Are Veterans Getting Their Preferred Depression Treatment? A National Observational Study in the Veterans Health Administration.

Background: Physician responsiveness to patient preferences for depression treatment may improve treatment adherence and clinical outcomes.

Objective: To examine associations of patient treatment preferences with types of depression treatment received and treatment adherence among Veterans initiating depression treatment.

Design: Patient self-report surveys at treatment initiation linked to medical records.

Association of Costs and Days at Home With Transfer Hospital in Home.

Importance: New Centers for Medicare & Medicaid Services waivers created a payment mechanism for hospital at home services. Although it is well established that direct admission to hospital at home from the community as a substitute for hospital care provides superior outcomes and lower cost, the effectiveness of transfer hospital at home-that is, completing hospitalization at home-is unclear.

Objective: To evaluate the outcomes of the transfer component of a Veterans Affairs (VA) Hospital in Home program (T-HIH), taking advantage of natural geographical limitations in a program's service area.

Patient and Hospital Factors Associated With Differences in Mortality Rates Among Black and White US Medicare Beneficiaries Hospitalized With COVID-19 Infection.

Importance: Black patients hospitalized with COVID-19 may have worse outcomes than White patients because of excess individual risk or because Black patients are disproportionately cared for in hospitals with worse outcomes for all.

Objectives: To examine differences in COVID-19 hospital mortality rates between Black and White patients and to assess whether the mortality rates reflect differences in patient characteristics by race or by the hospitals to which Black and White patients are admitted.

Design, Setting, And Participants: This cohort study assessed Medicare beneficiaries admitted with a diagnosis of COVID-19 to 1188 US hospitals from January 1, 2020, through September 21, 2020.

Insomnia: Sex differences and age of onset in active duty Army soldiers.

Background: The prevalence of insomnia symptoms, insomnia diagnostic status, and age of onset compared by sex is understudied within the military population.

Method: Data were examined from the All Army Study to Assess Risk and Resilience in Service members (N = 21,294; 18-61 years; 11.7% female and 87.

VA home-based primary care interdisciplinary team structure varies with Veterans' needs, aligns with PACE regulation.

Background: Interdisciplinary team (IDT) care is central to home-based primary care (HBPC) of frail elders. Traditionally, all HBPC disciplines managed a patient (Full IDT), a costly approach to maintain. The recent PACE (Program of All-inclusive Care for the Elderly) regulation provides for a flexible approach of annual assessments from a core team with involvement of additional disciplines dependent upon patient needs (Core+).

Treatment Differences in Primary and Specialty Settings in Veterans with Major Depression.

Introduction: The Veterans Health Administration (VHA) supports the nation's largest primary care-mental health integration (PC-MHI) collaborative care model to increase treatment of mild to moderate common mental disorders in primary care (PC) and refer more severe-complex cases to specialty mental health (SMH) settings. It is unclear how this treatment assignment works in practice.

Methods: Patients (n = 2610) who sought incident episode VHA treatment for depression completed a baseline self-report questionnaire about depression severity-complexity.

Variation in US Hospital Mortality Rates for Patients Admitted With COVID-19 During the First 6 Months of the Pandemic.

Importance: It is unknown how much the mortality of patients with coronavirus disease 2019 (COVID-19) depends on the hospital that cares for them, and whether COVID-19 hospital mortality rates are improving.

Objective: To identify variation in COVID-19 mortality rates and how those rates have changed over the first months of the pandemic.

Design, Setting, And Participants: This cohort study assessed 38 517 adults who were admitted with COVID-19 to 955 US hospitals from January 1, 2020, to June 30, 2020, and a subset of 27 801 adults (72.

Study design and implementation of the PRecision Medicine In MEntal health Care (PRIME Care) Trial.

Genomic testing has the potential to improve patient outcomes and reduce patient care costs by personalizing medication selection. Commercial pharmacogenetic (PGx) testing for psychotropic and other medications is widely available and promoted as a means to implement "precision medicine." Despite evidence that genetic variation affects the metabolism of psychotropic medications, the clinical utility of these test results has not been established.

Rethinking ethical oversight in the era of the learning health system.

Opportunities to advance science increasingly arise through investigations embedded within routine clinical practice in the form of learning health systems. Such activities challenge conventional approaches to research regulation that have not caught up with those opportunities, often imposing burdens generalized from riskier research. We analyze the rules and conventions in the US, demonstrating how even those rules are compatible with a much more flexible approach to participant risk, institutional oversight, participant consent, and disclosure for low-risk learning activities in all jurisdictions.

The relationship between insomnia and the intensity of drinking in treatment-seeking individuals with alcohol dependence.

Background: Although insomnia is highly prevalent in alcohol use disorders(AUD), its associations with the severity of alcohol use, pre-existing psychiatric comorbidities and psychosocial problems are understudied. The present study evaluates the interplay between these factors using a structural equation model (SEM).

Methods: We assessed baseline cross-sectional data on patients with AUD (N = 123) recruited to a placebo-controlled medication trial.

Utilization and Cost Effects of the VHA Caring for Older Adults and Caregivers at Home (COACH) Program.

Since 2010, the Veterans Health Administration has initiated a home-based Caring for Older Adults and Caregivers at Home (COACH) program to provide clinical support to dementia patients and family caregivers. But its impact on health care utilization and costs is unknown. We compared 354 COACH care recipients with a propensity score weighted comparison group of 9,857 community-dwelling Veterans during fiscal years 2010-2015.

Author Correction: Variability in Language used on Social Media Prior to Hospital Visits.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

An Integrated Sleep and Reward Processing Model of Major Depressive Disorder.

Major depressive disorder with comorbid sleep disturbance has been associated with negative outcomes, including lower rates of treatment response and a greater likelihood of depressive relapse compared to those without sleep disturbance. However, little, if any, research has been conducted to understand why such negative treatment outcomes occur when sleep disturbance is present. In this conceptual review, we argue that the relationship of sleep disturbance and negative treatment outcomes may be mediated by alterations in neural reward processing in individuals with blunted trait-level reward responsivity.

Monitoring functional status using a wearable real-time locating technology.

Sensor technologies enable real-time, continuous, and objective monitoring of activity and functioning in later life. In long-term care, timely assessment of functional status is needed to prevent falls and other acute events. However, the electronic forms and paper and pencil tools currently used are time-consuming and conducted too infrequently (e.

Variability in Language used on Social Media prior to Hospital Visits.

Forecasting healthcare utilization has the potential to anticipate care needs, either accelerating needed care or redirecting patients toward care most appropriate to their needs. While prior research has utilized clinical information to forecast readmissions, analyzing digital footprints from social media can inform our understanding of individuals' behaviors, thoughts, and motivations preceding a healthcare visit. We evaluate how language patterns on social media change prior to emergency department (ED) visits and inpatient hospital admissions in this case-crossover study of adult patients visiting a large urban academic hospital system who consented to share access to their history of Facebook statuses and electronic medical records.

Wakemeter relies on changing perception thresholds across sleep stages.

Miller KE, Woodward SH. Wakemeter relies on changing perception thresholds across sleep stages. .

Changing health behaviours in rheumatology: an introduction to behavioural economics.

Although the management of patients with rheumatic diseases has evolved substantially over the past 20 to 30 years, lifestyle changes (such as weight reduction, physical activity and medication adherence) remain an important and unmet challenge in improving patient outcomes. The field of behavioural economics considers the many ways that individuals behave irrationally and uses the predictability of these patterns to create opportunities to anticipate and avoid or harness these behaviours to improve patient outcomes. Existing among other motivational approaches, the concepts in behavioural economics have only been applied to health care in the past 10 to 15 years.

Is sleep disturbance linked to short- and long-term outcomes following treatments for recurrent depression?

Background: Pre-treatment sleep disturbance has been shown to predict antidepressant treatment outcomes. How changes in sleep disturbance during acute treatment affect longitudinal outcomes, or whether continuation-phase treatment further improves sleep disturbance, is unclear.

Methods: We assessed sleep disturbance repeatedly in: a) 523 adults with recurrent MDD who consented to 12-14 weeks of acute-phase cognitive therapy (A-CT) and b) 241 A-CT responders at elevated risk for depression relapse/recurrence who were randomized to 8 months of continuation-phase treatment (CCT vs.

The Relationship between Alcohol Craving and Insomnia Symptoms in Alcohol-Dependent Individuals.

Aim: This preliminary investigation evaluated the link between alcohol craving and insomnia in actively drinking patients with alcohol dependence (AD).

Methods: We conducted a secondary analysis of data from a clinical trial of treatment-seeking patients with AD who drank heavily (N = 61). The Penn Alcohol Craving Scale (PACS) evaluated alcohol craving, and the Short Sleep Index (SSI) assessed insomnia symptoms.

Measuring Self-Appraised Changes following Participation in an Intervention for Caregivers of Individuals with Dementia.

This study examined the psychometric properties of the Self-Appraisal of Change Scale, a measure designed to capture domains that are subjectively relevant to caregivers, associated with overall well-being, and amenable to change upon engaging in an intervention. Data from 107 caregivers of veterans with dementia enrolled in a randomized controlled trial of a telephone-delivered caregiver psychoeducation and support group program (the Telehealth Education Program (TEP)) were analyzed. The TEP, which was delivered by master's prepared social workers and a nurse dementia care manager, targeted caregivers' dementia-related knowledge, attitudes, and self-management skills.