Publications by authors named "Mary McDonell"
Background: Angina and depression are common in ischemic heart disease (IHD), but their association remains understudied.
Purpose: This study was conducted in order to evaluate the association of 1 year change in depression with change in patient-reported outcomes of stable angina.
Methods: Five hundred sixty-nine stable angina patients completed the Seattle Angina Questionnaire and Patient Health Questionnaire (PHQ) at baseline and 1 year.
Background: Statistical models that identify patients at elevated risk of death or hospitalization have focused on population subsets, such as those with a specific clinical condition or hospitalized patients. Most models have limitations for clinical use. Our objective was to develop models that identified high-risk primary care patients.
View Article and Find Full Text PDFPatients with heart failure (HF) are at high risk of hospitalization or death. The objective of this study was to develop prediction models to identify patients with HF at highest risk for hospitalization or death. Using clinical and administrative databases, we identified 198,460 patients who received care from the Veterans Health Administration and had ≥1 primary or secondary diagnosis of HF that occurred within 1 year before June 1, 2009.
View Article and Find Full Text PDFIntroduction: To improve the health of overweight and obese veterans, the Department of Veterans Affairs (VA) developed the MOVE! Weight Management Program for Veterans. The aim of this evaluation was to assess its reach and effectiveness.
Methods: We extracted data on program involvement, demographics, medical conditions, and outcomes from VA administrative databases in 4 Western states.
Background: Accumulating evidence suggests that collaborative models of care enhance communication among primary care providers, improving quality of care and outcomes for patients with chronic conditions. We sought to determine whether a multifaceted intervention that used a collaborative care model and was directed through primary care providers would improve symptoms of angina, self-perceived health, and concordance with practice guidelines for managing chronic stable angina.
Methods: We conducted a prospective trial, cluster randomized by provider, involving patients with symptomatic ischemic heart disease recruited from primary care clinics at 4 academically affiliated Department of Veterans Affairs health care systems.
Background: Little is known about geographic differences in health status among patients with chronic obstructive pulmonary disease (COPD).
Objectives: The aim of this study was to examine regional variations in self-reported health status of COPD patients at 7 Veterans Affairs clinics.
Methods: The Ambulatory Care Quality Improvement Project was a multicenter, randomized trial conducted from 1997 to 2000 that evaluated a quality improvement intervention in the primary care setting.
The VA Cardiovascular Assessment, Reporting, and Tracking (CART) system is a customized electronic medical record system which provides standardized report generation for cardiac catheterization procedures, serves as a national data repository, and is the centerpiece of a national quality improvement program. Like many health information technology projects, CART implementation did not proceed without some barriers and resistance. We describe the nationwide implementation of CART at the 77 VA hospitals which perform cardiac catheterizations in three phases: (1) strategic collaborations; (2) installation; and (3) adoption.
View Article and Find Full Text PDFBackground: Mortality from acute myocardial infarction (AMI) is declining worldwide. We sought to determine if mortality in the Veterans Health Administration (VHA) has also been declining.
Methods: We calculated 30-day mortality rates between 2004 and 2006 using data from the VHA External Peer Review Program (EPRP), which entails detailed abstraction of records of all patients with AMI.
Background: In the United States, relatively little is known about cause of death in individuals who die prior to or after hospital discharge for acute coronary syndromes (ACS). The purpose of this report was to compare baseline patient characteristics according to whether the underlying cause of death was cardiac or non-cardiac.
Methods: We linked cause of death information from Washington State death records to the Department of Veterans Affairs (VA) External Peer Review Program ACS registry.
Objective: To determine whether a history of depression and/or posttraumatic stress disorder (PTSD) is associated with all-cause mortality in primary care patients over an average of 2 years.
Methods: Patients from seven Department of Veterans Affairs medical centers completed mailed questionnaires. Depression and PTSD status were determined from patient self-report of a prior diagnosis and/or electronic administrative data.
Background: There are many measures of refill adherence available, but few have been designed or validated for use with repeated measures designs and short observation periods.
Objective: To design a refill-based adherence algorithm suitable for short observation periods, and compare it to 2 reference measures.
Methods: A single composite algorithm incorporating information on both medication gaps and oversupply was created.
Rationale And Objectives: Lung cancer is a frequent cause of death among patients with chronic obstructive pulmonary disease (COPD). We examined whether the use of inhaled corticosteroids among patients with COPD was associated with a decreased risk of lung cancer.
Methods: We performed a cohort study of United States veterans enrolled in primary care clinics between December 1996 and May 2001.
Background: Use of complementary and alternative medicine (CAM) is increasing in the United States. This study investigates whether the use of alternative medicine is associated with a delay of treatment in head and neck cancer.
Methods: This study used the records obtained from a large trial involving ambulatory care US veterans.
This study examined the extent to which 3559 VA primary care patients with depression symptomatology received depression diagnoses and/or antidepressant prescriptions. Symptomatology was classified as mild (13%), moderate (42%) or severe (45%) based on SCL-20 scores. Diagnosis and treatment was related to depression severity and other patient characteristics.
View Article and Find Full Text PDFBackground: We sought to examine health care resource utilization in the last 6 months of life among patients who died with chronic obstructive pulmonary disease (COPD) compared with those who died with lung cancer and to examine geographic variations in care.
Methods: We performed a retrospective cohort study of patients diagnosed as having COPD or lung cancer, who were seen in 1 of 7 Veteran Affairs medical centers primary care clinics and who died during the study period. Our outcome of interest was health care resource utilization in the last 6 months of life.
Objective: We compared single- and multi-item measures of general self-rated health (GSRH) to predict mortality and clinical events a large population of veteran patients.
Data Source/study Setting: We analyzed prospective cohort data collected from 21,732 patients as part of the Veterans Affairs Ambulatory Care Quality Improvement Project (ACQUIP), a randomized controlled trial investigating quality-of-care interventions.
Study Design: We created an age-adjusted, logistic regression model for each predictor and outcome combination, and estimated the odds of events by response category of the GSRH question and compared the discriminative ability of the predictors by developing receiver operator characteristic curves and comparing the associated area under the curve (AUC)/c-statistic for the single- and multi-item measures.
Objective: To determine the extent to which chronic illness and disease severity affect patient satisfaction with their primary care provider in general internal medicine clinics.
Design: Cross-sectional mailed questionnaire study.
Setting: Primary care clinics at 7 Veterans Affairs medical centers.
Objective: To evaluate the performance of different prospective risk adjustment models of outpatient, inpatient, and total expenditures of veterans who regularly use Veterans Affairs (VA) primary care.
Data Sources: We utilized administrative, survey and expenditure data on 14,449 VA patients enrolled in a randomized trial that gave providers regular patient health assessments.
Study Design: This cohort study compared five administrative data-based, two self-report risk adjusters, and base year expenditures in prospective models.
Objectives: We sought to assess the responses of providers to recommendations generated by a computer-management system for chronic heart failure (CHF).
Methods: This study is an analysis of primary care providers' responses to evidence-based computer-generated suggestions regarding patients with CHF at one center of a randomized trial. The trial randomized primary care providers from 2 VA Medical Centers to receive care suggestions regarding patients with CHF, with or without inclusion of patient symptom data obtained from pre-visit questionnaires.
Objective: The patient-clinician relationship is a central feature of primary care, and recent developments in the delivery of health care have tended to limit continuity of care. The objective of this study was to evaluate the extent to which continuity of care and other factors are related to patient satisfaction.
Design: Cross-sectional, mailed questionnaire study.
Purpose: To assess the association between the type of antihypertensive medication and all-cause mortality among patients with chronic obstructive pulmonary disease (COPD).
Methods: The cohort comprised 1966 patients (mean [+/- SD] age, 65.8 +/- 10.
Purpose: We hypothesized that obese adults with coronary heart disease, obstructive lung disease, or depression would report greater impairments in health-related quality of life owing to their angina, dyspnea, or depressive symptoms as compared with persons with normal body weight.
Methods: We analyzed cross-sectional data from the Ambulatory Care Quality Improvement Project, a multicenter study of veterans enrolled in general internal medicine clinics. Health-related quality of life was assessed using the Medical Outcomes Study Short Form-36, the Seattle Angina Questionnaire, the Seattle Obstructive Lung Disease Questionnaire, and the Hopkins Symptom Checklist for Depression.
Objective: Most patients who misuse alcohol do not receive alcohol counseling from their providers. This study evaluated primary care patient and provider characteristics associated with receipt of alcohol-related advice and whether patients were advised to drink less or to abstain.
Method: Outpatients from seven Veterans Affairs (VA) general medicine clinics were eligible if they screened positive for alcohol misuse, completed the Alcohol Use Disorders Identification Test (AUDIT) and answered questions about alcohol-related treatment and advice.
Background: Recent reports suggest an association between beta-agonists and the risk of incident chronic heart failure (CHF). We sought to examine the association between inhaled beta-agonists and risk of incident and nonincident heart failure.
Methods: We performed a nested case-control study within the Ambulatory Care Quality Improvement Project (ACQUIP).