Describing Adverse Pregnancy Events and Pregnancy-Associated Death Among Veterans.

Veterans who use VA pregnancy benefits may be at high risk for adverse pregnancy outcomes; however, little is known about rates of adverse pregnancy events or pregnancy-associated death among Veterans. We conducted a retrospective cohort study using VA national administrative data for Veterans ages 18-45 with at least one pregnancy outcome between October 2009 and September 2016 and a VA primary care visit within one year prior to pregnancy. We identified adverse events during pregnancy and up to 42 days after pregnancy and all-cause mortality within one year of pregnancy and compared prevalence of adverse events by Veteran race/ethnicity using adjusted logistic regression.

Abortion After Pregnancy Occurrence with Contraceptive Use Among Veterans.

Many people report becoming pregnant while using contraception. Understanding more about this phenomenon may provide insight into pregnant people's responses to and healthcare needs for these pregnancies. This study explores the outcome (e.

Facility-Level Variation in Racial Disparities in Anticoagulation for Atrial Fibrillation: The REACH-AF Study.

Background: Oral anticoagulation reduces stroke risk for patients with atrial fibrillation (AF). Prior research demonstrates lower anticoagulant prescribing in Black than in White individuals but few studies have examined racial differences in facility-level anticoagulant prescribing for AF.

Objective: To assess variation in anticoagulant initiation by race within Veterans Health Administration (VA) facilities.

Participation of Veterans Affairs Medical Centers in veteran-centric community-based service navigation networks: A mixed methods study.

Objective: To understand the determinants and benefits of cross-sector partnerships between Veterans Affairs Medical Centers (VAMCs) and geographically affiliated AmericaServes Network coordination centers that address Veteran health-related social needs.

Data Sources And Setting: Semi-structured interviews were conducted with AmericaServes and VAMC staff across seven regional networks. We matched administrative data to calculate the percentage of AmericaServes referrals that were successfully resolved (i.

Assessing an electronic self-report method for improving quality of ethnicity and race data in the Veterans Health Administration.

Objective: Evaluate self-reported electronic screening () in a VA Transition Care Management Program (TCM) to improve the accuracy and completeness of administrative ethnicity and race data.

Materials And Methods: We compared missing, declined, and complete (neither missing nor declined) rates between (1) (ethnicity and race entered into electronic tablet directly by patient using eScreening), (2) (Veteran-completed paper form plus interview, data entered by staff), and (3) (multiple processes, data entered by staff). The TCM-eScreening ( = 7113) and TCM-EHR groups ( = 7113) included post-9/11 Veterans.

Frailty predicts referral for elder abuse evaluation in a nationwide healthcare system-Results from a case-control study.

Background: Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. We examined the association between a recently validated frailty index and referral to social work (SW) for EA evaluation in the Veterans Administration (VA) healthcare system.

Association of Neighborhood Disadvantage and Anticoagulation for Patients with Atrial Fibrillation in the Veterans Health Administration: the REACH-AF Study.

Background: Atrial fibrillation (AF) is a common arrhythmia, the management of which includes anticoagulation for stroke prevention. Although disparities in anticoagulant prescribing have been well documented for individual socioeconomic factors, less is known about the association of neighborhood-level disadvantage and anticoagulation for AF.

Objective: To assess the association between neighborhood disadvantage and anticoagulant initiation for patients with incident AF.

Analysis of Initiating Anticoagulant Therapy for Atrial Fibrillation Among Persons Experiencing Homelessness in the Veterans Affairs Health System.

This cohort study examines the use of anticoagulant therapy among persons who have experienced homelessness treated for atrial fibrillation in the Veterans Affairs Health System.

Effect of Deintensifying Diabetes Medications on Negative Events in Older Veteran Nursing Home Residents.

Objective: Guidelines advocate against tight glycemic control in older nursing home (NH) residents with advanced dementia (AD) or limited life expectancy (LLE). We evaluated the effect of deintensifying diabetes medications with regard to all-cause emergency department (ED) visits, hospitalizations, and death in NH residents with LLE/AD and tight glycemic control.

Research Design And Methods: We conducted a national retrospective cohort study of 2,082 newly admitted nonhospice veteran NH residents with LLE/AD potentially overtreated for diabetes (HbA1c ≤7.

Using practice facilitation to improve alcohol-related care in primary care: a mixed-methods pilot study protocol.

Background: Alcohol use is a significant risk factor for disability and death in U.S. adults, and approximately one out of every six Veterans seen in primary care (PC) report unhealthy alcohol use.

Medical and Social Factors Associated With Referral for Elder Abuse Services in a National Health Care System.

Background: Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target health care-based interventions. Our objective was to examine sociodemographic and medical characteristics associated with documented referrals for EA assessment or services in a national U.S.

Association of Race and Ethnicity and Anticoagulation in Patients With Atrial Fibrillation Dually Enrolled in Veterans Health Administration and Medicare: Effects of Medicare Part D on Prescribing Disparities.

Background: Racial and ethnic disparities in anticoagulation exist in atrial fibrillation management in Medicare and the Veterans Health Administration, but the influence of dual Veterans Health Administration and Medicare enrollment is unclear. We compared anticoagulant initiation by race and ethnicity in dually enrolled patients and assessed the role of Medicare part D enrollment on anticoagulation disparities.

Methods: We identified patients with incident atrial fibrillation (2014-2018) dually enrolled in Veterans Health Administration and Medicare.

An Interrupted Time-series Evaluation of the Association Between State Laws Mandating Prescriber Use of Prescription Drug Monitoring Programs and Discontinuation of Chronic Opioid Therapy in US Veterans.

Background: Most states have recently passed laws requiring prescribers to use prescription drug monitoring programs (PDMPs) before prescribing opioid medications. The impact of these mandates on discontinuing chronic opioid therapy among Veterans managed in the Veterans Health Administration (VA) is unknown. We assess the association between the earliest of these laws and discontinuation of chronic opioid therapy in Veterans receiving VA health care.

Disparities in Anticoagulant Therapy Initiation for Incident Atrial Fibrillation by Race/Ethnicity Among Patients in the Veterans Health Administration System.

Importance: Atrial fibrillation is a common cardiac rhythm disturbance causing substantial morbidity and mortality that disproportionately affects racial/ethnic minority groups. Anticoagulation reduces stroke risk in atrial fibrillation, yet studies show it is underprescribed in racial/ethnic minority patients.

Objective: To compare initiation of anticoagulant therapy by race/ethnicity for patients in the Veterans Health Administration (VA) system with atrial fibrillation.

Evaluation of a collaborative VA network initiative to reduce racial disparities in blood pressure control among veterans with severe hypertension.

Background: Compared to White patients in the United States, Black patients have a higher prevalence of hypertension and more severe forms of this condition.

Objective: To decrease racial disparities in blood pressure (BP) control among Black veterans with severe hypertension within a regional network of Veterans Affairs Medical Centers (VAMCs).

Methods: Health system leaders, clinicians, and health services researchers collaborated on a 12-month quality improvement (QI) project to: (1) examine project implementation and the QI strategies used to improve BP control and (2) assess the effect of the initiative on Black-White differences in BP control among veterans with severe hypertension.

Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare.

Background And Objectives: Many kidney transplant recipients enrolled in the Veterans Health Administration are also enrolled in Medicare and eligible to receive both Veterans Health Administration and private sector care. Where these patients receive transplant care and its association with mortality are unknown.

Design, Setting, Participants, & Measurements: We conducted a retrospective cohort study of veterans who underwent kidney transplantation between 2008 and 2016 and were dually enrolled in Veterans Health Administration and Medicare at the time of surgery.

Measuring Female Veterans' Prepregnancy Wellness Using Department of Veterans Affairs' Health Record Data.

Objective: To estimate the feasibility of using measures developed by the Clinical Workgroup of the National Preconception Health and Health Care Initiative to assess women's prepregnancy wellness in a large health care system.

Methods: We examined Department of Veterans Affairs' (VA) national administrative data, including inpatient, outpatient, fee-basis, laboratory, pharmacy, and screening data for female veterans aged 18-45 who had at least one pregnancy outcome (ectopic pregnancy, spontaneous abortion, stillbirth, and live birth) during fiscal years 2010-2015 and a VA primary care visit within 1 year before last menstrual period (LMP). LMP was estimated from gestational age at the time of pregnancy outcome, then used as a reference point to assess eight prepregnancy indicators from the Workgroup consensus measures (eg, 3 or 12 months before LMP).

Identifying sociodemographic profiles of veterans at risk for high-dose opioid prescribing using classification and regression trees.

Objective: To identify sociodemographic profiles of patients prescribed high-dose opioids.

Design: Cross-sectional cohort study.

Setting/patients: Veterans dually-enrolled in Veterans Health Administration and Medicare Part D, with ≥1 opioid pre-scription in 2012.