scholarly journals A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative

2017 ◽  
Vol 38 (5) ◽  
pp. 513-520 ◽  
Author(s):  
Allison A. Kelly ◽  
Makoto M. Jones ◽  
Kelly L. Echevarria ◽  
Stephen M. Kralovic ◽  
Matthew H. Samore ◽  
...  
Keyword(s):  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Antimicrobial Utilization ◽  
Before And After ◽  
Gram Negative Organisms ◽  
Proportional Distribution

OBJECTIVETo detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program.DESIGNObservational analysis.SETTINGThe VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities.METHODSUtilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities.RESULTSNationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection.CONCLUSIONSThe VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs.Infect Control Hosp Epidemiol 2017;38:513–520

scholarly journals Health Care Utilization Among Texas Veterans Health Administration Enrollees Before and After Hurricane Harvey, 2016-2018

2021 ◽  
Vol 4 (12) ◽  
pp. e2138535
Author(s):  
Margaret Carrel ◽  
Gosia S. Clore ◽  
Seungwon Kim ◽  
Mary Vaughan Sarrazin ◽  
Eric Tate ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Veterans Health Administration ◽  
Care Utilization ◽  
Veterans Health ◽  
Health Administration ◽  
Before And After

scholarly journals Inpatient antibiotic utilization in the Veterans’ Health Administration during the coronavirus disease 2019 (COVID-19) pandemic

2020 ◽  
pp. 1-3 ◽  
Author(s):  
Thomas D. Dieringer ◽  
Daisuke Furukawa ◽  
Christopher J. Graber ◽  
Vanessa W. Stevens ◽  
Makoto M. Jones ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Veterans Health Administration ◽  
Antibiotic Prescribing ◽  
Veterans Health ◽  
Health Administration ◽  
Prescribing Practices ◽  
Antibiotic Utilization ◽  
Days Of Therapy

Abstract Antibiotic prescribing practices across the Veterans’ Health Administration (VA) experienced significant shifts during the coronavirus disease 2019 (COVID-19) pandemic. From 2015 to 2019, antibiotic use between January and May decreased from 638 to 602 days of therapy (DOT) per 1,000 days present (DP), while the corresponding months in 2020 saw antibiotic utilization rise to 628 DOT per 1,000 DP.

scholarly journals Protocol for a mixed methods study of hospital readmissions: sensemaking in Veterans Health Administration healthcare system in the USA

BMJ Open ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. e020169
Author(s):  
Lauren S Penney ◽  
Luci K Leykum ◽  
Polly Noël ◽  
Erin P Finley ◽  
Holly Jordan Lanham ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Healthcare System ◽  
Hospital Readmissions ◽  
Veterans Health Administration ◽  
Mixed Methods Study ◽  
Veterans Health ◽  
Health Administration ◽  
The Usa

scholarly journals Validation of an algorithm to identify heart failure hospitalisations in patients with diabetes within the veterans health administration

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020455 ◽  
Author(s):  
Caroline A Presley ◽  
Jea Young Min ◽  
Jonathan Chipman ◽  
Robert A Greevy ◽  
Carlos G Grijalva ◽  
...  
Keyword(s):  
Heart Failure ◽  
Healthcare System ◽  
Predictive Value ◽  
Decompensated Heart Failure ◽  
Veterans Health Administration ◽  
Secondary Outcome ◽  
Discharge Diagnosis ◽  
Veterans Health ◽  
Health Administration ◽  
Patients With Diabetes

ObjectivesWe aimed to validate an algorithm using both primary discharge diagnosis (International Classification of Diseases Ninth Revision (ICD-9)) and diagnosis-related group (DRG) codes to identify hospitalisations due to decompensated heart failure (HF) in a population of patients with diabetes within the Veterans Health Administration (VHA) system.DesignValidation study.SettingVeterans Health Administration—Tennessee Valley Healthcare SystemParticipantsWe identified and reviewed a stratified, random sample of hospitalisations between 2001 and 2012 within a single VHA healthcare system of adults who received regular VHA care and were initiated on an antidiabetic medication between 2001 and 2008. We sampled 500 hospitalisations; 400 hospitalisations that fulfilled algorithm criteria, 100 that did not. Of these, 497 had adequate information for inclusion. The mean patient age was 66.1 years (SD 11.4). Majority of patients were male (98.8%); 75% were white and 20% were black.Primary and secondary outcome measuresTo determine if a hospitalisation was due to HF, we performed chart abstraction using Framingham criteria as the referent standard. We calculated the positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity for the overall algorithm and each component (primary diagnosis code (ICD-9), DRG code or both).ResultsThe algorithm had a PPV of 89.7% (95% CI 86.8 to 92.7), NPV of 93.9% (89.1 to 98.6), sensitivity of 45.1% (25.1 to 65.1) and specificity of 99.4% (99.2 to 99.6). The PPV was highest for hospitalisations that fulfilled both the ICD-9 and DRG algorithm criteria (92.1% (89.1 to 95.1)) and lowest for hospitalisations that fulfilled only DRG algorithm criteria (62.5% (28.4 to 96.6)).ConclusionsOur algorithm, which included primary discharge diagnosis and DRG codes, demonstrated excellent PPV for identification of hospitalisations due to decompensated HF among patients with diabetes in the VHA system.

Iraq and Afghanistan Veterans’ Use of Veterans Health Administration and Purchased Care Before and After Veterans Choice Program Implementation

Medical Care ◽  
2017 ◽  
Vol 55 ◽  
pp. S37-S44 ◽  
Author(s):  
Megan E. Vanneman ◽  
Alex H.S. Harris ◽  
Steven M. Asch ◽  
Winifred J. Scott ◽  
Samantha S. Murrell ◽  
...  
Keyword(s):  
Program Implementation ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Before And After ◽  
Choice Program

Evaluation of antibiotic prescribing in emergency departments and urgent care centers across the Veterans’ Health Administration

2020 ◽  
pp. 1-8
Author(s):  
James L. Lowery ◽  
Bruce Alexander ◽  
Rajeshwari Nair ◽  
Brett H. Heintz ◽  
Daniel J. Livorsi
Keyword(s):  
Emergency Departments ◽  
Respiratory Infections ◽  
Antibiotic Use ◽  
Veterans Health Administration ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Veterans Health ◽  
Health Administration ◽  
Urgent Care Centers ◽  
Exacerbation Of Copd

Abstract Objective: Assessments of antibiotic prescribing in ambulatory care have largely focused on viral acute respiratory infections (ARIs). It is unclear whether antibiotic prescribing for bacterial ARIs should also be a target for antibiotic stewardship efforts. In this study, we evaluated antibiotic prescribing for viral and potentially bacterial ARIs in patients seen at emergency departments (EDs) and urgent care centers (UCCs). Design: This retrospective cohort included all ED and UCC visits by patients who were not hospitalized and were seen during weekday, daytime hours during 2016–2018 in the Veterans Health Administration (VHA). Guideline concordance was evaluated for viral ARIs and for 3 potentially bacterial ARIs: acute exacerbation of COPD, pneumonia, and sinusitis. Results: There were 3,182,926 patient visits across 129 sites: 80.7% in EDs and 19.3% in UCCs. Mean patient age was 60.2 years, 89.4% were male, and 65.6% were white. Antibiotics were prescribed during 608,289 (19.1%) visits, including 42.7% with an inappropriate indication. For potentially bacterial ARIs, guideline-concordant management varied across clinicians (median, 36.2%; IQR, 26.0–52.7) and sites (median, 38.2%; IQR, 31.7–49.4). For viral ARIs, guideline-concordant management also varied across clinicians (median, 46.2%; IQR, 24.1–68.6) and sites (median, 40.0%; IQR, 30.4–59.3). At the clinician and site levels, we detected weak correlations between guideline-concordant management for viral ARIs and potentially bacterial ARIs: clinicians (r = 0.35; P = .0001) and sites (r = 0.44; P < .0001). Conclusions: Our findings suggest that, across EDs and UCCs within VHA, there are major opportunities to improve management of both viral and potentially bacterial ARIs. Some clinicians and sites are more frequently adhering to ARI guideline recommendations on antibiotic use.

scholarly journals Research Agenda for Antimicrobial Stewardship in the Veterans Health Administration

2018 ◽  
Vol 39 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Katie J. Suda ◽  
Daniel J. Livorsi ◽  
Michihiko Goto ◽  
Graeme N. Forrest ◽  
Makoto M. Jones ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Research Agenda ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration

scholarly journals Disparities in Breastfeeding Among Military Veterans

2019 ◽  
Vol 36 (1) ◽  
pp. 64-73
Author(s):  
Shimrit Keddem ◽  
Phyllis Solomon ◽  
Steve C. Marcus ◽  
Marilyn M. Schapira ◽  
Kristin M. Mattocks
Keyword(s):  
Military Service ◽  
Ecological Model ◽  
Women Veterans ◽  
Veterans Health Administration ◽  
National Sample ◽  
Veterans Health ◽  
Health Administration ◽  
Multiple Sources ◽  
Care Needs ◽  
Before And After

Background: Although breastfeeding is a major public health priority and provides numerous benefits, women veterans encounter many barriers to initiating and sustaining breastfeeding. Women veterans are a growing population with unique health care needs related to exposures and injuries experienced during military service. These military experiences are linked to health diagnoses known to impact postpartum health behaviors, such as breastfeeding. Research aim: The aim of this study was to identify factors associated with breastfeeding at 4 weeks postpartum among women veterans. Methods: We used 2016-to-2018 survey data from women veterans ( N = 420), interviewed before and after delivery, who were enrolled in maternity care coordination at a national sample of Veterans Health Administration facilities. Using the social ecological model, logistic regression was employed to explore the relationship between breastfeeding at least 4 weeks and postpartum and maternal/infant characteristics, interpersonal dynamics, community influences, and system factors. Results: The rate of breastfeeding at 4 weeks postpartum was 78.6% among this sample of veterans. Self-employed participants were 2.8 times more likely to breastfeed than those who were employed outside the home. Participants who had been deployed at any point in their military career were twice as likely to breastfeed compared with those who never deployed. In this study sample, race independently predicted lower rates of breastfeeding, with African American participants being 48% less likely to breastfeed as compared with white participants. Conclusion: Our analysis suggests significant racial disparities in breastfeeding within veteran populations utilizing Veterans Health Administration, despite access to multiple sources of support from both the Veterans Health Administration and the community.

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