Physician Tenure and Clinical Productivity for Internal and External Hires: A Retrospective Cohort Study.

Background: New employees generally demonstrate lower productivity than experienced colleagues in non-healthcare sectors, but there is limited evidence on how tenure affects physician productivity.

Objective: To evaluate the association between tenure and clinical productivity for attending physicians in the Veterans Health Administration (VHA) and explore whether this relationship differs by prior VHA residency or fellowship training.

Design: Retrospective cohort evaluation.

Veterans May Be Seeing Lower-Quality Clinicians In The VHA Community Care Network.

With the rapid expansion of veterans' access to community care under the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018, ensuring that veterans receive high-quality community care has become a national priority. Using Veterans Health Administration (VHA) data and Medicare performance scores, we assessed how clinicians' performance on quality measures differed between those who treated veterans within the VHA Community Care Network and those who did not. We found that in 2022, 66.

Medicare Advantage Plans With High Numbers Of Veterans: Enrollment, Utilization, And Potential Wasteful Spending.

Medicare Advantage (MA) plans are increasingly enrolling veterans. Because MA plans receive full capitated payments regardless of whether or not veterans use Medicare services, the federal government can incur substantial duplicative, wasteful spending if veterans in MA plans predominantly seek care through the Veterans Health Administration (VHA) system. The recent growth of MA plans that disproportionately enroll veterans could further exacerbate such wasteful spending.

State Policies Targeting Patient Brokering and Deceptive Marketing of Substance Use Disorder Treatment.

Objectives: To characterize state laws targeting patient brokering and deceptive marketing of substance use disorder (SUD) treatment.

Background: Patient brokering and deceptive marketing of SUD treatment leads to poor outcomes for individuals with SUD, including relapse- or overdose-related hospitalizations, ED visits, or death. In response, several states within the United States have passed laws targeting unethical practices of SUD treatment in recent years.

Medical training program size and clinical staff productivity and turnover.

Objective: The objective of this analysis was to evaluate the effect of resident program training size on clinician productivity and turnover in the Veterans Health Administration (VHA), the largest education and training platform for medical professionals in the United States.

Data Sources: We retrieved administrative data on training programs and training facilities from the VA Office of Academic Affiliations and the VHA Corporate Data Warehouse. Data on primary care physician shortage areas were retrieved from the Health Resources and Services Administration.

Impact of Nurse Residency Program on Time-to-Fill Nurse Vacancies at the Veterans Health Administration.

Background: The Department of Veterans Affairs (VA) offers a 1-year Post-Baccalaureate-Registered Nurse Residency (PB-RNR) Program. The impact of the PB-RNR program on local RN recruitment was unknown.

Objectives: We aimed to evaluate the effect of the size of the PB-RNR program at a VA facility on its time-to-fill RN vacancies.

Landmark Based Bronchoscope Localization for Needle Insertion Under Respiratory Deformation.

Bronchoscopy is currently the least invasive method for definitively diagnosing lung cancer, which kills more people in the United States than any other form of cancer. Successfully diagnosing suspicious lung nodules requires accurate localization of the bronchoscope relative to a planned biopsy site in the airways. This task is challenging because the lung deforms intraoperatively due to respiratory motion, the airways lack photometric features, and the anatomy's appearance is repetitive.

Effect of mental health staffing inputs on initiation of care among recently separated Veterans.

Objective: To estimate a causal relationship between mental health staffing and time to initiation of mental health care for new patients.

Data Sources And Study Setting: As the largest integrated health care delivery system in the United States, the Veterans Health Administration (VHA) provides a unique setting for isolating the effects of staffing on initiation of mental health care where demand is high and out-of-pocket costs are not a relevant confounder. We use data from the Department of Defense and VHA to obtain patient and facility characteristics and health care use.

Effect of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act Scribes Trial on Emergency Department Provider Productivity and Patient Throughput Times.

Background: To help improve access to care, section 507 of the VA MISSION (Maintaining Internal Systems and Strengthening Integrated Outside Networks) Act of 2018 mandated a 2-year trial of medical scribes in the Veterans Health Administration (VHA).

Objective: The impact of scribes on provider productivity and patient throughput time in VHA emergency departments (EDs) was evaluated.

Methods: A clustered randomized trial was designed using intent-to-treat difference-in-differences analysis.

Comparison of Full-Time Equivalent and Clinic Time Labor Input Measures in Productivity Metrics.

Goal: A lack of improvement in productivity in recent years may be the result of suboptimal measurement of productivity. Hospitals and clinics benefit from external benchmarks that allow assessment of clinical productivity. Work relative value units have long served as a common currency for this purpose.

The effects of the Veterans Health Administration's Referral Coordination Initiative on referral patterns and waiting times for specialty care.

Objective: To investigate whether the Veterans Health Administration's (VA) 2019 Referral Coordination Initiative (RCI) was associated with changes in the proportion of VA specialty referrals completed by community-based care (CC) providers and mean appointment waiting times for VA and CC providers.

Data Sources/study Settings: Monthly facility level VA data for 3,097,366 specialty care referrals for eight high-volume specialties (cardiology, dermatology, gastroenterology, neurology, ophthalmology, orthopedics, physical therapy, and podiatry) from October 1, 2019 to May 30, 2022.

Study Design: We employed a staggered difference-in-differences approach to evaluate RCI's effects on referral patterns and wait times.

Costs and Productivity Benefits of the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act Scribes Trial.

Objectives: To improve access, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 mandated a 2-year study of medical scribes in Veterans Health Administration specialty clinics and emergency departments. Medical scribes are employed in clinical settings with the goals of increasing provider productivity and satisfaction by minimizing physicians' documentation burden. Our objective is to quantify the economic outcomes of the MISSION Act scribes trial.

A framework for inferring and analyzing pharmacotherapy treatment patterns.

Background: To discover pharmacotherapy prescription patterns and their statistical associations with outcomes through a clinical pathway inference framework applied to real-world data.

Methods: We apply machine learning steps in our framework using a 2006 to 2020 cohort of veterans with major depressive disorder (MDD). Outpatient antidepressant pharmacy fills, dispensed inpatient antidepressant medications, emergency department visits, self-harm, and all-cause mortality data were extracted from the Department of Veterans Affairs Corporate Data Warehouse.

Telehealth Access and Substitution in the VHA.

Background: In response to COVID-19, the Veterans Health Administration (VHA) expanded telehealth availability, allowing veterans to receive care at home. We explore the extent of substitution of telehealth for in-person care among medical centers (facilities), providers, and patients. We explore the extent to which patient preferences drive telehealth utilization, and compare access to care (as measured by waiting times) for telehealth and in-person visits.

SlicerSALT: From Medical Images to Quantitative Insights of Anatomy.

Three-dimensional (3D) shape lies at the core of understanding the physical objects that surround us. In the biomedical field, shape analysis has been shown to be powerful in quantifying how anatomy changes with time and disease. The Shape AnaLysis Toolbox (SALT) was created as a vehicle for disseminating advanced shape methodology as an open source, free, and comprehensive software tool.

Impact of Medical Training Programs on Time-to-Fill Physician Vacancies at the Veterans Health Administration.

Background: The Department of Veterans Affairs (VA) provides the largest Graduate Medical Education (GME) training platform for health professionals in the United States. Studies on the impact of VA GME programs on physician recruitment were lacking.

Objectives: To examine the impact of the size of residency training programs at a VA facility on the facility's time-to-fill physician vacancies, and whether the impact differs by the socioeconomic deprivation and public school quality of the geographic area.

Clinical effectiveness and cost-impact after 2 years of a ketogenic diet and virtual coaching intervention for patients with diabetes.

Aim: We previously evaluated the impacts at 5 months of a digitally delivered coaching intervention in which participants are instructed to adhere to a very low carbohydrate, ketogenic diet. With extended follow-up (24 months), we assessed the longer-term effects of this intervention on changes in clinical outcomes, health care utilization and costs associated with outpatient, inpatient and emergency department use in the Veterans Health Administration.

Materials And Methods: We employed a difference-in-differences model with a waiting list control group to estimate the 24-month change in glycated haemoglobin, body mass index, blood pressure, prescription medication use, health care utilization rates and associated costs.

Measuring restrictiveness of Medicare Advantage networks: A claims-based approach.

Objective: To develop and validate a measure of provider network restrictiveness in the Medicare Advantage (MA) population.

Data Sources: Prescription drug event data and beneficiary information for Part D enrollees from the Center for Medicare and Medicaid Services, along with prescriber identifiers; geographic variables from the Area Health Resources Files.

Study Design: A prediction model was used to predict the unique number of primary care providers that would have been seen by MA beneficiaries absent network restrictions.

Trajectories of care and outcomes of Veterans receiving home-based primary care.

Background: Veterans Affairs (VA) home-based primary care (HBPC) provides comprehensive longitudinal care to patients with complex, chronic disabling disease. While enrollment is associated with lower hospitalization rates and costs, detailed trajectories have not been well described.

Methods: We performed a longitudinal descriptive study of patients newly enrolled in VA HBPC in fiscal year (FY) 2015.

Skeletons, Object Shape, Statistics.

Objects and object complexes in 3D, as well as those in 2D, have many possible representations. Among them skeletal representations have special advantages and some limitations. For the special form of skeletal representation called "s-reps," these advantages include strong suitability for representing slabular object populations and statistical applications on these populations.

Growth of community-based immunotherapy treatment in the Veterans Health Administration.

Background: The MISSION and CHOICE Acts expanded the Veterans Health Administration's (VA) capacity to purchase immunotherapy services for VA patients from community-based providers. Our objective was to identify predictors of community-based immunotherapy treatment, and assess differences in cost and utilization across community treatment settings METHODS: We examined claims for 21,257 patients who started immunotherapy treatment between 2015 and 2020. We assessed growth in VA community-based immunotherapy care, predictors of community-based immunotherapy treatment using multivariable logistic regression based on patients' sociodemographic and clinical characteristics.

Effect of a National VHA Medical Scribe Pilot on Provider Productivity, Wait Times, and Patient Satisfaction in Cardiology and Orthopedics.

Background: Section 507 of the VA MISSION Act of 2018 mandated a 2-year pilot study of medical scribes in the Veterans Health Administration (VHA), with 12 VA Medical Centers randomly selected to receive scribes in their emergency departments or high wait time specialty clinics (cardiology and orthopedics). The pilot began on June 30, 2020, and ended on July 1, 2022.

Objective: Our objective was to evaluate the impact of medical scribes on provider productivity, wait times, and patient satisfaction in cardiology and orthopedics, as mandated by the MISSION Act.

Delivery system emergency department capacity and its effect on nonsystem service utilization.

Background: Emergency department (ED) use is often seen as a source of excess health care spending, prompting managers to limit ED capacity in their health systems. However, if limited ED capacity in a delivery system leads patients to seek emergency care elsewhere, then health care quality and efficient management may be compromised within the system.

Objective: The objective of this study was to explore the effect of the Veterans Health Administration (VHA) in-house ED clinician capacity on VHA community care (CC) ED claims.