Article
Medicine, General & Internal
Liam Rose, Marion Aouad, Laura Graham, Lena Schoemaker, Todd Wagner
Summary: This study evaluated changes in health care utilization after an expansion in the Veterans Affairs Health Care System (VA) health care network. Results showed that expanded network access was associated with increased outpatient utilization rates, especially among younger individuals without service-connected disabilities.
Article
Health Care Sciences & Services
Megan Lafferty, Diana J. J. Govier, Sara E. E. Golden, Natalie G. G. Disher, Denise M. M. Hynes, Christopher G. G. Slatore
Summary: This study interviewed Veterans who were eligible for both VA-delivered and VA-purchased care to understand the factors they consider when deciding whether to use VA-delivered or VA-purchased care. The study found that the quality of relationships with providers and the healthcare environment influenced Veterans' decisions, and that they desired more information about providers, services, and coordination of care. The findings emphasize the importance of collecting and providing information on these aspects of care to ensure that Veterans' healthcare decisions reflect their needs and preferences.
JOURNAL OF GENERAL INTERNAL MEDICINE
(2023)
Article
Geriatrics & Gerontology
Melissa W. Wachterman, Dawn Smith, Joan G. Carpenter, Hillary L. Griffin, Joshua Thorpe, Shelli L. Feder, Jillian Hoelter, Mary Ersek, Scott Shreve, Ann Kutney-Lee
Summary: This study compared the quality of end-of-life care for Veterans receiving hospice in VA community living centers (CLCs) and VA-contracted community nursing homes (CNHs). The findings revealed inadequacies in multiple aspects of end-of-life care and highlighted the urgent need for policy and practice interventions to improve this care.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2023)
Article
Medicine, General & Internal
Megan E. Vanneman, Jean Yoon, Sara J. Singer, Todd H. Wagner, Mary K. Goldstein, Jiaqi Hu, Derek Boothroyd, Liberty Greene, Donna M. Zulman
Summary: The use of multiple systems by U.S. Veterans Affairs (VA) patients presents challenges for VA clinicians responsible for coordinating their care. This study examined the relationship between drive distance, drive time, and Veterans' reliance on VA for different types of care. The findings showed that drive distance affected the likelihood of outpatient specialty care being provided in VA, while drive time was associated with a decreased likelihood of VA providing outpatient specialty care.
Article
Urology & Nephrology
Rajiv Saran, Aaron Pearson, Anca Tilea, Vahakn Shahinian, Jennifer Bragg-Gresham, Michael Heung, David W. Hutton, Diane Steffick, Kai Zheng, Hal Morgenstern, Brenda W. Gillespie, Alan Leichtman, Eric Young, Ann M. O'Hare, Michael Fischer, John Hotchkiss, Eddie Siew, Denise Hynes, Linda Fried, Daniel Balkovetz, Karen Sovern, Chuan-Fen Liu, Susan Crowley
Summary: The study describes the development of a renal information system by the US Department of Veterans Affairs for disease surveillance and care of patients with chronic kidney disease (CKD). VA identified a large number of CKD patients based on operational definitions, with most of the costs allocated to CKD stage 3. This system contributes to enhancing the quality and value of care.
AMERICAN JOURNAL OF KIDNEY DISEASES
(2021)
Article
Social Sciences, Interdisciplinary
Sara E. Golden, Megan Lafferty, Anna Tyzik, Diana Govier, Jennifer Barton, Alan R. Teo, Samuel T. Edwards, Sarah S. Ono, Denise M. Hynes, Christopher G. Slatore
Summary: This study conducted interviews with clinicians and staff to evaluate their experiences with Veterans' decisions on healthcare and identify areas for improvement. Insufficient time and knowledge were found to be barriers to assisting Veterans in making decisions about community care. Concerns about quality of community care and lack of patient understanding also emerged. Clinicians need decision support that integrates informational needs, referral process clarity, and improved quality measurement and description methods. While new initiatives have been established, the rollout is complex and ongoing.
Article
Oncology
Megan A. Mullins, Julie J. Ruterbusch, Philippa Clarke, Shitanshu Uppal, Lauren P. Wallner, Michele L. Cote
Summary: The clinical landscape has shifted towards less aggressive end-of-life care for women with ovarian cancer, but the use of aggressive end-of-life services persists, with non-White women receiving the most aggressive care.
Article
Health Care Sciences & Services
Aimee Kroll-Desrosiers, Rebecca L. Kinney, Valerie Marteeny, Kristin M. Mattocks
Summary: This study examines the feasibility of comprehensive perinatal mental healthcare screening and treatment in VA care, by exploring the acceptance of United States Preventive Services Task Force (USPSTF) recommendations among pregnant and postpartum Veterans. The results show that less than half of the women saw a mental health provider at the beginning of their pregnancy, and that Veterans support the USPSTF recommendations, considering mental healthcare during the perinatal period to be very important. They also express a desire for better access to mental healthcare resources and peer support networks.
JOURNAL OF GENERAL INTERNAL MEDICINE
(2022)
Article
Public, Environmental & Occupational Health
Joya G. Chrystal, Susan Frayne, Karen E. Dyer, Jessica L. Moreau, Cynthia E. Gammage, Fay Saechao, Eric Berg, Donna L. Washington, Elizabeth M. Yano, Alison B. Hamilton
Summary: This study analyzed the use of VA healthcare by women veterans, finding reasons for attrition including challenging medical experiences and the availability of private health insurance. Recommendations to decrease attrition included increasing outreach, improving access, and tailoring care delivery to the needs of women veterans.
WOMENS HEALTH ISSUES
(2022)
Article
Clinical Neurology
Elizabeth K. K. Seng, Brenda T. T. Fenton, Kaicheng Wang, Richard B. B. Lipton, John Ney, Teresa Damush, Amy S. S. Grinberg, Melissa Skanderson, Jason J. J. Sico
Summary: Migraine care is common among veterans in the Veterans Health Administration (VHA), with a higher prevalence in women. Men with migraine are more likely to have a traumatic brain injury (TBI) diagnosis, while women with migraine are more likely to report military sexual trauma. Primary care is the most common setting for headache care, but a significant number of veterans seek care in the emergency department. Overweight/obesity, nonheadache pain disorders, and mental health disorders are common comorbidities among veterans with diagnosed migraine.
Article
Geriatrics & Gerontology
Susan P. Y. Wong, Mary Beth Foglia, Jennifer Cohen, Taryn Oestreich, Ann M. O'Hare
Summary: In this study, researchers analyzed the documentation of patients' preferences for life-sustaining treatments (LST) in the medical records of individuals with advanced kidney disease. The findings revealed that LST notes were often completed as a reactive response to medical crises and focused on short-term goals and preferences. Additionally, the study highlighted the practitioner-driven nature of these conversations and the challenges in communication with patients and surrogates.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2022)
Article
Health Care Sciences & Services
Lisa S. Callegari, Siobhan S. Mahorter, Sam K. Benson, Xinhua Zhao, Eleanor Bimla Schwarz, Sonya Borrero
Summary: Opportunities exist to improve the quality of contraceptive counseling within VA primary care settings, including more consistent efforts to seek patients' perspectives with respect to contraceptive decisions.
JOURNAL OF GENERAL INTERNAL MEDICINE
(2022)
Article
Geriatrics & Gerontology
Daniel Kinder, Dawn Smith, Mary Ersek, Melissa Wachterman, Joshua Thorpe, Darlene Davis, Ann Kutney-Lee
Summary: This study found that veterans enrolled in the HBPC program who received community-based hospice services had higher ratings of end-of-life care from bereaved family members, which may help improve the overall experience of end-of-life care for veterans and their families.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2022)
Article
Health Care Sciences & Services
Omonyele L. Adjognon, Marlena H. Shin, Melissa J. A. Steffen, Jennifer Moye, Samantha Solimeo, Jennifer L. Sullivan
Summary: The study identified key factors affecting GeriPACT implementation, including model structure, design quality, resource availability, leadership support, and team communication. Older patients with multiple chronic conditions require high levels of care management and coordination.
HEALTH SERVICES RESEARCH
(2021)
Article
Geriatrics & Gerontology
Caitlin S. Chan, Darlene Davis, Dayna Cooper, Thomas Edes, Ciaran S. Phibbs, Orna Intrator, Bruce Kinosian
Summary: The study evaluated whether the Department of Veterans Affairs home-based primary care has adopted the flexible structure of the PACE regulation to align with the needs of veterans. The results showed a strong association between HBPC team patterns and patient frailty, indicating tailored care to match veteran needs.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2021)
Article
Critical Care Medicine
Lisa M. Knowlton, Linda D. Tran, Katherine Arnow, Amber W. Trickey, Arden M. Morris, David A. Spain, Todd H. Wagner
Summary: Hospital Presumptive Eligibility (HPE) is an effective way to provide temporary Medicaid insurance and ensure long-term coverage for trauma patients. The study found that 69.7% of HPE-approved trauma patients were able to sustain Medicaid insurance at 6 months after injury. Factors such as injury severity, surgical intervention, and post-discharge services influenced the likelihood of sustaining Medicaid coverage.
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
(2023)
Article
Health Policy & Services
Megan E. Vanneman, Amy K. Rosen, Todd H. Wagner, Michael Shwartz, Sarah H. Gordon, Greg Greenberg, Tianyu Zheng, James Cook, Erin Beilstein-Wedel, Tom Greene, Taylor Kelley
Summary: This study examined the usage of VHA-purchased community care by VHA enrollees, and found that a portion of inpatient behavioral health care and outpatient visits were provided by community care instead of VHA. The study highlights the importance of coordination between VHA and the community to ensure appropriate follow-up care and address outpatient needs.
PSYCHIATRIC SERVICES
(2023)
Article
Health Care Sciences & Services
Jacqueline M. Ferguson, Charlie M. Wray, Josephine Jacobs, Liberty Greene, Todd H. Wagner, Michelle C. Odden, Jeremy Freese, James Van Campen, Steven M. Asch, Leonie Heyworth, Donna M. Zulman
Summary: This study aims to identify which Veteran populations are routinely accessing video-based care. The findings suggest that there are variations in video care utilization patterns by type of care, and certain Veteran populations may require greater resources and support to initiate and sustain video care use. Specifically, service-specific outreach to homeless and American Indian/Alaska Native Veterans is important.
HEALTH SERVICES RESEARCH
(2023)
Article
Geriatrics & Gerontology
Portia Y. Cornell, Kate H. Magid, Emily Corneau, Leah M. Haverhals, Cari Levy
Summary: A study found that there was a decline in admissions to community nursing homes among Veterans following the onset of the COVID-19 pandemic. The decline was attributed to fewer available beds, concerns about Veterans being exposed to COVID-19 in nursing homes, and a preference for home-based care. The impact of this decline on the health outcomes and well-being of Veterans and their caregivers is a matter of concern.
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
(2023)
Article
Surgery
Danielle H. Rochlin, Nada M. Rizk, Evan Matros, Todd H. Wagner, Clifford C. Sheckter
Summary: The Hospital Price Transparency Rule, enacted in 2021, aims to lower healthcare costs and facilitate market competition. A cross-sectional study evaluated the commercial price variation for breast reconstruction, finding that prices decreased in more competitive healthcare markets. This suggests that transparency policies and measures to promote competition can help lower healthcare costs.
Review
Geriatrics & Gerontology
Connie S. Cole, Jessica Roydhouse, Regina M. Fink, Mustafa Ozkaynak, Joan G. Carpenter, Evan Plys, Shaowei Wan, Cari R. Levy
Summary: This review aimed to identify validated palliative care screening tools for nursing home residents and evaluate the quality of their measurement properties. Only one tool met the criteria, but it lacked sufficient testing of reliability and sensitivity in the nursing home setting. Therefore, further validation of existing tools and the development of new instruments specifically for nursing home use are recommended.
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
(2023)
Article
Substance Abuse
Vilija R. Joyce, Elizabeth M. Oliva, Carla C. Garcia, Jodie Trafton, Steven M. Asch, Todd H. Wagner, Keith Humphreys, Douglas K. Owens, Mark Bounthavong
Summary: A retrospective cohort study examined healthcare costs and use among US Veterans Health Administration patients with opioid use disorder (OUD) who experienced an opioid overdose compared to those who did not. The study found that patients with an overdose had significantly higher healthcare costs and use in the month following the overdose and throughout the year.
Article
Surgery
Clifford C. Sheckter, Danielle H. Rochlin, Robyn Rubenstein, Meghana G. Shamsunder, Arden M. Morris, Todd H. Wagner, Evan Matros
Summary: This study aimed to investigate the impact of high-deductible health plans (HDHPs) on the timing of surgery for breast and colon cancer patients. The results showed that HDHPs were associated with delays in screening and surgery, but not with delays in the time to surgery (TTS). Therefore, interventions to improve cancer care outcomes in the HDHP population should focus on reducing barriers to timely screening.
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
(2023)
Letter
Medicine, General & Internal
Liam Rose, Anna Schmidt, Elizabeth Gehlert, Laura A. Graham, Marion Aouad, Todd H. Wagner
Summary: Using survey data, this cross-sectional study examines the correlation between reliance on the Department of Veterans Affairs (VA) for health care and self-reported health among VA enrollees, considering different types of insurance coverage.
Meeting Abstract
Oncology
Heather M. Selby, Charles Liu, Vipul Sheth, Sandy Napel, Todd Wagner, Arden M. Morris
JOURNAL OF CLINICAL ONCOLOGY
(2023)
Article
Respiratory System
Lucas M. Donovan, Camilla M. Hoyos, R. John Kimoff, Mary J. Morrell, Nicholas A. Bosch, David M. Chooljian, R. Doug McEvoy, Amy M. Sawyer, Todd H. Wagner, Rasha R. Al-Lamee, David Bishop, Margaret A. Carno, Matt Epstein, Mark Hanson, Mary S. M. Ip, Marie Letourneau, Sushmita Pamidi, Sanjay R. Patel, Jean-Louis Pepin, Naresh M. Punjabi, Susan Redline, J. Daryl Thornton, Susheel P. Patil
Summary: Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnea (OSA), but there is uncertainty about its full benefits on long-term outcomes. Observational studies suggest that patients with symptoms may benefit from CPAP, but ethical and practical concerns limit their participation in prior trials. This workshop aimed to identify strategies to understand the causal effects of CPAP on long-term outcomes among symptomatic OSA patients.
ANNALS OF THE AMERICAN THORACIC SOCIETY
(2023)
Meeting Abstract
Geriatrics & Gerontology
T. S. Jones, L. McKown, A. Lane, C. Horney, M. Unruh, N. Brown, E. Jones, C. R. Levy, T. Robinson
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2023)
Article
Medicine, General & Internal
Alexander B. Gibson, Wesley D. Hendricks, Katherine Arnow, Linda D. Tran, Todd H. Wagner, Lisa Marie Knowlton
Summary: This cross-sectional study aims to explore the variations in state-level hospital presumptive eligibility programs and their impact on access, considering the Medicaid expansion status.
Meeting Abstract
Health Care Sciences & Services
Rebecca L. Tisdale, Jacqueline M. Ferguson, Alison L. Greene, James Van Campen, Todd H. Wagner, Donna Zulman
JOURNAL OF GENERAL INTERNAL MEDICINE
(2023)
Meeting Abstract
Health Care Sciences & Services
Linda D. Tran, Todd H. Wagner, Paul Shekelle, Stephan D. Fihn, Karin Nelson, Lisa V. Rubenstein
JOURNAL OF GENERAL INTERNAL MEDICINE
(2023)