376 results match your criteria: "Center for Health Services and Outcomes Research[Affiliation]"

Accuracy, thoroughness, and quality of outpatient primary care documentation in the U.S. Department of Veterans Affairs.

BMC Prim Care

July 2024

Center for Health Information and Communication, Department of Veterans Affairs, Health Services Research and Development Service, Veterans Health Administration, Richard L. Roudebush VA Medical Center, CIN 13 416, Indianapolis, IN, USA.

Background: Electronic health records (EHRs) can accelerate documentation and may enhance details of notes, or complicate documentation and introduce errors. Comprehensive assessment of documentation quality requires comparing documentation to what transpires during the clinical encounter itself. We assessed outpatient primary care notes and corresponding recorded encounters to determine accuracy, thoroughness, and several additional key measures of documentation quality.

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Background: Inferior vena cava (IVC) filter tilt is associated with technical difficulties at the time of retrieval. However, the degree of tilt that predisposes patients to undergo complex or failed retrieval has not been defined.

Methods: The electronic charts of patients undergoing IVC filter removal between 2010 and 2019 at a single tertiary center were reviewed.

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Mixed-Methods Analysis of Provider-Documented and Patient-Reported Urinary Tract Infection Symptoms Among Veterans With Neurogenic Bladder.

Am J Phys Med Rehabil

November 2024

From the Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois (MW, PS, FMW, CTE); Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (FMW); Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (KJS); Department of Medicine, Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (KJS); Spinal Cord Injury/Disorders Service, VA Puget Sound Healthcare System, Seattle, Washington (SPB); Department of Physical Medicine and Rehabilitation, University of Washington School of Medicine, Seattle, Washington (SPB); Department of Medicine, Division of Infectious Diseases, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin (NS); Department of Medicine, Division of Infectious Diseases, William S. Middleton VA Hospital, Madison, Wisconsin (NS); College of Nursing, University of Illinois Chicago, Chicago, Illinois (EC); Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois (CTE); Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (MAF); and Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado (MAF).

Inappropriate urinary tract infection diagnosis in patients with neurogenic bladder may result from ambiguous symptoms experienced by these patients and contributes to antibiotic overuse. Characterization of patient-reported signs and symptoms may help providers more appropriately diagnose urinary tract infections. A previous study collected signs and symptoms recorded in electronic medical records of patients with neurogenic bladder due to spinal cord injury/disorder, multiple sclerosis, and Parkinson's disease with at least one urinary tract infection diagnosis between 2017-2018 at four medical centers.

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Background: Malnutrition in hospitalized patients is associated increased length of stay, cost, readmission, and death. No recent studies have examined trends in prevalence or outcomes of hospitalized patients with a diagnosis of malnutrition.

Objectives: To study the prevalence of malnutrition diagnostic codes and associated hospital outcomes in the United States between 2016 and 2019.

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Objectives: Interhospital transfer of patients with acute respiratory failure (ARF) is relevant in the current landscape of critical care delivery. However, current transfer practices for patients with ARF are highly variable, poorly formalized, and lack evidence. We aim to synthesize the existing evidence, identify knowledge gaps, and highlight persisting questions related to interhospital transfer of patients with ARF.

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Article Synopsis
  • Burnout is a significant issue for healthcare workers, impacting their wellbeing and the quality of care they provide, necessitating both systemic changes and personal resilience skills.
  • A trial was conducted with 554 healthcare workers to assess the feasibility and effectiveness of the PARK program, an online self-guided coping skills intervention designed to help combat burnout during the COVID-19 pandemic.
  • Results indicated that participants receiving PARK showed significant improvements in anxiety levels compared to those in a waitlist group, even though overall burnout and wellbeing changes between the two groups were not statistically significant.
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Background: Chronic cough (CC) affects about 10% of adults, but opioid use in CC is not well understood.

Objectives: To determine the use of opioid-containing cough suppressant (OCCS) prescriptions in patients with CC using electronic health records.

Design: Retrospective cohort study.

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Clinical outcomes of arteriovenous fistulae (AVF) for hemodialysis remain inadequate since biological mechanisms of AVF maturation and failure are still poorly understood. Aortocaval fistula creation (AVF group) or a sham operation (sham group) was performed in C57BL/6 mice. Venous limbs were collected on postoperative day 7 and total RNA was extracted for high throughput RNA sequencing and bioinformatic analysis.

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Development and implementation of a nationwide multidrug-resistant organism tracking and alert system for Veterans Affairs medical centers.

Infect Control Hosp Epidemiol

May 2024

National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA.

Objective: Develop and implement a system in the Veterans Health Administration (VA) to alert local medical center personnel in real time when an acute- or long-term care patient/resident is admitted to their facility with a history of colonization or infection with a multidrug-resistant organism (MDRO) previously identified at any VA facility across the nation.

Methods: An algorithm was developed to extract clinical microbiology and local facility census data from the VA Corporate Data Warehouse initially targeting carbapenem-resistant (CRE) and methicillin-resistant (MRSA). The algorithm was validated with chart review of CRE cases from 2010-2018, trialed and refined in 24 VA healthcare systems over two years, expanded to other MDROs and implemented nationwide on 4/2022 as "VA Bug Alert" (VABA).

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Decreasing the time to contact precautions (CP) is critical to carbapenem-resistant Enterobacterales (CRE) prevention. Identifying factors associated with delayed CP can decrease the spread from patients with CRE. In this study, a shorter length of stay was associated with being placed in CP within 3 days.

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Utilization of at-home tests for coronavirus disease 2019 (COVID-19) among healthcare workers in Chicago.

Antimicrob Steward Healthc Epidemiol

April 2024

Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

Objective: To describe utilization of at-home coronavirus disease 2019 (COVID-19) testing among healthcare workers (HCW).

Design: Serial cross-sectional study.

Setting And Participants: HCWs in the Chicago area.

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Background: Recent evidence showing that computer-assisted total knee arthroplasty (TKA) is associated with better outcomes compared with conventional TKA for patients with end-stage knee osteoarthritis has not been included in economic evaluations of computer-assisted TKA, which are needed to support coverage decisions. This study evaluated the cost-effectiveness of computer-assisted TKA from a payer's perspective, incorporating recent evidence.

Methods: We compared computer-assisted TKA with conventional TKA with regard to costs (in 2022 U.

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Evidence suggests system-level norms and care processes influence individual patients' medical decisions, including end-of-life decisions for patients with critical illnesses like acute respiratory failure. Yet, little is known about how these processes unfold over the course of a patient's critical illness in the intensive care unit (ICU). Our objective was to map current-state ICU care delivery processes for patients with acute respiratory failure and to identify opportunities to improve the process.

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Background Since headache specialists cannot treat all the patients with headache disorders, multidisciplinary teams that include health psychologists are becoming more prevalent. Health psychologists mainly use a form of cognitive-behavioral therapy (CBT), along with biofeedback on occasion, to effectively address patients' pain and headache disorders. The Veterans Health Administration (VHA) is one setting that routinely includes a health psychologist with advanced training in pain disorders in their pain care to its veterans.

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Background: Persons living with dementia (PLWD) experience frequent and costly emergency department (ED) visits, with poor outcomes attributed to suboptimal care and postdischarge care transitions. Yet, patient-centered data on ED care experiences and postdischarge needs are lacking. The objective of this study was to examine the facilitators and barriers to successful ED care and care transitions after discharge, according to PLWD and their caregivers.

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Objectives: While factors contributing to dental antibiotic overprescribing have previously been described, previous work has lacked any theoretical behavior change framework that could guide future intervention development. The purpose of this study was to use an evidence-based conceptual model to identify barriers and facilitators of appropriate antibiotic prescribing by dentists as a guide for future interventions aimed at modifying antibiotic prescribing.

Methods: Semi-structured interviews were conducted with dentists from the National Dental Practice Based Research Network (PBRN) exploring patient and practice factors perceived to impact antibiotic prescribing.

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Benchmark findings from a veteran electronic patient-reported outcomes evaluation from a chronic pain management telehealth program.

BMC Health Serv Res

March 2024

Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Hines, Jr. VA Hospital, 5000 South 5th Ave., Hines, IL, 60141, USA.

Background: Chronic pain is a leading cause of disability and negatively impacts biological/physical, psychological, and social aspects of life resulting in significant pain interference or disability. This project was part of a longitudinal mixed-methods implementation evaluation of the TelePain-Empower Veterans Program (EVP), a non-pharmacological chronic pain intervention. The purpose of this quality management project was to examine electronic patient-reported outcome measures (ePROs) including primary pain-related (intensity, interference, catastrophizing, kinesiophobia) and secondary outcomes (physical, psychological, acceptance, social) to determine TelePain-EVP effectiveness.

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Study Design: Qualitative study.

Objectives: To explore how knowledge, perceptions, and beliefs about urinary tract infections (UTIs) among persons with neurogenic bladder (NB) may impact health behaviors and provider management and enhance person-centeredness of interventions to improve UTI management.

Setting: Three Veterans Affairs (VA) medical centers.

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Background: Evidence of higher hospital volume being associated with improved outcomes for patients undergoing total knee replacement (TKR) is mostly based on arbitrary distribution-based thresholds.

Objective: We aimed to define outcome-based volume thresholds using data from a national database.

Methods: We used the MedPAR Limited Data Set inpatient data from 2010-2015 to identify patients who had undergone primary TKR.

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Clinical chatbots are increasingly used to help integrate genetic testing into clinical contexts, but no chatbot exists for Apolipoprotein L1 (APOL1) genetic testing of living kidney donor (LKD) candidates of African ancestry. Our study aimed to culturally adapt and assess perceptions of the Gia® chatbot to help integrate APOL1 testing into LKD evaluation. Ten focus groups and post-focus group surveys were conducted with 54 LKDs, community members, and kidney transplant recipients of African ancestry.

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Qualitative Evaluation Informs the Implementation of a Telehealth Program to Manage Chronic Pain.

J Pain

July 2024

Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida; Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.

In response to the opioid epidemic and high rates of chronic pain among the veteran population, the U.S. Department of Veterans Affairs implemented the TelePain-Empower Veterans Program (EVP), a nonpharmacological pain management program for veterans.

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Introduction: Dry socket and infection are complications of tooth extractions. The objective was to determine risk factors for post-extraction complications in patients without antibiotic prophylaxis stratified by early- and late-complications and complication type (oral infection and dry socket).

Methods: Retrospective, case (with complications)-control (without complications) study of patients (n = 708) who had ≥1 extraction performed at any Veterans Health Administration facility between 2015-2019 and were not prescribed an antibiotic 30 days pre-extraction.

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Purpose: To investigate the association between visual impairment and employment status due to disability, utilizing data from the 2022 National Health Interview Survey (NHIS).

Methods: Adults 18 years of age and older were extracted from the 2022 NHIS dataset. A multivariable logistic regression model was created to evaluate the odds of unemployment ("laid off" and "looking for work").

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Antibiotics prescribed as infection prophylaxis prior to dental procedures have the potential for serious adverse drug events (ADEs). However, the extent to which guideline concordance and different dental settings are associated with ADEs from antibiotic prophylaxis is unknown. The purpose was to assess guideline concordance and antibiotic-associated ADEs and whether it differs by VA and non-VA settings.

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