Dissertations / Theses on the topic 'Veterans Veterans Quality of Health Care'

The objective of this dissertation was to examine the association between patients' race and receipt of National Comprehensive Cancer Network guideline-adherent and timely colorectal cancer (CRC) and non-small cell lung cancer (NSCLC) care in the Veterans Affairs (VA) healthcare system. Data were from the External Peer Review Program (EPRP) Special Study on CRC and NSCLC, originally purposed for performance monitoring, examined in an observational, retrospective study design. The sample consisted of African American (AA) and Caucasian patients diagnosed with CRC between 2003 and 2006 or NSCLC between 2006 and 2007 at VA hospitals nationwide. Statistical analysis approaches included multivariate logistic regression and survival analysis methods.

Our first analysis used multivariable logistic regression to examine associations between race and receipt of guideline-concordant care (computed tomography scan, preoperative carcinoembryonic antigen, clear surgical margins, medical oncology referral for Stages II-III; fluorouracil-based adjuvant chemotherapy for Stage III; surveillance colonoscopy for Stages I-III). There were no significant racial differences in receipt of guideline-concordant CRC care. Our second analysis examined associations between race and CRC care timeliness. There were no racial differences in time to chemotherapy initiation (HR 0.82, p=0.61) or surgery to death (HR 0.94, p=0.0.49). Caucasian race was protective for shorter time to first surveillance colonoscopy (HR 0.63, p=0.02). On average, the difference in time to colonoscopy was sixteen days. Our third analysis examined associations between race and NSCLC care timeliness. There were no racial differences in time to initiation of treatment (72 days for AA versus 65 days for Caucasian patients, HR 1.03, p=0.80) or palliative care or hospice referral (129 versus 116 days, HR 1.10, p=0.34). However, the adjusted model found longer survival for African American compared to Caucasian patients (133 versus 117 days, HR 1.31, p=0.00).

In these data there were minimal statistically significant racial differences. We identified no clinically meaningful racial differences in cancer care quality, timeliness, or patient outcomes. This suggests that VA may be a leader in providing equitable cancer care. Future studies could examine causal pathways for the VA's equal, quality care and ways to translate the VA's success into other hospital systems.

This project analyses data from the California Health Interview Survey (CHIS) to compare the healthcare needs of veterans with those who never served in the military. This project will attempt to elucidate if military service creates poorer outcomes and subsequently a greater need for healthcare services for those who enlist. The project will test eleven hypotheses which are indicators of health status for both veteran and non-veteran respondents. For all hypotheses, the independent variable will be if the respondent has ever served in the United States Military. The eleven dependent variables are as follows: respondent self-reported health status, current and former tobacco use, likelihood of alcohol abuse, likelihood the respondent is overweight or obese, prevalence of heart disease, prevalence of diabetes, prevalence of hypertension, state of emotional health, state of work, family, and social relationships, marital status, and income status. All eleven hypotheses state that veterans' are more likely to experience poorer health outcomes than their civilian counterparts.

Analysis of all eleven outcomes had diversified results. Veterans were more likely to self-report poorer states of health, be former tobacco users, abuse alcohol, be overweight or obese, and have diagnoses of heart disease, diabetes or hypertension. This could be due to rigors of military service. It may also be increased access to healthcare services, enabling veterans to receive medical diagnoses. Conversely, veterans were less likely to be current tobacco users, self-report better emotional health, self-report better relationships, more likely to be married, and have higher incomes. This could be because the military in some facets acts as a health protector. It could also be due to the highly stigmatized perceptions of mental illness or dysfunction. This project finds several reasons veterans may need more healthcare services, but also finds further research on this topic is necessary.

The purpose of this study was to collaborate with one of the New England VA Healthcare Systems to conduct research to evaluate the current leadership competencies at the Department of Veterans Affairs (VA) to identified competencies essential for leadership by the VA. The researcher also assessed how VA front-line staff, first-line supervisors, mid-level managers, and senior/executive leadership rate their performance and that of their supervisors. Lastly, the researcher evaluated how these leaders are trained to assume their important roles at the VA and how much of a role are executive coaching and mentoring play in this training process. The research is a quantitative research study, and the competencies and specific behavior indicators were assessed using a web-based survey via a self-administered competency instrument designated to determine employee’s perceptions. The data collected comprised data from four different surveys/questionnaires for each position level within the organization including the demographic data. A total of 143 VA employees participated in the research study and completed surveys to measure the frequency of behaviors on a 10-point scale to answer the research questions. The results answered the key research questions asked in this study to measure leaders and emerging leader competence.

Posttraumatic stress disorder (PTSD) is a serious issue for post-deployment United States Marine Corps (USMC) veterans, especially because PTSD can increase the risk of suicide. Marines are screened post-deployment, yet little is known about Marine veterans’ perceptions of the PTSD screening process. The purpose of this phenomenological study was to explore USMC male veterans’ perceptions of the Post- Deployment Health Reassessment (PDHRA). The social cognitive theory constructs of a triadic relationship among person, environment, and behavior were the framework for understanding this population’s perceptions of the PDHRA and potential stigma. Two research questions focused on how people, culture, and behavior affect Marines perception of the PDHRA and PTSD attached stigma. Interviews were conducted with 10 Marine veterans’ participants and transcribed interview responses were input into NVivo 11 software to retain a reliable database and Colaizzi’s strategy to identify emerging themes. Key findings revealed potential positive social change to military chaplains and veterans’ health service providers. This knowledge might inform about the perceptions of Marines through informed understanding and may help develop an updated evaluation tool. Future researchers might focus on the forthcoming answers and treatment of PTSD and the attached stigma among Marines by alleviating repercussions for Marines’ answers on the PDHRA. An understanding of the study’s findings may elicit strategies for health care administrators to expound on the PDHRA and provide educational programs to assist in future screening environments and processes through Marines perspectives.

The suicide rate among post-9/11 veterans has become a national crisis. At a staggering number of 22 suicides per day, our wounded warriors are in dire need of psychological assistance. Currently, the treatment interventions used in the rehabilitation of veterans suffering from mental health disorders are limited. Furthermore, these therapy options available to veterans are not realizing adequate improvements in the management of their symptoms.

This business proposal advocates the utilization of psychiatric service dogs as an alternative intervention to help veterans manage their PTSD symptoms. Rescues for Warriors (RFW), a nonprofit 501(c)(3) organization, aims to pair task trained service dogs with veterans in need of a rehabilitative canine companion. Using evidence-based selection tools, RFW rescues dogs from local animal shelters and uses comprehensive techniques to train them to patient-specific symptoms. This service will be free of charge for all veteran participants, and therefore, marketing and funding will be very important aspects of this business. While this plan does acknowledge the potential challenges in opening charitable organizations, RFW is rigorously committed to increase the quality of life of our nation’s heroes and rescue dogs alike.

Health care organizations typically have a hierarchical structure, with physicians dominant and nurses subordinate. The challenge to open and honest communication between doctors and nurses is real, and communication errors contribute significantly to undesirable patient outcomes. Nurse executives (NEs) have a responsibility to help lead transformation of health care organizations to support nurses to speak up and communicate all critical information.

NEs are challenged to improve safety and quality, decrease costs and increase access to care. Combining health care expertise with business ability can support these goals. Rooke and Torbert found correlations between successful business leaders and postconventional action-logics, or world-views. Action-logics can be developed to make leaders increasingly effective.

The Magnet Recognition Program recognizes health care organizations that have achieved high quality care and excellence in nursing practice. The purpose of this study was to determine what action-logics the NEs demonstrate who have led their organizations to Magnet designation or re-designation in the Veterans Healthcare Administration. The study also sought to determine what actions NEs took to support nurses speaking up about their concerns, the barriers that impede those efforts, and the sources of influence these NEs implemented to support nurses speaking up. This exploratory study used a mixed methods design and each participant completed the Maturity Assessment Instrument (MAP) and an interview.

The study demonstrated, in contrast with other business leaders, that conventional action-logic was sufficient for the NE to bring an organization to Magnet status. However, the study found specific limitations those possessing conventional action-logic have to support speaking up, and that those possessing postconventional action-logic have transcended these limitations. This strength of the postconventional action-logic is very important to support speaking up in health care. The use of multiple sources of behavioral influence by Magnet NEs was confirmed, as was the existence of a culture of organizational silence. Multiple speaking up behaviors were required to address every single barrier encountered to speaking up, and strong emotion routinely accompanied speaking up. The absence of sources of behavioral influence in an organization was determined to be a barrier to speaking up.