131 results match your criteria: "Partnered Evidence-Based Policy Resource Center[Affiliation]"

Background: Although long-term opioid therapy (LTOT) has its own risks, opioid discontinuation could pose harm for high-risk Veterans Health Administration (VHA) patients receiving LTOT. There is limited information on the impact of a mandate requiring providers to perform case reviews on high-risk patients with an active opioid prescription (ie, mandated case review policy) on opioid discontinuation and mortality.

Methods: Our study is a secondary data analysis of a 23-month stepped-wedge cluster randomized controlled trial between April 2018 and March 2020.

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

J Am Geriatr Soc

January 2024

Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

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.

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Importance: The COVID-19 pandemic represents a unique stressor in Americans' daily lives and access to health services. However, it remains unclear how the pandemic impacted perceived health status and engagement in health-related behaviors.

Objective: To assess changes in self-reported health outcomes during the COVID-19 pandemic, and to explore trends in health-related behaviors that may underlie the observed health changes.

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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.

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Importance: The Patient Protection and Affordable Care Act (ACA) individual marketplaces are a source of insurance for millions of residents in the US. However, the association between enrollee risk, health spending, and metal tier selection remains unclear.

Objectives: To describe individual marketplace enrollees' metal tier selections by risk score and assess enrollees' health spending by metal tier, risk score, and spending type.

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Incorporating cultural sensitivity into healthcare settings is important to deliver high-quality and equitable care, particularly for marginalized communities who are non-White, non-English speaking, or immigrants. The Clinicians' Cultural Sensitivity Survey (CCSS) was developed as a patient-reported survey assessing clinicians' recognition of cultural factors affecting care quality for older Latino patients; however, this instrument has not been adapted for use in pediatric primary care. Our objective was to examine the validity and reliability of a modified CCSS that was adapted for use with parents of pediatric patients.

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Quality measurement is typically the domain of clinical experts and health system leaders; patient/caregiver perspectives are rarely solicited. We aimed to describe and integrate clinician and patient/caregiver conceptualizations of high-quality palliative symptom care for patients receiving care for advanced cancer within the US Veterans Health Administration in the context of existing quality measures. We conducted a secondary qualitative analysis of transcripts from prioritization discussions of process quality measures relevant to cancer palliative care.

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Background: Homebound status is a final common pathway for people with a variety of diseases and conditions. There are 7 million homebound older adults in the United States. Despite concerns regarding their high healthcare costs and utilization and limited access to care, the unique subsets within the homebound population are understudied.

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The use of crisis line services during the COVID-19 pandemic: Evidence from the veterans health administration.

Gen Hosp Psychiatry

April 2023

Partnered Evidence-based Policy Resource Center, Veterans Health Administration, Boston, MA, USA; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.

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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.

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Therapeutic and Economic Benefits of Service Dogs Versus Emotional Support Dogs for Veterans With PTSD.

Psychiatr Serv

August 2023

U.S. Department of Veterans Affairs (VA) Tennessee Valley Health Care System, Nashville (Richerson); VA Health Economics Resource Center, Palo Alto Health Care System, Menlo Park, California (Wagner, Illarmo); Center for Access Delivery Research and Evaluation, VA Iowa City Healthcare System, and Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Abrams); Atlanta VA Medical Center, Atlanta (Skelton, Fallon); Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, VA, Perry Point, Maryland (Biswas, McSherry, Stock); Partnered Evidence-Based Policy Resource Center, Research and Development, VA Boston Healthcare System, and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Frakt, Pizer); Department of Psychiatry and Behavioral Sciences, Military Sciences Division, and Department of Public Health Sciences, Division of Epidemiology, Medical University of South Carolina, Charleston (Magruder); VA Office of Research and Development, Washington, D.C. (Groer, Dorn, Huang).

Objective: This work aimed to assess the therapeutic and economic benefits of service dogs versus emotional support dogs for veterans with posttraumatic stress disorder (PTSD).

Methods: Veterans with PTSD (N=227) participating in a multicenter trial were randomly assigned to receive a service or emotional support dog; 181 veterans received a dog and were followed up for 18 months. Primary outcomes included overall functioning (assessed with World Health Organization Disability Assessment Scale II [WHODAS 2.

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Background: Care leakage from health systems can affect quality and cost of health care delivery. Identifying modifiable predictors of care leakage may help health systems avoid adverse consequences. Out-of-system emergency department (ED) use may be one modifiable cause of care leakage.

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Context: Investigators in palliative care rely heavily on routinely collected data, which carry risk of unobserved confounding and selection bias. 'Natural experiments' offer opportunities to generate credible causal treatment effect estimates from observational data.

Objectives: We aimed first to review studies that employed 'natural experiments' to evaluate palliative care, and second to consider implications for expanding use of these methods.

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Aims: The Veterans Health Administration (VHA) implemented the Stratification Tool for Opioid Risk Mitigation (STORM) to reduce the risk of serious adverse events (SAE) among patients with opioid analgesic prescriptions. VHA facilities were mandated to case review patients identified as high risk by STORM. The aim of this study was to measure the effect of this mandate on all-cause mortality and SAEs among VHA patients newly diagnosed with opioid use disorder (OUD).

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Objective: The COVID-19 pandemic disproportionately affected racial and ethnic minorities among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans.

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Objective: To investigate the relationship between community care (CC) treatment and a postoperative surgical complication in elective hernia surgery among Veterans using multiple approaches to control for potential selection bias.

Data Sources And Study Setting: Veterans Health Administration (VHA) data sources included Corporate Data Warehouse (VHA encounters and patient data), the Program Integrity Tool and Fee tables (CC encounters), the Planning Systems Support Group (geographic information), and the Paid file (VHA primary care providers).

Study Design: Prior works suggest patient outcomes are better in VHA than in CC settings; however, these studies may not have appropriately accounted for the selection of higher-risk cases into CC.

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The US health system is replete with health service pricing idiosyncrasies and opacity unrelated to quality. Online tools intended to make health care purchasing resemble consumerism by making prices transparent have had little if any effect on improving health care market functioning and changing patient behavior. Although price transparency is still in its infancy, it holds promise to be as useful to patient-consumers as it has been to large purchasers (eg, employers) of health services and policymakers.

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Grading Evidence to Support Legislative and Budget Proposals-Veterans Health Administration's Key to Implementing the Evidence Act.

Value Health

June 2023

Partnered Evidence-Based Policy Resource Center, Boston VA Healthcare System, Boston, MA, USA; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA.

Objectives: The Foundations for Evidence-Based Policymaking Act of 2018 requires cabinet-level agencies to use evidence to justify and support budget and policy making. As investigators from the Quality Enhancement Research Initiative (QUERI) program, we were tasked with assisting Veterans Health Administration (VHA) leadership with the implementation of the Evidence-Based Policymaking Act of 2018. Through meetings with stakeholders, we identified a gap in the review process for legislative and budget proposals; no systematic process existed to evaluate the supporting evidence base for proposals.

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This cross-sectional study identifies changes in referral volume and wait times for veterans seeking care from the specialists in the Veterans Health Administration or the community.

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Differences Between VHA-Delivered and VHA-Purchased Behavioral Health Care in Service and Patient Characteristics.

Psychiatr Serv

February 2023

Informatics, Decision-Enhancement and Analytic Sciences Center, Department of Veterans Affairs (VA) Salt Lake City Health Care System (Vanneman, Zheng, Kelley), and Department of Internal Medicine (Vanneman, Greene, Kelley) and Department of Population Health Sciences (Zheng, Greene), University of Utah School of Medicine, Salt Lake City; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System (Rosen, Shwartz, Beilstein-Wedel), and Department of Surgery, Boston University School of Medicine, Boston (Rosen); Department of Operations and Technology Management, Boston University Questrom School of Business, Boston (Shwartz); Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, and Department of Surgery, Stanford University School of Medicine, Stanford, California (Wagner); Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, and Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston (Gordon); Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven, and Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Greenberg); Health Catalyst, Salt Lake City (Cook).

Article Synopsis
  • Federal legislation has increased Veterans Health Administration (VHA) enrollees' access to community care, prompting a study on differences in behavioral health care provided by the VHA versus community sources and the factors affecting those differences.* -
  • The study analyzed data from over 200,000 VHA enrollees, revealing that 20% of inpatient stays were through community care, and most outpatient visits were still handled by VHA, with community care growing but involving less experienced clinicians.* -
  • The findings emphasize the need for better coordination between VHA and community care providers to ensure veterans receive quality inpatient follow-up and outpatient services, leveraging VHA’s expertise in behavioral health.*
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Background: Homebound older adults have complex social, medical, and financial needs, but little is known about their healthcare utilization and spending.

Objective: To characterize healthcare utilization and spending among homebound older adults.

Design: Cohort study using National Health and Aging Trends Study data linked to Medicare Fee-for-Service (FFS) claims data.

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