COVID-19 mortality among veterans with serious mental illness in the veterans health administration.

Objective: Persons with serious mental illness (SMI: schizophrenia-spectrum disorders, bipolar disorder) experience increased risk of mortality after contracting COVID-19 based on the results of several international evaluations. However, information about COVID-19 mortality risk among patients with SMI in the Veterans Health Administration (VHA) has been limited, precluding identification of protective factors. The current evaluation was conducted to assess COVID-19 mortality risk among VHA patients with SMI and to evaluate potential protective factors in mitigating mortality risk following a positive COVID-19 diagnosis.

Facilitating future implementation and translation to clinical practice: The Implementation Planning Assessment Tool for clinical trials.

Implementation assessment plans are crucial for clinical trials to achieve their full potential. Without a proactive plan to implement trial results, it can take decades for one-fifth of effective interventions to be adopted into routine care settings. The Veterans Health Administration Office of Research and Development is undergoing a systematic transformation to embed implementation planning in research protocols through the Cooperative Studies Program, its flagship clinical research program.

How the VA is training the Next-Generation workforce for learning health systems.

Objectives: The U.S. Department of Veterans Affairs (VA) has been a national leader in Learning Health System (LHS) implementation due to its combined mission of research, education, clinical care, and emergency preparedness.

Veterans affairs serious mental illness patients: Differences in high-intensity service use by personality disorder status.

Individuals with serious mental illnesses (SMI) or personality disorders (PD) have complex treatment needs and are at risk of adverse outcomes. Yet, little is known about the impact of comorbid SMI and PD on risk factors. This study used the Veterans Health Administration (VHA)'s corporate data warehouse (CDW) to assess the differences between those with and without a comorbid PD, as well as the prevalence and impact of PD diagnoses on high-intensity/emergency service utilization in VHA patients with a SMI diagnosis (schizophrenia spectrum disorders and bipolar spectrum disorders).

Comparative risks of all-cause mortality for Veterans with schizophrenia with ongoing receipt of clozapine and other antipsychotic medications.

To guide care for patients with schizophrenia, the Veterans Health Administration (VHA) evaluated the associations between current or recent use of clozapine and all-cause mortality and explored associations for other antipsychotic medications. Using a case-control design, patients with schizophrenia who died in fiscal years 2014-2018 were matched on age, sex, race, and VHA facility to up to 10 controls who were alive on the case's date of death (index date). Medication coverage during the 91 days before the index date was classified as none, partial (1-44 days), and consistent (45-91 days).

Sustaining effective research/operational collaborations: Lessons learned from a National Partnered Evaluation Initiative.

Introduction: Effective research-operational partnerships require that researchers ask questions targeting top clinical operational priorities. However, disconnects exist between healthcare researchers and operational leadership that result in significant delays between discovery and implementation of breakthroughs in healthcare.

Objective: Using the Veterans Health Administration Quality Enhancement Research Initiative (QUERI) Partnered Evaluation Initiative (PEI) as a case study, we identified relationship characteristics of collaborative research projects designed to address the research/operations gap.

Predictors of High-Intensity Psychiatric Service Utilization by Veterans Health Administration Patients With Early Psychosis.

Objective: People with early episode psychosis (EEP) have more negative care outcomes than do people with later episode psychosis (LEP), including higher levels of high-intensity psychiatric service use. It is unclear whether these differences are best explained by clinical differences between these two groups or whether people with EEP have specific treatment needs. An assessment of the treatment needs of patients with EEP can help inform the implementation of national treatment programming designed to provide better care to this group.

Access to timely mental health care treatment initiation among Veterans Health Administration patients with and without serious mental illness.

Timely care initiation is a priority within the Veterans Health Administration (VHA). Patients with serious mental illnesses (SMI) are a group that benefits from timely care initiation due to elevated risks of negative outcomes with delayed care. However, no evaluation has assessed whether VHA SMI patients disproportionately experience delays in mental health care initiation.

Quality Enhancement Research Initiative Implementation Roadmap: Toward Sustainability of Evidence-based Practices in a Learning Health System.

Background: Learning Health Systems strive to continuously integrate innovations and evidence-based practices (EBPs) into routine care settings. Few models provide a specified pathway to accelerate adoption and spread of EBPs across diverse settings.

Objective: The US Department of Veterans Affairs Quality Enhancement Research Initiative (QUERI) Implementation Roadmap facilitates uptake of EBPs in routine practice by aligning research and health system priorities.

Research Lifecycle to Increase the Substantial Real-world Impact of Research: Accelerating Innovations to Application.

Background: US health care systems face a growing demand to incorporate innovations that improve patient outcomes at a lower cost. Funding agencies increasingly must demonstrate the impact of research investments on public health. The Learning Health System promotes continuous institutional innovation, yet specific processes to develop innovations for further research and implementation into real-world health care settings to maximize health impacts have not been specified.

Psychometric examination of care quality measures in VA psychosocial rehabilitation and recovery centers (PRRCs).

The Veterans Health Administration (VHA) developed Psychosocial Rehabilitation and Recovery Centers (PRRCs) to enhance recovery-oriented mental health services to large populations of veterans diagnosed with serious mental illness (e.g., psychotic disorders, bipolar disorder) and significant functional challenges.

Individual and neighborhood characteristics as predictors of depression symptom response.

Objective: Assess whether neighborhood characteristics predict patient-reported outcomes for depression.

Data Sources: VA electronic medical record data and U.S.

Outreach to veterans with serious mental illness who are lost to care: Predictors of outreach contact.

This evaluation identified factors associated with outreach contact to veterans with serious mental illness (SMI) who were lost to Veterans Health Administration (VHA) care. From March 2012 through September 2013, the VHA SMI Re-Engage initiative identified 4,241 veterans for reengagement outreach; 31% of whom were successfully contacted. Higher odds of contact was associated with older age, married status, no history of homelessness, bipolar disorder diagnosis, having no recent inpatient stay, living closer to a VHA medical center, fewer years since last visit, and having a service-connected disability.

Quasi-experimental evaluation of the impact of a cognitive behavioral pretreatment intervention for veterans seeking psychotherapy.

Pretreatment interventions have documented efficacy for reducing initial therapy refusal and early therapy departure. However, these interventions have not been well-studied in diagnostically diverse patient populations or within Veterans Affairs (VA) health care settings. We designed a manualized 4-session group cognitive-behavioral therapy-based pretreatment intervention (PTI) for a diagnostically diverse population of Veterans referred for psychotherapy in a general mental health clinic (MHC) in a large VA hospital.

Sex Differences in Weight Loss among Veterans with Serious Mental Illness: Observational Study of a National Weight Management Program.

Purpose: Obesity disproportionately burdens individuals with serious mental illness (SMI), especially women. This observational study investigated whether there were sex differences in weight loss and program participation among veterans with SMI enrolled in the Veterans Health Administration's (VHA) MOVE! weight management program.

Procedures: Participants were identified from a national cohort of 148,254 veterans enrolled in MOVE! during fiscal years 2008 through 2012 who attended two or more sessions within 12 months of enrollment.

Innovating team-based outpatient mental health care in the Veterans Health Administration: Staff-perceived benefits and challenges to pilot implementation of the Behavioral Health Interdisciplinary Program (BHIP).

In the past decade, the demand for Veterans Health Administration (VHA) mental health care has increased rapidly. In response to the increased demand, the VHA developed the Behavioral Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery. The present formative evaluation gathered information about pilot implementation of BHIP to understand the struggles and successes that staff experienced during facility transitions to the BHIP model.

Self-Determination Theory and Outpatient Follow-Up After Psychiatric Hospitalization.

The objective of this study was to assess whether the constructs of self-determination theory-autonomy, competence, and relatedness-are associated with adherence to outpatient follow-up appointments after psychiatric hospitalization. 242 individuals discharged from inpatient psychiatric treatment within the Veterans Health Administration completed surveys assessing self-determination theory constructs as well as measures of depression and barriers to treatment. Medical records were used to count the number of mental health visits and no-shows in the 14 weeks following discharge.

Social networks, mental health problems, and mental health service utilization in OEF/OIF National Guard veterans.

Purpose: Low social support and small social network size have been associated with a variety of negative mental health outcomes, while their impact on mental health services use is less clear. To date, few studies have examined these associations in National Guard service members, where frequency of mental health problems is high, social support may come from military as well as other sources, and services use may be suboptimal.

Methods: Surveys were administered to 1448 recently returned National Guard members.