Development and psychometric assessment of a survey to measure specialty care coordination as experienced by primary care providers.

Objective: To assess the psychometric properties and construct validity of a survey of primary care providers' (PCPs') experience of specialty care coordination, which is a counterpart to our existing survey ("CSC-Specialist") that measures specialists' experience of specialty care coordination.

Data Sources: We surveyed PCPs from Veterans Health Administration medical centers and community-based outpatient clinics nationwide (N = 1576) in April 2018.

Study Design: We developed candidate items through literature review, existing surveys, PCP interviews, and expert opinion.

Coordination of Care as Experienced by the Specialist: Validation of the CSC-Specialist Survey in the Private Sector and the Effect of a Shared Electronic Health Record.

Background: We previously developed 2 complementary surveys to measure coordination of care as experienced by the specialist and the primary care provider (PCP). These Coordination of Specialty Care (CSC) surveys were developed in the Veterans Health Administration (VA), under an integrated organizational umbrella that includes a shared electronic health record (EHR).

Objective: To develop an augmented version of the CSC-Specialist in the private sector and use that version (CSC-Specialist 2.

Development and psychometric assessment of a novel survey to measure care coordination from the specialist's perspective.

Objective: To develop an online survey of care coordination with primary care providers as experienced by medical specialists, evaluate its psychometric properties, and test its construct validity.

Data Sources: Physicians (N = 633) from 13 medical specialties across the Veterans Health Administration.

Study Design: We developed the survey based on prior work (literature review, specialist interviews) and by adapting existing measures and developing new items.

A two-state comparative implementation of peer-support intervention to link veterans to health-related services after incarceration: a study protocol.

Background: Approximately 600,000 persons are released from prison annually in the United States. Relatively few receive sufficient re-entry services and are at risk for unemployment, homelessness, poverty, substance abuse relapse and recidivism. Persons leaving prison who have a mental illness and/or a substance use disorder are particularly challenged.

Electronic consultations (e-consults) to improve access to specialty care: a systematic review and narrative synthesis.

Background: We define electronic consultations ("e-consults") as asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. Our goal was to systematically review and summarize the literature describing the use and effects of e-consults.

Resource use and guideline concordance in evaluation of pulmonary nodules for cancer: too much and too little care.

Importance: Pulmonary nodules are common, and more will be found with implementation of lung cancer screening. How potentially malignant pulmonary nodules are evaluated may affect patient outcomes, health care costs, and effectiveness of lung cancer screening programs. Guidelines for evaluating pulmonary nodules for cancer exist, but little is known about how nodules are evaluated in the usual care setting.

Guideline-recommended medications: variation across Medicare Advantage plans and associated mortality.

Objectives: To evaluate variation in the prescription of guideline-recommended medications across Medicare Advantage (MA) plans and to determine whether such variation is associated with increased mortality.

Methods: Observational study of 111,667 patients aged 65 years or older receiving care in 203 MA plans. We linked data from the Medicare Health Outcomes (HOS) Survey cohort 9 (April 2006-May 2008) with the Medicare Part D prescription benefit files (January 1, 2006-December 31, 2007) to examine variation in treatment across MA plans and its association with differences in observed (O)/expected (E) mortality ratio for 5 high-volume chronic conditions: diabetes, coronary artery disease (CAD), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD)/asthma, and depression.

Going beyond patient classification systems to create an evidence-based staffing methodology.

The Department of Veterans Affairs developed a nationally standardized nurse staffing methodology, using an evidence-based process. We present an overview, linking an integrative review of recent literature on patient classification systems, interdisciplinary expert panel consultation, operational feasibility assessment, and frontline manager involvement. This resulted in 7 candidate indicators for inclusion in unit-specific staffing models.

Variation in antibiotic treatment for diabetic patients with serious foot infections: a retrospective observational study.

Background: Diabetic foot infections are common, serious, and diverse. There is uncertainty about optimal antibiotic treatment, and probably substantial variation in practice. Our aim was to document whether this is the case: A finding that would raise questions about the comparative cost-effectiveness of different regimens and also open the possibility of examining costs and outcomes to determine which should be preferred.

A classification of diabetic foot infections using ICD-9-CM codes: application to a large computerized medical database.

Background: Diabetic foot infections are common, serious, and varied. Diagnostic and treatment strategies are correspondingly diverse. It is unclear how patients are managed in actual practice and how outcomes might be improved.

Comparison of health outcomes for male seniors in the Veterans Health Administration and Medicare Advantage plans.

Objectives: To compare the Veterans Health Administration (VHA) with the Medicare Advantage (MA) plans with regard to health outcomes.

Data Sources: The Medicare Health Outcome Survey, the 1999 Large Health Survey of Veteran Enrollees, and the Ambulatory Care Survey of Healthcare Experiences of Patients (Fiscal Years 2002 and 2003).

Study Design: A retrospective study.

Differences in risk-adjusted mortality between medicaid-eligible patients enrolled in medicare advantage plans and those enrolled in the veterans health administration.

Background: We compared risk-adjusted mortality rates between Medicaid-eligible patients in the Medicare Advantage plans ("MA dual enrollees") and Medicaid-eligible patients in the Veterans Health Administration ("VHA dual enrollees").

Methods: We used the Death Master File to ascertain the vital status of 1912 MA and 2361 VHA dual enrollees. We used Cox regression models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12).

Purpose: The purpose of this project was to develop an updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12).

Angioedema incidence in US veterans initiating angiotensin-converting enzyme inhibitors.

Angioedema is a rare but potentially serious complication of angiotensin-converting enzyme inhibitor (ACE) use. We conducted a study to estimate incidence of ACE-related angioedema and explore its determinants in a large racially diverse patient population. We used linked medical and pharmacy records to identify all patients in the US Veterans Affairs Health Care System from April 1999 through December 2000 who received first prescriptions for antihypertensive medications.

Potentially inappropriate prescribing for the elderly: effects of geriatric care at the patient and health care system level.

Background: Many studies have identified patient characteristics associated with potentially inappropriate prescribing in the elderly (PIPE), however, little attention has been directed toward how health care system factors such as geriatric care may affect this patient safety issue.

Objective: This study examines the association between geriatric care and PIPE in a community dwelling elderly population.

Research Design: Cross-sectional retrospective database study.

Health care resource utilization and expenditures associated with the use of insulin glargine.

Background: Newer insulins, such as long-acting analogues, offer promise of better glycemic control, reduced risk for diabetes complications, and moderation of health care use and costs.

Objective: We studied initiation of insulin glargine to evaluate its association with subsequent health service utilization and estimated expenditures.

Methods: Patients of the Veterans Health Administration, US Department of Veterans Affairs (VA) who initiated insulin glargine (n=5064) in 2001-2002 were compared with patients receiving other insulin (n=69,944), matched on prescription month (index date).

Change in health status and mortality as indicators of outcomes: comparison between the Medicare Advantage Program and the Veterans Health Administration.

Background: Comparing health outcomes with adequate methodology is central to performance assessments of health care systems. We compared the Medicare Advantage Program (MAP) and the Veterans Health Administration (VHA) with regard to changes in health status and mortality.

Methods: We used the Death-Master-File for vital status and the Short-Form 36 to determine physical (PCS) and mental (MCS) health at baseline and at 2 years.

Risk-adjusted mortality as an indicator of outcomes: comparison of the Medicare Advantage Program with the Veterans' Health Administration.

Background: The Medicare Advantage Program (MAP) and the Veterans' Health Administration (VHA) currently provide many services that benefit the elderly, and a comparative study of their risk-adjusted mortality rates has the potential to provide important information regarding these 2 systems of care.

Objective: The objective of this retrospective study was to compare mortality rates between the MAP and the VHA after controlling for case-mix differences.

Subjects: This study consisted of 584,294 MAP patients and 420,514 VHA patients.

Three complementary definitions of polypharmacy: methods, application and comparison of findings in a large prescription database.

Purpose: To develop and compare three operational definitions of polypharmacy using a large prescription database.

Methods: We defined Cumulative polypharmacy as all prescriptions filled during a 178 day window--which captured 95% of eventual refills as calculated from Kaplan-Meier and cumulative incidence curves. Continuous polypharmacy was all prescriptions filled in two such windows 6 months apart.