Healthy hair starts with a healthy body: hair stylists as lay health advisors to prevent chronic kidney disease.

Background: Chronic kidney disease affects one in nine Americans. Diabetes and hypertension account for nearly three quarters of all kidney failure cases. Disproportionate rates of chronic kidney disease, diabetes, and hypertension have been observed among African Americans.

Use of central venous catheter-related bloodstream infection prevention practices by US hospitals.

Objective: To examine the extent to which US acute care hospitals have adopted recommended practices to prevent central venous catheter-related bloodstream infections (CR-BSIs).

Participants And Methods: Between March 16, 2005, and August 1, 2005, a survey of infection control coordinators was conducted at a national random sample of nonfederal hospitals with an intensive care unit and more than 50 hospital beds (n=600) and at all Department of Veterans Affairs (VA) medical centers (n=119). Primary outcomes were regular use of 5 specific practices and a composite approach for preventing CR-BSIs.

Operative mortality after renal transplantation--does surgeon type matter?

Purpose: Currently there are 64 accredited renal transplantation fellowships in Canada and the United States. Only 27% are limited in scope to kidney transplants. In the remaining fellowships the trainee learns to transplant multiple abdominal organs.

Overcoming the influence of chronic pain on older patients' difficulty with recommended self-management activities.

Purpose: Many older patients with common chronic conditions also experience chronic pain. We examined how chronic pain affects patients' difficulty with recommended self-management activities and the potential intervening role of self-efficacy (the level of confidence in one's own ability to perform a specific task).

Design And Methods: We obtained data from a cross-sectional nationwide survey of older patients, primarily older men, with chronic health conditions (N = 543).

Advancing evidence-based care for diabetes: lessons from the Veterans Health Administration.

The Veterans Health Administration (VHA) is a unique laboratory for using the electronic health record (EHR) to transform health care and accelerate discovery. This is particularly evident in the care of veterans with diabetes, who constitute a quarter of those served by the VHA. Although EHRs have enabled rapid learning, additional factors were necessary, including the lead participation of clinician-investigators, accountability through performance measurement, a delivery system focused on population health, and favorable economic externalities.

Reading habits of infection control coordinators in the United States: peer-reviewed or non-peer-reviewed evidence?

Background: Because evidence-based health care is taking on increasing importance, we surveyed a national sample of infection control coordinators on their reading habits to discern which and how often various media are utilized.

Methods: Infection control coordinators at 797 hospitals in the United States were mailed a survey asking which peer-reviewed journals and other publications they subscribe to, their perception of the quality of the infection control articles provided by each, and the extent to which they use various resources for their work.

Results: The survey response rate was 74%.

Economics of diabetes mellitus.

The increasing prevalence of diabetes and prediabetes makes the cost of diabetes care a pressing concern. Nurses in all settings play a critical role in helping to reduce the cost of diabetes not only for individual patients but ultimately for the health care system. This article focuses on four main issues related to the economic impact of diabetes for patients and health systems: (1) overall estimates of the direct and indirect costs of diabetes and its associated complications, (2) the impact of cost on diabetes care and health outcomes, (3) the ways in which federal- and state-mandated insurance for persons with diabetes is being used to promote more cost-effective and high-quality diabetes care, and (4) the use of cost-effectiveness analysis to evaluate interventions designed to prevent diabetes or diabetes-related complications.

Translating infection prevention evidence into practice using quantitative and qualitative research.

Infection control professionals and hospital epidemiologists, using the valid methods of applied epidemiology-surveillance, benchmarking, intervention, evaluation--have largely been responsible for dramatically reducing the incidence of health care-associated infections over the past several decades. However, we believe that the field of infection control can--and should--also be a leader in understanding how research findings can be efficiently and effectively translated into clinical practice. Unfortunately, there is no current reliable information about which preventive practices are being used in US hospitals to prevent common device-related infections.

Personal and treatment factors associated with foot self-care among veterans with diabetes.

We developed and validated a survey of foot self-care education and behaviors in 772 diabetic patients with high-risk feet at eight Department of Veterans Affairs medical centers. Principal components analysis identified six subscales with satisfactory internal consistency: basic foot-care education, extended foot-care education, basic professional foot care, extended professional foot care, basic foot self-care, and extended foot self-care (alpha = 0.77-0.

Diabetes treatment among VA patients with comorbid serious mental illness.

Objective: Patients with serious mental illnesses, such as schizophrenia, bipolar disorder, and other psychoses, may be less likely to receive adequate care for chronic medical conditions than patients without serious mental illness. The quality and outcomes of diabetes care were compared in an observational study among patients with and without serious mental illness.

Methods: National data were studied for 36,546 individuals receiving care within the U.

Gender disparities in lipid management: the presence of disparities depends on the quality measure.

Objective: To determine if the use of a more detailed quality measure affected the finding of gender disparities in lipid management.

Study Design: Retrospective cohort study.

Methods: Study subjects included 2589 patients with diabetes mellitus in a managed care plan in 2000-2001.

The role of patient-physician trust in moderating medication nonadherence due to cost pressures.

Background: Prescription drug costs constitute a burden for many chronically ill adults and are strongly related to patients' likelihood of using less medication than prescribed. We examined the extent to which patients' trust in their physicians may moderate the impact of economic constraints and other risk factors for cost-related adherence problems.

Methods: A total of 912 patients with diabetes recruited from 5 Veterans Affairs health systems completed a detailed cross-sectional survey.

Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial.

Objective: To evaluate the effect of case management by a clinical pharmacist on glycemic control and preventive measures in patients with type 2 diabetes mellitus.

Study Design: Randomized controlled trial in a university-affiliated primary care internal medicine clinic.

Methods: We recruited 80 patients with poorly controlled type 2 diabetes mellitus.

Veterans Affairs primary care organizational characteristics associated with better diabetes control.

Objective: To examine organizational features of Veterans Affairs (VA) primary care programs hypothesized to be associated with better diabetes control, as indicated by hemoglobin A1C (HbA1C) levels.

Study Design: Cross-sectional cohort.

Methods: We established a cohort of 224 221 diabetic patients using the VA Diabetes Registry and Dataset and VA corporate databases.

The effect of chronic pain on diabetes patients' self-management.

Objective: Many adults experience chronic pain, yet little is known about the consequences of such pain among individuals with diabetes. The purpose of this study was to examine whether and how chronic pain affects diabetes self-management.

Research Design And Methods: This is a cross-sectional study of 993 patients with diabetes receiving care through the Department of Veterans Affairs (VA).

Diabetes care quality in the Veterans Affairs Health Care System and commercial managed care: the TRIAD study.

Background: No studies have compared care in the Department of Veterans Affairs (VA) with that delivered in commercial managed care organizations, nor have studies focused in depth on care comparisons for chronic, outpatient conditions.

Objective: To compare the quality of diabetes care between patients in the VA system and those enrolled in commercial managed care organizations by using equivalent sampling and measurement methods.

Design: Cross-sectional patient survey with retrospective review of medical records.

Case management for patients with poorly controlled diabetes: a randomized trial.

Purpose: To evaluate the effects of a collaborative case management intervention for patients with poorly controlled type 2 diabetes on glycemic control, intermediate cardiovascular outcomes, satisfaction with care, and resource utilization.

Methods: We conducted a randomized controlled trial at two Department of Veterans Affairs Medical Centers involving 246 veterans with diabetes and baseline hemoglobin A(1C) (HbA(1C)) levels >or=7.5%.

Quality improvement initiatives: issues in moving from diabetes guidelines to policy.

Objective: To outline the principles that direct the Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) dedicated to diabetes quality improvement (QUERI-DM).

Research Design And Methods: We discuss the VA initiatives aimed at improving diabetes care for veterans as well as general issues that should be considered in quality improvement initiatives. We specifically describe some of the epidemiological, statistical, and organizational issues that have guided our quality improvement (QI) programs.

Racial disparities in diabetes care processes, outcomes, and treatment intensity.

Background: Black Americans with diabetes have a higher burden of illness and mortality than do white Americans. However, the extent to which differences in medical care processes and treatment intensity contribute to poorer diabetes outcomes is unknown.

Objective: To assess racial disparities in the quality of diabetes care processes, intermediate outcomes, and treatment intensity.

Building a better quality measure: are some patients with 'poor quality' actually getting good care?

Background: National performance measures monitor the proportion of diabetic patients with low-density lipoprotein (LDL) levels >/=130 mg/dL, but such simple intermediate outcomes measure poor control, not necessarily poor care. "Tightly linked" quality measures define good quality either by a good intermediate outcome (LDL <130 mg/dL) or by evidence of appropriate responses to poor control (eg, starting or optimizing medications for high LDL or not doing so in the face of contraindications).

Objectives: We examined hyperlipidemia therapy for patients with diabetes to determine the relative accuracy of quality assessment using simple intermediate outcome versus tightly linked quality measures.

How well do patients' assessments of their diabetes self-management correlate with actual glycemic control and receipt of recommended diabetes services?

Objective: Although patient diabetes self-management is a key determinant of health outcomes, there is little evidence on whether patients' own assessments of their self-management correlates with glycemic control and key aspects of high-quality diabetes care. We explored these associations in a nationwide sample of Veterans' Affairs (VA) patients with diabetes.

Research Design And Methods: We abstracted information on achieved level of glycemic control (HbA(1c)) and diabetes processes of care (receipt of HbA(1c) test, eye examination, and nephropathy screen) from medical records of 1032 diabetic patients who received care from 21 VA facilities and had answered the Diabetes Quality Improvement Program survey in 2000.

Whom should we profile? Examining diabetes care practice variation among primary care providers, provider groups, and health care facilities.

Objective: To evaluate the amount of variation in diabetes practice patterns at the primary care provider (PCP), provider group, and facility level, and to examine the reliability of diabetes care profiles constructed using electronic databases.

Data Sources/study Setting: Clinical and administrative data obtained from the electronic information systems at all facilities in a Department of Veterans Affairs' (VA) integrated service network for a study period of October 1997 through September 1998.

Study Design: This is a cohort study.

Comparing clinical automated, medical record, and hybrid data sources for diabetes quality measures.

Background: Little is known about the relative reliability of medical record and clinical automated data, sources commonly used to assess diabetes quality of care. The agreement between diabetes quality measures constructed from clinical automated versus medical record data sources was compared, and the performance of hybrid measures derived from a combination of the two data sources was examined.

Methods: Medical records were abstracted for 1,032 patients with diabetes who received care from 21 facilities in 4 Veterans Integrated Service Networks.

Aspirin use and counseling about aspirin among patients with diabetes.

Objective: Despite being a safe, effective therapy for lowering cardiovascular risk, only 20% of diabetic patients were using aspirin in the early 1990s. This study examines current physician practices and the use of aspirin therapy by individuals with diabetes.

Research Design And Methods: A random sample of diabetic patients receiving care in the Department of Veterans Affairs health care system were surveyed during January-March 2000.