Electronic Health Record Time Allocation Among Primary Care Clinicians at the Veterans Health Administration Using Virtual Observations.

Background: Prior research has shown that primary care clinicians (PCPs) spend a large portion of clinic visits on tasks within the electronic health record (EHR). However, no time allocation studies have been done in the Veterans Health Administration (VHA) and little is known about EHR time spent during virtual visits.

Objective: To estimate the proportion of clinician time spent working within the EHR during primary care visits at VHA clinics.

Association of Family Ratings of Quality of End-of-Life Care With Stopping Dialysis Treatment and Receipt of Hospice Services.

Importance: Approximately 1 in 4 patients receiving maintenance dialysis for end-stage renal disease eventually stop treatment before death. Little is known about the association of stopping dialysis and quality of end-of-life care.

Objectives: To evaluate the association of stopping dialysis before death with family-rated quality of end-of-life care and whether this association differed according to receipt of hospice services at the time of death.

Family Perceptions of Quality of End-of-Life Care for Veterans with Advanced CKD.

Background And Objectives: Little is known about the quality of end-of-life care for patients with advanced CKD. We describe the relationship between patterns of end-of-life care and dialysis treatment with family-reported quality of end-of-life care in this population.

Design, Setting, Participants, & Measurements: We designed a retrospective observational study among a national cohort of 9993 veterans with advanced CKD who died in Department of Veterans Affairs facilities between 2009 and 2015.

Chronic Lower Limb Wound Outcomes Among Rural and Urban Veterans.

Purpose: Veterans in rural areas generally have lower health care utilization than veterans in urban areas, but the impact of this difference on health outcomes has received little study. Chronic wounds provide a model for studying access to complex chronic care since they often are related to underlying health conditions and require lengthy treatment. Our goals were to describe chronic wound care utilization among rural and urban veterans and to determine the association between rural residence and wound healing.

Implementation of an education and skills programme in a teledermatology project for rural veterans.

In July 2009 we implemented a store-and-forward teledermatology project to provide dermatology care to veterans living in underserved rural areas of the Pacific Northwest region of the US. We also developed an educational programme for rural primary care providers and imaging technicians. Participants were tested and their competencies were assessed at baseline and during a two-year project.