Improving a Sanctioned Homeless Encampment for Veterans During COVID-19 Through Multilevel Partnerships.

A veteran-clinician-researcher partnership-the Care, Treatment, and Rehabilitation Service (CTRS)-enabled quality improvement within a U.S. Department of Veterans Affairs-sanctioned homeless encampment created in response to the COVID-19 pandemic.

A Sanctioned Encampment as a Strategy for Increasing Homeless Veterans' Access to Housing and Healthcare During the COVID-19 Pandemic.

Background: The COVID-19 pandemic intersected with a housing crisis for unsheltered Veterans experiencing homelessness (VEHs); congregate settings became high risk for viral spread. The VA Greater Los Angeles responded by creating the Care, Treatment, and Rehabilitation Service (CTRS), an outdoor, low-barrier-to-entry transitional housing program on VA grounds. This novel emergency initiative offered a protected outdoor environment ("sanctioned encampment") where VEHs lived in tents and had access to three meals a day, hygiene resources, and health and social services.

Novel student roles in health care delivery: An example emerging from the COVID-19 health care crisis in 2021.

In 2021, the rapid rise in COVID-19 infections put overwhelming demand on health care services. It was recognised that patients could be managed in the community if an appropriate monitoring service existed. Medical students were recruited for roles that combined technology, teamwork and clinical skills.

Implementation of a patient-collected audio recording audit & feedback quality improvement program to prevent contextual error: stakeholder perspective.

Background: Using patient audio recordings of medical visits to provide clinicians with feedback on their attention to patient life context in care planning can improve health care delivery and outcomes, and reduce costs. However, such an initiative can raise concerns across stakeholders about surveillance, intrusiveness and merit. This study examined the perspectives of patients, physicians and other clinical staff, and facility leaders over 3 years at six sites during the implementation of a patient-collected audio quality improvement program designed to improve patient-centered care in a non-threatening manner and with minimal effort required of patients and clinicians.

A Sector Wheel Approach to Understanding the Needs and Barriers to Services among Homeless-Experienced Veteran Families.

Background: Veteran family homelessness is a significant issue, yet little is known about the needs and barriers to services of veteran families experiencing homelessness. This qualitative study examined the experiences, needs, and barriers to services among homeless-experienced veteran families to inform providers for this important population.

Methods: Twenty-five semi-structured interviews were conducted from February through September 2016 with 18 veteran parents with a recent history of homelessness (9 mothers, 9 fathers), and 7 homeless service providers throughout Los Angeles County.

Movement-Based Therapies in Rehabilitation.

Movement therapy refers to a broad range of Eastern and Western mindful movement-based practices used to treat the mind, body, and spirit concurrently. Forms of movement practice are universal across human culture and exist in ancient history. Research demonstrates forms of movement therapy, such as dance, existed in the common ancestor shared by humans and chimpanzees, approximately 6 million years ago.

Significant reductions in tertiary hospital encounters and less travel for families after implementation of Paediatric Care Coordination in Australia.

Background: Over a third of Australian children have long-term health conditions, often involving multiple organ systems and resulting in complex health care needs. Our healthcare system struggles to meet their needs because of sectoral fragmentation and episodic models of care. Children with medical complexity (CMC) currently rely on tertiary paediatric hospitals for most of their healthcare, but this is not sustainable.

"Dealing with the Hospital has Become too Difficult for Us to Do Alone" - Developing an Integrated Care Program for Children with Medical Complexity (CMC).

Introduction: Children with medical complexity (CMC) require highly specialised care, often from multiple providers and over many years. This paper describes the first 18 months of development of the Kids Guided Personalised Services (GPS) Integrated Care Program (the Program). This Program aims to improve health care experience; communication and to streamline provision of care.

A qualitative study of health care providers' perceptions and experiences of working together to care for children with medical complexity (CMC).

Background: Children with medical complexity (CMC) have a wide range of long term health problems and disabilities that have an adverse impact on their quality of life. They have high levels of family identified health care needs and health care utilisation. There is no Australian literature on the experiences of health care providers working in the Australian tertiary, secondary and primary health care system, whilst managing CMC.

Feasibility and Acceptability of a Colocated Homeless-Tailored Primary Care Clinic and Emergency Department.

Objectives: Homeless adults have low primary care engagement and high emergency department (ED) utilization. Homeless-tailored, patient-centered medical homes (PCMH) decrease this population's acute care use. We studied the feasibility (focused on patient recruitment) and acceptability (conceptualized as clinicians' attitudes/beliefs) of a pilot initiative to colocate a homeless-tailored PCMH with an ED.

Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care.

Background: Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation.

Purpose: Our evaluation objectives were to (a) assess design element implementation, (b) describe implementation barriers and facilitators, and (c) assess successful quality improvement project completion and spread.

Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health-care System: findings from an online expert panel.

Context: There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care.

Methods: We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional).

Veterans Affairs Telemedicine: Bringing Urologic Care to Remote Clinics.

Objective: To report the use of telemedicine to deliver general urologic care to remote locations within the Veterans Affairs Greater Los Angeles Healthcare System. We describe the diagnoses managed, patient satisfaction, safety, and benefit to patients in terms of saved travel time and expense.

Methods: We conducted a retrospective chart review examining care delivered through urology telemedicine clinics over a 6-month period.

Early lessons learned in implementing a women's health educational and virtual consultation program in VA.

Background: Many Veterans Health Administration primary care providers (PCPs) have small female patient caseloads, making it challenging for them to build and maintain their women's health (WH) knowledge and skills. To address this issue, we implemented a longitudinal WH-focused educational and virtual consultation program using televideo conferencing.

Objective: To perform a formative evaluation of the program's development and implementation.

A patient-centered primary care practice approach using evidence-based quality improvement: rationale, methods, and early assessment of implementation.

Background: Healthcare systems and their primary care practices are redesigning to achieve goals identified in Patient-Centered Medical Home (PCMH) models such as Veterans Affairs (VA)'s Patient Aligned Care Teams (PACT). Implementation of these models, however, requires major transformation. Evidence-Based Quality Improvement (EBQI) is a multi-level approach for supporting organizational change and innovation spread.

Implementation outcomes of evidence-based quality improvement for depression in VA community based outpatient clinics.

Background: Collaborative-care management is an evidence-based practice for improving depression outcomes in primary care. The Department of Veterans Affairs (VA) has mandated the implementation of collaborative-care management in its satellite clinics, known as Community Based Outpatient Clinics (CBOCs). However, the organizational characteristics of CBOCs present added challenges to implementation.

Reducing costs of acute care for ambulatory care-sensitive medical conditions: the central roles of comorbid mental illness.

Background: New patient-centered models of ambulatory care aim to substitute better primary care for preventable acute care within existing primary care practices. This study aims to identify whether mental illness and other characteristics of primary care patients are related to risk for an acute event for an ambulatory care-sensitive condition (ACSC).

Methods: We conducted a 2-year, longitudinal analysis comparing ambulatory care-sensitive admissions and emergency department (ED) visits for a cohort of 18,526 primary care patients followed in 5 veterans affairs (VA) primary care sites.

Organizational characteristics associated with the availability of women's health clinics for primary care in the Veterans Health Administration.

Objective: Women's health clinics (WHCs) offering integrated primary care (PC) and gender-specific services reduce fragmentation and improve quality of care for women. Our objective was to understand organizational influences on the development of WHCs for PC delivery in Veterans Health Administration (VA) facilities.

Methods: We surveyed PC directors at 219 VA facilities about the presence of separate WHCs for PC and evaluated organizational characteristics (e.

A past medical history of gestational diabetes: its medical significance and its dental implications.

Approximately 7% of pregnant women develop gestational diabetes mellitus (GDM), a usually transient form of diabetes mellitus, because of the production of some placental and maternal adipose tissue elaborated hormones that alter glucose metabolism. In most women the disorder resolves at delivery, but within 10 years 50% to 70% of these women go on to develop type 2 diabetes. The identification of women with past medical histories of GDM is a clinically useful marker for alerting the dentist to patients at heightened risk of occult type 2 diabetes, with a possible greater risk of developing periodontal disease and dental caries.