohol-related knowledge and skills; (2) limited interdisciplinary collaboration and communication around alcohol-related care; (3) inadequate alcohol assessment protocols and poor integration with the electronic medical record; (4) concerns about negative patient reaction and limited patient motivation to address alcohol use; (5) questionable compatibility of screening, BI and RT with the acute care paradigm and nursing role; and (6) logistical issues (e.g., lack of time/privacy). Suggested facilitators of nurse-delivered screening, BI, and RT focused on provider- and system-level factors related to: (1) improved provider knowledge, skills, communication, and collaboration

  15. 76 FR 40749 - Cost-Based and Inter-Agency Billing Rates for Medical Care or Services Provided by the Department...

    Science.gov (United States)

    2011-07-11

    ... BUDGET DEPARTMENT OF VETERANS AFFAIRS Cost-Based and Inter-Agency Billing Rates for Medical Care or... updates the Cost-Based and Inter-Agency billing rates for medical care or services provided by the... care or services provided by VA is set forth in 38 CFR 17.102(h). These rates apply to medical care or...

  16. Prazosin for Prophylaxis of Chronic Post Traumatic Headaches in OEF/OIF/OND Service Members and Veterans with Mild TBI

    Science.gov (United States)

    2016-10-01

    Department of Veterans Affairs, 4/1/12-3/31/16 New Support on: 1. Neurobehavior, Neuropathology, and Risk Factors in Alzheimer’s Disease (T32 AG052354...Detection, Diagnosis, Course, and Risk Factors (U01 NS093334, Robert Stern), National Institutes of Health / NINDS, 12/15/15-11/30/22, $2,252,000, 0.6 CM...Role: Co-Investigator  What other organizations were involved as partners? A subcontract to Henry Jackson Foundation provides support for

  17. Facilitating reintegration for military service personnel, veterans, and their families: An introduction to the special issue.

    Science.gov (United States)

    Elnitsky, Christine A; Kilmer, Ryan P

    2017-01-01

    As service members return from active duty and, in some cases, exit the military, they face a process of reintegration (also referred to as community reintegration) as they seek to resume participation in their life roles as civilians. Facilitating this dynamic process of reintegration for service members, veterans, and their families-including outlining potential strategies for supporting this return to civilian life and its demands, roles, and responsibilities-is the focus of this Special Issue. Reintegration has been framed as a national priority (U.S. Department of Veterans Affairs, 2015) and has been a point of emphasis of efforts at federal, state, and local levels. As the articles in this issue suggest, multiple public, private, and voluntary systems and the communities to which service members, veterans, and their families return can help influence their health outcomes and, ultimately, their reintegration. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  18. Health care utilization and costs after entry into an outreach program for homeless mentally ill veterans.

    Science.gov (United States)

    Rosenheck, R; Gallup, P; Frisman, L K

    1993-12-01

    This study evaluated the impact of a Department of Veterans Affairs outreach and residential treatment program for homeless mentally ill veterans on utilization and cost of health care services provided by the VA. Veterans at nine program sites (N = 1,748) were assessed with a standard intake instrument. Services provided by the outreach program were documented in quarterly clinical reports and in residential treatment discharge summaries. Data on nonprogram VA health service utilization and health care costs were obtained from national VA data bases. Changes in use of services and cost of services from the year before initial contact with the program to the year after were analyzed by t test. Multivariate analyses were used to examine the relationship of these changes to indicators of clinical need and to participation in the outreach program. Although utilization of inpatient service did not increase after veterans' initial contact with the program, use of domiciliary and outpatient services increased substantially. Total annual costs to the VA also increased by 35 percent, from $6,414 to $8,699 per veteran per year. Both clinical need and participation in the program were associated with increased use of health services and increased cost. Veterans with concomitant psychiatric and substance abuse problems used fewer health care services than others. Specialized programs to improve the access of homeless mentally ill persons to health care services appear to be effective, but costly. Dually diagnosed persons seem especially difficult to engage in treatment.

  19. 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.

  20. 77 FR 64386 - Agency Information Collection Activities (Per Diem for Nursing Home Care of Veterans in State...

    Science.gov (United States)

    2012-10-19

    ... AFFAIRS Agency Information Collection Activities (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State Homes) Under OMB Review AGENCY: Veterans Health... day health services care to Veterans. VA requires facilities providing nursing home and adult day...

  1. 78 FR 46421 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

    Science.gov (United States)

    2013-07-31

    ... AFFAIRS Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State Homes): Comment Request AGENCY: Veterans Health... home and adult day health services care to Veterans. VA requires facilities providing nursing home and...

  2. 77 FR 38395 - Agency Information Collection (Appointment of Veterans Service Organization/or Individuals as...

    Science.gov (United States)

    2012-06-27

    ... AFFAIRS Agency Information Collection (Appointment of Veterans Service Organization/or Individuals as... of Veterans Affairs, will submit the collection of information abstracted below to the Office of... information collection and its expected cost and burden; it includes the actual data collection instrument...

  3. 77 FR 20849 - Homeless Veterans' Reintegration Program

    Science.gov (United States)

    2012-04-06

    ... Veterans' Reintegration Program AGENCY: Veterans' Employment and Training Service (VETS), Department of...: Section 2021 of Title 38 of the United States Code (U.S.C.) reauthorizes the Homeless Veterans Reintegration Program (HVRP) through fiscal year (FY) 2012 and indicates: ``the Secretary of Labor shall conduct...

  4. Trust is the basis for effective suicide risk screening and assessment in veterans.

    Science.gov (United States)

    Ganzini, Linda; Denneson, Lauren M; Press, Nancy; Bair, Matthew J; Helmer, Drew A; Poat, Jennifer; Dobscha, Steven K

    2013-09-01

    To reduce suicides among Veterans, the Department of Veterans Affairs (VA) has designated suicide risk assessments for Veterans who screen positive for depression or post-traumatic stress disorder as a national performance goal. Many VA Medical Centers (VAMCs) are using brief suicidal ideation screens, administered in non-mental health ambulatory care settings, as the first step in the assessment process. To explore Veterans' perceptions of the suicide screening and risk assessment process, the barriers and facilitators to disclosing suicidal thoughts, and perceptions of possible consequences of revealing suicidal thoughts. Investigators recorded one semi-structured interview with each Veteran. Transcripts were analyzed using a modified grounded theory approach. Thirty-four Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who screened positive for suicidal ideation in non-mental health ambulatory care settings in 2009 and 2010. Veterans accepted the need to assess suicide risk. They increasingly experienced attempts to suppress and avoid thoughts of suicide as burdensome and exhausting. Despite this, Veterans often failed to disclose severe and pervasive suicidal thoughts when screened because: (1) they considered suicidal thoughts as shameful and a sign of weakness; (2) they believed suicidal thoughts were private and not to be divulged to strangers; (3) they worried that disclosure would lead to unwanted hospitalization or medication recommendations; and (4) the templated computer reminder process was perceived as perfunctory and disrespectful. In contrast, admitting and discussing thoughts of suicide with a health provider who focused on building a relationship, demonstrated genuineness and empathy, offered information on the rationale for suicide risk assessment, and used straightforward and understandable language, all promoted trust that resulted in more honest disclosure of suicidal thoughts. In ambulatory care settings, both provider

  5. Investigating the risk of cancer in 1990-1991 US Gulf War veterans with the use of state cancer registry data.

    Science.gov (United States)

    Young, Heather A; Maillard, Jessica D; Levine, Paul H; Simmens, Samuel J; Mahan, Clare M; Kang, Han K

    2010-04-01

    The purpose of this study was to determine whether proportional cancer incidence is greater among Gulf War veterans compared with non-Gulf War veterans. Files obtained from the Defense Manpower Data Center included data for 621,902 veterans who were deployed to the Persian Gulf during the 1990 to 1991 Gulf War (August 2, 1990, to March 1, 1991) and 746,248 non-Gulf War veteran controls. Identification of veterans who received a cancer diagnosis between 1991 and 2006 was accomplished through record linkage of the Defense Manpower Data Center dataset with files from 28 state cancer registries and the Department of Veterans Affairs Central Cancer Registry. By the use of logistic regression, proportional incidence ratios adjusted for demographic and military characteristics were calculated by comparing the proportion of a specific cancer among all cancers in the Gulf War veterans to the proportion of that specific cancer among all cancers in the non-Gulf War veterans. Only lung cancer showed a statistically significant relative excess among Gulf War veterans compared with non-Gulf War veterans (adjusted proportional incidence ratios, 1.15; 95% confidence interval, 1.03-1.29). When adjusted for race, age, and sex, the overall proportion of cancers among Gulf War and non-Gulf War veterans was similar (odds ratio, 0.99; 95% CI, 0.96-1.02). With the exception of lung cancer, there is little evidence of excess risk of cancer associated with Gulf War deployment. A follow-up study is warranted to confirm this finding and to evaluate the role of greater smoking rates among deployed personnel. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  6. 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

  7. 76 FR 40451 - Agency Information Collection (Veterans Mortgage Life Insurance-Change of Address Statement...

    Science.gov (United States)

    2011-07-08

    ... AFFAIRS Agency Information Collection (Veterans Mortgage Life Insurance-- Change of Address Statement.... 2900-0503.'' SUPPLEMENTARY INFORMATION: Title: Veterans Mortgage Life Insurance--Change of Address... continued ownership of property issued under Veterans Mortgage Life Insurance when an address change for the...

  8. 75 FR 52065 - Proposed Information Collection (Veterans Mortgage Life Insurance Statement) Activity: Comment...

    Science.gov (United States)

    2010-08-24

    ... AFFAIRS Proposed Information Collection (Veterans Mortgage Life Insurance Statement) Activity: Comment... solicits comments for information needed to decline Veterans Mortgage Life Insurance. DATES: Written...: Veterans Mortgage Life Insurance Statement, VA Form 29-8636. OMB Control Number: 2900-0212. Type of Review...

  9. 78 FR 58264 - Servicemembers' Group Life Insurance and Veterans' Group Life Insurance Information Access

    Science.gov (United States)

    2013-09-23

    ... AFFAIRS 38 CFR Part 9 RIN 2900-AO42 Servicemembers' Group Life Insurance and Veterans' Group Life... Insurance (SGLI), Family SGLI, SGLI Traumatic Injury Protection, and Veterans' Group Life Insurance (all...-AO42 Servicemembers' Group Life Insurance and Veterans' Group Life Insurance Information Access...

  10. 76 FR 40455 - Agency Information Collection (Veterans Mortgage Life Insurance Inquiry) Activity Under OMB Review

    Science.gov (United States)

    2011-07-08

    ... AFFAIRS Agency Information Collection (Veterans Mortgage Life Insurance Inquiry) Activity Under OMB Review... INFORMATION: Title: Veterans Mortgage Life Insurance Inquiry, VA Form 29-0543. OMB Control Number: 2900-0501... insured under Veterans Mortgage Life Insurance (VMLI) completes VA Form 29-0543 to report any recent...

  11. 76 FR 73019 - Proposed Information Collection (Agreement To Train on the Job Disabled Veterans) Activity...

    Science.gov (United States)

    2011-11-28

    ... AFFAIRS Proposed Information Collection (Agreement To Train on the Job Disabled Veterans) Activity... comments on information needed to assure that on the job training establishments are providing veterans... use of other forms of information technology. Title: Agreement to Train on the Job Disabled Veterans...

  12. 78 FR 41195 - Fund Availability Under the Grants for Transportation of Veterans in Highly Rural Areas

    Science.gov (United States)

    2013-07-09

    ... AFFAIRS Fund Availability Under the Grants for Transportation of Veterans in Highly Rural Areas AGENCY... announcing the availability of funds under the Grants for Transportation of Veterans in Highly Rural Areas. This Notice contains information concerning the Grants for Transportation of Veterans in Highly Rural...

  13. 76 FR 82212 - Grants for Transportation of Veterans in Highly Rural Areas

    Science.gov (United States)

    2011-12-30

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AO01 Grants for Transportation of Veterans in Highly Rural Areas AGENCY... to ``RIN 2900-AO01, Grants for Transportation of Veterans in Highly Rural Areas.'' Copies of comments... award grants to eligible entities to assist veterans in highly rural areas to travel to VA medical...

  14. 78 FR 56773 - Notice of Funds Availability Inviting Applications for Grants for Transportation of Veterans in...

    Science.gov (United States)

    2013-09-13

    ... AFFAIRS Notice of Funds Availability Inviting Applications for Grants for Transportation of Veterans in... deadline for funds available under the Grant Program for Transportation of Veterans in Highly Rural Areas..., Highly Rural Transportation Grants, Veterans Transportation Program, Chief Business Office (10NB2G), 2957...

  15. 78 FR 77204 - Proposed Information Collection (VA National Veterans Sports Programs and Special Event Surveys...

    Science.gov (United States)

    2013-12-20

    ... AFFAIRS Proposed Information Collection (VA National Veterans Sports Programs and Special Event Surveys... solicits comments on the information needed to evaluate the National Veterans Sports Programs and Special... ``OMB Control No. 2900-NEW (VA National Veterans Sports Programs and Special Event Surveys)'' in any...

  16. A participatory approach to designing and enhancing integrated health information technology systems for veterans: protocol.

    Science.gov (United States)

    Haun, Jolie N; Nazi, Kim M; Chavez, Margeaux; Lind, Jason D; Antinori, Nicole; Gosline, Robert M; Martin, Tracey L

    2015-02-27

    The Department of Veterans Affairs (VA) has developed health information technologies (HIT) and resources to improve veteran access to health care programs and services, and to support a patient-centered approach to health care delivery. To improve VA HIT access and meaningful use by veterans, it is necessary to understand their preferences for interacting with various HIT resources to accomplish health management related tasks and to exchange information. The objective of this paper was to describe a novel protocol for: (1) developing a HIT Digital Health Matrix Model; (2) conducting an Analytic Hierarchy Process called pairwise comparison to understand how and why veterans want to use electronic health resources to complete tasks related to health management; and (3) developing visual modeling simulations that depict veterans' preferences for using VA HIT to manage their health conditions and exchange health information. The study uses participatory research methods to understand how veterans prefer to use VA HIT to accomplish health management tasks within a given context, and how they would like to interact with HIT interfaces (eg, look, feel, and function) in the future. This study includes two rounds of veteran focus groups with self-administered surveys and visual modeling simulation techniques. This study will also convene an expert panel to assist in the development of a VA HIT Digital Health Matrix Model, so that both expert panel members and veteran participants can complete an Analytic Hierarchy Process, pairwise comparisons to evaluate and rank the applicability of electronic health resources for a series of health management tasks. This protocol describes the iterative, participatory, and patient-centered process for: (1) developing a VA HIT Digital Health Matrix Model that outlines current VA patient-facing platforms available to veterans, describing their features and relevant contexts for use; and (2) developing visual model simulations based on

  17. 38 CFR 11.84 - Redemption because of veteran's death.

    Science.gov (United States)

    2010-07-01

    ... veteran's death. 11.84 Section 11.84 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS...'s death. If the veteran dies before the maturity of the loan, the amount of the unpaid principal and... day the loan matures or within six months thereafter, the bank holding the note and certificate shall...

  18. Department of Defense Annual Report on Sexual Assault in the Military. Fiscal Year 2011

    Science.gov (United States)

    2012-04-01

    well as referral information for legal resources, chaplain support, healthcare services, the Department of Veterans Affairs ( DVA ) National Suicide...Guard, the Coast Guard, and the DVA ; and created data collection tools and issue resolution mechanisms to ensure proper operation and maintenance of...SAPRO focused on fostering two new working relationships: one with the DVA , and another with the Defense Advisory Committee on Women in the Services

  19. 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.

  20. Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition.

    Science.gov (United States)

    Gates, Margaret A; Holowka, Darren W; Vasterling, Jennifer J; Keane, Terence M; Marx, Brian P; Rosen, Raymond C

    2012-11-01

    Posttraumatic stress disorder (PTSD) is a psychiatric disorder that affects 7-8% of the general U.S. population at some point during their lifetime; however, the prevalence is much higher among certain subgroups, including active duty military personnel and veterans. In this article, we review the empirical literature on the epidemiology and screening of PTSD in military and veteran populations, including the availability of sensitive and reliable screening tools. Although estimates vary across studies, evidence suggests that the prevalence of PTSD in deployed U.S. military personnel may be as high as 14-16%. Prior studies have identified trauma characteristics and pre- and posttrauma factors that increase risk of PTSD among veterans and military personnel. This information may help to inform prevention and screening efforts, as screening programs could be targeted to high-risk populations. Large-scale screening efforts have recently been implemented by the U.S. Departments of Defense and Veterans Affairs. Given the prevalence and potential consequences of PTSD among veterans and active duty military personnel, development and continued evaluation of effective screening methods is an important public health need.

  1. Evaluating the impact of dental care on housing intervention program outcomes among homeless veterans.

    Science.gov (United States)

    Nunez, Elizabeth; Gibson, Gretchen; Jones, Judith A; Schinka, John A

    2013-12-01

    In this retrospective longitudinal cohort study, we examined the impact of dental care on outcomes among homeless veterans discharged from a Department of Veterans Affairs (VA) transitional housing intervention program. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did not. Primary outcomes of interest were program completion, employment or stable financial status on discharge, and transition to permanent housing. We calculated descriptive statistics and compared the 2 study groups with respect to demographic characteristics, medical and psychiatric history (including alcohol and substance use), work and financial support, and treatment outcomes. Veterans who received dental care were 30% more likely than those who did not to complete the program, 14% more likely to be employed or financially stable, and 15% more likely to have obtained residential housing. Provision of dental care has a substantial positive impact on outcomes among homeless veterans participating in housing intervention programs. This suggests that homeless programs need to weigh the benefits and cost of dental care in program planning and implementation.

  2. Latent homeless risk profiles of a national sample of homeless veterans and their relation to program referral and admission patterns.

    Science.gov (United States)

    Tsai, Jack; Kasprow, Wesley J; Rosenheck, Robert A

    2013-12-01

    We identified risk and need profiles of homeless veterans and examined the relation between profiles and referrals and admissions to Department of Veterans Affairs (VA) homeless service programs. We examined data from the VA's new Homeless Operations Management and Evaluation System on 120,852 veterans from 142 sites nationally in 2011 and 2012 using latent class analyses based on 9 homeless risk factors. The final 4-class solution compared both referral and admission to VA homeless services. We identified 4 latent classes: relatively few problems, dual diagnosis, poverty-substance abuse-incarceration, and disabling medical problems. Homeless veterans in the first group were more likely to be admitted to the VA's permanent supportive housing program, whereas those in the second group were more likely to be admitted to more restrictive VA residential treatment. Homeless veterans in the third group were more likely to be admitted to the VA's prisoner re-entry program, and those in the fourth group were more likely to be directed to VA medical services. The heterogeneous risk and need profiles of homeless veterans supported the diversity of VA homeless services and encouraged the development of specialized services to meet their diverse needs.

  3. The Availability and Utility of Services to Address Risk Factors for Recidivism among Justice-Involved Veterans.

    Science.gov (United States)

    Blonigen, Daniel M; Rodriguez, Allison L; Manfredi, Luisa; Britt, Jessica; Nevedal, Andrea; Finlay, Andrea K; Rosenthal, Joel; Smelson, David; Timko, Christine

    2017-10-01

    The availability and utility of services to address recidivism risk factors among justice-involved veterans is unknown. We explored these issues through qualitative interviews with 63 Specialists from the Department of Veterans Affairs' (VA) Veterans Justice Programs. To guide the interviews, we utilized the Risk-Need-Responsivity (RNR) model of offender rehabilitation. Specialists reported that justice-involved veterans generally have access to services to address most RNR-based risk factors (substance abuse; lack of positive school/work involvement; family/marital dysfunction; lack of prosocial activities/interests), but have less access to services targeting risk factors of antisocial tendencies and associates and empirically-based treatments for recidivism in VA. Peer-based services, motivational interviewing/cognitive-behavioral therapy, and Veterans Treatment Courts were perceived as useful to address multiple risk factors. These findings highlight potential gaps in provision of evidence-based care to address recidivism among justice-involved veterans, as well as promising policy-based solutions that may have widespread impact on reducing recidivism in this population.

  4. Using a service sector segmented approach to identify community stakeholders who can improve access to suicide prevention services for veterans.

    Science.gov (United States)

    Matthieu, Monica M; Gardiner, Giovanina; Ziegemeier, Ellen; Buxton, Miranda

    2014-04-01

    Veterans in need of social services may access many different community agencies within the public and private sectors. Each of these settings has the potential to be a pipeline for attaining needed health, mental health, and benefits services; however, many service providers lack information on how to conceptualize where Veterans go for services within their local community. This article describes a conceptual framework for outreach that uses a service sector segmented approach. This framework was developed to aid recruitment of a provider-based sample of stakeholders (N = 70) for a study on improving access to the Department of Veterans Affairs and community-based suicide prevention services. Results indicate that although there are statistically significant differences in the percent of Veterans served by the different service sectors (F(9, 55) = 2.71, p = 0.04), exposure to suicidal Veterans and providers' referral behavior is consistent across the sectors. Challenges to using this framework include isolating the appropriate sectors for targeted outreach efforts. The service sector segmented approach holds promise for identifying and referring at-risk Veterans in need of services. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  5. 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.

  6. Student Affairs as Perceived Through Abraham Maslow's Hierarchy of Needs.

    Science.gov (United States)

    Nowacki, Steven

    The needs of human behavior are explored and correlated to the various departments within Student Affairs in an effort to show how Student Affairs can satisfy those needs. Maslow's Hierarchy of needs is briefly explained and related to the following Student Affairs departments: Financial Aid, Student Management, Career Development and Placement,…

  7. 78 FR 51266 - Foreign Affairs Policy Board Meeting Notice

    Science.gov (United States)

    2013-08-20

    ..., 5 U.S.C. App., the Department of State announces a meeting of the Foreign Affairs Policy Board to take place on September 9, 2013, at the Department of State, Washington, DC. The Foreign Affairs Policy... national security interests; (3) tools and capacities of the civilian foreign affairs agencies; and (4...

  8. 78 FR 34702 - Foreign Affairs Policy Board Meeting Notice

    Science.gov (United States)

    2013-06-10

    ..., 5 U.S.C. App., the Department of State announces a meeting of the Foreign Affairs Policy Board to take place on July 15, 2013, at the Department of State, Washington, DC. The Foreign Affairs Policy... national security interests; (3) tools and capacities of the civilian foreign affairs agencies; and (4...

  9. Veterans' homecomings

    DEFF Research Database (Denmark)

    Sørensen, Birgitte Refslund

    2015-01-01

    social identity and find a meaningful life in the civilian world. When doing so, they need to navigate an ambiguous political environment and emergent public imaginaries of the veteran while also wrestling with their own military socialization and personal experiences of war. The certainty previously...... experiences, present conditions, and future ambitions are embedded in webs of concealment, disclosure, exposure, deception, lying, silence, and so forth, only partially controlled by the veterans themselves. The intricacies and anxieties associated with secrecy work are discussed in relation to three veteran...

  10. Mortality patterns among women Vietnam-era veterans: results of a retrospective cohort study.

    Science.gov (United States)

    Cypel, Yasmin; Kang, Han

    2008-03-01

    This research compiled and analyzed the data of two cohorts of women veterans who either served in Vietnam ("Vietnam veteran" cohort, n = 4586) or served elsewhere during the Vietnam War ("non-Vietnam veteran" cohort, n = 5325). All cause and cause-specific mortality were compared between Vietnam and non-Vietnam veteran cohorts, to the U.S. population, and to earlier research. Similar analyses were performed for nurses only. Vital status was determined through December 31, 2004, using primarily the U.S. Department of Veterans Affairs beneficiary file and the Social Security Administration Death Master File. Selected data were submitted to the National Center for Health Statistics for merging with the National Death Index to obtain cause of death. Cox proportional hazard analysis modeling was used to obtain adjusted relative risks (ARR). SEER( *)Stat software was used to compute standardized mortality ratios (SMR) for comparisons to the U.S. population. Women Vietnam veterans showed a significant deficit (ARR = 0.78, 95% confidence interval [CI] 0.62-0.98) in circulatory system disease relative to non-Vietnam veterans, but significant deficits also were observed when the Vietnam and non-Vietnam cohorts were each compared with women in the U.S. population (SMR = 0.65, 95% CI 0.54-0.77; SMR=0.82, 95% CI 0.73-0.93, respectively). Vietnam veterans had significantly lower mortality than women in the U.S. population for all causes (SMR = 0.87, 95% CI 0.80-0.94). Vietnam veterans were at significantly greater risk of mortality from motor vehicle accidents than non-Vietnam veterans (ARR = 2.60, 95% CI 1.22-5.55) and this appeared to be specific to service in Vietnam based on comparisons to the U.S. population. Patterns did not differ greatly for the analysis on nurse veterans or to earlier mortality studies of these cohorts. Mortality from motor vehicle accidents was significantly associated with service in Vietnam. Mortality patterns generally resembled those reported on

  11. Risk factors for ED use among homeless veterans.

    Science.gov (United States)

    Tsai, Jack; Rosenheck, Robert A

    2013-05-01

    Despite national concern about homeless veterans, there has been little examination of their use of emergency department (ED) services. This study examines factors related to the use of ED services in the Veterans Affairs (VA) healthcare system, where insurance is not a barrier to ambulatory healthcare. National VA administrative data from fiscal year 2010 are used to describe the proportions of ED users among homeless and domiciled VA patients. A case-control design is then used to compare homeless ED and non-ED users on sociodemographic and clinical correlates, as well as use of ambulatory care and psychotropic medications. Sixteen percent of domiciled VA patients used EDs at least once during the year and 1% were frequent ED users (>4 ED visits) compared to 45% of homeless VA patients, 10% who were frequent ED users. Among homeless VA patients, those who used EDs were more likely to have a range of psychiatric and medical conditions, and had more service visits and psychotropic medication prescriptions than non-ED users. Multivariate analyses suggest their risk for psychiatric and medical conditions increase their likelihood of using ED services. The high rate of ED use among homeless veterans is associated with significant morbidity, but also greater use of ambulatory care and psychotropics suggesting their ED use may reflect unmet psychosocial needs. Published by Elsevier Inc.

  12. Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria

    Science.gov (United States)

    Peterson, Rachel; Gundlapalli, Adi V.; Metraux, Stephen; Carter, Marjorie E.; Palmer, Miland; Redd, Andrew; Samore, Matthew H.; Fargo, Jamison D.

    2015-01-01

    Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations. PMID:26172386

  13. Homeless veterans' experiences with substance use, recovery, and treatment through photo elicitation.

    Science.gov (United States)

    Sestito, Samuel F; Rodriguez, Keri L; Saba, Shaddy K; Conley, James W; Mitchell, Michael A; Gordon, Adam J

    2017-01-01

    Homeless veterans often have addictions and comorbidities that complicate utilization of longitudinal health care services, such as primary care. An understanding of experiences of veterans enrolled in a Homeless Patient Aligned Care Team (H-PACT) may improve addiction treatment engagement in these settings. The authors aimed to describe H-PACT veterans' experiences with substance use (SU), substance use recovery (SUR), and substance use treatment (SUT). Homeless veterans were recruited from a veteran primary care medical home clinic between September 2014 and March 2015. Twenty veterans were given digital cameras and prompts for taking photographs about their health and health care and participated in 2 photo elicitation interviews. For this secondary analysis, transcripts from the audio-recorded interviews were analyzed by 2 coders using qualitative content analysis. The majority of participants (75%, n = 15) discussed SU, SUR, and/or SUT in regards to their health and health care utilization. SU themes centered on disclosure of addiction or dependency; substances used; repercussions of SU; SU as a coping mechanism; and association of SU with military service. SUR themes included disclosure of length of sobriety; perceived facilitators of SUR in health, beliefs, social, environmental, financial, and creative pursuit domains; and perceived barriers to SUR in beliefs, social, and environmental domains. SUT themes focused on perceived facilitators of SUT in access to Department of Veterans Affairs (VA) and non-VA services and social domains and perceived barriers to SUT in the social domain. Providers seeking to elicit addiction-related clinical history and facilitate SUR and SUT might look to the current findings for guidance. Provider training in motivational interviewing may be warranted, which allows for an exploration of health-related consequences of SU and supports patients' self-efficacy.

  14. Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria.

    Directory of Open Access Journals (Sweden)

    Rachel Peterson

    Full Text Available Researchers at the U.S. Department of Veterans Affairs (VA have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012 of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services, plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%. Adding allied V60 codes increased that to 31,260 (rate 3.3%. While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations.

  15. Changes in medication regimen complexity and the risk for 90-day hospital readmission and/or emergency department visits in U.S. Veterans with heart failure.

    Science.gov (United States)

    Yam, Felix K; Lew, Tiffany; Eraly, Satish A; Lin, Hsiang-Wen; Hirsch, Jan D; Devor, Michelle

    2016-01-01

    Heart failure (HF) hospitalization is associated with multiple medication modifications. These modifications often increase medication regimen complexity and may increase the risk of readmission and/or emergency department (ED) visit. To determine the association between changes in medication regimen complexity (MRC) during hospitalization of patients with heart failure and the risk of readmission or ED visit at 90 days. Secondary objectives include examining the association between changes in MRC and time to readmission as well as the relationship between number of medications and MRC. This was a retrospective cohort study that included U.S. Veterans hospitalized with heart failure. MRC was quantified using the medication regimen complexity index (MRCI). The change in MRCI was the difference between admission MRCI and discharge MRCI recorded during the index hospitalization. Demographic and clinical data were collected to characterize the study population. Patient data for up to one year after discharge was recorded to identify hospital readmissions and ED visits. A total of 174 patients were included in the analysis. Sixty-two patients (36%) were readmitted or had an ED visit at 90 days from the index hospitalization. The mean change (SD) in MRCI during the index hospitalization among the cohort was 4.7 (8.3). After multivariate logistic regression analysis, each unit increase in MRCI score was associated with a 4% lower odds of readmission or ED visit at 90 days but this finding was not statistically significant (OR 0.955; 95% CI 0.911-1.001). In the cox proportional hazard model, the median time to hospital readmission or ED visit was 214 days. Each unit increase in MRCI score was associated with a modest but non-significant increase in probability of survival from readmission or ED visit (HR 0.978; 95% CI 0.955, 1.001). Changes in medication regimen complexity that occur during hospitalization may also be associated with optimization of medical therapy and do

  16. 76 FR 67558 - Proposed Information Collection (Application for Work-Study Allowance) Activity: Comment Request

    Science.gov (United States)

    2011-11-01

    ... AFFAIRS Proposed Information Collection (Application for Work-Study Allowance) Activity: Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA), Department of Veterans Affairs (VA), is announcing an opportunity...

  17. Increasing Prevalence of Chronic Lung Disease in Veterans of the Wars in Iraq and Afghanistan.

    Science.gov (United States)

    Pugh, Mary Jo; Jaramillo, Carlos A; Leung, Kar-Wei; Faverio, Paola; Fleming, Nicholas; Mortensen, Eric; Amuan, Megan E; Wang, Chen-Pin; Eapen, Blessen; Restrepo, Marcos; Morris, Michael J

    2016-05-01

    Research from the wars in Afghanistan and Iraq have focused on traumatic brain injury (TBI) and mental health conditions; however, it is becoming clear that other health concerns, such as respiratory illnesses, warrant further scientific inquiry. Early reports from theater and postdeployment health assessments suggested an association with deployment-related exposures (e.g., sand, burn pits, chemical, etc.) and new-onset respiratory symptoms. We used data from Veterans Affairs medical encounters between fiscal years 2003 and 2011 to identify trends in chronic obstructive pulmonary disease, asthma, and interstitial lung disease in veterans. We used data from Veterans Affairs and Department of Defense sources to identify sociodemographic (age, sex, race), military (e.g., service branch, multiple deployments) and clinical characteristics (TBI, smoking) of individuals with and without chronic lung diseases. Generalized estimating equations found significant increases over time for chronic obstructive pulmonary disease and asthma in both unadjusted and adjusted analyses. Trends for interstitial lung disease were significant only in adjusted analyses. Age, smoking, and TBI were also significantly associated with chronic lung diseases; however, multiple deployments were not associated. Research is needed to identify which characteristics of deployment-related exposures are linked with chronic lung disease. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  18. Veterans Health Administration

    Science.gov (United States)

    ... code here VA » Veterans Health Administration Veterans Health Administration Veterans – Here's how to Avoid Getting the Flu ... Read more » VA Medical Centers The Veterans Health Administration is home to the United States’ largest integrated ...

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

    Directory of Open Access Journals (Sweden)

    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

  20. Intimate Partner Violence Victimization and Associated Implications for Health and Functioning Among Male and Female Post-9/11 Veterans.

    Science.gov (United States)

    Iverson, Katherine M; Vogt, Dawne; Maskin, Rachel M; Smith, Brian N

    2017-09-01

    There is increased emphasis on identifying patients who experience intimate partner violence (IPV) in Department of Veterans Affairs and other health care settings. A better understanding of IPV's implications for health and functioning is needed among post-911 Veterans, and especially male Veterans, to inform IPV screening and response. To identify past 6-month IPV experienced among partnered post-9/11 Veterans and examine sex-based associations between IPV and health. A national sample of Veterans completed a survey that included measures of IPV victimization and health. Types of IPV and relationships with health and functioning were examined separately for male and female Veterans. In total, 407 post-9/11 Veterans (52% women) in intimate relationships. IPV victimization was assessed with the Conflict Tactics Scales-Revised. Health and functioning indicators included posttraumatic stress disorder (PCL-5) and depression (Beck Depression Inventory-Primary Care) symptoms, physical health-related quality of life (Short-Form 12-item Health Survey), and occupational functioning (Inventory of Psychosocial Functioning). Nearly two thirds of both men and women reported past 6-month IPV, with greatest endorsement of psychological aggression (65% of men, 59% of women). A total of 8% of men and 7% of women reported physical IPV and 4% of men and 7% of women reported sexual IPV. Psychological aggression was strongly linked with mental health for both sexes and greater occupational impairment for men. Physical and sexual IPV were associated with more severe mental health symptoms for women while physical IPV was negatively associated with physical health-related quality of life for men. Recent IPV victimization, especially psychological aggression, is a key health issue for partnered male and female post-9/11 Veterans. Practice and research implications are discussed.

  1. Traumatic Brain Injury Severity, Comorbidity, Social Support, Family Functioning, and Community Reintegration Among Veterans of the Afghanistan and Iraq Wars.

    Science.gov (United States)

    Pugh, Mary Jo; Swan, Alicia A; Carlson, Kathleen F; Jaramillo, Carlos A; Eapen, Blessen C; Dillahunt-Aspillaga, Christina; Amuan, Megan E; Delgado, Roxana E; McConnell, Kimberly; Finley, Erin P; Grafman, Jordan H

    2018-02-01

    To examine the association between traumatic brain injury (TBI) severity; social, family, and community reintegration outcomes; and return to work status among post-9/11 veterans in Department of Veterans Affairs (VA) care. Retrospective observational cohort study. Mail/online survey fielded to a national sample of veterans. Sample of post-9/11 veterans with at least 3 years of VA care stratified according to TBI severity and comorbidities who completed and returned surveys (N=2023). Not applicable. Deployment Risk and Resilience Inventory-2 family functioning and social support subscales; Military to Civilian Questionnaire; and employment status. Bivariate analyses revealed that veterans with every classification of TBI severity reported significantly more difficulty on social, family, and community reintegration outcomes than those with no TBI. In the fully adjusted model, veterans with unclassified and moderate/severe TBI reported significantly more difficulty with community reintegration and were less likely to be employed relative to those with no TBI; those with unclassified TBI also reported significantly more difficulty with family functioning. Veterans with mild TBI also reported significantly more difficulty with community reintegration. This study provides insight into long-term outcomes associated with TBI in post-9/11 veterans and suggests that exposure to TBI has a negative effect on social and family functioning, community reintegration, and return to work even after controlling for comorbidity, deployment experiences, and sociodemographic characteristics. Additional research is required to explicate what appears to be complex interactions among TBI severity, psychosocial well-being, combat exposures, and socioeconomic resources in this population. Published by Elsevier Inc.

  2. Homeless Veterans' Use of Peer Mentors and Effects on Costs and Utilization in VA Clinics.

    Science.gov (United States)

    Yoon, Jean; Lo, Jeanie; Gehlert, Elizabeth; Johnson, Erin E; O'Toole, Thomas P

    2017-06-01

    The study compared health care utilization and costs among homeless veterans randomly assigned to peer mentors or usual care and described contacts with peer mentors. Homeless patients at four Department of Veterans Affairs clinics were randomly assigned to a peer mentor (N=195) or to usual care (N=180). Administrative data on utilization and costs over a six-month follow-up were combined with peer mentors' reports of patient contacts. Most patients (87%) in the peer mentor group had at least one peer contact. Patients in this group spent the largest proportions of time discussing housing and health issues with peer mentors and had more outpatient encounters than those in usual care, although differences were not significant. No other between-group differences were found in utilization or costs. Although significant impacts of peer mentors on health care patterns or costs were not detected, some patients had frequent contact with peer mentors.

  3. Veterans and Homelessness

    Science.gov (United States)

    2013-11-29

    health care and rehabilitation services for homeless veterans (the Health Care for Homeless Veterans and Domiciliary Care for Homeless Veterans...Health Care for Homeless Veterans ................................................................................... 19 Domiciliary Care for Homeless...for Homeless Veterans (HCHV), Domiciliary Care for Homeless Veterans (DCHV), the Compensated Work Therapy/Therapeutic Residences Program, and the

  4. A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans: A Randomized Clinical Trial.

    Science.gov (United States)

    Allen, Kelli D; Yancy, William S; Bosworth, Hayden B; Coffman, Cynthia J; Jeffreys, Amy S; Datta, Santanu K; McDuffie, Jennifer; Strauss, Jennifer L; Oddone, Eugene Z

    2016-01-19

    Management of osteoarthritis requires both medical and behavioral strategies, but some recommended therapies are underused. To examine the effectiveness of a combined patient and provider intervention for improving osteoarthritis outcomes. Cluster randomized clinical trial with assignment to osteoarthritis intervention and usual care groups. (ClinicalTrials.gov: NCT01130740). Department of Veterans Affairs Medical Center in Durham, North Carolina. 30 providers (clusters) and 300 outpatients with symptomatic hip or knee osteoarthritis. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through the electronic medical record. The primary outcome was total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months. Secondary outcomes were WOMAC function and pain subscale scores, physical performance (Short Physical Performance Battery), and depressive symptoms (Patient Health Questionnaire-8). Linear mixed models that were adjusted for clustering of providers assessed between-group differences in improvement in outcomes. At 12 months, WOMAC scores were 4.1 points lower (indicating improvement) in the osteoarthritis intervention group versus usual care (95% CI, -7.2 to -1.1 points; P = 0.009). WOMAC function subscale scores were 3.3 points lower in the intervention group (CI, -5.7 to -1.0 points; P = 0.005). WOMAC pain subscale scores (P = 0.126), physical performance, and depressive symptoms did not differ between groups. Although more patients in the osteoarthritis intervention group received provider referral for recommended osteoarthritis treatments, the numbers who received them did not differ. The study was conducted in a single Veterans Affairs medical center. The combined patient and provider intervention resulted in

  5. Service Utilization of Veterans Dually Eligible for VA...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Service Utilization of Veterans Dually Eligible for VA and Medicare Fee-For-Service, 1999-2004 According to findings in Service Utilization of Veterans Dually...

  6. 76 FR 55570 - Per Diem Payments for the Care Provided to Eligible Veterans Evacuated From a State Home as a...

    Science.gov (United States)

    2011-09-08

    ... veteran receiving nursing home care, domiciliary care, and adult day health care in State home facilities... AFFAIRS 38 CFR Parts 17 and 51 RIN 2900-AN63 Per Diem Payments for the Care Provided to Eligible Veterans... for providing a specified level of care to eligible veterans in a facility that is officially...

  7. War, its aftermath, and U.S. health policy: toward a comprehensive health program for America's military personnel, veterans, and their families.

    Science.gov (United States)

    Jackonis, Michael J; Deyton, Lawrence; Hess, William J

    2008-01-01

    This essay discusses the challenges faced by veterans returning to society in light of the current organization and structure of the military, veterans', and overall U.S. health care systems. It also addresses the need for an integrated health care financing and delivery system to ensure a continuum of care for service members, veterans, dependents, and other family members. The health care systems of both the Department of Defense and the Department of Veterans Affairs execute their responsibilities to active duty service members, while their families and retirees/veterans are under separate legal authorities. Although they perform their mandates with extraordinary commitment and demonstrably high quality, both systems need to explore improved communication, coordination, and sharing, as well as increased collaboration with the Department of Health and Human Services programs serving the same populations, far beyond current efforts. The health care-related missions and the locus of health care delivery of each agency are admittedly unique, but their distinctions must not be permitted to impede system integration and coordination of a continuum of care provided to the men and women who serve the nation, and their families.

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

    Science.gov (United States)

    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.

  9. Veterans and Pell Grant Eligibility in 1982. Joint Hearing before the Subcommittee on Postsecondary Education of the Committee on Education and Labor and the Subcommittee on Education, Training and Employment of the Committee on Veterans Affairs, House of Representatives, Ninety-Seventh Congress, Second Session. Serial No. 97-81.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. House Committee on Education and Labor.

    This is a Congressional hearing to review and receive comment on H.R. 6190, legislation that would amend Title 38, United States Code, to exempt GI bill educational benefits from the determination of a veteran's eligibility for Federal educational benefits. Testimony includes statements, prepared statements, letters, and supplemental materials…

  10. 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.

  11. Mortality ascertainment of women veterans: a comparison of sources of vital status information, 1979-2002.

    Science.gov (United States)

    Savas, Lara S; del Junco, Deborah J; Bastian, Lori A; Vernon, Sally W

    2009-01-01

    To support health research on the unique cohort of women with a history of military service, this study assessed the completeness of mortality ascertainment for Texas women veterans in Department of Veterans Affairs (VA) and non-VA databases. We examined female veteran-specific mortality ascertainment comparing the VA Beneficiary Identification and Records Locator Subsystem Death File (BIRLS DF), VA Patient Treatment Files (PTF), and Social Security Administration-Death Master File (SSA-DMF) with Texas death certificate data. Databases were deterministically cross-linked, using female sex and social security numbers. Deterministic and probabilistic linkage methods were also compared. Of 6,297 decedents identified by death certificates, SSA-DMF, BIRLS DF, and PTF databases identified 97.5% collectively and 94%, 77%, and 5% individually. Compared with Texas death certificates, sensitivity of VA and SSA databases improved with increasing age. This study highlights that although the VA and SSA administrative databases have less complete ascertainment for younger decedents, combined these electronic databases provide nearly complete ascertainment for women veterans. Challenges related to large female-specific cross-linkage studies are explored, and a need to examine methods for female-specific health research studies in the general population is identified.

  12. Paternal history of mental illness associated with posttraumatic stress disorder among veterans.

    Science.gov (United States)

    Shepherd-Banigan, Megan; Kelley, Michelle L; Katon, Jodie G; Curry, John F; Goldstein, Karen M; Brancu, Mira; Wagner, H Ryan; Fecteau, Teresa E; Van Houtven, Courtney H

    2017-10-01

    This study examined the association between parent and family reported history of non-PTSD mental illness (MI), PTSD specifically, and substance use problems, and participant clinical diagnosis of PTSD. Participants were drawn from the US Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) Post-Deployment Mental Health (PDMH) study (n = 3191), an ongoing multi-site cohort study of US Afghanistan and Iraq conflict era veterans. Participants who recalled a father history of PTSD had a 26-percentage point higher likelihood of meeting criteria for PTSD; while participants reporting any family history of PTSD had a 15-percentage point higher probability of endorsing symptoms consistent with PTSD. Mother history of substance use problems was associated with Veteran current PTSD, but results were sensitive to model specification. Current PTSD was not associated with family/parent history of non-PTSD mental illness, mother history of PTSD, or family/father history of substance use problems. Family history of PTSD may increase PTSD risk among veterans exposed to trauma, particularly when a father history is reported. Knowledge of family history could improve clinical decision-making for trauma-exposed individuals and allow for more effective targeting of programs and clinical services. Published by Elsevier B.V.

  13. 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.

  14. Associations Between Provider Designation and Female-specific Cancer Screening in Women Veterans

    Science.gov (United States)

    Bean-Mayberry, Bevanne; Bastian, Lori; Trentalange, Mark; Murphy, Terrence E.; Skanderson, Melissa; Allore, Heather; Reyes-Harvey, Evelyn; Maisel, Natalya C.; Gaetano, Vera; Wright, Steven; Haskell, Sally; Brandt, Cynthia

    2017-01-01

    Background In 2010, the Department of Veterans Affairs Healthcare System (VA) implemented policy to provide Comprehensive Primary Care (for acute, chronic, and female-specific care) from designated Women’s Health providers (DWHPs) at all VA sites. However, since that time no comparisons of quality measures have been available to assess the level of care for women Veterans assigned to these providers. Objectives To evaluate the associations between cervical and breast cancer screening rates among age-appropriate women Veterans and designation of primary-care provider (DWHP vs. non-DWHP). Research Design Cross-sectional analyses using the fiscal year 2012 data on VA women’s health providers, administrative files, and patient-specific quality measures. Subjects The sample included 37,128 women Veterans aged 21 through 69 years. Measures Variables included patient demographic and clinical factors (ie, age, race, ethnicity, mental health diagnoses, obesity, and site), and provider factors (ie, DWHP status, sex, and panel size). Screening measures were defined by age-appropriate subgroups using VA national guidelines. Results Female-specific cancer screening rates were higher among patients assigned to DWHPs (cervical cytology 94.4% vs. 91.9%, P screening (odds ratio, 1.26; 95% confidence interval, 1.07–1.47; P screening (odds ratio, 1.24; 95% CI, 1.10–1.39; P screening within VA. Separate evaluation of sex neutral measures is needed to determine whether other measures accrue benefits for patients with DWHPs. PMID:25767975

  15. Impact of the seeking safety program on clinical outcomes among homeless female veterans with psychiatric disorders.

    Science.gov (United States)

    Desai, Rani A; Harpaz-Rotem, Ilan; Najavits, Lisa M; Rosenheck, Robert A

    2008-09-01

    Seeking Safety is a manualized cognitive-behavioral therapy intervention that is designed to treat clients with comorbid substance abuse and trauma histories. This study examined its effectiveness when used with homeless women veterans with psychiatric or substance abuse problems at 11 Department of Veterans Affairs medical centers that had Homeless Women Veterans Programs. The intervention consists of 25 sessions that cover topics to help build safety in clients' lives and is present-focused, offering psychoeducation and coping skills. A cohort of homeless women veterans (N=359) was recruited before Seeking Safety was implemented (phase I). After clinicians were trained and certified in Seeking Safety, a postimplementation cohort was recruited and offered Seeking Safety treatment (phase II, N=91). Phase I lasted from January 2000 to June 2003. Phase II lasted from June 2003 to December 2005. The intervention lasted for six months. All participants were interviewed every three months for one year and received intensive case management and other services during the study. Mixed models were used to compare one-year clinical outcomes across phases. There were few differences across groups at baseline. All women entering the Homeless Women Veterans Programs showed significant improvement on most clinical outcome measures over one year. The Seeking Safety cohort reported significantly better outcomes over one year in employment, social support, general symptoms of psychiatric distress, and symptoms of posttraumatic stress disorder, particularly in the avoidance and arousal clusters. However, the Seeking Safety cohort was significantly more likely to have used drugs in the past 30 days. Seeking Safety appears to have had a moderately beneficial impact on several clinical outcomes. Although the nonequivalent comparison groups and low follow-up rates limit the internal validity of these results, availability of Seeking Safety may be of benefit for homeless female veterans

  16. Differential impact of supported housing on selected subgroups of homeless veterans with substance abuse histories.

    Science.gov (United States)

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

    2012-12-01

    Studies have demonstrated that supported housing is an effective intervention for individuals who are homeless and have a mental illness or substance use disorder. This study examined data from an experimental trial of the U.S. Department of Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program to identify differences in the program's impact on subgroups defined by sociodemographic or clinical characteristics. Data were analyzed from 259 male homeless veterans with substance abuse problems who were randomly assigned to HUD-VASH (intensive case management [ICM] plus rent subsidy vouchers), ICM only, or treatment as usual between June 1992 and December 1995. Four subgroups were defined: African American versus Caucasian, younger versus older than 42.3 years, co-occurring diagnoses of mental illness versus diagnosis of a substance use disorder only, and active versus less active substance use upon program entry. Mixed models were used to identify significant interactions between HUD-VASH assignment and each subgroup. Compared with ICM alone, HUD-VASH was associated with more positive housing outcomes for Caucasians, veterans with co-occurring mental disorders, and veterans who were active substance users. HUD-VASH was associated with more positive socioclinical outcomes for African Americans. No differences were observed in housing or socioclinical outcomes as a function of age. Among homeless veterans with a substance use disorder, Caucasians and those with active substance use showed greater housing benefits than other veterans from HUD-VASH than from ICM alone. African Americans showed greater socioclinical benefit than Caucasians from HUD-VASH versus ICM. Interaction analysis deserves further study.

  17. 76 FR 81984 - Bureau of International Labor Affairs; Office of Trade and Labor Affairs; Bahrain-United States...

    Science.gov (United States)

    2011-12-29

    ... of the Secretary Bureau of International Labor Affairs; Office of Trade and Labor Affairs; Bahrain--United States Free Trade Agreement; Notice of Extension of the Period of Review for Submission 2011-01 AGENCY: Bureau of International Labor Affairs, U.S. Department of Labor. ACTION: Notice. SUMMARY: The...

  18. Important aspects of end-of-life care among veterans: implications for measurement and quality improvement.

    Science.gov (United States)

    Casarett, David; Pickard, Amy; Amos Bailey, F; Ritchie, Christine; Furman, Christian; Rosenfeld, Ken; Shreve, Scott; Shea, Judy A

    2008-02-01

    To identify aspects of end-of-life care in the U.S. Department of Veterans Affairs (VA) health care system that are not assessed by existing survey instruments and to identify issues that may be unique to veterans, telephone interviews using open-ended questions were conducted with family members of veterans who had received care from a VA facility in the last month of life. Responses were compared to validated end-of-life care assessment instruments in common use. The study took place in four VA medical centers and one family member per patient was invited to participate, selected from medical records using predefined eligibility criteria. These family members were asked to describe positive and negative aspects of the care the veteran received in the last month of life. Interview questions elicited perceptions of care both at VA sites and at non-VA sites. Family reports were coded and compared with items in five existing prospective and retrospective instruments that assess the quality of care that patients receive near the end of life. Interviews were completed with 66 family members and revealed 384 codes describing both positive and negative aspects of care during the last month of life. Almost half of these codes were not represented in any of the five reference instruments (n=174; 45%). These codes, some of which are unique to the veteran population, were grouped into eight categories: information about VA benefits (n=36; 55%), inpatient care (n=36; 55%), access to care (n=33; 50%), transitions in care (n=32; 48%), care that the veteran received at the time of death (n=31; 47%), home care (n=26; 40%), health care facilities (n=12; 18%), and mistakes and complications (n=18; 27%). Although most of the reference instruments assessed some aspect of these categories, they did not fully capture the experiences described by our respondents. These data suggest that many aspects of veterans' end-of-life care that are important to their families are not assessed by

  19. 32 CFR 644.405 - Transfers to Veterans Administration.

    Science.gov (United States)

    2010-07-01

    ... Transfers to Veterans Administration. 38 U.S.C. 5003 authorizes the Secretaries of the military departments to transfer, without reimbursement, to the Veterans Administration, facilities, supplies, equipment... 32 National Defense 4 2010-07-01 2010-07-01 true Transfers to Veterans Administration. 644.405...

  20. educational affairs.

    Science.gov (United States)

    Nielsen-Gammon, John W.; Biggerstaff, Michael I.; Alcorn, Marion E.; Austin, Daniel; Bowman, Kenneth P.; Djuri, Duan; Guynes, Jerry; Panetta, R. Lee; White, Robert; Wicker, Louis J.

    1996-12-01

    Improvements in computer technology, particularly the explosive growth of Internet applications, have created unprecedented educational opportunities, but with concomitantly little experience on how educators can best take advantage of them. The Laboratory for the Exploration of Atmospheric Processes (LEAP) is a new 15-workstation computer laboratory operated by the Department of Meteorology at Texas A&M University. The setup and use of LEAP in a variety of undergraduate and graduate courses are described. Particular emphasis is placed on applications that use the World Wide Web or specialized meteorological software, with the aims of fostering greater discussion of computer-based teaching methods in meteorology and sharing and improvement of Web-based teaching materials.

  1. Health Programs for Veterans

    Science.gov (United States)

    ... Health Administration » Health Programs for Veterans Veterans Health Administration Health Programs for Veterans Beyond the doctors and ... families of patients receiving medical care at major military and VA medical centers Geriatrics & Extended Care Geriatric ...

  2. Chronic disease management for recently homeless veterans: a clinical practice improvement program to apply home telehealth technology to a vulnerable population.

    Science.gov (United States)

    Gabrielian, Sonya; Yuan, Anita; Andersen, Ronald M; McGuire, James; Rubenstein, Lisa; Sapir, Negar; Gelberg, Lillian

    2013-03-01

    Although vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a "digital divide" in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Affairs (VA) HIT-care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the US Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. Peers were used to support patient participation. CCHT uses in-home messaging devices to provide health education and daily questions about clinical indicators from chronic illness care guidelines, with patient responses reviewed by VHA nurses. Patients could also receive adjunctive peer support. We used medical record review, Veteran interviews, and staff surveys to "diagnose" barriers to CCHT use, assess program acceptability, explore the role of peer support, and inform future quality improvement. Fourteen eligible Veterans in HUD-VASH agreed to CCHT participation. Ten of these Veterans opted to have adjunctive peer support and the other 4 enrolled in CCHT usual care. Although barriers to enrollment/engagement must be addressed, this subset of Veterans in HUD-VASH was satisfied with CCHT. Most Veterans did not require support from peers to engage in CCHT but valued peer social assistance amidst the isolation felt in their scattered-site homes. HIT tools hold promise for in-home care management for recently housed Veterans. Patient-level barriers to enrollment must be addressed in the next steps of quality improvement, testing and evaluating peer-driven CCHT recruitment.

  3. Retaining homeless veterans in outpatient care: a pilot study of mobile phone text message appointment reminders.

    Science.gov (United States)

    McInnes, D Keith; Petrakis, Beth Ann; Gifford, Allen L; Rao, Sowmya R; Houston, Thomas K; Asch, Steven M; O'Toole, Thomas P

    2014-09-01

    We examined the feasibility of using mobile phone text messaging with homeless veterans to increase their engagement in care and reduce appointment no-shows. We sent 2 text message reminders to participants (n = 20) before each of their outpatient appointments at an urban Veterans Affairs medical center. Evaluation included pre- and postsurvey questionnaires, open-ended questions, and review of medical records. We estimated costs and savings of large-scale implementation. Participants were satisfied with the text-messaging intervention, had very few technical difficulties, and were interested in continuing. Patient-cancelled visits and no-shows trended downward from 53 to 37 and from 31 to 25, respectively. Participants also experienced a statistically significant reduction in emergency department visits, from 15 to 5 (difference of 10; 95% confidence interval [CI]  = 2.2, 17.8; P = .01), and a borderline significant reduction in hospitalizations, from 3 to 0 (difference of 3; 95% CI = -0.4, 6.4; P = .08). Text message reminders are a feasible means of reaching homeless veterans, and users consider it acceptable and useful. Implementation may reduce missed visits and emergency department use, and thus produce substantial cost savings.

  4. Examining aggression in male Vietnam veterans who receive VA services: the role of traumatic events and combat exposure.

    Science.gov (United States)

    Lenhardt, Jenna M; Howard, Jamie M; Taft, Casey T; Kaloupek, Danny G; Keane, Terence M

    2012-08-01

    We examined the relationship between trauma exposure and the perpetration of aggression by male Vietnam veterans (N = 1,328) using archival data from a multisite study conducted by the Cooperative Studies Program of the Department of Veteran Affairs (CSP-334) in the early 1990s. Both traumatic events in civilian life and combat exposure were examined as correlates of aggression. Results indicated that pre- and postmilitary traumatic events and combat exposure were all related to perpetration of aggression at the bivariate level; r = .07, r = .20, and r = .13, respectively. When these variables were examined simultaneously, only combat exposure (β = .14, p traumatic events (β = .20, p effects were found for civilian traumatic events and combat in relation to aggression. Results highlight the importance of attending to the psychological aftermath of exposure to traumatic events experienced during and following deployment before aggressive patterns develop. Copyright © 2012 International Society for Traumatic Stress Studies.

  5. 30th November 2010 - Norwegian Ministry of Government Administration, Reform and Church Affairs State Secretary R. Valle signing the guest book with Head of International Relations F. Pauss and Director for Research and Scientific Computing S. Bertolucci; visiting CERN Computer Centre with Information Technology Department Head F. Hemmer.

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    30th November 2010 - Norwegian Ministry of Government Administration, Reform and Church Affairs State Secretary R. Valle signing the guest book with Head of International Relations F. Pauss and Director for Research and Scientific Computing S. Bertolucci; visiting CERN Computer Centre with Information Technology Department Head F. Hemmer.

  6. 17 October 2013 - C. Ashton High Representative of the European Union for Foreign Affairs and Security Policy, Vice-President of the European Commission visiting the ATLAS cavern with ATLAS Collaboration Spokesperson D. Charlton; visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry and signing the Guest book with CERN Director-General R. Heuer.

    CERN Multimedia

    Maximilien Brice

    2013-01-01

    17 October 2013 - C. Ashton High Representative of the European Union for Foreign Affairs and Security Policy, Vice-President of the European Commission visiting the ATLAS cavern with ATLAS Collaboration Spokesperson D. Charlton; visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry and signing the Guest book with CERN Director-General R. Heuer.

  7. 77 FR 70210 - Agency Information Collection (VA Subcontracting Report for Service Disabled Veteran-owned Small...

    Science.gov (United States)

    2012-11-23

    ... AFFAIRS Agency Information Collection (VA Subcontracting Report for Service Disabled Veteran-owned Small....'' SUPPLEMENTARY INFORMATION: Title: VA Subcontracting Report for Service Disabled Veteran-owned Small Business and... from subcontractors to compare information obtained from subcontracting plans submitted by prime...

  8. 76 FR 70827 - Proposed Information Collection (Board of Veterans' Appeals Customer Satisfaction With Hearing...

    Science.gov (United States)

    2011-11-15

    ... AFFAIRS Proposed Information Collection (Board of Veterans' Appeals Customer Satisfaction With Hearing... techniques or the use of other forms of information technology. Title: Board of Veterans' Appeals Customer Satisfaction with Hearing Survey Card, VA Form 0745. OMB Control Number: 2900-0548. Type of Review: Extension...

  9. 77 FR 3843 - Agency Information Collection (Board of Veterans' Appeals Customer Satisfaction With Hearing...

    Science.gov (United States)

    2012-01-25

    ... AFFAIRS Agency Information Collection (Board of Veterans' Appeals Customer Satisfaction With Hearing... techniques or the use of other forms of information technology. Title: Board of Veterans' Appeals Customer Satisfaction with Hearing Survey, VA Form 0745. OMB Control Number: 2900-0548. Type of Review: Extension of a...

  10. 76 FR 24570 - Proposed Information Collection (Veterans Mortgage Life Insurance-Change of Address Statement...

    Science.gov (United States)

    2011-05-02

    ... AFFAIRS Proposed Information Collection (Veterans Mortgage Life Insurance--Change of Address Statement... Mortgage Life Insurance. DATES: Written comments and recommendations on the proposed collection of... information technology. Title: Veterans Mortgage Life Insurance--Change of Address Statement, VA Form 29-0563...

  11. Veterans Health Administration: Actions Needed to Better Recruit and Retain Clinical and Administrative Staff

    Science.gov (United States)

    2017-03-22

    VETERANS HEALTH ADMINISTRATION Actions Needed to Better Recruit and Retain Clinical and Administrative Staff Statement of...the Subcommittee on Health, Committee on Veterans’ Affairs, House of Representatives. March 22, 2017 VETERANS HEALTH ADMINISTRATION Actions...Needed to Better Recruit and Retain Clinical and Administrative Staff What GAO Found Challenges in recruiting and retaining both clinical and human

  12. 77 FR 66069 - Veterans' Group Life Insurance (VGLI) No-Health Period Extension

    Science.gov (United States)

    2012-11-01

    ..., particularly disabled veterans who may not qualify for private life insurance due to their disabilities. In... AFFAIRS 38 CFR Part 9 RIN 2900-AO24 Veterans' Group Life Insurance (VGLI) No-Health Period Extension... Life Insurance (VGLI) to extend to 240 days the current 120-day ``no-health'' period during which...

  13. 77 FR 7243 - Proposed Information Collection (Operation Enduring Freedom/Operation Iraqi Freedom Veterans...

    Science.gov (United States)

    2012-02-10

    ... AFFAIRS Proposed Information Collection (Operation Enduring Freedom/ Operation Iraqi Freedom Veterans... ``OMB Control No. 2900-0728.'' SUPPLEMENTARY INFORMATION: Title: Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs Assessment, VA Form 10-21091. OMB Control Number: 2900-0728. Type of...

  14. 78 FR 4983 - Proposed Information Collection; Women Veterans Healthcare Barriers Survey Activity: Comment Request

    Science.gov (United States)

    2013-01-23

    ... AFFAIRS Proposed Information Collection; Women Veterans Healthcare Barriers Survey Activity: Comment... response to the notice to conduct an independent comprehensive study of the barriers to the provision of comprehensive health care for women Veterans. DATES: Written comments and recommendations on the proposed...

  15. Moving From Discovery to System-Wide Change: The Role of Research in a Learning Health Care System: Experience from Three Decades of Health Systems Research in the Veterans Health Administration.

    Science.gov (United States)

    Atkins, David; Kilbourne, Amy M; Shulkin, David

    2017-03-20

    The Veterans Health Administration is unique, functioning as an integrated health care system that provides care to more than six million veterans annually and as a home to an established scientific enterprise that conducts more than $1 billion of research each year. The presence of research, spanning the continuum from basic health services to translational research, has helped the Department of Veterans Affairs (VA) realize the potential of a learning health care system and has contributed to significant improvements in clinical quality over the past two decades. It has also illustrated distinct pathways by which research influences clinical care and policy and has provided lessons on challenges in translating research into practice on a national scale. These lessons are increasingly relevant to other health care systems, as the issues confronting the VA-the need to provide timely access, coordination of care, and consistent high quality across a diverse system-mirror those of the larger US health care system.

  16. Mental and Physical Health Conditions in US Combat Veterans: Results From the National Health and Resilience in Veterans Study.

    Science.gov (United States)

    Thomas, Melissa M; Harpaz-Rotem, Ilan; Tsai, Jack; Southwick, Steven M; Pietrzak, Robert H

    2017-06-22

    To identify sociodemographic and military characteristics of combat-exposed and non-combat-exposed veterans in the United States and to compare rates of mental and physical health conditions in these populations. Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a contemporary, nationally representative survey of 1,480 US veterans conducted September-October 2013. Poststratification weights were applied to analyses to permit generalizability of results to the US veteran population. Outcomes measured included lifetime and current psychiatric disorders and physical health conditions. A total 38% of US veterans reported being exposed to combat. Compared to noncombat veterans, combat veterans were younger, had greater household income, and served a greater number of years in the military; were more likely to be male, to have served in the Marine Corps, and to use the Veterans Affairs Healthcare System as their main source of health care; and reported a greater number of lifetime potentially traumatic events. After adjustment for these sociodemographic and military differences, combat veterans were more than 3 times as likely as noncombat veterans to screen positive for lifetime posttraumatic stress disorder (PTSD) and more than twice as likely for current PTSD and had 82% greater odds of screening positive for current generalized anxiety disorder. After additionally controlling for lifetime diagnoses of PTSD and depression, alcohol or drug use disorder, and nicotine dependence, combat veterans had 68% greater odds of having attempted suicide and 85% and 38% greater odds of being diagnosed with a stroke and chronic pain, respectively. Younger combat veterans were more likely than older combat veterans to screen positive for lifetime (30.6% vs 10.1%) and current PTSD (19.2% vs 4.9%) and suicidal ideation (18.6% vs 6.9%) and to have been diagnosed with migraine headaches (12.8% vs 2.1%), while older combat veterans were more likely than

  17. Military service member and veteran self reports of efficacy of cranial electrotherapy stimulation for anxiety, posttraumatic stress disorder, insomnia, and depression.

    Science.gov (United States)

    Kirsch, Daniel L; Price, Larry R; Nichols, Francine; Marksberry, Jeffrey A; Platoni, Katherine T

    2014-01-01

    Cranial electrotherapy stimulation (CES) is being prescribed for service members and veterans for the treatment of anxiety, posttraumatic stress disorder (PTSD), insomnia and depression. The purpose of this study was to examine service members' and veterans' perceptions of the effectiveness and safety of CES treatment. Service members and veterans (N=1,514) who had obtained a CES device through the Department of Defense or Veterans Affairs Medical Center from 2006-2011 were invited to participate in the web based survey via email. One hundred fifty-two participants returned questionnaires. Data were analyzed using descriptive statistics. Participants reported clinical improvement of 25% or more from using CES for anxiety (66.7%), PTSD (62.5%), insomnia (65.3%) and depression (53.9%). The majority of these participants reported clinical improvement of 50% or more. Respondents also perceived CES to be safe (99.0%). Those individuals who were not taking any prescription medication rated CES more effective than the combined CES and prescription medication group. CES provides service members and veterans with a safe, noninvasive, nondrug, easy to use treatment for anxiety, PTSD, insomnia, and depression that can be used in the clinical setting or self-directed at home.

  18. A Randomized Trial of Dialectical Behavior Therapy in High-Risk Suicidal Veterans.

    Science.gov (United States)

    Goodman, Marianne; Banthin, David; Blair, Nicholas J; Mascitelli, Kathryn A; Wilsnack, Jaime; Chen, Jennifer; Messenger, Julie W; Perez-Rodriguez, M Mercedes; Triebwasser, Joseph; Koenigsberg, Harold W; Goetz, Raymond R; Hazlett, Erin A; New, Antonia S

    2016-12-01

    Despite advances in suicide prevention implemented throughout the US Department of Veterans Affairs (VA) including the hiring of Suicide Prevention Coordinators (SPCs) at every VA hospital, enhanced monitoring, and the availability of 24-hour crisis hotline services, suicide by veterans remains a critical problem affecting 20 veterans daily. Few empirically based treatment strategies for suicide prevention for postdeployment military personnel exist. This study aimed to test whether dialectical behavior therapy (DBT), one of the few psychosocial treatments with proven efficacy in diminishing suicidal behavior in individuals with personality disorder, can be applied to veterans irrespective of personality diagnosis. From January 2010 to December 2014, 91 nonpsychotic veterans at high risk for suicide (61 men, 30 women) were randomly assigned to a 6-month treatment trial at a veterans' medical center comparing standard DBT to treatment as usual (TAU) and followed for 6 months after trial completion. Primary outcome was suicide attempts, measured with the Columbia-Suicide Severity Rating Scale, and secondary outcomes were suicide ideation, depression, hopelessness, and anxiety. There were no exclusions pertaining to substance abuse, homelessness, or medical comorbidity. Both DBT and TAU resulted in improvements in suicidal ideation, depression, and anxiety during the course of the 6-month treatment trial that did not differ between treatment arms. Survival analyses for suicide attempts and hospitalizations did not differ between treatment arms. However, DBT subjects utilized significantly more individual mental health services than TAU subjects (28.5 ± 19.6 vs 14.7 ± 10.9, F₁,₇₇ = 11.60, P = .001). This study is the first to examine 6-month DBT in a mostly male, veteran population. Increased mental health treatment service delivery, which included enhanced monitoring, outreach, and availability of a designated SPC, did not yield statistically significant

  19. Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison.

    Science.gov (United States)

    Carlson, Kathleen F; Taylor, Brent C; Hagel, Emily M; Cutting, Andrea; Kerns, Robert; Sayer, Nina A

    2013-01-01

    To examine the prevalence and correlates of headache diagnoses, by gender, among Iraq and Afghanistan War Veterans who use Department of Veterans Affairs (VA) health care. Understanding the health care needs of recent Veterans, and how these needs differ between women and men, is a priority for the VA. The potential for a large burden of headache disorders among Veterans seeking VA services exists but has not been examined in a representative sample. We conducted a historical cohort study using national VA inpatient and outpatient data from fiscal year 2011. Participants were all (n = 470,215) Iraq and Afghanistan War Veteran VA users in 2011; nearly 13% were women. We identified headache diagnoses using International Classification of Diseases (ICD-9) diagnosis codes assigned during one or more VA inpatient or outpatient encounters. Descriptive analyses included frequencies of patient characteristics, prevalence and types of headache diagnoses, and prevalence of comorbid diagnoses. Prevalence ratios (PR) with 95% confidence intervals (CI) were used to estimate associations between gender and headache diagnoses. Multivariate models adjusted for age and race. Additional models also adjusted for comorbid diagnoses. In 2011, 56,300 (11.9%) Veterans received a headache-related diagnosis. While controlling for age and race, headache diagnoses were 1.61 times more prevalent (95% CI = 1.58-1.64) among women (18%) than men (11%). Most of this difference was associated with migraine diagnoses, which were 2.66 times more prevalent (95% CI = 2.59-2.73) among women. Cluster and post-traumatic headache diagnoses were less prevalent in women than in men. These patterns remained the same when also controlling for comorbid diagnoses, which were common among both women and men with headache diagnoses. The most prevalent comorbid diagnoses examined were depression (46% of women with headache diagnoses vs 40% of men), post-traumatic stress disorder (38% vs 58%), and back

  20. Impact of Supported Housing on Social Relationships Among Homeless Veterans.

    Science.gov (United States)

    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.