Adverse events and perceived abandonment: learning from patients' accounts of medical mishaps.

Background: Adverse medical events affect 10% of American households annually, inducing a variety of harms and attitudinal changes. The impact of adverse events on perceived abandonment by patients and their care partners has not been methodically assessed.

Objective: To identify ways in which providers, patients and families responded to medical mishaps, linking these qualitatively and statistically to reported feelings of abandonment and sequelae induced by perceived abandonment.

Glycated Hemoglobin A1c Time in Range and Dementia in Older Adults With Diabetes.

Importance: Individuals with diabetes commonly experience Alzheimer disease and related dementias (ADRD). Factors such as hypoglycemia, hyperglycemia, and glycemic variability have been associated with increased risk of ADRD. Traditional glycemic measures, such as mean glycated hemoglobin A1c (HbA1c), may not identify the dynamic and complex pathophysiologic factors in the association between diabetes and ADRD.

Delivery at an inadequate level of maternal care is associated with severe maternal morbidity.

Background: Implementing levels of maternal care is one strategy proposed to reduce maternal morbidity and mortality. The levels of maternal care framework outline individual medical and obstetrical comorbidities, along with hospital resources required for individuals with these different comorbidities to deliver safely. The overall goal is to match individuals to hospitals so that all birthing people get appropriate resources and personnel during delivery to reduce maternal morbidity.

Risk of Severe Maternal Morbidity in Birthing People With Opioid Use Disorder.

Introduction: We examined severe maternal morbidity (SMM) among birthing people with opioid use disorder (OUD) and evaluated the extent to which differences in SMM exist by race and ethnicity.

Methods: We performed a retrospective cohort study using hospital discharge data for all Massachusetts births between 2016 and 2020. SMM rates for all SMM indicators, except transfusions, were computed for those diagnosed with and without OUD.

Association of hemoglobin A1c stability with mortality and diabetes complications in older adults with diabetes.

Introduction: Hemoglobin A1c (A1c) treatment goals in older adults should be individualized to balance risks and benefits. It is unclear if A1c stability over time within unique target ranges also affects adverse outcomes.

Research Design And Methods: We conducted a retrospective observational cohort study from 2004 to 2016 of veterans with diabetes and at least four A1c tests during a 3-year baseline.

Association of hemoglobin A1c time in range with risk for diabetes complications.

Introduction: We assessed the association between hemoglobin A1c time in range (A1c TIR), based on unique patient-level A1c target ranges, with risks of developing microvascular and macrovascular complications in older adults with diabetes.

Research Design And Methods: We used a retrospective observational study design and identified patients with diabetes from the Department of Veterans Affairs (n=397 634). Patients were 65 years and older and enrolled in Medicare during the period 2004-2016.

A novel dataset of predictors of mortality for older Veterans living with type II diabetes.

The dataset summarized in this article includes a nationwide prevalence sample of U.S. military Veterans who were aged 65 years or older, dually enrolled in the Veterans Health Administration and traditional Medicare and had a previous diagnosis of diabetes (diabetes mellitus) as of December 2005 ( = 275,190) [1].

Differences in patient outcomes after outpatient GI endoscopy across settings: a statewide matched cohort study.

Background And Aims: Outpatient GI endoscopy has been shifting from hospital outpatient departments (HOPDs) to ambulatory surgery centers (ASCs) in recent years. However, evidence on whether patient outcomes after endoscopic procedures are comparable across settings is limited. This study compares the incidence of unplanned hospital visits after GI endoscopy performed in ASCs versus HOPDs.

Comparing total medical expenditure between patients receiving direct oral anticoagulants vs warfarin for the treatment of atrial fibrillation: evidence from VA-Medicare dual enrollees.

Direct oral anticoagulants (DOACs) are an alternative to warfarin for treatment of atrial fibrillation (AF). Evidence demonstrating the efficacy and safety of DOACs has primarily been from clinical trial settings. The real-world effectiveness of DOACs in specific nontrial populations that differ in age, comorbidity burden, and socioeconomic status is unclear.

Increased Hemoglobin A Time in Range Reduces Adverse Health Outcomes in Older Adults With Diabetes.

Objective: Short- and long-term glycemic variability are risk factors for diabetes complications. However, there are no validated A1C target ranges or measures of A1C stability in older adults. We evaluated the association of a patient-specific A1C variability measure, A1C time in range (A1C TIR), on major adverse outcomes.

Association between hemoglobin A1c variability and hypoglycemia-related hospitalizations in veterans with diabetes mellitus.

Introduction: To study the impact of hemoglobin A1c (A1c) variability on the risk of hypoglycemia-related hospitalization (HRH) in veterans with diabetes mellitus.

Research Design And Methods: 342 059 veterans with diabetes aged 65 years or older were identified for a retrospective cohort study. All participants had a 3-year baseline period from January 1, 2005 to December 31, 2016, during which they had at least four A1c tests.

Predicting 5- and 10-Year Mortality Risk in Older Adults With Diabetes.

Objective: Several diabetes clinical practice guidelines suggest that treatment goals may be modified in older adults on the basis of comorbidities, complications, and life expectancy. The long-term benefits of treatment intensification may not outweigh short-term risks for patients with limited life expectancy. Because of the uncertainty of determining life expectancy for individual patients, we sought to develop and validate prognostic indices for mortality in older adults with diabetes.

Implementing Teledermatology for Rural Veterans: An Evaluation Using the RE-AIM Framework.

Few systematic evaluations of implementing teledermatology programs in large health care systems exist. We conducted a longitudinal evaluation of a U.S.

Priority access to health care: Evidence from an exogenous policy shock.

Access to care is an important issue in public health care systems. Unlike private systems, in which price equilibrates supply and demand, public systems often ration medical services through wait times. Access that is given on a first come, first served basis might not yield an allocation of resources that maximizes the health of a population, potentially creating suboptimal heterogeneity in wait times.

Association of open communication and the emotional and behavioural impact of medical error on patients and families: state-wide cross-sectional survey.

Background: How openly healthcare providers communicate after a medical error may influence long-term impacts. We sought to understand whether greater open communication is associated with fewer persisting emotional impacts, healthcare avoidance and loss of trust.

Methods: Cross-sectional 2018 recontact survey assessing experience with medical error in a 2017 random digit dial survey of Massachusetts residents.

Call center performance affects patient perceptions of access and satisfaction.

Objectives: There is little research on the relationship between call center performance and patient-centered outcomes. In this study, we quantified the relationships between 2 measures of telephone access, average speed of answer (ASA) and abandonment rate (AR), and patient satisfaction outcomes within the Veterans Health Administration (VHA).

Study Design: We analyzed 2015 and 2016 data from the Survey of Healthcare Experiences of Patients and linked them with administrative data to gather features of the patient visit and monthly measures of telephone access for each medical center.

study: protocol for a stepped-wedge cluster randomised trial to compare access to care for a mobile app versus a workstation-based store-and-forward teledermatology process.

Introduction: Teledermatology has emerged as an important strategy to enhance access to high-quality skin care. is a provider-facing, web-based mobile app designed to integrate into the existing teledermatology workflow in the US Veterans Health Administration (VHA). In this study, we will conduct a systematic evaluation of on access outcomes in VHA facilities using a pragmatic trial guided by clinical and operational leaders.

Guideline-concordant initiation of oral anticoagulant therapy for stroke prevention in older veterans with atrial fibrillation eligible for Medicare Part D.

Objective: To characterize the rate of guideline-concordant initiation of oral anticoagulation (OAC) among elderly Veterans with atrial fibrillation (AF) and high stroke risk.

Data Sources/study Setting: Veterans Health Administration (VHA) Corporate Data Warehouse (CDW) linked with Medicare claims 2011-2015.

Study Design: We identified 6619 elderly, high stroke-risk patients with a new episode of AF initially diagnosed in the VHA during fiscal years 2012-2015.

Overcoming Challenges to Evidence-Based Policy Development in a Large, Integrated Delivery System.

Objective: To describe a new Veterans Health Administration (VHA) program to foster the learning health system paradigm by rigorously evaluating health care initiatives and to report key lessons learned in designing those evaluations.

Principal Findings: The VHA's Quality Enhancement Research Initiative and its Health Services Research and Development Service are cooperating on several large, randomized program evaluations aimed at improving the care veterans receive and the efficiency with which it is delivered. The evaluations we describe involve collaborative design, outcomes assessment, and implementation science through partnerships between VHA operations and researchers.

Preventing Hospitalization with Veterans Affairs Home-Based Primary Care: Which Individuals Benefit Most?

Objectives: To examine how medical complexity modifies the relationship between enrollment in Department of Veterans Affairs (VA) home-based primary care (HBPC) and hospitalization for ambulatory care-sensitive conditions (ACSC) for veterans with diabetes mellitus and whether the effect of HBPC on hospitalizations varies according to clinical condition.

Design: Retrospective cohort study.

Setting: VA and non-VA hospitals.

Consult Coordination Affects Patient Experience.

Objectives: The Medicare accountable care organization (ACO) program financially rewards ACOs for providing high-quality healthcare, and also factors in the patient experience of care. This study examined whether administrative measures of wait times for specialist consults are associated with self-reported patient satisfaction.

Study Design: Analyses used administrative and survey data from a clinically integrated healthcare system similar to an ACO.

Metrics That Matter.

Increasingly, performance metrics are seen as key components for accurately measuring and improving health care value. Disappointment in the ability of chosen metrics to meet these goals is exemplified in a recent Institute of Medicine report that argues for a consensus-building process to determine a simplified set of reliable metrics. Overall health care goals should be defined and then metrics to measure these goals should be considered.

Long-term outcomes of analogue insulin compared with NPH for patients with type 2 diabetes mellitus.

Background: Long-acting insulin analogues (eg, insulin glargine and insulin detemir) are an alternative to neutral protamine Hagedorn (NPH) insulin for maintaining glycemic control in patients with diabetes. Clinical trials comparing analogue insulin and NPH have neither been adequately powered nor had sufficient follow-up to examine long-term health outcomes.

Objectives: To compare the effects of NPH and long-acting insulin analogues on long-term outcomes.

Capitalizing on prescribing pattern variation to compare medications for type 2 diabetes.

Background: Clinical trials often compare hypoglycemic medications on the basis of glycemic control but do not examine long-term outcomes (e.g., mortality).

Home-based primary care and the risk of ambulatory care-sensitive condition hospitalization among older veterans with diabetes mellitus.

Importance: Primary care services based at home have the potential to reduce the likelihood of hospitalization among older adults with multiple chronic diseases.

Objective: To characterize the association between enrollment in Home-Based Primary Care (HBPC), a national home care program operated by the US Department of Veterans Affairs (VA), and hospitalizations owing to an ambulatory care-sensitive condition among older veterans with diabetes mellitus.

Design And Setting: Retrospective cohort study.