Evaluation of Solar-Powered Battery Systems for Individuals Using Electricity-Dependent Medical Devices in Puerto Rico Following Hurricane Maria.

Objectives: To determine if solar-powered battery systems could be successfully used for electricity-dependent medical devices by families during a power outage.

Methods: We assessed the use of and satisfaction with solar-powered battery systems distributed to 15 families following Hurricane Maria in rural Puerto Rico. Interviews were conducted in July 2018, 3 mo following distribution of the systems.

Healthcare Costs Related to Treatment of Hepatocellular Carcinoma Among Veterans With Cirrhosis in the United States.

Background & Aims: It is important to quantify medical costs associated with hepatocellular carcinoma (HCC), the incidence of which is rapidly increasing in the United States, for development of rational healthcare policies related to liver cancer surveillance and treatment of chronic liver disease. We aimed to comprehensively quantify healthcare costs for HCC among patients with cirrhosis in an integrated health system and develop a model for predicting costs that is based on clinically relevant variables.

Methods: Three years subsequent to liver cancer diagnosis, costs accrued by patients included in the Veteran's Outcome and Cost Associated with Liver disease cohort were compiled by using the Department of Veterans Affairs Corporate Data Warehouse.

Cost-effectiveness of strategies for testing current hepatitis C virus infection.

Unlabelled: Six strategies for identifying hepatitis C virus (HCV) viremia, involving testing for HCV antibody (HCVAb) followed by a nucleic acid test (NAT) for HCV RNA when the antibody test is positive, are compared. Decision analysis was used to determine mean relative cost per person tested and outcomes of HCV viremia detection. Parameters included proportions of test population with HCVAb and viremia plus specificity, sensitivity, and cost of individual tests.

Access to multiple sclerosis specialty care.

Background: Health care providers recommend an annual visit to a multiple sclerosis specialty care provider.

Objective: To examine potential barriers to the implementation of this recommendation in the Veterans Health Administration.

Design: Observational cohort study.

Costs of second allogeneic hematopoietic cell transplantation.

Background: A second allogeneic transplantation after a prior allogeneic (allo-allo) or autologous (auto-allo) hematopoietic cell transplantation (HCT) is usually performed for graft failure, disease recurrence, secondary malignancy, and, as planned, auto-allo transplantation for some diseases.

Methods: We sought to describe the costs of second allogeneic HCT and evaluate their relationship with patient characteristics and posttransplantation complications. Clinical information and medical costs for the first 100 days after transplantation of 245 patients (allo-allo, 55; auto-allo, 190) who underwent a second HCT between 2004 and 2010 were collected.

Cost-effective diagnostic strategies in patients with a high, intermediate, or low clinical probability of pulmonary embolism.

Rapid quantitative D-dimer assays (DD), lower extremity venous duplex ultrasonography (US), and multislice computed tomographic (CT) angiography have been shown to have adequate sensitivities and specificities for diagnostic purpose. The purpose of this study was to evaluate cost-effectiveness of diagnostic strategies for pulmonary embolism (PE) in patients with a high, intermediate, or low clinical probability of PE. A formal cost-effectiveness analysis for the diagnosis of PE was performed.

Cost-effectiveness of hepatitis A vaccination for individuals with chronic hepatitis C.

The incidence of hepatitis A infection in the United States has decreased dramatically in recent years because of childhood immunization programs. A decision analysis of the cost-effectiveness of hepatitis A vaccination for adults with hepatitis C was conducted. No vaccination strategy is cost-effective for adults with hepatitis C using the recent lower anticipated hepatitis A incidence, private sector costs, and a cost-effectiveness criterion of $100,000/QALY.

Assisted living pilot program: utilization and cost findings.

Objective. The Department of Veterans Affairs funded assisted living, adult family home, and adult residential care for the first time in the Assisted Living Pilot Program (ALPP). This article compares the use and cost for individuals that entered ALPP and a comparison group.

Assisted living pilot program: background, methods, and facility characteristics.

Objectives. The Department of Veterans Affairs (VA) funded assisted living (AL), adult family home (AFH), and residential care for the first time in the Assisted Living Pilot Program (ALPP). This article describes the background and methods of the ALPP evaluation and the characteristics and experiences of the facilities.

Equivalence of two healthcare costing methods: bottom-up and top-down.

This paper compares two quite different approaches to estimating costs: a 'bottom-up' approach, represented by the US Department of Veterans Affairs' (VA) Decision Support System that uses local costs of specific inputs; and a 'top-down' approach, represented by the costing system created by the VA Health Economics Resource Center, which assigns the VA national healthcare budget to specific products using various weighting systems. Total annual costs per patient plus the cost for specific services (e.g.

Assisted living pilot program: health outcomes.

Objectives. Assisted living programs demonstrate variation in structure and services. The Department of Veterans Affairs funded this care for the first time in the Assisted Living Pilot Program (ALPP).

The impact of contract primary care on health care expenditures and quality of care.

The Department of Veterans Affairs (VA) established community-based outpatient clinics to improve veterans' access to primary care. This article compares VA use and expenditures among primary care users at 76 VA-staffed community clinics (n = 17,060) and 32 non-VA contract community clinics receiving capitation (n = 6,842) using VA administrative databases. It estimates utilization using negative binomial models and expenditures using generalized linear one-part or two-part models.

Randomized trial of onsite versus referral primary medical care for veterans in addictions treatment.

Background: Patients presenting for treatment of substance use disorders (SUDs) often exhibit medical comorbidities that affect functional health status and healthcare costs. Providing primary care within addictions clinics (onsite care) may improve medical and SUD treatment outcomes in this population.

Objective: The objective of this study was to compare outcomes among Veterans' Administration (VA) patients who receive medical care within the SUD clinic and those referred to a general medicine clinic at the same facility.

The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System.

Objective: To describe the association between type of health insurance coverage and the quality of care provided to individuals with diabetes in the United States.

Data Source: The 2000 Behavioral Risk Factor Surveillance System.

Study Design: Our study cohort included individuals who reported a diagnosis of diabetes (n=11,647).

Cost effectiveness of testing strategies for chronic hepatitis C.

Objective: This paper compares nine strategies for determining hepatitis C antibody and viral status. They combine two tests for antibodies (enzyme immunoassays (EIA), recombinant immunoblot assays (RIBA)) and one for viremia (reverse transcription polymerase chain reaction (PCR)). Using optical density to divide EIA results into three categories (high positive, low positive, negative) was also considered.

Data resources in the Department of Veterans Affairs.

Objective: To provide an overview of databases that are maintained by the Department of Veterans Affairs (VA) and are of relevance to investigators involved in epidemiologic, clinical, and health services research.

Research Design And Methods: We reviewed both national and local VA databases and identified their strengths and limitations. We also referenced specific studies that have assessed the validity and reliability of VA databases.

Predictors of colorectal cancer screening participation in the United States.

Objective: Our aim was to identify predictors of colorectal cancer screening in the United States and subgroups with particularly low rates of screening.

Methods: The responses to a telephone-administered questionnaire of a nationally representative sample of 61,068 persons aged >/=50 yr were analyzed. Current screening was defined as either sigmoidoscopy/colonoscopy in the preceding 5 years or fecal occult blood testing (FOBT) in the preceding year, or both.

VA community-based outpatient clinics: cost performance measures.

Objective: To examine the direct costs of treating veterans in Community-Based Outpatient Clinics (CBOC) and primary care clinics operated by VA medical centers (VAMCs) between April 1998 and September 1998.

Research Design: In a retrospective observational study of patients in eighteen CBOCs and fourteen VAMCs, direct costs were compared. In addition, the costs of treating patients in new and established CBOCs were also examined.

VA community-based outpatient clinics: performance measures based on patient perceptions of care.

Background: The Department of Veterans Affairs (VA) recently initiated a system of Community- Based Outpatient Clinics (CBOCs) to enhance delivery of primary care to veterans.

Objective: The objective of this study was to determine the effect of CBOCs on patients' perceptions of care.

Research Design: The study design is a cross-sectional survey.

VA community-based outpatient clinics: quality of care performance measures.

Background: The Veterans Health Administration (VHA) recently initiated a system of Community-Based Outpatient Clinics (CBOCs) to enhance delivery of primary care to veterans.

Objective: The objective of this study was to compare quality of care provided to veterans at CBOCs and at traditional hospital-based VA Medical Center (VAMC) clinics.

Research Design: Quality of care was assessed using medical record data abstracted at CBOCs and VAMCs.

VA community-based outpatient clinics: access and utilization performance measures.

Objectives: The purpose of this study was to compare access and utilization performance measures between Community-Based Outpatient Clinics (CBOC) and primary care clinics at parent VA Medical Centers (VAMC) and between VA-staff CBOCs and contract CBOCs.

Methods: The study design was cross-sectional and retrospective. Performance measures were based on data routinely collected for administrative and research purposes by the VA.

Evaluation of the Department of Veterans Affairs community-based outpatient clinics.

Objective: This paper describes the history of the Department of Veterans Affairs (VA) Community-Based Outpatient Clinics (CBOCs), CBOC Performance Evaluation Project, and characteristics of CBOCs within the VA, and summarizes the findings and implications of the CBOC Performance Evaluation Project.

Subjects: There were 139 CBOCs in operation at the end of fiscal year 1998. Ninety-eight percent of CBOCs offered primary health care, and 28% offered primary health care and primary mental health care.