The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facilities.

Communication failure is a significant source of adverse events in health care and a leading root cause of sentinel events reported to the Joint Commission. The Veterans Health Administration National Center for Patient Safety established Clinical Team Training (CTT) as a comprehensive program to enhance patient safety and to improve communication and teamwork among health care professionals. CTT is based on techniques used in aviation's Crew Resource Management (CRM) training.

Access to Subspecialty Care And Survival Among Patients With Liver Disease.

Objectives: Access to subspecialty care may be difficult for patients with liver disease, but it is unknown whether access influences outcomes among this population. Our objectives were to determine rates and predictors of access to ambulatory gastrointestinal (GI) subspecialty care for patients with liver disease and to determine whether access to subspecialty GI care is associated with better survival.

Methods: We studied 28,861 patients within the Veterans Administration VISN 11 Liver Disease cohort who had an ICD-9-CM diagnosis code for liver disease from 1 January 2000 through 30 May 2011.

Employee attitudes about moving toward a smoke-free campus at a Veterans Affairs hospital.

Background: Although Veterans Affairs (VA) hospitals have been smoke-free inside of buildings since 1991, smoke-free campuses have not been initiated. The purpose of this article is to describe staff attitudes regarding making the VA hospital a smoke-free campus except for the mandated smoking shelters.

Methods: In 2008, a cross-sectional, anonymous survey was conducted with a convenience sample of employees at a Midwestern VA (N = 397).

Early mortality and years of potential life lost among Veterans Affairs patients with depression.

Objective: Substantial literature documents excess and early mortality among individuals with serious mental illness, but there are relatively few data about mortality and depression.

Methods: During fiscal year 2007, data from the U.S.

Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia.

Objective: We examined cardiometabolic disease and mortality over 8 years among individuals with and without schizophrenia.

Method: We compared 65,362 patients in the Veteran Affairs (VA) health system with schizophrenia to 65,362 VA patients without serious mental illness (non-SMI) matched on age, service access year and location. The annual prevalence of diagnosed cardiovascular disease, diabetes, dyslipidemia, hypertension, obesity, and all-cause and cause-specific mortality was compared for fiscal years 2000-2007.

Design and rationale of a randomized controlled trial to reduce cardiovascular disease risk for patients with bipolar disorder.

Background: Persons with bipolar disorder (BD) experience a disproportionate burden of medical comorbidity, notably cardiovascular disease (CVD), contributing to decreased function and premature mortality. We describe the design, rationale, and baseline findings for the Self-Management Addressing Heart Risk Trial (SMAHRT), a randomized controlled effectiveness trial of an intervention (Life Goals Collaborative Care; LGCC) designed to reduce CVD risk factors and improve physical and mental health outcomes in patients with BD.

Methods: Patients with BD and at least one CVD risk factor were recruited from a VA healthcare system and randomized to either LGCC or usual care (UC).

Evaluation of a nurse practitioner disease management model for chronic heart failure: a multi-site implementation study.

While disease management appears to be effective in selected, small groups of CHF patients from randomized controlled trials, its effectiveness in a broader CHF patient population is not known. This prospective, quasi-experimental study compared patient outcomes under a nurse practitioner-led disease management model (intervention group) with outcomes under usual care (control group) in both primary and tertiary medical centers. The study included 969 veterans (458 intervention, 511 control) treated for CHF at six VA medical centers.

Quality of general medical care among patients with serious mental illness: does colocation of services matter?

Objective: This study was conducted to determine whether patients with serious mental illness receiving care in Veterans Affairs (VA) mental health programs with colocated general medical clinics were more likely to receive adequate medical care than patients in programs without colocated clinics based on a nationally representative sample.

Methods: The study included all VA patients with diagnoses of serious mental illness in fiscal year (FY) 2006-2007 who were also part of the VA's External Peer Review Program (EPRP) FY 2007 random sample and who received care from VA facilities (N=107 facilities) with organizational data from the VA Mental Health Program Survey (N=7,514). EPRP included patient-level chart review quality indicators for common processes of care (foot and retinal examinations for diabetes complications; screens for colorectal health, breast cancer, and alcohol misuse; and tobacco counseling) and outcomes (hypertension, diabetes blood sugar, and lipid control).

Ratings of patient-provider communication among veterans: serious mental illnesses, substance use disorders, and the moderating role of trust.

Many individuals with a mental illness are not satisfied with their communication with their primary provider. The present study examined the relationship of serious mental illness (SMI), substance use disorder (SUD), and trust for the provider with provider communication. The sample included Veterans Administration (VA) patients throughout the United States who either had a SMI diagnosis (schizophrenia or bipolar disorder) or were in a random sample of non-SMI patients (total N=8,089).

The relationship between religious involvement and clinical status of patients with bipolar disorder.

Objective: Religion and spirituality are important coping strategies in depression but have been rarely studied within the context of bipolar disorder. The present study assessed the association between different forms of religious involvement and the clinical status of individuals treated for bipolar disorder.

Methods: A cross-sectional observation study of follow-up data from a large cohort study of patients receiving care for bipolar disorder (n = 334) at an urban Veterans Affairs mental health clinic was conducted.

Quality of care for cardiometabolic disease: associations with mental disorder and rurality.

Background: This study examines quality of cardiometabolic care among veterans receiving care in the Veterans Affairs (VA) health system. We assess whether quality of care disparities by mental disorder status are magnified for individuals living in rural areas.

Research Design: We identified all patients in a 2005 national Veterans Administration cardiometabolic quality of care chart review.

Clinical and demographic factors associated with homelessness and incarceration among VA patients with bipolar disorder.

Objectives: We assessed the association between homelessness and incarceration in Veterans Affairs patients with bipolar disorder.

Methods: We used logistic regression to model each participant's risk of incarceration or homelessness after we controlled for known risk factors.

Results: Of 435 participants, 12% reported recent homelessness (within the past month), and 55% reported lifetime homelessness.

Health-related quality of life and utilities among patients with depression in the Department of Veterans Affairs.

Objective: This study establishes veteran-specific utility measures for patients with and those without depression.

Methods: A cross-sectional study was conducted of 87,797 Veterans Affairs (VA) patients who had completed the 12-Item Short-Form Health Survey (SF-12) portion of the VA's Large Health Survey of Veteran Enrollees administered in 1999 (58,442 veterans had an ICD-9 diagnosis of depression and 29,355 did not have such a diagnosis).

Results: All demographic and clinical comparisons were statistically significant between the two groups.

Using pharmacy data on partial adherence to inform clinical care of patients with serious mental illness.

Objective: Low adherence to antipsychotic medications is a risk factor for poor outcomes for people with serious mental illness. Pharmacy data might be used by health systems to identify partially adherent patients for interventions. This study assessed whether using pharmacy data is an accurate screening method for identifying at-risk patients.

Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression.

Objective: Depression is commonly found as a coexisting condition in dementia. An earlier retrospective study by the authors found that patients with coexisting dementia and depression (CDD) were high utilizers of inpatient and nursing home care. The current prospective study was designed to investigate specific factors that might contribute to outcomes such as nursing home placement by examining the detection and course of CDD subjects as compared with subjects with either disorder alone.

Race, gender, and psychiatrists' diagnosis and treatment of major depression among elderly patients.

Objective: This study examined psychiatrists' contributions to racial and gender disparities in diagnosis and treatment among elderly persons.

Methods: Psychiatrists who volunteered to participate in the study were randomly assigned to one of four video vignettes depicting an elderly patient with late-life depression. The vignettes differed only in terms of the race of the actor portraying the patient (white or African American) and gender.

Variation in outcomes in Veterans Affairs intensive care units with a computerized severity measure.

Objective: To quantify the variability in risk-adjusted mortality and length of stay of Veterans Affairs intensive care units using a computer-based severity of illness measure.

Design: Retrospective cohort study.

Setting: A stratified random sample of 34 intensive care units in 17 Veterans Affairs hospitals.

Herbal products and other supplements: use by elderly veterans with depression and dementia and their caregivers.

The use of herbal products and other "natural" supplements among the US population is on the rise. Limited data suggest that such use among the elderly may correlate with higher education levels as well as psychiatric symptoms. The authors examined herbal/supplement use among elderly veterans with depression and/or dementia (n = 82) and their primarily elderly caregivers (n = 56).

Automated intensive care unit risk adjustment: results from a National Veterans Affairs study.

Context: Comparison of outcome among intensive care units (ICUs) requires risk adjustment for differences in severity of illness and risk of death at admission to the ICU, historically obtained by costly chart review and manual data entry.

Objective: To accurately estimate patient risk of death in the ICU using data easily available in hospital electronic databases to permit automation.

Design And Setting: Cohort study to develop and validate a model to predict mortality at hospital discharge using multivariate logistic regression with a split derivation (17,731) and validation (11,646) sample formed from 29,377 consecutive first ICU admissions to medical, cardiac, and surgical ICUs in 17 Veterans' Health Administration hospitals between February 1996 and July 1997.