Improving care to patients with ischemic heart disease: experiences in a single network of the Veterans Health Administration.

Background: Ischemic heart disease (IHD) is the leading cause of death in the United States. Lowering serum cholesterol levels reduces coronary events and mortality; this effect is most evident in patients with preexisting IHD.

Aims: The primary aim of this article is to describe a set of interventions that were piloted in a single, regional Veterans Integrated Service Network (VISN) to promote secondary prevention among patients with IHD and to explore the effect of those interventions on patient outcomes.

A qualitative study to identify barriers and facilitators to implementation of pilot interventions in the Veterans Health Administration (VHA) Northwest Network.

Objective: To identify barriers and facilitators to implementation of pilot interventions designed to improve measurement and management of low-density lipoprotein cholesterol (LDL-c) levels in coronary heart disease patients using the evidence/context/facilitation model of implementation of evidence-based practice.

Design: Theory-based conceptual content analysis of structured interviews conducted between January and April 2001.

Setting: Six medical centers in the United States Veterans Health Administration Northwest Network.

The association between clinical integration of care and transfer of veterans with acute coronary syndromes from primary care VHA hospitals.

Background: Few studies report on the effect of organizational factors facilitating transfer between primary and tertiary care hospitals either within an integrated health care system or outside it. In this paper, we report on the relationship between degree of clinical integration of cardiology services and transfer rates of acute coronary syndrome (ACS) patients from primary to tertiary hospitals within and outside the Veterans Health Administration (VHA) system.

Methods: Prospective cohort study.

Adherence with statin therapy in secondary prevention of coronary heart disease in veterans administration male population.

This retrospective cohort study enrolled 8,768 male Veterans Administration patients with coronary heart disease who were prescribed statins from July 1, 1999, to June 30, 2000. After 18 months of follow-up, 71% of the patients had been dispensed >or=80% of the medication. Our population's persistence in using statins was higher than in other open-population cohorts but lower than in randomized controlled trials.