Assessing Hospital Disaster Readiness Over Time at the US Department of Veterans Affairs

2016 ◽  
Vol 32 (1) ◽  
pp. 46-57 ◽  
Author(s):  
Claudia Der-Martirosian ◽  
Tiffany A. Radcliff ◽  
Alicia R. Gable ◽  
Deborah Riopelle ◽  
Farhad A. Hagigi ◽  
...  
Keyword(s):  
Phase I ◽  
Emergency Management ◽  
Phase Ii ◽  
Veterans Affairs ◽  
Assessment Tools ◽  
Department Of Veterans Affairs ◽  
The Us ◽  
Two Phases ◽  
Hospital Readiness ◽  
Over Time

AbstractIntroductionThere have been numerous initiatives by government and private organizations to help hospitals become better prepared for major disasters and public health emergencies. This study reports on efforts by the US Department of Veterans Affairs (VA), Veterans Health Administration, Office of Emergency Management’s (OEM) Comprehensive Emergency Management Program (CEMP) to assess the readiness of VA Medical Centers (VAMCs) across the nation.Hypothesis/ProblemThis study conducts descriptive analyses of preparedness assessments of VAMCs and examines change in hospital readiness over time.MethodsTo assess change, quantitative analyses of data from two phases of preparedness assessments (Phase I: 2008-2010; Phase II: 2011-2013) at 137 VAMCs were conducted using 61 unique capabilities assessed during the two phases. The initial five-point Likert-like scale used to rate each capability was collapsed into a dichotomous variable: “not-developed=0” versus “developed=1.” To describe changes in preparedness over time, four new categories were created from the Phase I and Phase II dichotomous variables: (1) rated developed in both phases; (2) rated not-developed in Phase I but rated developed in Phase II; (3) rated not-developed in both phases; and (4) rated developed in Phase I but rated not- developed in Phase II.ResultsFrom a total of 61 unique emergency preparedness capabilities, 33 items achieved the desired outcome – they were rated either “developed in both phases” or “became developed” in Phase II for at least 80% of VAMCs. For 14 items, 70%-80% of VAMCs achieved the desired outcome. The remaining 14 items were identified as “low-performing” capabilities, defined as less than 70% of VAMCs achieved the desired outcome.Conclusion:Measuring emergency management capabilities is a necessary first step to improving those capabilities. Furthermore, assessing hospital readiness over time and creating robust hospital readiness assessment tools can help hospitals make informed decisions regarding allocation of resources to ensure patient safety, provide timely access to high-quality patient care, and identify best practices in emergency management during and after disasters. Moreover, with some minor modifications, this comprehensive, all-hazards-based, hospital preparedness assessment tool could be adapted for use beyond the VA.Der-MartirosianC, RadcliffTA, GableAR, RiopelleD, HagigiFA, BrewsterP, DobalianA. Assessing hospital disaster readiness over time at the US Department of Veterans Affairs. Prehsop Disaster Med. 2017;32(1):46–57.

Developing Valid Measures of Emergency Management Capabilities within US Department of Veterans Affairs Hospitals

2016 ◽  
Vol 31 (5) ◽  
pp. 475-484 ◽  
Author(s):  
Aram Dobalian ◽  
Judith A. Stein ◽  
Tiffany A. Radcliff ◽  
Deborah Riopelle ◽  
Pete Brewster ◽  
...  
Keyword(s):  
Phase I ◽  
Emergency Management ◽  
Phase Ii ◽  
Veterans Affairs ◽  
Clear Understanding ◽  
Department Of Veterans Affairs ◽  
Fit Statistics ◽  
Veterans Affairs Hospitals ◽  
Hospital Preparedness ◽  
Management Capabilities

AbstractIntroductionHospitals play a critical role in providing health care in the aftermath of disasters and emergencies. Nonetheless, while multiple tools exist to assess hospital disaster preparedness, existing instruments have not been tested adequately for validity.Hypothesis/ProblemThis study reports on the development of a preparedness assessment tool for hospitals that are part of the US Department of Veterans Affairs (VA; Washington, DC USA).MethodsThe authors evaluated hospital preparedness in six “Mission Areas” (MAs: Program Management; Incident Management; Safety and Security; Resiliency and Continuity; Medical Surge; and Support to External Requirements), each composed of various observable hospital preparedness capabilities, among 140 VA Medical Centers (VAMCs). This paper reports on two successive assessments (Phase I and Phase II) to assess the MAs’ construct validity, or the degree to which component capabilities relate to one another to represent the associated domain successfully. This report describes a two-stage confirmatory factor analysis (CFA) of candidate items for a comprehensive survey implemented to assess emergency preparedness in a hospital setting.ResultsThe individual CFAs by MA received acceptable fit statistics with some exceptions. Some individual items did not have adequate factor loadings within their hypothesized factor (or MA) and were dropped from the analyses in order to obtain acceptable fit statistics. The Phase II modified tool was better able to assess the pre-determined MAs. For each MA, except for Resiliency and Continuity (MA 4), the CFA confirmed one latent variable. In Phase I, two sub-scales (seven and nine items in each respective sub-scale) and in Phase II, three sub-scales (eight, four, and eight items in each respective sub-scale) were confirmed for MA 4. The MA 4 capabilities comprise multiple sub-domains, and future assessment protocols should consider re-classifying MA 4 into three distinct MAs.ConclusionThe assessments provide a comprehensive and consistent, but flexible, approach for ascertaining health system preparedness. This approach can provide an organization with a clear understanding of areas for improvement and could be adapted into a standard for hospital readiness.DobalianA, SteinJA, RadcliffTA, RiopelleD, BrewsterP, HagigiF, Der-MartirosianC. Developing valid measures of emergency management capabilities within US Department of Veterans Affairs hospitals. Prehosp Disaster Med. 2016;31(5):475–484.

scholarly journals Three case studies of community behavioral health support from the US Department of Veterans Affairs after disasters

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tamar Wyte-Lake ◽  
Susan Schmitz ◽  
Reginald J. Kornegay ◽  
Felix Acevedo ◽  
Aram Dobalian
Keyword(s):  
Mental Health ◽  
Emergency Management ◽  
Behavioral Health ◽  
Case Studies ◽  
The United States ◽  
Veterans Affairs ◽  
Response Strategy ◽  
Department Of Veterans Affairs ◽  
Health Response ◽  
The Us

Abstract Background Community disaster resilience is comprised of a multitude of factors, including the capacity of citizens to psychologically recover. There is growing recognition of the need for public health departments to prioritize a communitywide mental health response strategy to facilitate access to behavioral health services and reduce potential psychological impacts. Due to the US Department of Veterans Affairs’ (VA) extensive experience providing trauma-informed behavioral healthcare to its Veterans, and the fact that VA Medical Centers (VAMCs) are located throughout the United States, the VA is well situated to be a key partner in local communities’ response plans. In this study we examined the role the VA can play in a community’s behavioral health response using case studies from three disasters. Methods This study investigated experiences of VA employees in critical emergency response positions (N = 17) in communities where disasters occurred between 2017 and 2019. All respondents were interviewed March–July 2019. Data were collected via semi-structured interviews exploring participants’ experiences and knowledge about VA activities provided to communities following the regional disasters. Data were analyzed using thematic and grounded theory coding methods. Results Respondents underscored VA’s primary mission after a disaster was to maintain continuity of care to Veterans. The majority also described the VA supporting community recovery. Specifically, three recent events provided key examples of VA’s involvement in disaster behavioral health response. Each event showed VA’s integration into local response structures was facilitated by pre-existing emergency management and clinical relationships as well as prioritization from VA leadership to engage in humanitarian missions. The behavioral health interventions were provided by behavioral health teams integrated into disaster assistance centers and non-VA hospitals, VA mobile units deployed into the community, and VA telehealth services. Conclusions Recent disasters have revealed that coordinated efforts between multidisciplinary agencies can strengthen communities’ capacity to respond to mental health needs, thereby fostering resilience. Building relationships with local VAMCs can help expedite how VA can be incorporated into emergency management strategies. In considering the strengths community partners can bring to bear, a coordinated disaster mental health response would benefit from involving VA as a partner during planning.

Transformation of the US Veterans Health Administration

2006 ◽  
Vol 1 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Jonathan B. Perlin
Keyword(s):  
United States ◽  
Health Care ◽  
Veterans Health Administration ◽  
The United States ◽  
Veterans Affairs ◽  
United States Department ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
The Us

Ten years ago, it would have been hard to imagine the publication of an issue of a scholarly journal dedicated to applying lessons from the transformation of the United States Department of Veterans Affairs Health System to the renewal of other countries' national health systems. Yet, with the recent publication of a dedicated edition of the Canadian journal Healthcare Papers (2005), this actually happened. Veterans Affairs health care also has been similarly lauded this past year in the lay press, being described as ‘the best care anywhere’ in the Washington Monthly, and described as ‘top-notch healthcare’ in US News and World Report's annual health care issue enumerating the ‘Top 100 Hospitals’ in the United States (Longman, 2005; Gearon, 2005).

Improving the Lung Cancer Resection Rate in the US Department of Veterans Affairs Health System

2006 ◽  
Vol 7 (4) ◽  
pp. 268-272 ◽  
Author(s):  
Mark Thomas Dransfield ◽  
Brion Jacob Lock ◽  
Robert I. Garver
Keyword(s):  
Lung Cancer ◽  
Health System ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Resection Rate ◽  
Cancer Resection ◽  
The Us

scholarly journals COVID-19 and radiation oncology: the experience of a two-phase plan within a single institution in central Italy

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Luciana Caravatta ◽  
Consuelo Rosa ◽  
Maria Bernadette Di Sciascio ◽  
Andrea Tavella Scaringi ◽  
Angelo Di Pilla ◽  
...  
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Central Italy ◽  
Significant Risk ◽  
Tumor Board ◽  
Radiotherapy Planning ◽  
Two Phase ◽  
Hospital Environments ◽  
Two Phases

Abstract Background COVID-19 in Italy has led to the need to reorganize hospital protocols with a significant risk of interruption to cancer treatment programs. In this report, we will focus on a management model covering the two phases of the COVID-19 emergency, namely lockdown-phase I and post-lockdown-phase II. Methods The following steps were taken in the two phases: workload during visits and radiotherapy planning, use of dedicated routes, measures for triage areas, management of suspected and positive COVID-19 cases, personal protective equipment, hospital environments and intra-institutional meetings and tumor board management. Due to the guidelines set out by the Ministry of Health, oncological follow-up visits were interrupted during the lockdown-phase I; consequently, we set about contacting patients by telephone, with laboratory and instrumental exams being viewed via telematics. During the post-lockdown-phase II, the oncological follow-up clinic reopened, with two shifts operating daily. Results By comparing our radiotherapy activity from March 9 to May 4 2019 with the same period in 2020 during full phase I of the COVID-19 emergency, similar results were achieved. First radiotherapy visits, Simulation Computed Tomography and Linear Accelerator treatments amounted to 123, 137 and 151 in 2019 compared with 121, 135 and 170 in 2020 respectively. There were no cases of COVID-19 positivity recorded either in patients or in healthcare professionals, who were all negative to the swab tests performed. Conclusion During both phases of the COVID-19 emergency, the planned model used in our own experience guaranteed both continuity in radiotherapy treatments whilst neither reducing workload nor interrupting treatment and, as such, it ensured the safety of cancer patients, hospital environments and staff.

scholarly journals A pareto ensemble based spectral clustering framework

2020 ◽  
Author(s):  
Juanjuan Luo ◽  
Huadong Ma ◽  
Dongqing Zhou
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Spectral Clustering ◽  
Clustering Algorithms ◽  
Divide And Conquer ◽  
Nonzero Entry ◽  
Similarity Matrix ◽  
Diversity Preservation ◽  
Two Phases ◽  
Matrix Construction

Abstract Similarity matrix has a significant effect on the performance of the spectral clustering, and how to determine the neighborhood in the similarity matrix effectively is one of its main difficulties. In this paper, a “divide and conquer” strategy is proposed to model the similarity matrix construction task by adopting Multiobjective evolutionary algorithm (MOEA). The whole procedure is divided into two phases, phase I aims to determine the nonzero entries of the similarity matrix, and Phase II aims to determine the value of the nonzero entries of the similarity matrix. In phase I, the main contribution is that we model the task as a biobjective dynamic optimization problem, which optimizes the diversity and the similarity at the same time. It makes each individual determine one nonzero entry for each sample, and the encoding length decreases to O(N) in contrast with the non-ensemble multiobjective spectral clustering. In addition, a specific initialization operator and diversity preservation strategy are proposed during this phase. In phase II, three ensemble strategies are designed to determine the value of the nonzero value of the similarity matrix. Furthermore, this Pareto ensemble framework is extended to semi-supervised clustering by transforming the semi-supervised information to constraints. In contrast with the previous multiobjective evolutionary-based spectral clustering algorithms, the proposed Pareto ensemble-based framework makes a balance between time cost and the clustering accuracy, which is demonstrated in the experiments section.

scholarly journals Involvement of NO in Antinociception of NSAIDS in Murine Formalin Hind Paw Assay

Drug Research ◽  
2020 ◽  
Vol 70 (04) ◽  
pp. 145-150 ◽  
Author(s):  
Viviana Noriega ◽  
Hugo F. Miranda ◽  
Juan Carlos Prieto ◽  
Ramón Sotomayor-Zárate ◽  
Fernando Sierralta
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Dose Response ◽  
Rank Order ◽  
Linear Regression Analysis ◽  
Second Phase ◽  
Response Curves ◽  
Before And After ◽  
Two Phases ◽  
Phase Phase

AbstractThere are different animal models to evaluate pain among them the formalin hind paw assay which is widely used since some of its events appear to be similar to the clinical pain of humans. The assay in which a dilute solution of formalin is injected into the dorsal hindpaw of a murine produces two ‘phases’ of pain behavior separated by a inactive period. The early phase (Phase I) is probably due to direct activation of nociceptors and the second phase (Phase II) is due to ongoing inflammatory input and central sensitization. Mice were used to determine the potency antinociceptive of piroxicam (1,3,10,and 30 mg/kg), parecoxib (0.3, 1,3,10 and 30 mg/kg), dexketoprofen (3,10,30 and 100 mg/kg) and ketoprofen (3,10,30 and 100 mg/kg). Dose-response for each NSAIDs were created before and after 5 mg/kg of L-NAME i.p. or 5 mg/kg i.p. of 7-nitroindazole. A least-squares linear regression analysis of the log dose–response curves allowed the calculation of the dose that produced 50% of antinociception (ED50) for each drug. The ED50 demonstrated the following rank order of potency, in the phase I: piroxicam > dexketoprofen > ketoprofen > parecoxib and in the phase II: piroxicam > ketoprofen > parecoxib > dexketoprofen. Pretreatment of the mice with L-NAME or 7-nitroindazol induced a significant increase of the analgesic power of the NSAIDs, with a significant reduction of the ED50. It is suggested that NO may be involved in both phases of the trial, which means that nitric oxide regulates the bioactivity of NSAIDs.

Forecasting Areawide Hospital Utilization: A Comparison of Five Univariate Time Series Techniques

1993 ◽  
Vol 6 (3) ◽  
pp. 178-190 ◽  
Author(s):  
Thomas W. Weiss ◽  
Carol M. Ashton ◽  
Nelda P. Wray
Keyword(s):  
Time Series ◽  
Average Length ◽  
Discharge Rate ◽  
Veterans Affairs ◽  
Economic Modeling ◽  
Hospital Utilization ◽  
Patient Treatment ◽  
Department Of Veterans Affairs ◽  
Univariate Time Series ◽  
Over Time

Time series analysis is one of the methods health services researchers, managers and planners have to examine and predict utilization over time. The focus of this study is univariate time series techniques, which model the change in a dependent variable over time, using time as the only independent variable. These techniques can be used with administrative healthcare databases, which typically contain reliable, time-specific utilization variables, but may lack adequate numbers of variables needed for behavioral or economic modeling. The inpatient discharge database of the Department of Veterans Affairs, the Patient Treatment File, was used to calculate monthly time series over a six-year period for the nation and across US Census Bureau regions for three hospital utilization indicators: Average length of stay, discharge rate, and multiple stay ratio, a measure of readmissions. The first purpose of this study was to determine the accuracy of forecasting these indicators 24 months into the future using five univariate time series techniques. In almost all cases, techniques were able to forecast the magnitude and direction of future utilization within a 10% mean monthly error. The second purpose of the study was to describe time series of the three hospital utilization indicators. This approach raised several questions concerning Department of Veterans Affairs hospital utilization.

Identifying Criteria for Continuous Evaluation of Software Engineers for Reward and Recognition

2016 ◽  
Vol 7 (4) ◽  
pp. 61-78 ◽  
Author(s):  
Sreejith S. S. ◽  
Muthu Mathirajan
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Employee Performance ◽  
Exploratory Research ◽  
Structured Interviews ◽  
Continuous Evaluation ◽  
Software Engineers ◽  
Two Phases ◽  
R Process ◽  
Reward And Recognition

Reward and Recognition (R&R) should be given to employees in a timely manner, based on continuous evaluation of their performance. Success of an R&R process lies in clear and well defined criteria for continuous evaluation of employee performance. Often such criteria are decided by the organization with no input from the employees. The purpose of this paper is to use qualitative research methods to explore and identify the criteria to be used for continuous employee performance evaluation for R&R in Information Technology organizations, from the perspectives of software engineers (SEs) and project managers (PMs). Exploratory research was conducted in two phases. In Phase I, unstructured interviews are used to elicit information from 7 SEs. Caselets are prepared based on these interviews and 19 criteria are identified. In Phase II, the criteria identified in Phase I are confirmed using content analysis of semi-structured interviews, conducted on relatively larger group of SEs (in stage 1) and PMs (in stage 2). Additionally, 12 criteria are also identified in Phase II. Collectively 31 criteria are identified. The proposed criteria set is expected to comprehensively cover the SE performance on a continuous basis in various dimensions to award R&R.

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