Enhancing representation of special populations: An approach to the inclusion of women veterans in VA clinical trials.

The under-recruitment of historically marginalized populations into clinical trials thwarts equitable inclusion of individuals who could benefit from healthcare innovations and limits the generalizability of results. For decades, the Veterans Health Administration (VA) has conducted large clinical trials that impact clinical guidelines for veterans and civilians alike. Within the VA, women are a numeric minority, and recruitment of this population into trials is challenged by gender-specific care structures, distinct demographic characteristics, and mistreatment such as higher rates of military sexual trauma and harassment on VA grounds.

Training an Embedded Workforce to Realize Health System Impacts and the Promise of Learning Health Systems Comment on "Early Career Outcomes of Embedded Research Fellows: An Analysis of the Health System Impact Fellowship Program".

Learning health systems (LHSs) are designed to systematically integrate external evidence of effective practices with internal data and experience to put knowledge into practice as a part of a culture of continuous learning and improvement. Researchers embedded in health systems are an essential component of LHSs, with defined competencies. However, many of these competencies are not generated by traditional graduate/post-graduate training programs; evaluation of new LHS training programs has been limited.

Burnout and Turnover Among Veterans Health Administration Primary Care Providers From Fiscal Years 2017-2021.

Objectives: We examined how individual-level turnover among Veterans Health Administration primary care providers (PCPs) from fiscal years 2017 to 2021 was associated with health care system-level burnout and turnover intent.

Background: Burnout among PCPs has been well documented in recent studies, but less is known about the potential relationship between burnout and turnover.

Methods: We identified a national cohort of 6444 PCPs (physicians, nurse practitioners, and physician assistants) in 129 Veterans Health Administration health care systems in the first quarter of fiscal year 2017 and tracked their employment status for 20 quarters.

Human Papillomavirus (HPV) Vaccination Rates Among U.S. Military Veteran Females and Males and Non-Veterans in the National Health Interview Survey.

Introduction: Human papillomavirus (HPV) infection is a major risk factor for the development of multiple cancers. Active duty service members have higher rates of HPV infection than civilians, while Veterans are diagnosed with a disproportionately high burden of HPV-associated cancers compared to civilians without prior service. While a highly effective HPV vaccine has been available for over a decade, vaccination rates in the United States remain suboptimal.

Organizational Climate Related to Patient-Perpetrated Sexual Harassment: VA Primary Care Provider Perceptions.

Background: Patient-perpetrated sexual harassment toward health care providers is common and adversely affects provider well-being, workforce outcomes, and patient care. Organizational climate for sexual harassment-shared perceptions about an organization's practices, policies, and procedures-is one of the strongest predictors of harassment prevalence. We conducted a pilot survey assessing provider perceptions of the Veterans Health Administration (VA)'s climate related to patient-perpetrated sexual harassment.

Does a Welcoming Environment Influence Women Veterans' Primary Care Experiences?

Background: A welcoming environment may influence patient care experiences, and it may be particularly relevant for underrepresented groups, such as women veterans at Veterans Health Administration (VA) facilities where they represent only 8-10% of patients. Challenges to ensuring a welcoming environment for women veterans may include unwelcome comments from male veterans and staff or volunteers and feeling unsafe inside or outside VA facilities. We assessed associations between reports of gender-related environment of care problems and patient-reported outcomes.

Application of a comprehensive disability measure: Disability prevalence among US Veterans and non-veterans from the National Health Interview Survey Data from 2015 to 2018.

Background: Current measures of condition-specific disabilities or those capturing only severe limitations may underestimate disability prevalence, including among Veterans.

Objectives: To develop a comprehensive measure to characterize and compare disabilities among US Veterans and non-Veterans.

Methods: Using 2015-2018 pooled cross-sectional National Health Interview Survey data, we compared the frequency and survey-weighted prevalence of non-mutually exclusive sensory, social, and physical disabilities by Veteran status.

Enhancing Primary Care and Mental Health Integration for Women Veterans with Complex Healthcare Needs Using Evidence-Based Quality Improvement.

Background: Women Veterans with co-morbid medical and mental health conditions face persistent barriers accessing high-quality health care. Evidence-based quality improvement (EBQI) offers a systematic approach to implementing new care models that can address care gaps for women Veterans.

Objective: This study examines factors associated with the successful deployment of EBQI within integrated health systems to improve primary care for women Veterans with complex mental health needs.

Impact of Evidence-Based Quality Improvement on Tailoring VA's Patient-Centered Medical Home Model to Women Veterans' Needs.

Background: Women Veterans' numerical minority, high rates of military sexual trauma, and gender-specific healthcare needs have complicated implementation of comprehensive primary care (PC) under VA's patient-centered medical home model, Patient Aligned Care Teams (PACT).

Objective: We deployed an evidence-based quality improvement (EBQI) approach to tailor PACT to meet women Veterans' needs and studied its effects on women's health (WH) care readiness, team-based care, and burnout.

Design: We evaluated EBQI effectiveness in a cluster randomized trial with unbalanced random allocation of 12 VAMCs (8 EBQI vs.

Pain in your day? Get sleep treatment anyway! The role of pain in insomnia treatment efficacy in women veterans.

Insomnia and pain disorders are among the most common conditions affecting United States adults and veterans, and their comorbidity can cause detrimental effects to quality of life among other factors. Cognitive behavioural therapy for insomnia and related behavioural therapies are recommended treatments for insomnia, but chronic pain may hinder treatment benefit. Prior research has not addressed how pain impacts the effects of behavioural insomnia treatment in United States women veterans.

Qualitative interview study of strategies to support healthcare personnel mental health through an occupational health lens.

Background: Employee Occupational Health ('occupational health') clinicians have expansive perspectives of the experience of healthcare personnel. Integrating mental health into the purview of occupational health is a newer approach that could combat historical limitations of healthcare personnel mental health programmes, which have been isolated and underused.

Objective: We aimed to document innovation and opportunities for supporting healthcare personnel mental health through occupational health clinicians.

Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic.

Background: The COVID-19 pandemic involved a rapid change to the working conditions of all healthcare workers (HCW), including those in primary care. Organizational responses to the pandemic, including a shift to virtual care, changes in staffing, and reassignments to testing-related work, may have shifted more burden to these HCWs, increasing their burnout and turnover intent, despite their engagement to their organization. Our objectives were (1) to examine changes in burnout and intent to leave rates in VA primary care from 2017-2020 (before and during the pandemic), and (2) to analyze how individual protective factors and organizational context affected burnout and turnover intent among VA primary care HCWs during the early months of the pandemic.

Abnormal cervical cancer screening results among US Veteran and non-Veteran participants in the National Health Interview Survey (NHIS).

Female Veterans report cervical cancer risk factors at higher rates than non-Veterans. Using data from the National Health Interview Survey (NHIS), we tested whether Veterans with a recent cervical cancer screening test were more likely than non-Veterans to have received an abnormal result. NHIS is a population-based cross-sectional household survey with a stratified, multistage sampling design.

A non-inferiority randomized controlled trial comparing behavioral sleep interventions in women veterans: An examination of pain outcomes.

Objective: Insomnia is known to exacerbate pain symptoms. The purpose of the present study was to compare the secondary effects of cognitive behavioral therapy for insomnia (CBTI) against a novel treatment for insomnia called acceptance and behavioral changes for insomnia (ABC-I) among individuals with comorbid pain. Differences in the potential mechanisms through which these treatments impact pain were also examined.

Using Research to Transform Electronic Health Record Modernization: Advancing a VA Partnered Research Agenda to Increase Research Impacts.

Background: The U.S. Department of Veterans Affairs (VA) is undergoing an enterprise-wide transition from a homegrown electronic health record (EHR) system to a commercial off-the-shelf product.

Differing time trends for alcohol misuse and alcohol use disorder among Veteran men: A comparison of population surveillance and clinical data.

Introduction: Data on time trends are important to track the health burden of alcohol use disorder (AUD) and plan for alcohol-related healthcare needs. Our aim was to estimate time trends in AUD for male VA patients and to assess whether trends in documented diagnosis rates were similar to trends in unhealthy alcohol use measured through clinical screening or trends in AUD prevalence among US veterans in the general population.

Materials And Methods: We used VA electronic health record data (10/1/2009-9/30/2019) to measure AUD diagnosis rates and clinical alcohol screening data to measure unhealthy alcohol use.

Before and During the First COVID-19 Surge: Work Conditions, Burnout, and Mental Health Among Resident Physicians in a Department of Psychiatry in the USA.

Objective: Resident physicians are critical frontline workers during pandemics, and little is known about their health. The study examined occupational and mental health risks among US psychiatry residents before and during the first COVID-19 surge.

Methods: Longitudinal data were collected from a cohort of US psychiatry residents at one academic medical center in October 2019, before the pandemic, and April 2020 after the initiation of a state-level stay-at-home order.

Novel treatment based on acceptance and commitment therapy versus cognitive behavioral therapy for insomnia: A randomized comparative effectiveness trial in women veterans.

Objective: This randomized comparative effectiveness trial evaluated a novel insomnia treatment using acceptance and commitment therapy (ACT) among women veterans. Participants received either the acceptance and the behavioral changes to treat insomnia (ABC-I) or cognitive behavioral therapy for insomnia (CBT-I). The primary objectives were to determine whether ABC-I was noninferior to CBT-I in improving sleep and to test whether ABC-I resulted in higher treatment completion and adherence versus CBT-I.

Associations Between Primary Care Providers and Staff-Reported Access Management Challenges and Patient Perceptions of Access.

Background/objective: Optimizing patients' access to primary care is critically important but challenging. In a national survey, we asked primary care providers and staff to rate specific care processes as access management challenges and assessed whether clinics with more of these challenges had worse access outcomes.

Methods: Study design: Cross sectional.

Factors Associated with Military Sexual Trauma (MST) Disclosure During VA Screening Among Women Veterans.

Background: Capturing military sexual trauma (MST) exposure is critical for Veterans' health equity. For many, it improves access to VA services and allows for appropriate care.

Objective: Identify factors associated with nondisclosure of MST in VA screening among women.

Primary care provider perspectives on virtual and in-person depression management during the COVID-19 pandemic.

Introduction: During the COVID-19 pandemic, primary care providers (PCPs), nurses, and integrated mental health specialists continued to collaboratively manage depression among patients using both in-person and virtual (i.e., hybrid) modalities.

Assessing Racial Disparities in Access, Use, and Outcomes for Pregnant and Postpartum Veterans and Their Infants in Veterans Health Administration.

Limited population-based data examines racial disparities among pregnant and postpartum Veterans. Our objective was to determine whether Black/white racial disparities in health care access, use, and Veteran and infant outcomes are present among pregnant and postpartum Veterans and their infants using Veterans Health Administration (VA) care. The VA National Veteran Pregnancy and Maternity Care Survey included all Veterans with a VA paid live birth between June 2018 and December 2019.

Improving primary care team functioning through evidence based quality improvement: A comparative case study.

Background: Provision of team-based primary care (PC) is associated with improved care quality, but limited empirical evidence guides practices on how to optimize team functioning. We examined how evidence-based quality improvement (EBQI) was used to change PC team processes. EBQI activities were supported by research-clinical partnerships and included multilevel stakeholder engagement, external facilitation, technical support, formative feedback, QI training, local QI development and across-site collaboration to share proven practices.