538 results match your criteria: "Houston VA HSR&D Center of Excellence[Affiliation]"

Temporal changes in risk factors of hepatocellular carcinoma in a prospective cirrhosis cohort.

Clin Gastroenterol Hepatol

December 2024

Sections of VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA; Dan L Duncan Comprehensive Cancer Center, BCM, VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA; Health Services Research, Department of Medicine, Baylor College of Medicine, VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA. Electronic address:

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Mental Health Provider Knowledge and Attitudes Toward Diagnosing Anxiety Disorders in the Veterans Health Administration.

J Clin Psychol Med Settings

December 2024

Michael E. DeBakey VA Medical Center, VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.

Clinical practice guidelines indicate treatments for specific anxiety diagnoses. Misdiagnosing specific anxiety disorders as unspecified anxiety may prevent patients from receiving appropriate care. Provider knowledge and attitudes may influence diagnostic practices.

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Background: Colorectal cancer (CRC) diagnoses are frequently made through emergency presentations (EPs), a new cancer diagnosis following an emergency care episode or unplanned inpatient admission. The extent and implications of EPs are not well known in the Veterans Affairs (VA) health system, where robust CRC screening protocols exist. The impact of the COVID-19 pandemic on the route of CRC diagnosis also remains unclear.

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Background: Previous studies have reported higher circulating bile acid levels in patients with HCC compared to healthy controls. However, the association between prediagnostic bile acid levels and HCC risk among patients with cirrhosis is unclear.

Methods: We measured total BA (TBA) concentration in serum samples collected from a prospective cohort of patients with cirrhosis who were followed until the development of HCC, death, or last study date.

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Interval Advanced Adenomas and Neoplasia in Patients with Negative Colonoscopy Following Positive Stool-Based Colorectal Cancer Screening Test.

Dig Dis Sci

November 2024

Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM 285, Houston, TX, USA.

Background/aims: Fecal occult blood test (FOBT) and fecal immunohistochemical test (FIT) are used for colorectal cancer (CRC) screening. However, when no adenomas are found following a positive FOBT/FIT, the future risk of advanced adenomas or colorectal cancer (CRC) is unclear. We determined the incidence and determinants of advanced adenomas or CRC after a negative index colonoscopy following a positive FOBT/FIT.

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Accessible, low-cost digital programmes are emerging as a means by which to address high rates of mental health problems. However, the development and assessment of scalable training programmes for effective use of digital interventions has lagged. This is particularly important, as coach-supported digital interventions provide benefits that substantially and consistently exceed those of programmes that are entirely self-guided.

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Objective: Artificial intelligence (AI) is revolutionizing healthcare, but less is known about how it may facilitate methodological innovations in research settings. In this manuscript, we describe a novel use of AI in summarizing and reporting qualitative data generated from an expert panel discussion about the role of electronic health records (EHRs) in implementation science.

Materials And Methods: 15 implementation scientists participated in an hour-long expert panel discussion addressing how EHRs can support implementation strategies, measure implementation outcomes, and influence implementation science.

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The translation-to-policy learning cycle to improve public health.

Learn Health Syst

October 2024

Office of Research and Development, Veterans Health Administration, U.S. Department of Veterans Affairs Washington DC USA.

Objective: Learning Health Systems (LHSs) have not directly informed evidence-based policymaking. The Translation-to-Policy (T2P) Learning Cycle aligns scientists, end-users, and policymakers to support a repeatable roadmap of innovation and quality improvement to optimize effective policies toward a common public health goal. We describe T2P learning cycle components and provide examples of their application.

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Churning the tides of care: when nurse turnover makes waves in patient access to primary care.

BMC Nurs

October 2024

Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX, 77021, USA.

Article Synopsis
  • - The study examines how different levels of registered nurse (RN) staffing in Patient Aligned Care Teams (PACTs) within the Veterans Health Administration (VHA) affect patient access to healthcare services.
  • - It involved analyzing data from nearly 6,000 PACTs over a 24-month period, categorizing RN staffing stability into continuous churn, instability, vacancy, and stability, comparing their impact on various access measures.
  • - Findings indicated that RN churn significantly negatively impacted appointment availability, while staffing instability and vacancy did not show a notable effect; overall, adequate staffing and team stability were linked to better patient access.
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Article Synopsis
  • * Out of 876 providers, only 10% were aware of their patients' PGx test status, with 64% not having ordered any PGx tests in the past year.
  • * Most providers (55%) believed PGx testing could be valuable for pain medication prescriptions, and 51% indicated a need for local experts to assist with PGx testing, highlighting areas for improvement in the Veterans Health Administration's approach to pain management.
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Purpose: This study aimed to describe stroke survivors' experiences receiving telemedicine visits at the Lone Star Stroke Consortium during the COVID-19 pandemic.

Materials And Methods: A qualitative descriptive phenomenological design was applied to gather patients' telemedicine experiences through in-depth interviews, using a study guide. Audio-recorded interviews were conducted via ZOOM and transcribed verbatim.

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Factors associated with successful FLOW implementation to improve mental health access: a mixed-methods study.

Transl Behav Med

November 2024

Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.

Article Synopsis
  • - The FLOW program helps mental health providers move patients who have stabilized in specialty mental health care to primary care, aiming to improve access to such services across nine VA sites, where implementation was varied.
  • - The study uses the Consolidated Framework for Implementation Research (CFIR) to identify factors that contribute to successful implementation, utilizing a mixed-methods approach to analyze different metrics across the sites.
  • - Key themes for successful implementation include positive perceptions of the FLOW intervention, a supportive recovery-oriented care culture, low turnover of mental health providers, and effective internal facilitators, while other aspects like staffing and leadership support showed inconsistent effects.
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Key Points: Treatment discontinuation is common among patients with CKD prescribed sodium-glucose cotransporter-2 (SGLT2) inhibitors (discontinued in 37%) or glucagon-like peptide-1 receptor agonists (GLP-1 RA; discontinued in 47%). Discontinuation of SGLT2 inhibitors and GLP-1 RA was associated with recent hospitalizations, Black race, Hispanic ethnicity, and vascular disease. Discontinuation of both agents was associated with death and cardiovascular events.

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Article Synopsis
  • The study looked at people with and without hand osteoarthritis to find out who has marginal erosions (MEs), which are small damage spots in the bones.
  • It discovered that MEs are more common in older men who smoke and usually happen in joints that don’t have a lot of arthritis.
  • Lastly, MEs could help predict how the condition might get worse over time, since they are linked to more changes in bone damage compared to joints without MEs.
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Unseen foe: The financial toxicity of liver transplantation.

Liver Transpl

September 2024

Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.

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Racial and Ethnic Disparity in Healthcare Expenditure and Resource Utilization Among Patients with Cardiovascular Diseases.

J Racial Ethn Health Disparities

August 2024

Pharmaceutical Health Outcomes and Policy Department, College of Pharmacy, University of Houston, Texas Health Building 2, 4849 Calhoun Road, Room 4050, Houston, TX, 77204-5047, USA.

Background: Despite extensive research, significant gaps remain in understanding racial disparity among individuals with cardiovascular diseases (CVD). These disparities, influenced by factors such as access to care and comorbid conditions, necessitate further investigation to develop targeted interventions.

Aim: To evaluate the factors contributing to racial and ethnic disparities in healthcare resource utilization and total healthcare expenditure among individuals with CVD.

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Methotrexate: Borrowed Hope for Persons With Knee Osteoarthritis?

Ann Intern Med

September 2024

Section of Immunology, Allergy and Rheumatology, Department of Medicine, Baylor College of Medicine, and Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.

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Research regarding HIV, substance use disorders (SUD), and SARS-CoV-2 infections after COVID-19 vaccination is limited. In the Veterans Aging Cohort Study (VACS)-HIV cohort, we followed vaccinated persons with HIV (PWH) and without HIV (PWoH) from 12/2020 to 3/2022 and linked SARS-CoV-2 test results for laboratory-confirmed breakthrough infection through 9/2022. We examined associations of substance use (alcohol use disorder [AUD], other SUD, smoking status) and HIV status and severity with breakthrough infections, using Cox proportional hazards regression hazard ratios (HR).

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Effects of COVID-19 on Sleep Services Use and Its Recovery.

Nat Sci Sleep

June 2024

VA's Health Services Research and Development Service (HSR&D), Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA.

Article Synopsis
  • The COVID-19 pandemic significantly impacted sleep testing services, with notable declines in utilization for both Home Sleep Apnea Testing (HSAT) and Polysomnography (PSG) across various stages of the pandemic.
  • A study of 261,371 veterans revealed PSG usage fell drastically during different pandemic phases, while HSAT saw an initial drop followed by a recovery and increase post-vaccination.
  • By analyzing data from the Veterans Health Administration between 2019 and 2023, the study concluded that HSAT became more prominent in sleep testing services, particularly after vaccination efforts began.
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Purpose: This study aimed to develop a patient-centered survivorship care plan (SCP) for US military Veteran bladder cancer (BC) survivors in accordance with the National Academy of Medicine recommendation that survivors receive an SCP at treatment completion. BC, which differentially impacts older men, is a costly and highly recurrent cancer associated with invasive procedures and long-term surveillance. Veteran BC survivors may face challenges navigating the patient-to-survivor transition due to their age and comorbidities.

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The FLOW program was designed to facilitate appropriate and safe transitions of patients from specialty mental health (SMH) to primary care (PC) as a method of improving access and reducing appointment burden on veterans who have improved or remitted. In this study, the team evaluated the implementation of FLOW across nine Veterans Affairs (VA) sites using a mixed-methods evaluation in a cluster-randomized stepped wedge trial design. Outcome assessments used data from VA databases, dashboards, and semi-structured interviews and were guided by the Reach, Adoption, Effectiveness, Implementation, and Maintenance (RE-AIM) framework.

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