scholarly journals Incidence of Clostridioides difficile infections among young and middle-aged adults: Veterans Health Administration

2019 ◽  
Vol 40 (9) ◽  
pp. 997-1005 ◽  
Author(s):  
Ellyn M. Russo ◽  
Jennifer Kuntz ◽  
Holly Yu ◽  
Jeremy Smith ◽  
Ronald George Hauser ◽  
...  
Keyword(s):  
Veterans Health Administration ◽  
Health Concern ◽  
Charlson Comorbidity Index Score ◽  
Veterans Health ◽  
Health Administration ◽  
Middle Aged ◽  
Clostridioides Difficile ◽  
Using Data ◽  
Middle Aged Adult

AbstractObjective:Clostridioides difficile infection (CDI) remains a significant public health concern, resulting in excess morbidity, mortality, and costs. Additional insight into the burden of CDI in adults aged <65 years is needed.Design/Setting:A 6-year retrospective cohort study was conducted using data extracted from United States Veterans Health Administration electronic medical records.Patients/Methods:Patients aged 18–64 years on January 1, 2011, were followed until incident CDI, death, loss-to-follow-up, or December 31, 2016. CDI was identified by a diagnosis code accompanied by metronidazole, vancomycin, or fidaxomicin therapy, or positive laboratory test. The clinical setting of CDI onset was defined according to 2017 SHEA-IDSA guidelines.Results:Of 1,073,900 patients, 10,534 had a CDI during follow-up. The overall incidence rate was 177 CDIs per 100,000 person years, rising steadily from 164 per 100,000 person years in 2011 to 189 per 100,000 person years in 2016. Those with a CDI were slightly older (55 vs 51 years) and sicker, with a higher baseline Charlson comorbidity index score (1.4 vs 0.5) than those without an infection. Nearly half (48%) of all incident CDIs were community associated, and this proportion rose from 41% in 2011 to 56% in 2016.Conclusions:The findings from this large retrospective study indicate that CDI incidence, driven primarily by increasing community-associated infection, is rising among young and middle-aged adult Veterans with high service-related disability. The increasing burden of community associated CDI in this vulnerable population warrants attention. Future studies quantifying the economic and societal burden of CDI will inform decisions surrounding prevention strategies.

Capacity Rationing in Primary Care: Provider Availability Shocks and Channel Diversion

2021 ◽  
Author(s):  
Hessam Bavafa ◽  
Anne Canamucio ◽  
Steven C. Marcus ◽  
Christian Terwiesch ◽  
Rachel M. Werner
Keyword(s):  
Operations Management ◽  
Care Center ◽  
Urgent Care ◽  
Veterans Health ◽  
Health Administration ◽  
Urgent Care Center ◽  
Standard Deviations ◽  
Using Data ◽  
Capacity Constrained

We study capacity rationing by servers facing differentiated customer classes using data from the Veterans Health Administration, which is the largest integrated healthcare system in the U.S. Using more than 11 million health encounters over two years in which the system was capacity constrained, our study provides a comprehensive analysis of the impacts of provider availability shocks on care channel diversion and delays. The outcomes studied include emergency room (ER) visits broken down by type, urgent care center visits, office and phone visits with one’s own versus another provider, post-ER follow-up visits, and ER readmissions. Availability shocks in our analysis are a residualized measure characterizing weeks in which the provider has fewer (or more) office appointments than expected based on typical patterns. The main finding is that moving from two standard deviations above to two standard deviations below in availability shocks increases ER visits by 2.4%, or about 20,000 yearly ER visits. Interestingly, the increase in ER visits is only present for the non-emergent category, indicating differentiated service to emergent and non-emergent care requests; capacity-constrained providers still tend to the patients in most need. Another finding is that provider availability shocks delay and divert post-ER follow-up care. Yet there is no effect on ER readmissions, a severe outcome of delayed or foregone follow-up, indicating that providers ration by priority these follow-up appointments. This paper was accepted by Vishal Gaur, operations management.

Retained Guidewires

2014 ◽  
Vol 3 (1) ◽  
pp. 214-216 ◽  
Author(s):  
Theodore E. Dushane ◽  
Douglas E. Paull
Keyword(s):  
Central Venous Catheter ◽  
Invasive Procedure ◽  
Venous Catheter ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Central Venous ◽  
Left Behind ◽  
Using Data

Inserting a central venous catheter is a commonly performed invasive procedure. While much attention has been paid to the risk of blood borne infections as a consequence of using catheters, little notice has been made of another risk: during the placement of these catheters, the guidewire used can be left behind in the patient. The purpose of this study is to explore this complication using data collected by the Veterans Health Administration (VHA) at its 151 hospitals and clinics.

scholarly journals Mild TBI and risk of Parkinson disease

Neurology ◽  
2018 ◽  
Vol 90 (20) ◽  
pp. e1771-e1779 ◽  
Author(s):  
Raquel C. Gardner ◽  
Amy L. Byers ◽  
Deborah E. Barnes ◽  
Yixia Li ◽  
John Boscardin ◽  
...  
Keyword(s):  
Brain Injury ◽  
Parkinson Disease ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Mild Tbi ◽  
Psychiatric Comorbidities ◽  
Increased Risk ◽  
Severe Tbi

ObjectiveOur aim was to assess risk of Parkinson disease (PD) following traumatic brain injury (TBI), including specifically mild TBI (mTBI), among care recipients in the Veterans Health Administration.MethodsIn this retrospective cohort study, we identified all patients with a TBI diagnosis in Veterans Health Administration databases from October 2002 to September 2014 and age-matched 1:1 to a random sample of patients without TBI. All patients were aged 18 years and older without PD or dementia at baseline. TBI exposure and severity were determined via detailed clinical assessments or ICD-9 codes using Department of Defense and Defense and Veterans Brain Injury Center criteria. Baseline comorbidities and incident PD more than 1 year post-TBI were identified using ICD-9 codes. Risk of PD after TBI was assessed using Cox proportional hazard models adjusted for demographics and medical/psychiatric comorbidities.ResultsAmong 325,870 patients (half with TBI; average age 47.9 ± 17.4 years; average follow-up 4.6 years), 1,462 were diagnosed with PD during follow-up. Compared to no TBI, those with TBI had higher incidence of PD (no TBI 0.31%, all-severity TBI 0.58%, mTBI 0.47%, moderate-severe TBI 0.75%). In adjusted models, all-severity TBI, mTBI, and moderate-severe TBI were associated with increased risk of PD (hazard ratio [95% confidence interval]: all-severity TBI 1.71 [1.53–1.92]; mTBI 1.56 [1.35–1.80]; moderate-severe TBI 1.83 [1.61–2.07]).ConclusionsAmong military veterans, mTBI is associated with 56% increased risk of PD, even after adjusting for demographics and medical/psychiatric comorbidities. This study highlights the importance of TBI prevention, long-term follow-up of TBI-exposed veterans, and the need to determine mechanisms and modifiable risk factors for post-TBI PD.

Improving Perceptions of Teamwork Climate With the Veterans Health Administration Medical Team Training Program

2011 ◽  
Vol 26 (6) ◽  
pp. 480-484 ◽  
Author(s):  
Brian T. Carney ◽  
Priscilla West ◽  
Julia B. Neily ◽  
Peter D. Mills ◽  
James P. Bagian
Keyword(s):  
Veterans Health Administration ◽  
Team Training ◽  
Medical Team ◽  
Veterans Health ◽  
Health Administration ◽  
Safety Attitudes ◽  
Safety Attitudes Questionnaire ◽  
Physician Perceptions ◽  
Nonparametric Testing

There are differences between nurse and physician perceptions of teamwork. The purpose of this study was to determine whether these differences would be reduced with medical team training (MTT). The Safety Attitudes Questionnaire was administered to nurses and physicians working in the operating rooms of 101 consecutive hospitals before and at the completion of an MTT program. Responses to the 6 teamwork climate items on the Safety Attitudes Questionnaire were analyzed using nonparametric testing. At baseline, physicians had more favorable perceptions on teamwork climate items than nurses. Physicians demonstrated improvement on all 6 teamwork climate items. Nurses demonstrated improvement in perceptions on all teamwork climate items except “Nurse input is well received.” Physicians still had a more favorable perception than nurses on all 6 teamwork climate items at follow-up. Despite an improvement in perceptions by physicians and nurses, baseline nurse–physician differences persisted at completion of the Veterans Health Administration MTT Program.

Process mapping appointments to identify improvements in care delivered to patients who screen positive for depression

2016 ◽  
Vol 4 (3) ◽  
pp. 433
Author(s):  
Bo Kim ◽  
Stephanie Rodrigues ◽  
Natalie S Dell ◽  
Rani Elwy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Treatment ◽  
Veterans Health ◽  
Health Administration ◽  
Depression Care ◽  
Positive Screen ◽  
Novel Approach ◽  
Using Data

Rationale, aims and objectives  After screening positive for depression, many patients do not receive effective medication or maintain optimal contact with practitioners.  Our objective was to examine how appointments that patients have after screening positive may affect the delivery of evidence-based and guideline-concordant depression care. Methods  We reviewed treatment records for 271 patients who screened positive for depression in primary care across three United States Veterans Health Administration medical facilities.  For each patient, we mapped the process of appointments that took place following the positive screen, noting the number of appointments, the service line in which each appointment was held, as well as whether guideline-concordant depression care was in turn received over four months. Results  We found that (i) approximately half of the patients who screened positive had no follow-up appointments, (ii) all patients who had two or more follow-up appointments received some – but not necessarily guideline-concordant – mental health treatment, and (iii) there were distinct patterns across the three facilities regarding which service lines’ appointments most often resulted in treatment. Conclusions  Our work offers a novel approach of using data on appointments that patients have after screening positive for depression to shed light on current care practices.  The number of post-screening appointments can be an informative process measure for improving depression care to become more guideline-concordant.  Facilities vary substantially in terms of which service lines they use to attain guideline-concordance, likely due to notable differences in how their primary care, integrated primary care behavioral health, and mental health services are organized.

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