Learning from national implementation of the Veterans Affairs Clinical Resource Hub (CRH) program for improving access to care: protocol for a six year evaluation.

Background: The Veterans Affairs (VA) Clinical Resource Hub (CRH) program aims to improve patient access to care by implementing time-limited, regionally based primary or mental health staffing support to cover local staffing vacancies. VA's Office of Primary Care (OPC) designed CRH to support more than 1000 geographically disparate VA outpatient sites, many of which are in rural areas, by providing virtual contingency clinical staffing for sites experiencing primary care and mental health staffing deficits. The subsequently funded CRH evaluation, carried out by the VA Primary Care Analytics Team (PCAT), partnered with CRH program leaders and evaluation stakeholders to develop a protocol for a six-year CRH evaluation.

Medicaid Integrated Purchasing for Physical and Behavioral Health: Early Adopters' Perceptions of Payment Reform Implementation in Washington State.

The Centers for Medicare and Medicaid Innovation (CMMI) gave rise to the State Innovation Models (SIMs). Medicaid Integrated Purchasing for Physical and Behavioral Health, referred to as Payment Model 1 (PM1), was a core payment redesign area of the Washington State SIM project under which our research team was contracted to provide an evaluation. In doing so, we leveraged an open systems conceptual model to assess qualitatively Early Adopter stakeholders' perceived effects of implementation.

A conceptual model of health insurance stability in the United States health care system.

In the U.S. health care system, people under age 65 are at risk of losing and regaining health insurance coverage over their lifetimes, which has important consequences for their physical and mental health.

Analytic approaches to assess the impact of local spending on sexually transmitted diseases.

Objective: To compare the estimated associations between annual sexually transmitted diseases (STD) expenditures per capita and STD incidence rates among Florida and Washington local health departments (LHDs) from 2001 to 2017, using two approaches-a longitudinal regression model with lagged STD spending and a regression model with the Arellano-Bond panel estimator.

Data Sources: Secondary data for LHDs were obtained from Florida and Washington state government offices and combined with county sociodemographic and health system data from the federal government.

Study Design: We examined LHDs in Florida and Washington using a longitudinal panel study design to estimate ecological relationships between annual STD expenditures per capita and annual STD incidence rates from 2001 to 2017, with LHDs as the unit of analysis.

Statewide Evaluation of Washington's State Innovation Model Initiative: A Mixed-Methods Approach.

The Washington State Innovation Model (SIM) $65 million Test Award from the Center for Medicare and Medicaid Innovation is a statewide intervention expected to improve population health, quality of care, and cost growth through 4 initiatives in 2016-2018: (1) regional accountable communities of health linking health and social services to address local needs; (2) a practice transformation support hub; (3) four value-based payment reform pilot projects mainly in state employee and Medicaid populations; and (4) data and analytic infrastructure development to support system transformation with common measures. A mixed-methods study design and data from the 2013-2018 Behavioral Risk Factor Surveillance System Surveys are used to estimate whether SIM resulted in changes in access to care, health behaviors, and health status in Washington's adult population. Semi-structured qualitative interviews also were conducted to assess stakeholder perceptions of SIM performance.

Burnout and Patient Referral Among Primary Care Providers in Veterans Affairs Patient Aligned Care Teams (VA PACTs).

Using the Veterans Health Administration's 2018 national provider and staff survey, this study describes the practice patterns of 1453 primary care providers for specialty care consults, program referrals, secure messaging, and telephone visits; and examines whether the practice patterns are associated with provider burnout in primary care teamlets. About 51% of providers experienced moderate to severe burnout and 22% had severe burnout. Providers who embraced all 4 practice approaches had lower odds of severe burnout than providers endorsing none of the approaches (odds ratio range, 0.

RE-AIM Evaluation Plan for Washington State Innovation Models Project.

The State of Washington received a State Innovation Models (SIM) $65 million award from the federal Centers for Medicare & Medicaid Services to improve population health and quality of care and reduce the growth of health care costs in the entire state, which has over 7 million residents. SIM is a "complex intervention" that implements several interacting components in a complex, decentralized health system to achieve goals, which poses challenges for evaluation. Our purpose is to present the state-level evaluation methods for Washington's SIM, a 3-year intervention (2016-2018).

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs).

Purpose: Appropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown.

Methods: We performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative.

The 10 Conditions That Increased Vermont's Readiness to Implement Statewide Health System Transformation.

Following an arduous, 6-year policy-making process, Vermont is the first state implementing a unified, statewide all-payer integrated delivery system with value-based payment, along with aligned medical and social service reforms, for almost all residents and providers in a state. Commercial, Medicare, and Medicaid value-based payment for most Vermonters will be administered through a new statewide accountable care organization in 2018-2022. The purpose of this article is to describe the 10 conditions that increased Vermont's readiness to implement statewide system transformation.

Federally Qualified Health Center Substitution of Local Health Department Services.

Introduction: Strategic and budgetary considerations have shifted local health departments (LHDs) away from safety net clinical services and toward population-focused services. Federally Qualified Health Centers (FQHCs) play an increasing role in the safety net, and may complement or substitute for LHD clinical services. The authors examined the association between FQHC service levels in communities and the presence of specific LHD clinical services in 2010 and 2013.

Inflammatory Bowel Disease (IBD) pharmacotherapy and the risk of serious infection: a systematic review and network meta-analysis.

Background: The magnitude of risk of serious infections due to available medical therapies of inflammatory bowel disease (IBD) remains controversial. We conducted a systematic review and network meta-analysis of the existing IBD literature to estimate the risk of serious infection in adult IBD patients associated with available medical therapies.

Methods: Studies were identified by a literature search of PubMed, Cochrane Library, Medline, Web of Science, Scopus, EMBASE, and ProQuest Dissertations and Theses.

Health Outcomes of Population-Based Pharmacy Outreach to Increase Statin Use for Prevention of Cardiovascular Disease in Patients with Diabetes.

Background: In 2003, Group Health implemented a pharmacy-based, systemwide outreach effort to increase the preventive use of statins and angiotensin-converting enzyme inhibitors in enrollees at risk for cardiovascular disease, including all enrollees with diabetes.

Objective: To estimate the associations between the use of statins and major vascular events and the total costs in 2006-2010 for enrollees with diabetes, using a pharmacy-based, systemwide outreach.

Methods: In a 14-year (1997-2010) longitudinal cohort study design, the study population consisted of 6,975 Group Health enrollees with type 1 or type 2 diabetes, who were enrolled continuously and had no statin use before the Group Health outreach in 1997-2002.

Worldwide Incidence of Colorectal Cancer, Leukemia, and Lymphoma in Inflammatory Bowel Disease: An Updated Systematic Review and Meta-Analysis.

Background/Aims. Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC). In addition, there may be an association between leukemia and lymphoma and IBD.

The facilitators and barriers associated with implementation of a patient-centered medical home in VHA.

Background: The patient-centered medical home (PCMH) is a team-based, comprehensive model of primary care. When effectively implemented, PCMH is associated with higher patient satisfaction, lower staff burnout, and lower hospitalization for ambulatory care-sensitive conditions. However, less is known about what factors contribute to (or hinder) PCMH implementation.

A First Look at PCMH Implementation for Minority Veterans: Room for Improvement.

Background: Implementation of Patient Aligned Care Teams (PACT), a patient-centered medical home model, has been inconsistent among the >900 primary care facilities in the Veterans Health Administration.

Objective: Estimate if the degree of PACT implementation at a facility varied with the percentage of minority veteran patients at the facility.

Research Design: Cross-sectional, facility-level analysis of PACT implementation measures in 2012.

Implementing Value-Based Payment Reform: A Conceptual Framework and Case Examples.

This article develops a conceptual framework for implementation of value-based payment (VBP) reform and then draws on that framework to systematically examine six distinct multi-stakeholder coalition VBP initiatives in three different regions of the United States. The VBP initiatives deploy the following payment models: reference pricing, "shadow" primary care capitation, bundled payment, pay for performance, shared savings within accountable care organizations, and global payment. The conceptual framework synthesizes prior models of VBP implementation.

Dental attendance among low-income women and their children following a brief motivational counseling intervention: A community randomized trial.

Unlabelled: This study tested a behavioral intervention to increase dental attendance among rural Oregonian low-income women and their children. It utilized a multi-site, single-blind, randomized trial design. Four hundred women were randomized into one of four conditions to receive prenatal or postpartum motivational interviewing/counseling (MI) or prenatal or postpartum health education (HE).

Neighborhood Crime-Related Safety and Its Relation to Children's Physical Activity.

Crime is both a societal safety and public health issue. Examining different measures and aspects of crime-related safety and their correlations may provide insight into the unclear relationship between crime and children's physical activity. We evaluated five neighborhood crime-related safety measures to determine how they were interrelated.

Lessons from Washington State's Medical Home Payment Pilot: What It Will Take to Change American Health Care.

The Washington State Multi-Payer Medical Home Reimbursement Pilot (Pilot) tested a payment method for the patient-centered medical home (PCMH) model intended to reduce avoidable emergency department (ED) and hospitalization rates. Very little is known about the primary care clinic (clinic) experience with various payment methods designed for the medical home model. The objective was to elicit and describe the primary care clinic experience among various medical groups in Washington State's payment Pilot.

Emerging lessons from regional and state innovation in value-based payment reform: balancing collaboration and disruptive innovation.

Context: In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States.

Methods: As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice.

Hemoglobin A1c, comorbid conditions and all-cause mortality in older patients with diabetes: a retrospective 9-year cohort study.

Aims: To examine whether hemoglobin A1c levels and comorbid conditions are related to all-cause mortality in a cohort of patients with type 1 or 2 diabetes receiving continuous care for 9 years. In patients with comorbid congestive heart failure (CHF), we test for 'reverse epidemiology,' or whether greater HbA1c values are associated with lower risk of mortality.

Methods: The population for this longitudinal cohort study was 8820 Group Health enrollees in the Seattle area with type 1 or 2 diabetes in 1997 and enrolled continuously from 1997 to 2006.