QUALITY CARE ANALYSIS OF THE APPROPRIATENESS OF VETERANS AFFAIRS CARDIOLOGY CLINIC VISITS

2019 ◽  
Vol 73 (9) ◽  
pp. 3021
Author(s):  
Ayush Motwani ◽  
Karnika Ayinapudi ◽  
Twinkle Singh ◽  
Mark Cassidy ◽  
Anand Irimpen
Keyword(s):  
Quality Care ◽  
Veterans Affairs ◽  
Cardiology Clinic ◽  
Clinic Visits

Does the Veterans Affairs Depression Performance Measure Predict Quality Care?

2011 ◽  
Vol 37 (4) ◽  
pp. 170-AP2
Author(s):  
Brian Shiner ◽  
Bradley V. Watts ◽  
Marcy K. Traum ◽  
Samuel J. Huber ◽  
Yinong Young-Xu
Keyword(s):  
Quality Care ◽  
Performance Measure ◽  
Veterans Affairs

scholarly journals Taking prevention to the next step: implementation of a brief, sustainable frailty assessment in a cardiology clinic

2021 ◽  
Vol 10 (1) ◽  
pp. e001140
Author(s):  
Ariela R Orkaby ◽  
Kirstyn James ◽  
Jessica Leuchtenburg ◽  
Esther Solooki ◽  
J Michael Gaziano ◽  
...  
Keyword(s):  
Older Adults ◽  
Electronic Health Record ◽  
Gait Speed ◽  
Health Record ◽  
Speed Measurement ◽  
Frailty Assessment ◽  
Cardiology Clinic ◽  
Electronic Health ◽  
Usual Gait Speed ◽  
Clinic Visits

BackgroundFrailty measurement is recommended when assessing older adults with cardiovascular disease to individualise prevention and treatment. We sought to address this by incorporating routine gait speed measurement by clinicians into an outpatient preventive cardiology clinic.MethodsQuality improvement (QI) project initiated at VA Boston in January 2015 to measure usual gait speed in m/s over a 4 m distance for patients aged 70 and older. The primary outcome was completion and documentation of 4 m usual gait speed. Data were manually extracted from the electronic health record. Frequency distributions and descriptive statistics are presented.InterventionsSeveral change interventions were implemented over a 5-year period (January 2015–December 2019) addressing (1) stakeholder engagement and project champions, (2) staff education, (3) assessment space, (4) electronic health record template update and (5) sustaining the initiative. Statistical process control charts were used to monitor proportion of gait speed measurement and to detect shifts resulting from 5 phase change interventions.ResultsDuring this QI project, 178 patients aged 70 and older attended the clinic, accounting for 1042 individual clinic visits. Gait speed was measured at least once for 157 patients; 21 were never assessed. At the end of the first month (January 2015), gait speed was measured during 40% of clinic visits and rose to a median measurement rate of 78% at clinic visits during the 2018–2019 study period. An unanticipated result was the spread of the initiative to other cardiology clinics.ConclusionsGait speed measurement was successfully embedded into clinic assessments for older adults at a cardiology clinic following targeted interventions. This project highlights the feasibility of incorporating a brief frailty assessment such as gait speed, into non-geriatric medicine clinics.

scholarly journals Implementing video visits into an orthopedic hip arthroscopy practice: a case study

2021 ◽  
Author(s):  
John Wickman ◽  
Colleen Ferlotti ◽  
Justin Ferrell ◽  
Carolyn Hutyra ◽  
Donna Phinney ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Medical Center ◽  
Quality Care ◽  
Academic Medical Center ◽  
Cost Effective ◽  
Level Of Evidence ◽  
Face To Face ◽  
Academic Medical ◽  
Clinic Visits

Abstract Telehealth videoconferencing has been shown to be feasible, cost-effective and safe in numerous fields of medicine. In an effort to increase access and improve the quality of care offered to patients we implemented a telehealth initiative allowing for remote orthopedic clinic visits at a major academic medical center. Here we report on our experience and early outcomes. A telehealth platform was launched for a single fellowship trained orthopedic surgeon at a major academic hospital in August 2018. New patients residing outside the metro area, all return patients and patients with an uncomplicated post-operative course were offered the option to complete patient encounters remotely via a telehealth platform. Each patient was offered a Patient Satisfaction Survey following video visit. Patient zip codes were used to estimate patient commutes. Ninety-six percent of patients agreed/strongly agreed with the statement ‘I was satisfied with my Telehealth experience’ while 51% agreed/strongly agreed with the statement ‘This visit was just as good as a face to face visit’. In all, 94% of patients agreed/strongly agreed with the statement ‘Having a telehealth visit made receiving care more accessible for me’. The median miles saved on commutes were 123.3 miles. The no show rate for telehealth visits was 8.2% versus 3.2% for in-person (P < 0.001). Telehealth video visits provided patients with a modality for completing orthopedic clinic visits while maintaining a high-quality care and patient satisfaction. Patient convenience was optimized with video visits with elimination of long commutes. Level of evidence: IV.

scholarly journals Utilization of the Veterans Affairs’ Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study (Preprint)

2018 ◽  
Author(s):  
John R Blosnich ◽  
Keri L Rodriguez ◽  
Kristina L Hruska ◽  
Dio Kavalieratos ◽  
Adam J Gordon ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health Care Providers ◽  
Online Survey ◽  
Quality Care ◽  
Veterans Affairs ◽  
Ease Of Use ◽  
Care Providers ◽  
Provider Education ◽  
Care Plans ◽  
Barriers To Use

BACKGROUND In 2015, the Department of Veterans Affairs (VA) nationally implemented a transgender e-consultation (e-consult) program with expert clinical guidance for providers. OBJECTIVE This mixed-methods project aimed to describe providers’ program experiences, reasons for nonuse of the program, and ways to improve the program use. METHODS From January to May 2017, 15 urban and rural VA providers who submitted at least one e-consult in the last year participated in semistructured interviews about their program experiences, which were analyzed using content analysis. From November to December 2017, 53 providers who encountered transgender patients but did not utilize the program participated in a brief online survey on the reasons for nonuse of the program and the facilitators encouraging use. RESULTS Qualitative analysis showed that providers learned of the program through email; colleagues; the electronic health record (EHR) system; and participation in the VA Lesbian, Gay, Bisexual, and Transgender committees or educational trainings. Providers used the program to establish care plans, hormone therapy recommendations, sexual and reproductive health education, surgical treatment education, patient-provider communication guidance, and second opinions. The facilitators of program use included understandable recommendations, ease of use through the EHR system, and status as the only transgender resource for rural providers. Barriers to use included time constraints, communication-related problems with the e-consult, impractical recommendations for underresourced sites, and misunderstanding of the e-consult purpose. Suggestions for improvement included addition of concise or sectioned responses, expansion of program awareness among providers or patients, designation of a follow-up contact person, and increase in provider education about transgender veterans and related care. Quantitative analysis showed that the common reasons for nonuse of the program were no knowledge of the program (54%), no need of the program (32%), and receipt of help from a colleague outside of e-consult (24%). Common suggestions to improve the program use in quantitative analyses included provision of more information about where to find e-consult in the chart, guidance on talking with patients about the program, and e-mail announcements to improve provider awareness of the program. Post hoc exploratory analyses showed no differences between urban and rural providers. CONCLUSIONS The VA transgender e-consult program is useful for providers, but there are several barriers to implementing recommendations, some of which are especially challenging for rural providers. Addressing the identified barriers and enhancing the facilitators may improve program use and quality care for transgender veterans.

Clinic visits and prescribing patterns among veterans affairs maryland health care system dementia patients

2010 ◽  
Vol 14 (8) ◽  
pp. 677-683 ◽  
Author(s):  
G. B. Rattinger ◽  
C. D. Mullins ◽  
I. H. Zuckerman ◽  
E. Onukwugha ◽  
S. Delisle
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Veterans Affairs ◽  
Prescribing Patterns ◽  
Dementia Patients ◽  
Care System ◽  
Clinic Visits

Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 229-229
Author(s):  
Leah L. Zullig ◽  
William Ruffin Carpenter ◽  
David H. Abbott ◽  
Dawn T. Provenzale ◽  
Morris Weinberger ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Racial Differences ◽  
Cancer Care ◽  
Medical Oncology ◽  
Quality Care ◽  
Veterans Affairs ◽  
Equal Access ◽  
System Quality ◽  
Surveillance Colonoscopy ◽  
High Quality

229 Background: Racial disparities in cancer treatment and outcomes are a substantial problem nationally. The Veterans Affairs (VA) health system is nationwide, with goals of being equal access and delivering high-quality care; however, the presence or extent of racial disparities in CRC treatment and outcomes within the VA is poorly understood. We examined the relationship between race and receipt of National Comprehensive Cancer Network guideline-concordant CRC care in the VA. Methods: We identified 2,896 patients diagnosed with incident CRC between October 1, 2003 and March 31, 2006 from 128 VAMCs. We included white and black patients with invasive, non-metastatic disease, known comorbidity status, age, and marital status. Multivariable logistic regression examined the association between race and receipt of guideline-concordant care (CT scan, preoperative CEA, clear surgical margins, referral to medical oncology for stages II to III; receipt of 5FU-based adjuvant chemotherapy for stage III; receipt of surveillance colonoscopy for stages I-III). Explanatory variables included demographic and disease characteristics. Results: In the final sample of 2,022 men, mean age at diagnosis was 68 years; 85% were white, 52%, married, and 38% lived in the South. Stage was evenly distributed. No significant racial differences existed for most guidelines. Compared to blacks, whites were more likely to undergo surveillance colonoscopy 6 to 18 months following surgery (OR=1.32, 95% CI 1.01-1.73, p=0.04) and marginally more likely to be referred to medical oncology (OR=1.46, 95% CI 1.00-2.13, p=0.05). Patients who were 75 years or older at diagnosis (p<0.01) or with cardiovascular-related comorbidities (OR=0.65, 95% CI 0.50-0.89, p=0.01) were less likely to be referred to a medical oncologist than their younger, healthier counterparts. Conclusions: In general, the VA provides high quality, equal access cancer care; however, there may be room for improvement.

Patient Acceptance of Teleurology via Telephone vs Face-to-Face Clinic Visits for Hematuria Consultation at a Veterans Affairs Medical Center

2018 ◽  
Vol 5 (4) ◽  
pp. 253-259 ◽  
Author(s):  
Ilan J. Safir ◽  
Vitaly Zholudev ◽  
Dean Laganosky ◽  
Louis Aliperti ◽  
Usama Al-Qassab ◽  
...  
Keyword(s):  
Medical Center ◽  
Veterans Affairs ◽  
Patient Acceptance ◽  
Face To Face ◽  
Clinic Visits

scholarly journals Examining Potential Colorectal Cancer Care Disparities in the Veterans Affairs Health Care System

2013 ◽  
Vol 31 (28) ◽  
pp. 3579-3584 ◽  
Author(s):  
Leah L. Zullig ◽  
William R. Carpenter ◽  
Dawn Provenzale ◽  
Morris Weinberger ◽  
Bryce B. Reeve ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Racial Disparities ◽  
Racial Differences ◽  
Medical Oncology ◽  
Quality Care ◽  
Veterans Affairs ◽  
Care Quality ◽  
Surveillance Colonoscopy ◽  
Explanatory Variables ◽  
Causal Pathways

Purpose Racial disparities in cancer treatment and outcomes are a national problem. The nationwide Veterans Affairs (VA) health system seeks to provide equal access to quality care. However, the relationship between race and care quality for veterans with colorectal cancer (CRC) treated within the VA is poorly understood. We examined the association between race and receipt of National Comprehensive Cancer Network guideline–concordant CRC care. Patients and Methods This was an observational, retrospective medical record abstraction of patients with CRC treated in the VA. Two thousand twenty-two patients (white, n = 1,712; African American, n = 310) diagnosed with incident CRC between October 1, 2003, and March 31, 2006, from 128 VA medical centers, were included. We used multivariable logistic regression to examine associations between race and receipt of guideline-concordant care (computed tomography scan, preoperative carcinoembryonic antigen, clear surgical margins, medical oncology referral for stages II and III, fluorouracil-based adjuvant chemotherapy for stage III, and surveillance colonoscopy for stages I to III). Explanatory variables included demographic and disease characteristics. Results There were no significant racial differences for receipt of guideline-concordant CRC care. Older age at diagnosis was associated with reduced odds of medical oncology referral and surveillance colonoscopy. Presence of cardiovascular comorbid conditions was associated with reduced odds of medical oncology referral (odds ratio, 0.65; 95% CI, 0.50 to 0.89). Conclusion In these data, we observed no evidence of racial disparities in CRC care quality. Future studies could examine causal pathways for the VA's equal, quality care and ways to translate the VA's success into other hospital systems.

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