Teaching Medical Students to Communicate With Empathy and Clarity Using Improvisation.

Problem: Medical educators widely accept that health care providers need strong communication skills. The authors sought to develop a course incorporating improvisation to teach health professions students communication skills and build empathy.

Approach: Teaching health care professionals to communicate more effectively with patients, the public, and each other is a goal of the Alan Alda Center for Communicating Science at Stony Brook University.

A challenging empirical question: What are the effects of media on psychogenic illness during a community crisis?

Psychogenic illness during disasters can cripple emergency healthcare services. Almost all research into this phenomenon has been retrospective and observational, and much of it suggests that media coverage can amplify psychogenic outbreaks. But there is little empirical evidence that this is true or that, conversely, media reports can mitigate psychogenic symptoms.

Experimental induction of psychogenic illness in the context of a medical event and media exposure.

Objectives: Mass psychogenic illness can be a significant problem for triage and hospital surge in disasters; however, research has been largely limited to posthoc observational reports. Reports on the impact of public media during a disaster have suggested both salutary as well as iatrogenic psychological effects. This study was designed to determine if psychogenic illness can be evoked and if media will exacerbate it in a plausible, controlled experiment among healthy community adults.

Exploring the link between ambulatory care and avoidable hospitalizations at the Veteran Health Administration.

This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason.

Central nervous system and musculoskeletal medication profile of a veteran cohort with blast-related injuries.

Little is known about the utilization of central nervous system (CNS) and musculoskeletal (MS) medications in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans with blast-related injuries (BRIs). We followed prescription drug use among a cohort of 133 OIF/OEF veterans with BRIs by using the Joint Theatre Trauma Registry, the Tampa Polytrauma Registry, and electronic medical records. We extracted 12 months of national medication records from the Veterans Health Administration Decision Support System and analyzed them with descriptive statistics.

Rehabilitation outcomes for veterans with polytrauma treated at the Tampa VA.

Returning soldiers from Iraq and Afghanistan who have sustained polytrauma have a combination of complex physical and mental morbidities that require extensive therapy and rehabilitation. This study examined the effect of rehabilitation on 116 polytrauma patients with service-connected injuries treated at the Tampa VA; improvements in functional and cognitive abilities were measured using the Functional Independence Measure (FIM) scores and healthcare costs for rehabilitation treatment were also assessed. Intensive rehabilitation therapy increased functional ability in this cohort with an average improvement in total FIM scores of 23 points.

Benchmark data on the utilization and acquisition costs of central nervous system and muscular skeletal drugs among veterans with combat-related injuries.

Background: Little is known about the utilization and costs of central nervous system (CNS) and musculoskeletal medications in veterans with blast injuries.

Methods: Two years of national medication records of Operations Enduring Freedom and Iraqi Freedom veterans with blast injuries were extracted from the Veterans Health Administration Decision Support System and analyzed with descriptive statistics.

Results: Over the 2-year period, there was a total of 23,795 pharmacy claims (various drug classes) for 60 patients with blast injuries with a 2-year drug acquisition cost of $111,535 (mean per patient = $1,858; median per patient = $960).

Expanding participation in Alzheimer's association Safe Return by improving enrollment.

Every adult with a diagnosis of progressive dementia is at risk for wandering away or becoming lost. Those with dementia may not have the capacity to remember crucial contact information or recognize an unsafe situation, so enrollment in a program like Alzheimer's Association Safe Return is crucial. One facility-level enrollment plan at the James A.

A national perspective of Medicare expenditures for elderly veterans with hip fractures.

Introduction: The Centers for Medicare and Medicaid Services (CMS) recently announced that beginning in October 2008, Medicare will no longer reimburse hospitals for the costs of treating injuries from several preventable conditions, including inpatient falls resulting in hip fracture. If hospitals try to shift this care to other payers, elderly veterans who are dually eligible for care in Medicare and Veterans Health Administration (VHA) facilities may be adversely affected. As health care provided for a hip fracture can be substantial, the goal of this research was to calculate Medicare payments for a national cohort of elderly veterans with hip fractures, beginning with the first inpatient admission and continuing through one year.

Bone mineral density scans in veterans.

Goals: Recent findings suggest the prevalence of osteoporosis among men is under-recognized. The patient population of the Veterans Health Administration (VA) is predominantly male and many elderly veterans may be at risk of osteoporosis. Given the lack of data on male osteoporosis, we provide initial insight into diagnostic procedures for patients at one VA medical center.

Rehospitalization after hip fracture: predictors and prognosis from a national veterans study.

Objectives: To estimate the risk and long-term prognostic significance of 30-day readmission postdischarge of a 4-year cohort of elderly veterans first admitted to Medicare hospitals for treatment of hip fractures (HFx), controlling for comorbidities.

Design: Retrospective, national secondary data analysis.

Setting: National Medicare and Veterans Health Administration (VHA) facilities.

Agitation and resistiveness to care are two separate behavioral syndromes of dementia.

Objectives: To distinguish two behavioral syndromes of dementia: Agitation and resistiveness to care.

Design: Analysis of Minimum Data Set (MDS) data.

Setting: MDS data from Veterans Administration nursing homes collected from October 13, 2000, through October 14, 2004.

Risk-adjusted mortality rates of elderly veterans with hip fractures.

Purpose: The goal of this research was to estimate 12-month survival rates for a large sample of elderly veterans after hip fracture with a risk-adjusted model and to compare the results of men to those of women.

Methods: The study design was a retrospective, secondary data analysis of national Veterans Health Administration (VHA) Medicare beneficiaries. The study population was 43,165 veterans with hip fracture first admitted to a Medicare-eligible facility during our specified enrollment period of 1999-2002.

The declining rate of avoidable hospitalizations in the Veterans Health Administration.

Most research shows a lower rate of avoidable hospitalizations associated with better access to outpatient care. Such findings have important implications for the Veterans Health Administration (VHA), with its change from delivering mainly inpatient services to emphasizing quality ambulatory care. From 1999 to 2004 the number of avoidable hospitalizations at the VHA increased while the rate per 10,000 enrollees declined.

The enigma of higher income immigrants with lower rates of health insurance coverage in the United States.

This research compares rates of health insurance coverage among middle-class non-elderly immigrants to native-born American adults using data from the March 1996-2000 Supplements to the Current Population Survey. Probit regressions reveal that immigrants were three times as likely to be uninsured at income levels exceeding $50,000, controlling for economic, demographic and immigrant-related characteristics. Work-related characteristics, income, martial status and nativity considerably influenced health insurance status for all adults, but work-related factors had the strongest effect on immigrants' rates of coverage.

Economic aspects of dementia special care units in Veterans Affairs nursing homes.

Given the intermittent use of special care units (SCUs), we consider economic aspects associated with dementia SCUs by reviewing the literature and surveying 2 nursing homes in the VA healthcare network. In addition to reporting the features in different types of facilities in the Veterans Affairs (VA), we present an economic characterization useful for hospital and nursing home administrators whose decision-making processes incorporate clinical, management, and financial factors. We conclude that, theoretically, benefits likely outweigh the costs of instituting dementia SCUs in VA nursing homes with a large number of cognitively impaired residents.

Inpatient mortality of hip fracture patients in the Veterans Health Administration.

Hip fractures among elderly people frequently result in permanent disabilities, nursing home placement, and death. The bulk of hip fracture research focuses on elderly women. Within the Veterans Health Administration (VHA), the majority of patients are men.