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Knopf-Amelung, Sarah, Margaret Brommelsiek, Jane Anthony Peterson, Zack Roman, and Tracy Lynn Graybill. "Developing a measure for health professionals’ attitudes toward veterans." Journal of Nursing Education and Practice 8, no. 7 (February 27, 2018): 60. http://dx.doi.org/10.5430/jnep.v8n7p60.
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U.S. veterans have complex healthcare needs that require professionals who are properly trained to address these issues. However, little is known about the attitudes that nurses and other professionals have toward veteran patients, particularly those working in community-based settings where it is unlikely training on veterans’ issues has occurred. Understanding health professionals’ attitudes toward caring for veterans is an important step in developing a workforce that is knowledgeable and willing to serve this complex and growing population. The purpose of this study was to develop and validate the Health Professionals’ Attitudes Toward Veterans (HPATV) scale, which explores attitudes regarding military cultural sensitivity and awareness, provision of care to veteran patients, and the prominent veterans’ health issues. The HPATV was developed across several phases, including review of existing measures and literature regarding veterans’ health and attitude structure, hypothesis of a factor structure, identification of a theoretical framework for attitude construction, item generation, 3-round Delphi survey to refine items and test content validity, piloting the measure among health professions students, and exploratory (EFA) and confirmatory factor analysis (CFA). Following CFA, the final 14-item scale revealed 3 latent factors to describe health professionals’ more nuanced attitudes toward working with veteran patients: culture, care, and health. The HPATV is a validated and readily available tool for needs assessment, quality improvement, and evaluation. Use of this tool will help increase understanding of these culture, care, and health domains and generate quality improvement initiatives based on them—ultimately benefiting veteran patients through more sensitive, patient-centered care.
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Erbes, Christopher R., Eric Kuhn, Melissa A. Polusny, Josef I. Ruzek, Michele Spoont, Laura A. Meis, Elizabeth Gifford, et al. "A Pilot Trial of Online Training for Family Well-Being and Veteran Treatment Initiation for PTSD." Military Medicine 185, no. 3-4 (October 17, 2019): 401–8. http://dx.doi.org/10.1093/milmed/usz326.
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Abstract Introduction Family members are important supports for veterans with Posttrauamtic Stress Disroder (PTSD), but they often struggle with their own distress and challenges. The Veterans Affairs—Community Reinforcement and Family Training (VA-CRAFT) website was designed to teach family members of veterans with PTSD effective ways to interact with their veterans to encourage initiation of mental health services as well as to care for themselves and improve their relationships. This article presents a pilot investigation of VA-CRAFT. Materials and Method Spouse/partners of veterans who had screened positive for PTSD but were not in mental health treatment were randomized to either use the VA-CRAFT website (n = 22) or to a waitlist control condition (n = 19) for 3 months. Veteran mental health service initiation was assessed posttreatment. Spouse/partner distress, caregiver burden, quality of life, and relationship quality were assessed pre and posttreatment. The study was approved by the Minneapolis VA Health Care System Institutional Review Board (IRB). Results Differences between groups on veteran treatment initiation were small (Phi = 0.17) and not statistically significant. VA-CRAFT participants reported large and statistically significantly greater decreases in overall caregiver burden (η2 = 0.10) and objective caregiver burden (η2 = 0.14) than control participants. Effects were larger for those with greater initial distress. Effects sizes for other partner outcomes were negligible (η2 = 0.01) to medium (η2 = 0.09) and not statistically significant. Postintervention interviews suggested that only 33% of the VA-CRAFT participants talked with their veterans about starting treatment for PTSD during the trial. Conclusion Results from this pilot trial suggest that VA-CRAFT holds initial promise in reducing caregiver burden and as such it could be a useful resource for family members of veterans with PTSD. However, VA-CRAFT does not enhance veteran treatment initiation. It may benefit from enhancements to increase effectiveness and caregiver engagement.
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Haro, Elizabeth, Michael Mader, Polly H. Noël, Hector Garcia, Dawne Vogt, Nancy Bernardy, Mary Bollinger, Mary Jo V. Pugh, and Erin P. Finley. "The Impact of Trust, Satisfaction, and Perceived Quality on Preference for Setting of Future Care Among Veterans With PTSD." Military Medicine 184, no. 11-12 (April 20, 2019): e708-e714. http://dx.doi.org/10.1093/milmed/usz078.
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Abstract Introduction Among US veterans, posttraumatic stress disorder (PTSD) is a high-prevalence condition; more than a million veterans of all combat eras are service-connected for this condition. Research on factors driving veterans’ decision-making regarding preferred setting for PTSD care has been limited. The purpose of this study was to understand factors associated with preferences for setting of future PTSD care among veterans service-connected for PTSD. Materials and Methods We conducted a cross-sectional mailed survey among veterans with service connection for PTSD in Texas and Vermont identified from the Veterans Services Network Corporate Mini Master File (VETSNET). Survey items were intended to elucidate PTSD healthcare decision-making and queried utilization, perceived need for care, and satisfaction and preferences for VA, community, and/or military setting for receipt of future PTSD care. Logistic regression was used to identify factors associated with preference for care setting. UT Health San Antonio’s Institutional Review Board determined this quality improvement project to be non-research. Results Veterans (n = 2,327) were surveyed with an overall response rate of 37.1%. Most veterans (72.4%) identified VA as a preferred site for their future PTSD care; a substantial, but smaller, number of veterans identified being interested in receiving care in community (39.9%) and military (12.7%) settings. Factors associated with preferences for future care setting included demographics (e.g., ethnicity, income), availability of healthcare coverage, prior experiences of care, and attitudes related to perceived quality of care and trust in VA. Conclusions These findings suggest that it is important to retain foundational mental health services within VA, as well as to continue to invest in building provider and network capacity in community settings, to ensure alignment with veteran preferences for care setting.
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Peterson, Jane, Margaret Brommelsiek, and Sarah Knopf Amelung. "An Interprofessional Education Project to Address Veterans’ Healthcare Needs." International Journal of Higher Education 6, no. 1 (November 3, 2016): 1. http://dx.doi.org/10.5430/ijhe.v6n1p1.
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Background/Objective: The number of veterans and their families seeking healthcare and support within civilian communities is increasing worldwide. There is a need for healthcare providers to provide sensitive, comprehensive care for veterans with both physical and behavioral health conditions. Many civilian providers are unfamiliar with veterans’ issues and need training on military culture and combat experiences in order to provide compassionate, high quality care. An interprofessional (IPE) course to increase health professional students’ understanding of military culture and the associated health problems of veterans was implemented and evaluated. Methods: An 8-week IPE immersion course was offered for students with clinical experience at a Veterans’ Health primary care clinic and a didactic component. The class content included military culture, behavioral and physical health disorders common among veterans, and the related behavioral and pharmacological treatments. Faculty-led discussions with students in IPE teams used veteran-focused case studies and standardized patients to prepare students to work in IPE teams in the clinical care of veterans. Results: This educational project was evaluated using quantitative surveys and qualitative reflection questions and focus groups. Students scored high for readiness for interprofessional learning pre-course. Post-course students reported valuing the team approach to veterans care and students engaged in high levels of communication and collaboration within the team. Students’ knowledge scores increased related to understanding of military culture and their patient advocate role. Conclusions: Students learned about military culture and the provision of humanistic, high quality care for military veterans in this clinical and didactic immersion IPE course.
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Wilson, Sarah M., Alyssa M. Medenblik, Julia M. Neal, Jennifer L. Strauss, J. Murray McNiel, Warren E. Christian, Jean C. Beckham, and Patrick S. Calhoun. "Lifetime Smoking Patterns and Preferences for Smoking Cessation Among Women Veterans Receiving Veterans Health Administration Care." Qualitative Health Research 29, no. 14 (July 16, 2019): 2096–107. http://dx.doi.org/10.1177/1049732319857536.
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The objective of this study was to identify common themes among women veterans who smoke or recently quit and had used smoking cessation treatment within the Veterans Health Administration (VHA). The study built upon previous research by utilizing in-depth interviews to encourage disclosure of potentially stigmatized topics. Twenty women veterans enrolled in VHA care engaged in a quality improvement project focused on improving smoking cessation services. Qualitative analysis of de-identified interviews used a combination of content analysis and thematic analysis within the sociopharmacological model of tobacco addiction. Findings revealed that participants’ smoking was influenced by woman veteran identity and by several gender-related contextual factors, including military sexual trauma and gender discrimination. Findings also highlighted other contextual factors, such as personal autonomy, emotional smoking triggers, and chronic mental health concerns. Findings are interpreted within the context of cultural power imbalances, and recommendations are provided for VHA smoking cessation for women veterans.
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Tuepker, Anaïs, Summer Newell, Christina Nicolaidis, Marie-Elena Reyes, Maria Carolina González-Prats, Eleni Skaperdas, and Devan Kansagara. "Veteran Patient Perspectives and Experiences During Implementation of a Patient-Centered Medical Home Model." Journal of Patient Experience 5, no. 2 (October 6, 2017): 107–13. http://dx.doi.org/10.1177/2374373517731602.
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Background: The Veterans Health Administration (VA) has implemented the largest shift to a patient-centered medical home (PCMH) model of care in the United States to date. Objective: We interviewed veterans about their experiences of primary care to understand whether they observed changes in care during this period as well as to learn which characteristics of care mattered most to their experiences. Method: Qualitative interviews were conducted with 32 veterans receiving primary care at 1 of 8 VA clinics in the northwest United States. Interviews were analyzed using an inductive–deductive hybrid approach by an interdisciplinary team that included a veteran patient. Result: Participants noticed recent positive changes, including improved communications and shorter waits in clinic, but rarely were aware of VA’s PCMH initiative; a strong relationship with the primary care provider and feeling cared for/respected by everyone involved in care delivery were key components of quality care. The needs of the veteran community as a whole also shaped discussion of care expectations. Conclusion: The PCMH model may provide benefits even when invisible to patients. Veteran awareness of population needs suggests a promising role for veteran involvement in further PCMH transformation efforts.
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Nayar, Preethy, Diptee Ojha, Ann Fetrick, and Anh T. Nguyen. "Applying Lean Six Sigma to improve medication management." International Journal of Health Care Quality Assurance 29, no. 1 (February 8, 2016): 16–23. http://dx.doi.org/10.1108/ijhcqa-02-2015-0020.
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Purpose – A significant proportion of veterans use dual care or health care services within and outside the Veterans Health Administration (VHA). In this study conducted at a VHA medical center in the USA, the authors used Lean Six Sigma principles to develop recommendations to eliminate wasteful processes and implement a more efficient and effective process to manage medications for dual care veteran patients. The purpose of this study is to: assess compliance with the VHA’s dual care policy; collect data and describe the current process for co-management of dual care veterans’ medications; and draft recommendations to improve the current process for dual care medications co-management. Design/methodology/approach – Input was obtained from the VHA patient care team members to draw a process map to describe the current process for filling a non-VHA prescription at a VHA facility. Data were collected through surveys and direct observation to measure the current process and to develop recommendations to redesign and improve the process. Findings – A key bottleneck in the process that was identified was the receipt of the non-VHA medical record which resulted in delays in filling prescriptions. The recommendations of this project focus on the four domains of: documentation of dual care; veteran education; process redesign; and outreach to community providers. Research limitations/implications – This case study describes the application of Lean Six Sigma principles in one urban Veterans Affairs Medical Center (VAMC) in the Mid-Western USA to solve a specific organizational quality problem. Therefore, the findings may not be generalizable to other organizations. Practical implications – The Lean Six Sigma general principles applied in this project to develop recommendations to improve medication management for dual care veterans are applicable to any process improvement or redesign project and has valuable lessons for other VAMCs seeking to improve care for their dual care veteran patients. Originality/value – The findings of this project will be of value to VA providers and policy makers and health care managers who plan to apply Lean Six Sigma techniques in their organizations to improve the quality of care for their patients.
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Boucher, Nathan A., Karen E. Steinhauser, and Kimberly S. Johnson. "Older, Seriously Ill Veterans’ Views on the Role of Religion and Spirituality in Health-Care Delivery." American Journal of Hospice and Palliative Medicine® 35, no. 7 (April 1, 2018): 921–28. http://dx.doi.org/10.1177/1049909118767113.
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Objectives: To describe older Veteran’s perspectives on the current delivery of religious or spiritual (R/S) care. Methods: Semi-structured interviews with older veterans with advanced stage cancer, heart failure, or pulmonary disease to elicit views on when, how, and by whom religious and spiritual care is preferred. Results: The sample (n = 17) was largely male (94%), non-Hispanic white (52.9%), Christian (82.3%), and most had at least some college education (64.7%). Participants shared diagnoses of cancer (47%), heart failure (35.2%), or chronic obstructive pulmonary disease (17.6%). As a group, participants had moderate religiosity. Themes relevant to the study goal of improving VA care delivery are as follows: (1) process of R/S engagement, (2) timing of R/S engagement, and (3) awareness of services. Veterans discussed the need for VA providers to accommodate diverse spiritual beliefs, importance of screening for spiritual needs, inclusion of family spiritual support, need for higher visibility of services, use of nonchaplains for R/S support, and times when R/S is important. Discussion: Veterans recognize the diversity of their fellow veterans and note the opportunities and challenges in providing R/S support in the VA care setting. The findings have implications for quality improvement in VA care including efforts focused on enhanced outreach to veterans, bolstered education for staff, and more nuanced approaches to R/S support.
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Ortmeyer and Robey. "Companion Dog Foster Caregiver Program for Older Veterans at the VA Maryland Health Care System: A Feasibility Study." International Journal of Environmental Research and Public Health 16, no. 21 (November 4, 2019): 4285. http://dx.doi.org/10.3390/ijerph16214285.
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Veterans experience mental health conditions at a disproportionate rate compared to their civilian counterparts, and approximately 60% of older veterans who receive their care through the United States Department of Veterans Affairs (VA) do not meet physical activity (PA) recommendations. We tested the Veterans as Foster Ambassadors program at the VA Maryland Health Care System to examine whether fostering a companion dog would improve PA and function, heart rate variability (HRV), balance, and quality of life (QOL) in older veterans. Participants wore an accelerometer for ≥10 days during each phase (30 day baseline vs. 60 day foster period) to measure daily PA (n = 4). Six-minute walk (6MW) and balance testing (n = 4) and 24 h heart rate (HR) and HRV (n = 2) were determined at baseline and during the foster period. Compared to baseline, there were significant increases in (a) distance during the 6MW, (b) daily steps, and (c) time spent in moderate activity during the foster period. 24 h HR decreased and time- and frequency-domain measures of HRV significantly increased in a veteran with post-traumatic stress disorder during the foster period compared to baseline. All veterans offered positive feedback about the program and indicated that it was beneficial to them. The results from this pilot study provide evidence that fostering a companion dog can improve PA, health, and QOL in older veterans. Future research conducted with a larger sample size to validate the results is warranted.
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Seaman, Aaron T., Samantha Solimeo, and Byron Bair. "ENHANCING ACCESS AND QUALITY OF RURAL VETERANS’ CARE THROUGH TELEMEDICINE IMPLEMENTATION." Innovation in Aging 3, Supplement_1 (November 2019): S607. http://dx.doi.org/10.1093/geroni/igz038.2262.
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Abstract Telemedicine, a promising approach for clinicians to provide care to patients who are unable to attend face-to-face encounters, has been embraced by the Veterans Health Administration to improve the delivery of specialty care to rural Veterans and their caregivers. Presenters in this symposium report on the potential and challenges of telemedicine in a variety of specialty care contexts. Stakeholder (Veteran, caregiver, and provider) perspectives are discussed. Hung et al.’s study examines the implementation of a teleconsultation intervention designed to connect geriatric teams with rural clinics, reporting on both patient outcomes and the challenges of implementation variability that teams encountered. Solimeo, et al.’s qualitative study of primary care providers’ experience of an osteoporosis telemedicine clinic’s outreach and care delivery demonstrates stakeholder acceptance as well as potential missed opportunities for patient and provider education. Findings from Nichols and Martindale-Adams’ mixed methods evaluation of a telephone intervention to assist caregivers of older, rural-dwelling Veterans demonstrate the impact the intervention has had on participants’ perceptions of and abilities to care for their family members and themselves. Hicken et al. present on the implementation of a videoconferencing intervention to provide in-home support to rural Veterans and their caregivers, reporting on both provider and patient/caregiver experiences of the intervention and its implementation. The four studies highlight the unique ways telemedicine can improve care and the necessity of including stakeholder perspectives across the implementation process.
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Pyne, Jeffrey M., P. Adam Kelly, Ellen P. Fischer, Christopher J. Miller, Patricia Wright, Kara Zamora, Christopher J. Koenig, Regina Stanley, Karen Seal, and John C. Fortney. "Development of a Perceived Access Inventory for Community Care Mental Healthcare Services for Veterans." Military Medicine 184, no. 7-8 (January 23, 2019): e301-e308. http://dx.doi.org/10.1093/milmed/usy429.
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Abstract Introduction Access to high-quality healthcare, including mental healthcare, is a high priority for the Department of Veterans Affairs (VA). Meaningful monitoring of progress will require patient-centered measures of access. To that end, we developed the Perceived Access Inventory focused on access to VA mental health services (PAI-VA). However, VA is purchasing increasing amounts of mental health services from community mental health providers. In this paper, we describe the development of a PAI for users of VA-funded community mental healthcare that incorporates access barriers unique to community care service use and compares the barriers most frequently reported by veterans using community mental health services to those most frequently reported by veterans using VA mental health services. Materials and Methods We conducted mixed qualitative and quantitative interviews with 25 veterans who had experience using community mental health services through the Veterans Choice Program (VCP). We used opt-out invitation letters to recruit veterans from three geographic regions. Data were collected on sociodemographics, rurality, symptom severity, and service satisfaction. Participants also completed two measures of perceived barriers to mental healthcare: the PAI-VA adapted to focus on access to mental healthcare in the community and Hoge’s 13-item measure. This study was reviewed and approved by the VA Central Institutional Review Board. Results Analysis of qualitative interview data identified four topics that were not addressed in the PAI-VA: veterans being billed directly by a VCP mental health provider, lack of care coordination and communication between VCP and VA mental health providers, veterans needing to travel to a VA facility to have VCP provider prescriptions filled, and delays in VCP re-authorization. To develop a PAI for community-care users, we created items corresponding to each of the four community-care-specific topics and added them to the 43-item PAI-VA. When we compared the 10 most frequently endorsed barriers to mental healthcare in this study sample to the ten most frequently endorsed by a separate sample of current VA mental healthcare users, six items were common to both groups. The four items unique to community-care were: long waits for the first mental health appointment, lack of awareness of available mental health services, short appointments, and providers’ lack of knowledge of military culture. Conclusions Four new barriers specific to veteran access to community mental healthcare were identified. These barriers, which were largely administrative rather than arising from the clinical encounter itself, were included in the PAI for community care. Study strengths include capturing access barriers from the veteran experience across three geographic regions. Weaknesses include the relatively small number of participants and data collection from an early stage of Veteran Choice Program implementation. As VA expands its coverage of community-based mental healthcare, being able to assess the success of the initiative from the perspective of program users becomes increasingly important. The 47-item PAI for community care offers a useful tool to identify barriers experienced by veterans in accessing mental healthcare in the community, overall and in specific settings, as well as to track the impact of interventions to improve access to mental healthcare.
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Hicken, Bret, and Kimber Parry. "Supporting older military veterans in the rural US." Quality in Ageing and Older Adults 19, no. 4 (December 10, 2018): 286–97. http://dx.doi.org/10.1108/qaoa-04-2018-0017.
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Purpose The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas. Design/methodology/approach This is a descriptive paper summarizing population and program data about rural veterans. Findings VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas. Originality/value This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans.
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Kaur, Harsimran, Aayushi Sood, Devkarn Sandhu, and Vishal Bhatia. "Diabetes-Care Quality among Veterans in Southwest Indiana, United States." Journal of Social Health and Diabetes 7, no. 02 (December 2019): 84–88. http://dx.doi.org/10.1055/s-0039-3400215.
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Abstract Objective Diabetes is more prevalent among U.S. veterans than the general population. The study is among the U.S. veterans in Southwest Indiana with diabetes mellitus type 2 to understand their demographics, comorbidities, and complications that could help guide strategies to address the prevalence of diabetes among U.S. veterans in the area. Previous diagnosis and referral to the specialty clinics approaches are needed to lower the prevalence of diabetes among U.S. veterans and preventing diabetes-related complications to improve their health status. Method We constructed a retrospective study of veterans in the Southwest area with medically treated diabetes type 2, who received Veterans Health Administration primary care and were referred to our specialty clinic. We categorized based on demographics, comorbidities, initial HbA1c percentage, and complications, and created multivariable models. Results In our study of 80 U.S. veterans with diabetes, 90% had comorbidities already when they presented to our clinic. Diabetes was more prevalent in patients older than 60 years. Around 60% of patients presented with complications such as neuropathy, coronary arterial disease, and heart problems. We calculated the HbA1c when the patients came, and around 42% had hemoglobin A1c (HbA1c) over 10%. Patients with exposure to Agent Orange during the Vietnam War had HbA1c over 9%. Conclusion U.S. veterans with diabetes type 2 referred to the specialty clinic have high HbA1c and more complications on their first visit. Therefore, veterans need to be referred early to the specialty clinics during the course to improve their health status. Mission’s Act 2019 empowers veterans with increased access to community care.
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Cohen, Marlene Z., Leeza Struwe, Barbara Swore Fletcher, Eileen Kingston, Tammy Bockman, Deborah Shimerdla, Richard Harrington, Sharon Robino-West, and Apar Kishor Ganti. "The Meaning of Care for Veterans." International Journal for Human Caring 22, no. 4 (December 2018): 159–68. http://dx.doi.org/10.20467/1091-5710.22.4.159.
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Experiences of care shape the meaning of experience with health-care providers and are important to understand as they are related to quality of care. This hermeneutic phenomenological study describes the meaning of veterans’ experiences in a Veterans Administration (VA) hospital from analyses of interviews with 20 veterans. Caring is at the heart of what veterans valued. Veterans linked communicating, following up, and using specialized knowledge with caring. Veterans’ military and medical histores are complex and require specialized knowledge, care, and skills. Education and interventions that promote caring as perceived by veterans will improve the quality of care.
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Smith, Claire Elizabeth Powers, Pat Coke, Monica Kluger, Arif Kamal, and Michael J. Kelley. "National trends in end of life care for veterans with advanced cancer." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 3. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.3.
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3 Background: It is imperative to provide quality end of life (EOL) care for cancer patients. This entails minimizing aggressive measures at the EOL. Although rates of hospice utilization within the Veteran’s Health Administration have improved, chemotherapy administration and intensive care unit (ICU) admission at the EOL, indicators of aggressive care, are not clearly declining over recent years. Methods: We identified 32,665 veterans diagnosed with stage IV lung, colorectal, or pancreatic cancer who died between 2009-2016 using VA cancer registry and Corporate Data Warehouse data through a novel EOL Dashboard Tool, which has been validated at multiple VA sites. This EOL tool reports three indicators; incidence of chemotherapy use in the last 14 days of life, ICU admission in the last 30 days of life and hospice admission or consult. Change over time, 2009-2016, was assessed using a repeated measures one-way ANOVA with post hoc test for linear trend of time for individual cancers and two-way ANOVA for all cancers combined. Results: Chemotherapy use in the last 14 days of life declined from 6.8% in 2009 to 4.4% in 2016 (p < 0.05). ICU admission in the last 30 days did not change significantly, from 13.3% in 2009 to 14.7% in 2016. The exception was stage IV lung cancer patients in whom ICU admissions increased from 12.9% to 16.2% (p = 0.01). Patients utilizing hospice services increased from 32.4% to 52.6% (p < 0.01). When combined for all years in an unadjusted analysis by VA regional network (VISN), chemotherapy use ranged geographically from 4.2% to 8.1% and for ICU admission from 8.4% to 18.0%. Conclusions: While chemotherapy administration at the EOL is declining for veterans with stage IV cancer, ICU admissions are unchanged and becoming more common in stage IV lung cancer despite increasing hospice utilization. Compared to prior Medicare reports, veterans have similar rates of EOL chemotherapy use and fewer EOL ICU admissions, adding to a growing body of literature showing that despite veterans having poorer health and utilizing more medical resources, the VA performs at or above non-veteran health care institutions on end of life cancer care. There is notable geographic variation in aggressive EOL care.
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Pope, Charlene A., Boyd H. Davis, Leticia Wine, Lynne S. Nemeth, K. Sue Haddock, Tom Hartney, and R. Neal Axon. "Perceptions of U.S. Veterans Affairs and community healthcare providers regarding cross-system care for heart failure." Chronic Illness 14, no. 4 (September 14, 2017): 283–96. http://dx.doi.org/10.1177/1742395317729887.
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Objectives This study explores perceptions of US Veterans Affairs (VA) and non-VA healthcare providers caring for Veterans with heart failure (HF) regarding Veteran knowledge and motivations for dual use, provider roles in recommending and coordinating dual use, systems barriers and facilitators, and suggestions for improving cross-system care. Methods Twenty VA and 11 non-VA providers participated in semi-structured interviews, which were analyzed using parallel qualitative content and discourse analysis. Results VA and non-VA providers described variable HF knowledge and self-management among Veterans, and both groups described the need for improved education addressing medication adherence, self-care, and management of acute symptoms. Both groups described highly limited roles for providers in shaping choices surrounding dual use. VA and non-VA providers had significantly different perceptions regarding the availability, quality, and effectiveness of VA HF services. Multiple non-VA providers expressed frustration with and difficulty in contacting VA providers, accessing records, and making referrals into the VA system. Suggestions for improved care focused on patient education and care coordination. Discussion Dual healthcare system use for Veterans is increasingly common. Similarities and contrasts in perceptions of VA and non-VA providers are instructive and should be incorporated into future policy and program initiatives.
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Carpenter, Joan, Dawn Smith, Hilary Griffin, Daniel Kinder, Joshua Thorpe, Mary Ersek, and Ann Kutney-Lee. "Quality of End-of-Life Care for Vietnam Veterans: Implications for Practice and Policy." Innovation in Aging 4, Supplement_1 (December 1, 2020): 246. http://dx.doi.org/10.1093/geroni/igaa057.793.
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Abstract In federal response to the aging population of Vietnam-era Veterans, Congress directed the Department of Veterans Affairs (VA) to create a pilot program to identify and develop best practices for improving hospice care for this population. A first step in VA’s response was to identify whether the end-of-life (EOL) care needs and outcomes of Vietnam-era Veterans differed from previous generations. Using medical records and bereaved family surveys, we examined clinical characteristics, healthcare utilization, and EOL quality indicators for Vietnam-era Veterans who died in VA inpatient settings between 2013-17. Contemporaneous comparisons were made with World War II/Korean War-era Veterans. Compared to prior generations, higher percentages of Vietnam-era Veterans had mental health/substance use diagnoses and disability. Similar percentages of family members in both groups reported that overall EOL care was excellent; however, post-traumatic stress disorder management ratings by families of Vietnam-era Veterans were significantly lower. Although current VA EOL practices are largely meeting the needs of Vietnam-era Veterans, greater focus on mental health comorbidity, including post-traumatic stress disorder, Agent Orange-related conditions, and ensuring access to quality EOL care in the community is warranted. Policymakers and healthcare professionals should anticipate more physical and mental health comorbidities among Veterans at EOL as Vietnam-era Veterans continue to age. Findings are being used to inform the development of standardized EOL care protocols and training programs for non-VA healthcare providers that are tailored to the needs of this population.
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McDonagh, James G., William Blake Haren, Mary Valvano, Anouk L. Grubaugh, Frank C. Wainwright, Colette H. Rhue, Christine M. Pelic, Christopher G. Pelic, Renee Koval, and Janet A. York. "Cultural Change: Implementation of a Recovery Program in a Veterans Health Administration Medical Center Inpatient Unit." Journal of the American Psychiatric Nurses Association 25, no. 3 (July 4, 2018): 208–17. http://dx.doi.org/10.1177/1078390318786024.
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INTRODUCTION:The Freedom Commission’s recommendations, Substance Abuse and Mental Health Services Administration’s framework, and policy directives on recovery-oriented services have fueled the recovery transformation. Mental health recovery services have been implemented in a broad range of outpatient settings. However, psychiatric inpatient units remained embedded in the traditional model of care. AIMS: The purpose of this article is to describe an ongoing quality improvement implementation of recovery services in a Veterans Health Administration acute psychiatric inpatient unit. METHOD: An interprofessional Partnership for Wellness delivered 4 to 6 hours per day of evidence-based recovery and holistic population-specific health programs. Veteran, system, and program indicators were measured. RESULTS: Preliminary indicators over a 2-year period suggest that Veterans rated group content and relevance high, pre–post psychiatric rehospitalization rates decreased by 46%, and fidelity to recommended strategies was high. CONCLUSIONS: The project success reflects strong leadership, a partnership of committed staff, effective training, and an organizational culture exemplifying excellence in Veteran services and innovation.
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Rafferty, Laura, Sharon Stevelink, and Neil Greenberg. "O3E.5 Military veterans pathways to mental health support: the need for new solutions." Occupational and Environmental Medicine 76, Suppl 1 (April 2019): A31.2—A31. http://dx.doi.org/10.1136/oem-2019-epi.83.
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Military service can place personnel at a greater risk of developing mental health issues yet both serving personnel and military veterans are reluctant to seek help for mental health issues. Delay in seeking support for mental health distress can result in reduced quality of life as well as a worse treatment prognosis. This research aims to explore the barriers and facilitators to care for the UK veteran population, identifying the relationship between these factors and help seeking behaviour.Sixty- two in-depth qualitative interviews were conducted with male UK military veterans who had left the Armed Forces in the last five years and screened positive for a degree of mental health distress on self-report questionnaires covering common mental disorders (anxiety or depression), post-traumatic stress disorder or alcohol misuse. Thematic analysis was utilised to identify core themes which were developed into an illustrative journey to mental health support, outlining the key stages through which a veteran may travel on their journey to engaging in effective mental health treatment.Veterans’ decision to seek care was mainly concentrated on the perceived need for treatment. Those not in mental health treatment failed to identify problems they were having as being indicative of a ‘mental health disorder’ as they had not yet reached a crisis point where they could no longer cope. Those veterans who were in mental health treatment typically had reached a point where the severity of their condition meant that their need for treatment was highlighted regardless of their intention, either due to a crisis event or to another’s intervention.Interventions are needed to target early identification and management of mental health distress and encourage veterans to seek support before reaching a crisis event. The implications for this research to other high stress, masculine occupations will be explored within the talk.
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Melendez, Jesus, Rita Bodine, and Karen Park. "Reducing Medication Administration Frequency in Veteran Community Living Centers." Journal of Pharmacy Practice 33, no. 3 (November 28, 2018): 334–37. http://dx.doi.org/10.1177/0897190018815038.
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Background: A quality improvement initiative of the Veterans Health Administration (VHA) aims to reduce frequency of medication administration to Veterans per day. Medication administration practices in our community living center (CLC) units are similar to an acute care medical unit versus a home environment. The objective of this project was to reduce medication administration frequency in order to minimize the number of interruptions to both Veterans and nurses. Methods: A retrospective chart review was conducted for Veterans residing in a pilot CLC from January through March 2018. Electronic medical records and barcode medication administration (BCMA) logs were assessed. Data collected included demographic information and medication details (eg, drug name, frequency, administration time). Data were analyzed and pharmacist recommendations were documented into an Excel document, and then discussed with the pilot CLC unit medical provider in March 2018. The primary outcomes measured were the number and type of pharmacist recommendations, percent reduction in the average number of Veteran interruptions per day, and percent reduction in the average number of medication passes by nurse per day. Results: Thirty-one Veterans were identified with a range of 4 to 31 active prescription orders. Fifty-five pharmacist recommendations were made and 31 were implemented. The average number of Veteran interruptions per day was reduced by 13.9%. The average daily number of medication passes was reduced by 16.3%. Conclusion: Both Veteran interruptions and nurse workload decreased due to the implemented pharmacist recommendations. Pharmacists will continue medication consolidation on a monthly basis and spread this project to other CLC units.
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Wakefield, Bonnie J., and Mary Vaughan-Sarrazin. "Strain and Satisfaction in Caregivers of Veterans With Type 2 Diabetes." Diabetes Educator 44, no. 5 (July 30, 2018): 435–43. http://dx.doi.org/10.1177/0145721718790940.
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Purpose The purpose of this study was to identify predictors of informal caregiver strain and satisfaction associated with caring for veterans with type 2 diabetes (T2DM). Methods This study is a secondary analysis of data from 2 prior studies of caregiving in the Veterans Health Administration. The original studies used a telephone survey to examine veteran and caregiver (CG) characteristics associated with caregivers’ responses to caregiving. The data reported here include 202 veterans with T2DM and 202 caregivers. Linear regression models were generated alternatively using forward and backward selection of veteran and caregiver characteristics. Results Higher caregiver strain was associated with the CG providing activities of daily living assistance, CG receiving less help from friends and relatives and use of unpaid help, CG use of coping strategies, and CG depression scores. Predictors of CG satisfaction included better relationship quality with the veteran and receipt of social support. Conclusions The important role of family and friends in supporting patients with T2DM is widely accepted. Clinicians may engage the caregiver when there is inadequate self-care by the patient. However, less attention has been focused on the effect of caregiving on the caregiver. Greater attention needs to be focused on in-depth exploration of family needs to design and test effective interventions to meet these needs.
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Callegari, Lisa, Stephanie Edmonds, Sonya Borrero, Ginny Ryan, Caitlin Cusack, and Laurie Zephyrin. "Preconception Care in the Veterans Health Administration." Seminars in Reproductive Medicine 36, no. 06 (November 2018): 327–39. http://dx.doi.org/10.1055/s-0039-1678753.
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AbstractPreconception care (PCC), defined as a set of interventions to help women optimize their health and well-being prior to pregnancy, can improve pregnancy outcomes and is recommended by national organizations including the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists. Women Veterans who use the Department of Veterans Affairs (VA) health care system may face elevated risks of adverse pregnancy and birth outcomes due to a high prevalence of chronic medical and mental health conditions as well as psychosocial stressors including sexual trauma history and intimate partner violence. Many women Veterans of childbearing age experience poverty and homelessness, which are key social determinants of poor reproductive health outcomes. Furthermore, racial/ethnic disparities in maternal and neonatal outcomes are well documented, and nearly half of women Veterans of reproductive age are minority race/ethnicity. High-quality, equitable, patient-centered PCC services to address modifiable risks in this population are therefore a priority for VA. In this article, we provide a brief background of PCC, discuss the health risks of Veterans associated with adverse pregnancy outcomes, and highlight VA initiatives related to PCC. Lastly, we discuss implications and future directions for PCC research and policy within VA and across other health systems.
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Gibson-Gill, Carol McMara, Joyce Williams, and Denise Fyffe. "Triangle of Healthy Caregiving for Veterans With Spinal Cord Injury: Proposal for a Mixed Methods Study." JMIR Research Protocols 9, no. 5 (May 12, 2020): e14051. http://dx.doi.org/10.2196/14051.
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Background Spinal cord injury (SCI) is a debilitating injury that results in chronic paralysis, impaired functioning, and drastically altered quality of life (QOL). The Department of Veterans Affairs (VA) estimates that approximately 450 newly injured veterans and active-duty members receive rehabilitation at VA’s Spinal Cord Injury/Disorders Centers annually. VA virtual health services use technology and health informatics to provide veterans with better access and more effective care management. The “Triangle of Healthy Caregiving for SCI Veterans” is a patient-centered intervention that incorporates SCI veterans’ caregivers into the VA SCI health care team and extends into the homes of veterans with SCI by using real-time clinical video teleconferencing (CVT). CVT facilitates video-clinic visits, which can include different types of clinical evaluations, therapy (physical/occupational), or psychosocial services. The “Triangle of Healthy Caregiving for SCI Veterans” builds on interactive, interdisciplinary health care relationships that exist between the veterans with SCI, their caregivers, and the VA SCI health care team. SCI veterans’ propensity to multiple secondary complications makes a healthy partnership crucial for the success of keeping better health and functional outcomes as well as quality of life while living in their homes. Objective The goal of the proposed mixed methods project will assess SCI veterans’, their caregivers’, and the VA health care team’s perspectives and experiences in the “Triangle of Healthy Caregiving for SCI Veterans” to determine the benefits, challenges, and outcomes for everyone involved in the intervention. Methods Data collection methods will be implemented over three sequential phases. First, in-depth interviews will be conducted with the telehealth coordinators to systematically document the administrative procedures involved in enrollment of veterans with SCI into the CVT system. Next, structured observation of the CVT enrollment process and logistics of home installation of the CVT system will be conducted to validate the content of the in-depth interviews and highlight any discrepancies observed. Semistructured interviews will be conducted to assess specific elements of the “Triangle of Healthy Caregiving for SCI Veterans” program, their perceived utility, and effectiveness of the CVT system as well as the general impressions of the impact of the intervention on the SCI veterans’ health and function outcomes, caregiver burden, and daily caregiver burden. Finally, the research team will conduct a focus group to evaluate the ways in which the “Triangle of Healthy Caregiving for SCI Veterans” is useful for health care delivery to veterans with SCI and support services to SCI caregivers. Results This proposal was funded in July 2017. It was reviewed and received institutional review board approval in March 2018, and the project was started immediately after, in the same month. As of September 2019, we have completed Phases I and III and have recruited 52 subjects for Phase II. We are beginning the data analysis. The study is projected to be completed in late summer of 2020, and the expected results are to be published in the fall of 2020. Conclusions The findings from this study will highlight the ways in which virtual health care technologies can be used to improve access to SCI specialized care for veterans and provide an estimation of the potential impact on clinical outcomes for veterans with SCI and their caregivers. International Registered Report Identifier (IRRID) DERR1-10.2196/14051
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Depalma, Ralph G. "Surgical Quality Programs in the Veterans Health Administration." American Surgeon 72, no. 11 (November 2006): 999–1004. http://dx.doi.org/10.1177/000313480607201104.
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This review describes the development, implementation, and current status of programs that promote and maintain surgical quality performance within the Department of Veterans Affairs, Veterans Health Administration (VHA). It also considers evolving initiatives to improve surgical outcomes and enhance patient safety. The VHA is a nationwide health care system operated and funded by the federal government. It consists of 154 federal hospitals and 875 clinics staffed by 16,000 nurses, 33,000 other health care professionals, 15,000 doctors, and 25,000 university-affiliated faculty physicians. The VHA trains 90,000 health care professionals, and additionally its activities are supported by 140,000 dedicated volunteers. More than 1000 surgeons in all specialties serve in its facilities. Since these programs began more than 19 years ago, there has been a steady decrease in both risk-adjusted and actual mortality rates tracked annually.
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Simons, Kelsey, Katherine Luci, Lauren Hagemann, M. Lindsey Jacobs, Emily Bower, Morgan Eichorst, and Michelle Hilgeman. "ADDRESSING AN UNMET NEED FOR MENTAL HEALTH SUPPORT DURING CARE TRANSITIONS FROM NURSING FACILITIES." Innovation in Aging 3, Supplement_1 (November 2019): S360. http://dx.doi.org/10.1093/geroni/igz038.1311.
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Abstract Mental health (MH) disorders are common among skilled nursing facility (SNF) residents and may inhibit rehabilitation goals. Moreover, discharges to the community from SNFs are periods of heightened suicide risk within the Veterans Health Administration (VHA), suggesting an urgent need for improved continuity of MH care. This paper presents results of medical records reviews indicating a potential gap in MH services at discharge from VHA SNFs. A quality improvement project (”Suicide Awareness for Veterans Exiting Community Living Centers” – SAVE-CLC), designed to address this gap, will also be discussed. Piloted in 3 sites (N = 66) in 2018, SAVE-CLC clinicians administered depression screens by phone to 47 Veterans (71%) after SNF discharge and helped connect Veterans to MH services. 24 Veterans (26%) received a second such call. Patients and caregivers expressed high satisfaction with SAVE-CLC (n = 35, 97%). Implications for quality improvements in SNF care transitions will be discussed.
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Atkinson, David M., Bridget M. Doane, Paul D. Thuras, Mitch R. Leskela, and Paulo R. Shiroma. "Mental Health Diagnoses in Veterans Referred for Outpatient Geriatric Psychiatric Care at a Veterans Affairs Medical Center." Military Medicine 185, no. 3-4 (October 17, 2019): e347-e351. http://dx.doi.org/10.1093/milmed/usz288.
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Abstract Introduction Nearly half of the U.S. veterans are over 65 years of age. Older veterans are at higher risk for mental health (MH) conditions, which are associated with increased mortality and health care costs. Given the deficit of specialty-trained geriatric providers, we are conducting a Quality Improvement initiative to improve MH services for older veterans at Minneapolis Veterans Affairs Health Care System. Our first step is to understand the demographic and diagnostic characteristics of veterans referred for geriatric MH specialty treatment. Materials and Method We conducted a retrospective chart review of demographics and psychiatric diagnoses in veterans seen for outpatient geriatric MH intake between May 1, 2011 and April 30, 2016. We used chi-square and Spearman’s rho tests to examine age, diagnoses, and service-time era variables. Results 1,059 veterans were evaluated, average age of 73.5 years. Depressive (47%), neurocognitive (42%), and anxiety disorders (22%) were the most common MH conditions. Vietnam veterans showed higher prevalence of depressive (56%), post-traumatic stress (11%), and alcohol use (10%) disorders. World War II veterans showed higher prevalence of neurocognitive disorders (71%). Neurocognitive disorder prevalence was significantly correlated with age. Conclusions Prevalence and comorbidity of major MH conditions is high in veterans referred for geriatric MH services. Future work will examine challenges faced by non-specialty providers in caring for older veterans, with the goal of developing targeted educational and clinical interventions to better address aging veterans’ MH needs.
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Atkins, David, Amy M. Kilbourne, and David Shulkin. "Moving From Discovery to System-Wide Change: The Role of Research in a Learning Health Care System: Experience from Three Decades of Health Systems Research in the Veterans Health Administration." Annual Review of Public Health 38, no. 1 (March 20, 2017): 467–87. http://dx.doi.org/10.1146/annurev-publhealth-031816-044255.
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The Veterans Health Administration is unique, functioning as an integrated health care system that provides care to more than six million veterans annually and as a home to an established scientific enterprise that conducts more than $1 billion of research each year. The presence of research, spanning the continuum from basic health services to translational research, has helped the Department of Veterans Affairs (VA) realize the potential of a learning health care system and has contributed to significant improvements in clinical quality over the past two decades. It has also illustrated distinct pathways by which research influences clinical care and policy and has provided lessons on challenges in translating research into practice on a national scale. These lessons are increasingly relevant to other health care systems, as the issues confronting the VA—the need to provide timely access, coordination of care, and consistent high quality across a diverse system—mirror those of the larger US health care system.
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Wootton, Richard, Helen Gramotnev, and David Hailey. "Telephone-supported care coordination in an Australian veterans population: a randomized controlled trial." Journal of Telemedicine and Telecare 16, no. 2 (December 11, 2009): 57–62. http://dx.doi.org/10.1258/jtt.2009.090408.
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An evaluation was undertaken on the effectiveness and efficiency of care coordination in delivering health services to Australian veterans with chronic or complex medical conditions requiring multidisciplinary care and who had moderate to high care needs. The veterans participated in a randomized controlled trial (RCT) supported by the Department of Veterans' Affairs. For evaluation of the RCT, information on cost of care and quality of life (QOL) was collected before the commencement of coordinated care and at follow-up after 12 months. Of 525 veterans who were recruited, 481 were surveyed at baseline (243 in the intervention group and 238 controls). At follow-up, 421 were surveyed (213 intervention and 208 controls). There were no significant differences between the coordinated care and control groups of veterans in costs of care or in QOL measurements using the SF-12 Health Survey and the EuroQol Group EQ-5D. These findings are consistent with those reported in earlier studies which suggest that benefits from care coordination programmes may take some time to emerge.
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Thomas, Kate Hendricks, Sarah Plummer Taylor, Karl Hamner, John Glazer, and Emily Kaufman. "Multi-site Programming Offered to Promote Resilience in Military Veterans." Californian Journal of Health Promotion 13, no. 2 (September 1, 2015): 15–24. http://dx.doi.org/10.32398/cjhp.v13i2.1820.
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Background and Purpose: Military and veteran suicide rates exceed those found in the general population. Veterans often reject patient identities, creating barriers to care for mental health within the clinical sector and a mandate for prevention programs. The purpose of this study was to offer a postintervention process evaluation of one peer-led resilience program offered to military veterans of Iraq and Afghanistan at three sites in 2013. Methods: Secondary analysis of survey data collected involved mixed-methods analysis of open and closed-ended questions. In total, the research team reviewed 52 electronic survey responses; participant response rate was 48.1%. Results: Descriptive data analysis found that all participants rated Just Roll With It Bootcamp content as “somewhat useful” (17.9%) or “very useful” (82.1%). Qualitative analysis of open-ended questions found that content was perceived as valuable by participants. Emergent themes included: health practices, social support, and participant quality of life or satisfaction. Comments also informed four subthemes which included: meditation/mindfulness, nutrition, physical practice, and the seminars’ physical environment. Conclusion: Culturally-informed prevention programs that emphasize social support, physical movement, and peer-leadership have a vital role to play in working to prevent suicide by promoting quality of life for veterans.
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Herbert, Christina, Holly Winkler, and Troy A. Moore. "Outcomes of mental health pharmacist-managed electronic consults at a Veterans Affairs health care system." Mental Health Clinician 7, no. 3 (May 1, 2017): 131–36. http://dx.doi.org/10.9740/mhc.2017.05.131.
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Abstract Introduction: The demand for mental health services has increased as more veterans have been diagnosed with—and sought care for—one or more mental health conditions. Within the South Texas Veterans Health Care System (STVHCS), providers may submit electronic consults (e-consults) to mental health clinical pharmacy specialists for medication review and recommendations. These consults aim to manage veterans with uncomplicated mental health conditions in primary care, making specialty mental health providers more available for those who need such services. Pharmacists have improved outcomes and access to care for conditions such as diabetes and hypertension, but currently, there is limited evidence demonstrating the impact of pharmacists in mental health. Methods: This quality improvement project assessed the effectiveness of the e-consult service. Information was collected through a retrospective chart review of STVHCS veterans with the corresponding consult note placed in their chart from May 2014 through December 2015. Numbers of recommendations implemented and veterans maintained in primary care were analyzed as markers of effectiveness. Time and cost savings were secondarily explored. Results: A total of 361 consults were submitted for 353 unique patients. Of the 322 patients included in analyses, a total of 301 unique patients (93.5%) were maintained in primary care for at least 3 months. Of the 21 not maintained in primary care, 15 recommendations were implemented; of those maintained in primary care, 271 recommendations were implemented. Discussion: This service improves mental health care—and patient access—by promoting successful management and maintenance of less complicated patients in primary care.
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Cordasco, Kristina M., Jessica L. Moreau, and Neetu Chawla. "Coordinating Care for Reproductive Health Malignancies in the Veterans' Health Administration: Promising Practices, Ongoing Challenges, and Future Research." Seminars in Reproductive Medicine 37, no. 01 (January 2019): 032–42. http://dx.doi.org/10.1055/s-0039-1692398.
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AbstractIn cancer care, communication and coordination across the cancer continuum is paramount for delivering effective, high-quality, patient-centered care. However, achieving optimally coordinated cancer care is inherently challenging, especially in the case of Veterans Administration (VA) care for women's reproductive health cancers. Given the relatively small number of women Veterans requiring care for reproductive malignancies, VA often must rely on community providers to deliver this care, necessitating coordination across two or more health care systems. Recently, VA has invested heavily in improving care for women Veterans through several initiatives and efforts. This article reviews VA's successes, challenges, and future opportunities in research and innovation in the context of care coordination across the cancer continuum (i.e., prevention and screening, diagnosis and treatment, survivorship care, palliative and supportive care) for women Veterans with reproductive health malignancies. We describe how coordination of VA care for reproductive health malignancies currently reflects a mix of successes that demonstrate use of strong evidenced-based practices and challenges, with solutions yet to be fully developed and implemented. We conclude that there are a multitude of opportunities for future research, interventions, and potential avenues for implementing innovative approaches to coordinate VA reproductive cancer care across the cancer continuum.
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Kirk, Cain Eric, Autumn N. Gordon, Kelly D. Mooney, Garrett B. Aikens, Michael H. Robinson, and Molly E. Howard. "Impact of a Shared Medical Appointment on Hypertension Clinical Outcomes and Medication Adherence in a Veterans Affairs Health Care System." Journal of Pharmacy Technology 33, no. 5 (June 19, 2017): 177–82. http://dx.doi.org/10.1177/8755122517714578.
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Background:Shared medical appointments (SMAs) are utilized across health care systems to improve access and quality of care, with limited evidence to support the use of SMAs to improve clinical outcomes and medication adherence among hypertensive patients. Objective: Improve access and quality of care provided within a Veterans Affairs health care system via implementation of a hypertension SMA to improve clinical outcomes and medication adherence. Methods: Veterans were eligible for enrollment in the SMA if they received care within the health care system, were aged ≥18 years, were receiving at least 2 antihypertensive medications, and had systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg. A pre/post cohort design was used to evaluate the improvement in antihypertensive medication adherence as well as the change in SBP and DBP for all Veterans who attended at least 2 SMAs. Results: Twenty-one Veterans participated in at least 2 SMAs and were included in the analysis; 76.2% had a reduction in SBP with an overall average decrease of −8.3 mm Hg ( P = .02). The proportion of Veterans considered to have controlled blood pressure (BP; <140/90 mm Hg) increased from 14.3% at baseline to 42.9% during the SMA period ( P = .03). There was no significant difference found for the proportion of Veterans considered adherent to their prescribed antihypertensive medications (95.2% vs 85.7%, respectively; P = .50). Conclusions: SBP significantly improved for patients enrolled in a pharmacist-led SMA at a VA health care system, and the proportion of patients considered to have controlled BP increased significantly.
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Hale, Anne, Leah Haverhals, Chelsea Manheim, and Cari Levy. "Vet Connect: A Quality Improvement Program to Provide Telehealth Subspecialty Care for Veterans Residing in VA-Contracted Community Nursing Homes." Geriatrics 3, no. 3 (September 5, 2018): 57. http://dx.doi.org/10.3390/geriatrics3030057.
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Veterans residing in Veterans Health Administration (VA) contracted Community Nursing Homes (CNHs) receive primary care from the CNH they reside in, but often travel to Veterans Affairs Medical Centers (VAMCs) for specialty care services. The Vet Connect project is a quality improvement project aiming to implement video technology to support access to specialty care. Methods: Eight Denver VAMC specialty care providers and three project nurses underwent telehealth training and obtained appropriate equipment. To identify in-person visits eligible for substitution of video visits, project nurses review charts of CNH Veterans, consult directly with Veterans, and obtain recommendations from staff. Project nurses serve as tele-presenters within the CNHs, while VA specialists provide care from the VAMC. After each visit, team nurses coordinate care with and deliver specialty care recommendations to CNH staff. Results: We assessed clinical, business, and technical domains of the Vet Connect project, and utilized process mapping to identify barriers and facilitators to implementation. Clinically, starting on 26 June 2017 through 1 June 2018, N = 203 video visits have been conducted with 11 different CNHs in three subspecialties: geriatrics, palliative care, and mental health. These visits generated 49 referrals for 37 Veterans. Fiscally, cost analyses indicate that per visit, the health care system saves an estimated $310. Technologically, the success rate was 83%. Process mapping helped identify facilitators and barriers to implementation of the telehealth program, including cultivating buy-in from key stakeholders (i.e., medical and mental health providers, telehealth staff, and CNH staff), communication allowing for ongoing program adaptation, and building relationships. Conclusion: Subspecialty care delivery to nursing homes using video visit technology in the Vet Connect program is feasible using centralized organization to coordinate complex clinical, business and technical processes. Vet Connect has proved sustainable and has potential to expand within and outside of the VA.
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Jukić, Melita, Ana Marija Lukinac, Ivan Požgain, Jasminka Talapko, Marko Jukić, and Pavo Filaković. "The Role of Perceived Social Support in Assessing Posttraumatic Stress Disorder and Mental Health-Related Quality of Life in Veterans." Healthcare 8, no. 4 (October 12, 2020): 396. http://dx.doi.org/10.3390/healthcare8040396.
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This study aims to establish the effect of self-perceived social support on the intensity of Post-Traumatic Stress Disorder (PTSD) symptoms and Mental Health-Related Quality of Life (MHRQoL) in veterans more than two decades after exposure to trauma in the Homeland War in Croatia, which took place from 1990 to 1995. The sample comprised 259 Croatian Homeland War veterans diagnosed with PTSD, with at least 6 months of combat experience. Among them, 90 subjects had also experienced imprisonment in enemy prison camps (at least 1 month of captivity). The subjects were evaluated using the questionnaire on self-perceived social support, sociodemographic questionnaire, PTSD self-report checklist (PCL-5) and Short Form (SF-36) Health Survey questionnaire. A general regression model analysis was performed to determine whether social support affected patients’ MHRQoL and intensity of the PTSD symptoms. The obtained results showed that veterans who had a more positive perception of social support after the events of the war had less intense PTSD symptoms and better MHRQoL. Furthermore, captivity and socioeconomic status were shown to be important predictors of PTSD and MHRQoL. The nonimprisoned veteran group was more likely to develop more severe PTSD symptoms and have poorer MHRQoL compared to the group of former prisoners of war (ex-POWs). This could be due to better post-war care and social support, which ex-POWs received after their release from captivity.
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Painter, Kathleen, and Kathleen G. Charters. "Veterans Affairs Quality of Care and a Personal Health Record." CIN: Computers, Informatics, Nursing 26, no. 5 (September 2008): 305. http://dx.doi.org/10.1097/01.ncn.0000304834.85380.73.
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LaMonica, Haley M., Tracey A. Davenport, Jane Burns, Shane Cross, Stephanie Hodson, Jennifer Veitch, and Ian B. Hickie. "Technology-Enabled Mental Health Service Reform for Open Arms – Veterans and Families Counselling: Participatory Design Study." JMIR Formative Research 3, no. 3 (September 19, 2019): e13662. http://dx.doi.org/10.2196/13662.
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Background The impact of mental ill-health on every aspect of the lives of a large number of Australian Defence Force (ADF) personnel, their partners, and their families is widely recognized. Recent Senate inquiries have highlighted gaps in service delivery as well as the need for service reform to ensure appropriate care options for individuals who are currently engaged with mental health and support services as well as for those who, for a variety of reasons, have not sought help. To that end, successive Australian governments generally and the Department of Veterans’ Affairs specifically have prioritized veteran-centric reform. Open Arms is an Australia-wide service that provides counseling and support to current and former ADF personnel, and their family members, for mental health conditions. Objective The aim of this study was to develop and configure a prototypic Web-based platform for Open Arms – Veterans & Families Counselling (formerly Veterans and Veterans Families Counselling Service) with the Open Arms community to enhance the quality of mental health services provided by Open Arms. Methods The study aimed to recruit up to 100 people from the Open Arms community (current and former ADF personnel and their families, health professionals, service managers, and administrators) in regions of New South Wales, including Sydney, Canberra, Maitland, Singleton, and Port Stephens. Participants were invited to participate in 4-hour participatory design workshops. A variety of methods were used within the workshops, including prompted discussion, review of working prototypes, creation of descriptive artifacts, and group-based development of user journeys. Results Seven participatory design workshops were held, including a total of 49 participants. Participants highlighted that the prototype has the potential to (1) provide the opportunity for greater and better-informed personal choice in relation to options for care based on the level of need and personal preferences; (2) ensure transparency in care by providing the individual with access to all of their personal health information; and (3) improve collaborative care and care continuity by allowing information to be shared securely with current and future providers. Conclusions Our findings highlight the value of actively engaging stakeholders in participatory design processes for the development and configuration of new technologies.
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Etingen, Bella, Jamie Patrianakos, Marissa Wirth, Timothy P. Hogan, Bridget M. Smith, Elizabeth Tarlov, Kevin T. Stroupe, Rebecca Kartje, and Frances M. Weaver. "TeleWound Practice Within the Veterans Health Administration: Protocol for a Mixed Methods Program Evaluation." JMIR Research Protocols 9, no. 7 (July 20, 2020): e20139. http://dx.doi.org/10.2196/20139.
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Background Chronic wounds, such as pressure injuries and diabetic foot ulcers, are a significant predictor of mortality. Veterans who reside in rural areas often have difficulty accessing care for their wounds. TeleWound Practice (TWP), a coordinated effort to incorporate telehealth into the provision of specialty care for patients with skin wounds, has the potential to increase access to wound care by allowing veterans to receive this care at nearby outpatient clinics or in their homes. The Veterans Health Administration (VA) is championing the rollout of the TWP, starting with regional implementation. Objective This paper aims to describe the protocol for a mixed-methods program evaluation to assess the implementation and outcomes of TWP in VA. Methods We are conducting a mixed-methods evaluation of 4 VA medical centers and their community-based outpatient clinics that are participating in the initial implementation of the TWP. Data will be collected from veterans, VA health care team members, and other key stakeholders (eg, clinical leadership). We will use qualitative methods (ie, semistructured interviews), site visits, and quantitative methods (ie, surveys, national VA administrative databases) to assess the process and reach of TWP implementation and its impact on veterans’ clinical outcomes and travel burdens and costs. Results This program evaluation was funded in October 2019 as a Partnered Evaluation Initiative by the US Department of Veterans Affairs, Diffusion of Excellence Office, and Office of Research and Development, Health Services Research and Development Service, Quality Enhancement Research Initiative Program (PEC 19-310). Conclusions Evaluation of the TWP will identify barriers and solutions to TeleWound implementation in a small number of sites that can be used to inform successful rollout of the TWP nationally. Our evaluation work will inform future efforts to scale up the TWP across VA and optimize reach of the program to veterans across the nation. International Registered Report Identifier (IRRID) DERR1-10.2196/20139
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Uphold, Constance R., Meggan Jordan, and Magaly Freytes. "Family Caregivers of Veterans: A Critical Review of the Empirical Literature and Recommendations for Future Research." Annual Review of Nursing Research 32, no. 1 (October 2014): 155–202. http://dx.doi.org/10.1891/0739-6686.32.155.
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In recent years, research on caregiving has grown in both quality and quantity. Caregivers play an important role in supporting and promoting the health and recovery of injured, disabled, and ill family members in their care. Although researchers have made a substantial contribution to our understanding of family caregiving, less is known about family caregivers of U.S. Veterans. The purpose of this review is to identify and evaluate the research surrounding caregivers of U.S. Veterans, particularly two populations of Veterans: those who returned from the wars in Iraq and Afghanistan and those who had suffered a stroke. A search of the available literature from 1987 to present day resulted in a review of 18 publications on Operation Enduring Freedom/Operation Iraqi Freedom caregivers and 19 publications on caregivers of Veterans with stroke. We summarize empirical findings, critique the study methods, and provide our recommendations to improve the quality of care of Veterans and their caregivers.
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Pebole, Michelle M., Elizabeth E. VanVoorhees, Nivedita Chaudhry, Karen M. Goldstein, Jillian Thompson, Ryan Parker, Kelly M. Caron, and Katherine S. Hall. "Patient-centered behavioral services for women veterans with mental health conditions." Translational Behavioral Medicine 11, no. 9 (June 3, 2021): 1676–81. http://dx.doi.org/10.1093/tbm/ibab057.
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Abstract The Veterans Health Administration (VHA) is undergoing a transformational shift from disease-focused care to a Whole Health model that emphasizes physical, mental, emotional, and spiritual health and well-being. As this shift is occurring, women veterans using VHA services face challenges navigating a system that has historically served a primarily male demographic, without consistent consensus on which services require specialization by gender. A quality improvement project was conducted to solicit feedback on VHA behavioral and wellness programs from women veterans enrolled in VHA mental healthcare services. A multi-disciplinary work group of clinical researchers and healthcare providers developed a needs assessment survey to assess patient needs and preferences for behavioral health services. A convenience sample of female veterans using VHA mental healthcare services within a comprehensive Women’s Health Clinic were invited to complete this anonymous survey. 107 women Veterans 18–65+ years old (65.3% African American; 5.9% LatinX; 54.2% aged under 55) completed the survey. Over 50% of patients endorsed relationships, physical activity, sleep/nightmares, pain management, anger, or spiritual/moral pain as top wellness priorities. Programatic preferences included location (located at the main VA Hospital) and gender composition (female only group formats). Schedule conflicts were the most frequently cited barriers. Results from this quality improvement project highlight considerations for tailoring the content and delivery of behavioral services for women veterans with mental health conditions.
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Dalton, Jane, Sian Thomas, Hollie Melton, Melissa Harden, and Alison Eastwood. "The provision of services in the UK for UK armed forces veterans with PTSD: a rapid evidence synthesis." Health Services and Delivery Research 6, no. 11 (February 2018): 1–112. http://dx.doi.org/10.3310/hsdr06110.
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Background Our research arises from anticipated increases in demand for psychological trauma services in the UK, with particular reference to armed forces veterans with post-traumatic stress disorder (PTSD). Commissioning and service provider activity to improve veterans’ health is evolving. Objectives To explore what UK services exist and establish potentially effective models of care and effective treatments for armed forces veterans with PTSD. Design A four-stage rapid evidence synthesis comprising information gathering on UK service provision; an evidence review on models of care; a metareview on treatment effectiveness; and a synthesis highlighting research priorities. Setting For the evidence reviews, any setting that was relevant to the UK health and social care system. Participants UK armed forces veterans with PTSD following repeated exposure to traumatic events. Interventions Any model of care or treatment. Main outcome measures Any relevant outcome. Data sources Information about current UK practice. Searches of databases [including MEDLINE, PsycINFO and PILOTS (Published International Literature on Traumatic Stress)], guidelines and relevant websites, up to November 2016. Review methods We screened titles and abstracts using EPPI-Reviewer 4 (EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, UK) and EndNote X7 [Clarivate Analytics (formerly Thomson Reuters), Philadelphia, PA, USA]. Decisions to include papers were made by two reviewers independently. We conducted a narrative synthesis of research literature on models of care and on treatments, guided by information from UK practice. In our evidence reviews, we assessed (when appropriate) the quality of included studies using established criteria. To help interpret our findings, we consulted recently published public and patient involvement data, a veteran service user and experts with academic, military and commissioning backgrounds. Results We gathered information about current UK practice. Sixty-one studies were included in the rapid evidence review on models of care and seven systematic reviews in the rapid metareview of treatments. The quality of evidence in both evidence reviews was limited. Promising models of care from more robust studies (three randomised controlled trials and one qualitative study) were collaborative arrangements and community outreach for improving intervention access and uptake; integrated mental health services and behavioural intervention on increased smoking abstinence; and peer support as an acceptable complement to PTSD treatment. A poor fit was noted between the research literature and UK service provision. Promising treatments were psychosocial interventions (eye movement desensitisation and reprocessing, cognitive processing therapy, trauma-focused and exposure-based intervention) and pharmacotherapy (selective serotonin reuptake inhibitors, antidepressants, anticonvulsants, antipsychotics) for improving PTSD and mental health symptoms. Limitations The literature pool was larger than anticipated. Evidence for potentially effective models of care and potentially effective treatments is limited in quality and quantity. Although we aimed for a comprehensive evidence synthesis, pragmatic decisions in searching, screening and inclusion of studies may mean that relevant studies were overlooked. Conclusions There is tentative support for the effectiveness of some models of care and certain treatments currently delivered in UK practice. Our findings are timely for commissioners and service providers when developing present activity in veterans’ health care. Future work We report potential implications for future health-care practice, including early intervention for veterans transitioning from military life, improving general practitioners’ knowledge about services, implementing needs-based service design and tackling wider-system challenges. Regarding potential areas of future research, we have identified the need for more-robust (and longer) evaluative studies in the UK setting. Funding The National Institute for Health Research Health Services and Delivery Research programme.
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Wynn, Stephanie D. "Improving the Quality of Care of Veterans with Diabetes." Journal of Psychosocial Nursing and Mental Health Services 49, no. 2 (January 21, 2011): 38–43. http://dx.doi.org/10.3928/02793695-20110111-01.
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Ayele, Roman A., Emily Lawrence, Marina McCreight, Kelty Fehling, Russell E. Glasgow, Borsika A. Rabin, Robert E. Burke, and Catherine Battaglia. "Perspectives of Clinicians, Staff, and Veterans in Transitioning Veterans from non-VA Hospitals to Primary Care in a Single VA Healthcare System." Journal of Hospital Medicine, Volume 15, Issue 03 (October 23, 2019): 133–39. http://dx.doi.org/10.12788/jhm.3320.
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BACKGROUND: Veterans with healthcare needs utilize both Veterans Health Administration (VA) and non-VA hospitals. These dual-use veterans are at high risk of adverse outcomes due to the lack of coordination for safe transitions. OBJECTIVES: The aim of this study was to understand the barriers and facilitators to providing high-quality continuum of care for veterans transitioning from non-VA hospitals to the VA primary care setting. DESIGN: Guided by the practical robust implementation and sustainability model (PRISM) and the ideal transitions of care, we conducted a qualitative assessment using semi-structured interviews with clinicians, staff, and patients. SETTING: This study was conducted at a single urban VA medical center and two non-VA hospitals. PARTICIPANTS: A total of 70 participants, including 52 clinicians and staff (23 VA and 29 non-VA) involved in patient transition and 18 veterans recently discharged from non-VA hospitals, were included in this study. APPROACH: Data were analyzed using a conventional content analysis and managed in Atlas.ti (Berlin, Germany). RESULTS: Four major themes emerged where participants consistently discussed that transitions were delayed when they were not able to (1) identify patients as veterans and notify VA primary care of discharge, (2) transfer non-VA hospital medical records to VA primary care, (3) obtain follow-up care appointments with VA primary care, and (4) write VA formulary medications for veterans that they could fill at VA pharmacies. Participants also discussed factors involved in smooth transition and recommendations to improve care coordination. CONCLUSIONS: All participants perceived the current transition-of-care process across healthcare systems to be inefficient. Efforts to improve quality and safety in transitional care should address the challenges clinicians and patients experience when transitioning from non-VA hospitals to VA primary care.
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Wang, Virginia, Shailender Swaminathan, Emily A. Corneau, Matthew L. Maciejewski, Amal N. Trivedi, Ann M. O’Hare, and Vincent Mor. "Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD." Clinical Journal of the American Society of Nephrology 15, no. 11 (September 22, 2020): 1631–39. http://dx.doi.org/10.2215/cjn.02100220.
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Background and objectivesBecause of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers. Prior to 2011—when the VA implemented a process of standardizing payments and establishing national contracts for community-based dialysis care—payments to community providers were largely unregulated. This study examined the association of changes in the Department of Veterans Affairs payment policy for community dialysis with temporal trends in VA spending and veterans’ access to dialysis care and mortality.Design, setting, participants, & measurementsAn interrupted time series design and VA, Medicare, and US Renal Data System data were used to identify veterans who received VA–financed dialysis in community-based dialysis facilities before (2006–2008), during (2009–2010), and after the enactment of VA policies to standardize dialysis payments (2011–2016). We used multivariable, differential trend/intercept shift regression models to examine trends in average reimbursement for community-based dialysis, access to quality care (veterans’ distance to community dialysis, number of community dialysis providers, and dialysis facility quality indicators), and 1-year mortality over this time period.ResultsBefore payment reform, the unadjusted average per-treatment reimbursement for non–VA dialysis care varied widely ($47–$1575). After payment reform, there was a 44% reduction ($44–$250) in the adjusted price per dialysis session (P<0.001) and less variation in payments for dialysis ($73–$663). Over the same time period, there was an increase in the number of community dialysis facilities contracting with VA to deliver care to veterans with ESKD from 19 to 37 facilities (per VA hospital), and there were no changes in either the quality of community dialysis facilities or crude 1-year mortality rate of veterans (12% versus 11%).ConclusionsVA policies to standardize payment and establish national dialysis contracts increased the value of VA–financed community dialysis care by reducing reimbursement without compromising access to care or survival.
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Heydari, Abass, MohammadReza Fayyazi Bordbar, Mahdi Ebrahimi, and Ali Meshkinyazd. "The Impact of Spiritual Care Skills on Quality of Life in Spouses of Veterans with Post-traumatic Stress Disorder: A Randomized Controlled Trial." Journal of Caring Sciences 9, no. 4 (August 18, 2019): 220–24. http://dx.doi.org/10.34172/jcs.2020.033.
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Introduction: The wives of veterans are under great pressure because of their husbands ’physical and mental problems, and this can affect their mental health and quality of life. It seems that the training of some skills can have a significant impact on improving quality of life and reducing their mental burden. This study was conducted to determine the effect of spiritual care education in quality of life in wives of veterans with post-traumatic stress disorder (PTSD) that plays a major role in caring for them. Methods: This study was a quasi-experimental study in which 60 wives of PTSD-affected veterans in Ibn Sina hospital were selected and assigned randomly in two experimental and control groups. Spiritual care education was conducted in five sessions of two hours. Quality of life Questionnaire (SF-36) was used in this study. The questionnaire was implemented on participants of both groups in three stages: before, after and one months after the intervention (follow-up). Data were analysis using SPSS version 19. Results: The results of this study showed that spiritual care education could increase quality of life in the Wives of Veterans with Post Traumatic Stress Disorder and the subjects participating in the post-test had significantly higher quality of life. Conclusion: According to results of this, study that represent effect of spiritual care education on quality of life, so it is recommended spiritual care education can be used to improve the quality of life of people especially the families of veterans.
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Chumbler, Neale R., Britta Neugaard, Rita Kobb, Patricia Ryan, Haijing Qin, and Yongsung Joo. "Evaluation of a Care Coordination/Home-Telehealth Program for Veterans with Diabetes." Evaluation & the Health Professions 28, no. 4 (December 2005): 464–78. http://dx.doi.org/10.1177/0163278705281079.
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We evaluated a Veterans Health Administration (VHA) care coordination/ hometelehealth (CC/HT) programon the utilization of health care services and health-related quality of life (HRQL) in veterans with diabetes. Administrative records of 445 veterans with diabetes were reviewed to compare health care service utilization in the 1-year period before and 1-year period postenrollment and also examined self-reported HRQL at enrollment and 1 year later. Multivariate analyses indicated a statistically significant reduction in the proportion of patients who were hospitalized (50% reduction), emergency room use (11% reduction), reduction in the average number of bed days of care (decreased an average of 3.0 days), and improvement in the HRQL role-physical functioning, bodily pain, and social functioning. The results need to be interpreted with caution because we used a single-group study design that may be influenced by regression to the mean. Ideally, future research should use a randomized controlled trial design.
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Thurman, Whitney A., and Tracie Harrison. "Social Context and Value-Based Care." Policy, Politics, & Nursing Practice 18, no. 1 (February 2017): 26–35. http://dx.doi.org/10.1177/1527154417698145.
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Racial disparities in health are persistent and pervasive in the United States. Researchers and policymakers have known for decades that access to health care is not sufficient for addressing health disparities because of the socially situated roots of the disparities. We argue that the lack of progress in alleviating health disparities is the result of a lack of overarching framework to guide both policymakers and researchers in their efforts. We propose Amartya Sen’s capabilities approach as a theoretical framework that is expansive enough to address both the social context in which health occurs as well as the quality of health care provided. In this article, we use a subset of veterans receiving care from the Veterans Health Administration to review the theoretical concepts that link social inequalities with health disparities. Next, we provide empirical evidence of disparities in health based on race within the Veterans Health Administration, and we then provide a theoretical explanation for those disparities that exist at a system level. We close with a detailed examination of the applicability of the capabilities approach in addressing health disparities in the United States.
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Dexter, Ashley S., Janet F. Pope, Dawn Erickson, Catherine Fontenot, Elizabeth Ollendike, and Emily Walker. "Cooking Education Improves Cooking Confidence and Dietary Habits in Veterans." Diabetes Educator 45, no. 4 (May 10, 2019): 442–49. http://dx.doi.org/10.1177/0145721719848429.
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Purpose The purpose of the study was to evaluate a 12-week cooking education class on cooking confidence, dietary habits, weight status, and laboratory data among veterans with prediabetes and diabetes. Methods The sample for this study included 75 veterans within the Overton Brooks Veteran Affairs Medical Center who completed the 12-week class in an in-person group setting in Shreveport, Louisiana, or via Clinical Video Telehealth (CVT) in Longview, Texas. Veterans were referred to the Healthy Teaching Kitchen by their primary care provider or primary care dietitian. Enrollment in the class was on a volunteer basis. The cooking and nutrition education classes included topics such as carbohydrate counting, safety and sanitation, meal planning, and creating budget-friendly recipes. Participants completed 2 questionnaires for assessment of healthy dietary habits and confidence related to cooking. Changes in body weight, lipid panel, and hemoglobin A1C were assessed. Differences in class settings were tested via independent samples t tests. Paired samples t tests were completed to compare changes in mean laboratory results, weight, and questionnaire responses. Results Subjects lost a mean 2.91 ± 5.8 lbs ( P < .001). There was no significant difference in percent change in laboratory data and weight between subjects participating via CVT and subjects in the live class. Overall, there was significant improvement in the confidence questionnaire ratings and Healthy Habits Questionnaire responses. Conclusions Cooking and nutrition education can increase cooking confidence and dietary quality. These results provide support for the need for further research on the long-term effects of nutrition cooking education and for the benefits of using CVT software to provide education to remote facilities.
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Fyffe, Denise C., Joyce Williams, Paul Tobin, and Carol Gibson-Gill. "Spinal Cord Injury Veterans’ Disability Benefits, Outcomes, and Health Care Utilization Patterns: Protocol for a Qualitative Study." JMIR Research Protocols 8, no. 10 (October 4, 2019): e14039. http://dx.doi.org/10.2196/14039.
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Background An estimated 42,000 people currently living with chronic spinal cord injury (SCI) are veterans. SCI was a common combat-related injury in the World Wars and Vietnam era and now affects more than 11% of military personnel injured in Operation Iraqi Freedom and Operation Enduring Freedom. The Veterans Benefits Administration primarily offers financial compensation for disabilities sustained or re-aggravated during military service, called service-connected disability compensation. With the overwhelming cost of living with an SCI, this monthly financial compensation can provide service-connected veterans and their families with access to additional supportive resources (eg, assistive devices and personal aide) and maintain their quality of life (QOL). Little is known about personal, health, functional, and QOL outcomes associated with service-connected and nonservice-connected status for veterans living with an SCI. Objective The aim of this study is to compare the ways in which Veterans Affairs’ (VA) service-connected and nonservice-connected status may be associated with health and functional outcomes, choice of health care provider, and overall QOL for veterans living with an SCI and their caregivers. Methods This cross-sectional qualitative study will gather data using retrospective chart reviews, semistructured interviews, and focus groups. After obtaining institutional review board (IRB) approval, purposeful sampling techniques will be used to recruit and enroll the following key stakeholders: veterans living with an SCI, family caregivers, and SCI health care providers. Concurrent data collection will take place at 2 sites: Veterans Administration New Jersey Healthcare System and Northern New Jersey Spinal Cord Injury System. Results This study was funded in July 2015. IRB approval was obtained by November 2016 at both sites. Enrollment and data collection for phase 1 to phase 4 are complete. A total of 69 veterans, 18 caregivers, and 19 SCI clinicians enrolled in the study. Data analyses for these phases are underway. In phase 5, the follow-up focus group activities are scheduled. The final results are expected by the end of 2019. Conclusions The factors that contribute to veterans living with SCI seeking and not seeking VA disability compensation benefits are not well understood in rehabilitation research. Triangulation of these data sources will allow us to compare, contrast, and integrate the results, which can be used to develop clinical guidelines, caregiver training, and patient education programs. International Registered Report Identifier (IRRID) DERR1-10.2196/14039
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Burnett-Zeigler, Inger, Kara Zivin, Mark A. Ilgen, and Amy S. B. Bohnert. "Perceptions of Quality of Health Care Among Veterans With Psychiatric Disorders." Psychiatric Services 62, no. 9 (September 2011): 1054–59. http://dx.doi.org/10.1176/ps.62.9.pss6209_1054.
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HALPERN, JAY. "The Measurement of Quality of Care in the Veterans Health Administration." Medical Care 34, Supplement (March 1996): 55–68. http://dx.doi.org/10.1097/00005650-199603001-00006.
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