Clinical Validity of the PROMIS Healthcare Engagement 8-Item Short Form.

Background: Healthcare engagement is a key measurement target for value-based healthcare, but a reliable and valid patient-reported measure has not yet been widely adopted.

Objective: To assess the validity of a newly developed patient-reported measure of healthcare engagement, the 8-item PROMIS Healthcare Engagement (PHE-8a).

Design: Prospective cohort study of the association between healthcare engagement and quality of care over 1 year.

Randomized Policy Evaluation of the Veterans Health Administration Stratification Tool for Opioid Risk Mitigation (STORM).

Background: The Veterans Health Administration (VHA) developed a dashboard Stratification Tool for Opioid Risk Mitigation (STROM) to guide clinical practice interventions. VHA released a policy mandating that high-risk patients of an adverse event based on the STORM dashboard are to be reviewed by an interdisciplinary team of clinicians.

Aim: Randomized program evaluation to evaluate if patients in the oversight arm had a lower risk of opioid-related serious adverse events (SAEs) or death compared to those in the non-oversight arm.

Psychometric evaluation of a patient-reported item bank for healthcare engagement.

Purpose: Healthcare engagement is a core measurement target for efforts to improve healthcare systems. This construct is broadly defined as the extent to which healthcare services represent collaborative partnerships with patients. Previous qualitative work operationalized healthcare engagement as generalized self-efficacy in four related subdomains: self-management, collaborative communication, health information use, and healthcare navigation.

Tracking implementation strategies in the randomized rollout of a Veterans Affairs national opioid risk management initiative.

Background: In 2018, the Department of Veterans Affairs (VA) issued Notice 2018-08 requiring facilities to complete "case reviews" for Veterans identified in the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard as high risk for adverse outcomes among patients prescribed opioids. Half of the facilities were randomly assigned to a Notice version including additional oversight. We evaluated implementation strategies used, whether strategies differed by randomization arm, and which strategies were associated with case review completion rates.

Factors Influencing Primary Care Providers' Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study.

Background: Clinical practice guidelines suggest that magnetic resonance imaging of the lumbar spine (LS-MRI) is unneeded during the first 6 weeks of acute, uncomplicated low-back pain. Unneeded LS-MRIs do not improve patient outcomes, lead to unnecessary surgeries and procedures, and cost the US healthcare system about $300 million dollars per year. However, why primary care providers (PCPs) order unneeded LS-MRI for acute, uncomplicated low-back pain is poorly understood.

"They are interrelated, one feeds off the other": A taxonomy of perceived disease interactions derived from patients with multiple chronic conditions.

Objective: To understand patients' experiences with condition interactions and develop a taxonomy to inform care for patients with multiple chronic conditions.

Methods: We conducted qualitative and quantitative analysis of free-text data from patient surveys in which respondents were asked to indicate their most bothersome chronic condition and describe how their other conditions affect their self-care for that condition. Using standard content analysis, we developed a taxonomy comprising how patients perceive interactions among their conditions, and examined cross-cutting themes that reflect qualities of these interactions.

Opportunity or Burden? A Behavioral Framework for Patient Engagement.

Background: Engaging patients as partners in their care is clinically appealing, yet challenging to implement, and we lack a measurement framework that is applicable to vulnerable populations. To address this gap, we conducted a qualitative study to refine a conceptual framework that reflects an individual's propensity to engage with care.

Objectives: Our objectives were to refine the framework's domains of engagement behavior; identify key behaviors within each domain that describe engagement with providers, health systems or settings; and illustrate examples for each behavior where higher self-efficacy describes an opportunity to enhance engagement, and lower self-efficacy describes difficulties with engagement that risk burden.

Randomized program evaluation of the Veterans Health Administration Stratification Tool for Opioid Risk Mitigation (STORM): A research and clinical operations partnership to examine effectiveness.

The United States is facing an opioid crisis in which overdose is the leading cause of injury death-misuse of opioids constitutes the vast majority of those deaths. In 2016 alone, over 42,000 people died from opioid overdose, an increase of 27% from the prior year. Deployment of the Stratification Tool for Opioid Risk Mitigation (STORM), a clinical decision support tool to improve opioid safety, is one response by the Veterans Health Administration (VHA) to the opioid crisis.

Overdose Risk Associated with Opioid Use upon Hospital Discharge in Veterans Health Administration Surgical Patients.

Objective: To determine an association between opioid use upon hospital discharge (ongoing and newly started) in surgical patients and risks of opioid overdose and delirium for the first year.

Design: Retrospective, cohort study.

Setting: Population-level study of Veterans Health Administration patients.

Patient and provider perspectives on the development of personalized medicine: a mixed-methods approach.

While genetic testing gains adoption in specialty services such as oncology, neurology, and cardiology, use of genetic and genomic testing has yet to be adopted as widely in primary care. The purpose of this study is to identify and compare patient and primary care provider (PCP) expectations of genetics services in primary care. Patient and PCP perspectives were assessed through a mixed-method approach combining an online survey and semi-structured interviews in a primary care department of a large academic medical institution.

Providers' Perspectives on Barriers and Facilitators to Connecting Women Veterans to Alcohol-Related Care From Primary Care.

Background: Unhealthy drinking is relatively common among women U.S. military Veterans.

Patient Perceptions of Primary Care-Based Skin Cancer Screening.

This analysis of a series of interviews seeks to better understand patient perceptions of primary care–based skin cancer screening.

Primary Care-Based Skin Cancer Screening in a Veterans Affairs Health Care System.

Importance: Skin cancer screening may improve melanoma outcomes and keratinocyte carcinoma morbidity, but little is known about the feasibility of skin cancer training and clinical skin examination (CSE) by primary care practitioners (PCPs) in large health care systems.

Objective: To assess the association of skin cancer training and screening by PCPs with dermatology referral patterns and rates of skin biopsies.

Design, Setting, And Participants: In this pilot interventional study performed at the Veterans Affairs Palo Alto Health Care System, patients 35 years or older scheduled for an annual health habits screen in the PCP general medicine clinics were studied.

"I had to change so much in my life to live with my new limitations": Multimorbid patients' descriptions of their most bothersome chronic conditions.

Objective To characterize diseases that are described as most bothersome by individuals with multiple chronic conditions and to identify themes that characterize their experiences with their most bothersome condition. Methods In a survey of patients at an academic center and a Veterans Affairs hospital, we asked individuals with multiple chronic conditions to identify their most bothersome chronic condition and describe why it is challenging. Standard content analysis methods were used to code responses and identify themes reflecting characteristics of most bothersome conditions.

Providers' perceptions of barriers and facilitators to disclosure of alcohol use by women veterans.

Unlabelled: Aim To better understand barriers and facilitators that hinder or help women veterans discuss their alcohol use with providers in primary care in order to better identify problematic drinking and enhance provider-patient communication about harmful drinking.

Background: Women presenting to primary care may be less likely than men to disclose potentially harmful alcohol use. No studies have qualitatively examined the perspectives of primary care providers about factors that affect accurate disclosure of alcohol use by women veterans during routine clinic visits.

Time-to-Cessation of Postoperative Opioids: A Population-Level Analysis of the Veterans Affairs Health Care System.

Objective: This study aims to determine 1) the epidemiology of perioperative opioid use; and 2) the association between patterns of preoperative opioid use and time-to-cessation of postoperative opioids.

Design: Retrospective, cohort study.

Setting: National, population-level study of Veterans Healthcare Administration (VHA) electronic clinical data.

Receptivity to alcohol-related care among U.S. women Veterans with alcohol misuse.

Previous research indicates women Veterans have a potentially large, unmet need for alcohol-related care but are under-represented in treatment settings. The purpose of this study was to identify factors associated with women Veterans' receptivity to a recommendation for alcohol-related care when they present to Veterans Affairs (VA) primary care with alcohol misuse. Semi-structured interviews were conducted from 2012-2013 with 30 women Veterans at two VA facilities who screened positive for alcohol misuse during a primary care visit and discussed their alcohol use with their primary-care provider.

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

Background: 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.

Factors Affecting Women's Disclosure of Alcohol Misuse in Primary Care: A Qualitative Study with U.S. Military Veterans.

Background: One in five women veterans screens positive for alcohol misuse. Women may be less likely than men to disclose alcohol use to a primary care provider (PCP), resulting in women being less likely to receive effective interventions. We sought to qualitatively examine factors that may affect women veterans' willingness to disclose alcohol use to a PCP.

How Can eHealth Technology Address Challenges Related to Multimorbidity? Perspectives from Patients with Multiple Chronic Conditions.

Background: Patient eHealth technology offers potential support for disease self-management, but the value of existing applications for patients with multiple chronic conditions (MCCs) is unclear.

Objectives: To understand self-management and health care navigation challenges that patients face due to MCCs and to identify opportunities to support these patients through new and enhanced eHealth technology.

Design: After administering a screening survey, we conducted 10 focus groups of 3-8 patients grouped by age, sex, and common chronic conditions.

Sex differences in chronic pain management practices for patients receiving opioids from the Veterans Health Administration.

Background: Women experience chronic pain and use pain-related health care at higher rates than men. It is not known whether the pain-related health care female veterans receive is consistent with clinical practice guideline recommendations or whether receipt of this care differs between men and women.

Objective: The aim of this study was to identify whether sex differences in chronic pain management care exist for patients served by the Veterans Health Administration (VHA).

What do patients do with unused opioid medications?

Objectives: The volume of opioid medications being prescribed in the United States is increasing rapidly. Problems associated with the misuse of opioid medications are also increasing, in part because of medication diversion from legitimate prescriptions. However, little is known about what patients do with any unused opioid medications.