scholarly journals Medical and Social Factors Associated with Referral for Elder Abuse Services in a National Healthcare System

2021 ◽  
Author(s):  
Lena K Makaroun ◽  
Carolyn T Thorpe ◽  
Maria K Mor ◽  
Hongwei Zhang ◽  
Elijah Lovelace ◽  
...  
Keyword(s):  
Healthcare System ◽  
Elder Abuse ◽  
Healthcare Services ◽  
Veterans Health ◽  
Health Administration ◽  
Next Of Kin ◽  
Eligibility Criteria ◽  
Logistic Regression Models ◽  
Neighborhood Socioeconomic Status ◽  
Factors Associated

Abstract Background Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target healthcare-based interventions. Our objective was to examine sociodemographic and medical characteristics associated with documented referrals for EA assessment or services in a national US healthcare system. Methods We conducted a national case-control study in US Veterans Health Administration facilities of primary care (PC)-engaged Veterans age ≥60 years who were evaluated by social work (SW) for EA-related concerns between 2010-18. Cases were matched 1:5 to controls with a PC visit within 60 days of the matched case SW encounter. We examined the association of patient sociodemographic and health factors with receipt of EA services in unadjusted and adjusted models. Results Of 5,567,664 Veterans meeting eligibility criteria during the study period, 15,752 (0.3%) received services for EA (cases). Cases were mean age 74, and 54% unmarried. In adjusted logistic regression models (aOR; 95%CI), age ≥85 (3.56 v. age 60-64; 3.24-3.91), female sex (1.96; 1.76-2.21), child as next-of-kin (1.70 v. spouse; 1.57-1.85), lower neighborhood socioeconomic status (1.18 per higher quartile; 1.15-1.21), dementia diagnosis (3.01; 2.77-3.28) and receiving a VA pension (1.34; 1.23-1.46) were associated with receiving EA services. Conclusion In the largest cohort of patients receiving EA-related healthcare services studied to date, this study identified novel factors associated with clinical suspicion of EA that can be used to inform improvements in healthcare-based EA surveillance and detection.

‘The face of the programme’: How local clinicians shape decisions about eligibility for a national caregiver support programme in the USA

2020 ◽  
pp. 135581962098337
Author(s):  
Nina R Sperber ◽  
Rebecca Bruening ◽  
Joshua Dadolf ◽  
Katherine Miller ◽  
Jennifer Henius ◽  
...  
Keyword(s):  
Social Services ◽  
Interdisciplinary Teams ◽  
Assessment Tools ◽  
Assessment Process ◽  
Therapeutic Relationships ◽  
Veterans Health ◽  
Health Administration ◽  
Eligibility Criteria ◽  
Caregiver Support ◽  
Potential Harm

Objective To examine the causes of variation for determining clinical eligibility for a national caregiver programme in the US Veterans Health Administration (VHA) and so help inform standardization of clinical eligibility assessment for support and establish conditions for more consistent caregiver experiences across the country. Methods We used mixed methods, including a national survey of caregiver support coordinators (CSCs) across VHA medical centres, semi-structured interviews with a purposive sample of 53 CSCs and interdisciplinary team members, and observations of four VHA medical centre sites. Results A majority (70%) of CSCs across VHA medical centres reported that they used interdisciplinary teams to conduct assessments. Interdisciplinary teams were seen to help mitigate potential harm to therapeutic relationships from eligibility decisions. Survey respondents reported using a range of assessment tools provided by the national VHA Caregiver Support Program office, but participants expressed concerns that the tools did not necessarily effectively assess clinical need. Some local sites had developed innovative person-centered approaches, in which the assessment process provided an opportunity to assess veterans’ holistic clinical needs, in contrast to a programme-centered approach, which focused on assessing whether veterans/their caregivers meet eligibility criteria. Conclusion Discretion by those involved in making decisions on programme eligiblity is important for implementing a national social services programme based on clinical need. Interdisciplinary teams can help mitigate potential harm to therapeutic relationships. Discretion allows for innovation. This work has implications for setting policy in other programme contexts in which applying eligibility criteria requires clinical judgment.

scholarly journals Leaning Into Whole Health: Sustaining System Transformation While Supporting Patients and Employees During COVID-19

2021 ◽  
Vol 10 ◽  
pp. 216495612110210
Author(s):  
Eileen M Dryden ◽  
Rendelle E Bolton ◽  
Barbara G Bokhour ◽  
Juliet Wu ◽  
Kelly Dvorin ◽  
...  
Keyword(s):  
Healthcare System ◽  
Technology Use ◽  
Care Delivery ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Veterans Health ◽  
Health Administration ◽  
System Transformation ◽  
Virtual Technology ◽  
Exogenous Shock

Background The US Veterans Health Administration (VA) is transforming its healthcare system to create a Whole Health System (WHS) of care. Akin to such reorganization efforts as creating patient-centered medical homes and primary care behavioral health integration, the WHS goes beyond by transforming the entire system to one that takes a proactive approach to support patient and employee health and wellness. The SARS-CoV-2 pandemic disrupted the VA’s healthcare system and added stress for staff and patients, creating an exogenous shock for this transformation towards a WHS. Objective We examined the relationship between VA’s WHS transformation and the pandemic to understand if transformation was sustained during crisis and contributed to VA’s response. Methods Qualitative interviews were conducted as part of a multi-year study of WHS transformation. A single multi-person interview was conducted with 61 WHS leaders at 18 VA Medical Centers, examining WH transformation and use during the pandemic. Data were analyzed using rapid directed content analysis. Results While the pandemic initially slowed transformation efforts, sites intentionally embraced a WH approach to support patients and employees during this crisis. Efforts included conducting patient wellness calls, and, for patients and employees, promoting complementary and integrative health therapies, self-care, and WH concepts to combat stress and support wellbeing. A surge in virtual technology use facilitated innovative delivery of complementary and integrative therapies and promoted continued use of WH activities. Conclusion The pandemic called attention to the need for healthcare systems to address the wellbeing of both patients and providers to sustain high quality care delivery. At a time of crisis, VA sites sustained WH transformation efforts, recognizing WH as one strategy to support patients and employees. This response indicates cultural transformation is taking hold, with WH serving as a promising approach for promoting wellbeing among patients and employees alike.

scholarly journals Factors Associated with Hospital Admission after Outpatient Surgery in the Veterans Health Administration

2018 ◽  
Vol 53 (5) ◽  
pp. 3855-3880 ◽  
Author(s):  
Hillary J. Mull ◽  
Amy K. Rosen ◽  
William J. O'Brien ◽  
Nathalie McIntosh ◽  
Aaron Legler ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Outpatient Surgery ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Factors Associated

scholarly journals Variation in Surgeons’ Requests for General Anesthesia When Scheduling Carpal Tunnel Release

Hand ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 608-614
Author(s):  
Alex H. S. Harris ◽  
Esther L. Meerwijk ◽  
Robin N. Kamal ◽  
Erika D. Sears ◽  
Mary Hawn ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Veterans Health Administration ◽  
Mixed Effects ◽  
Veterans Health ◽  
Health Administration ◽  
Patient Factors ◽  
Factors Associated ◽  
Future Clinical Practice

Background: Carpal tunnel release (CTR) can be performed with a variety of anesthesia techniques. General anesthesia is associated with higher risk profile and increased resource utilization, suggesting it should not be routinely used for CTR. The purpose of this study was to examine the patient factors associated with surgeons’ requests for general anesthesia for CTR and the frequency of routine use of general anesthesia by Veterans Health Administration (VHA) surgeons and facilities. Methods: National VHA data for fiscal years 2015 and 2017 were used to identify patients receiving CTR. Mixed-effects logistic regression was used to evaluate patient, procedure, and surgeon factors associated with requests by the surgeon for general anesthesia versus other anesthesia techniques. Results: In all, 18 145 patients underwent CTR performed by 780 surgeons in 113 VHA facilities. Overall, there were 2218 (12.2%) requests for general anesthesia. Although some patient (eg, older age, obesity), procedure (eg, open vs endoscopic), and surgeon (eg, higher volume) factors were associated with lower odds of requests for general anesthesia, there was substantial facility- and surgeon-level variability. The percentage of patients with general anesthesia requested ranged from 0% to 100% across surgeons. Three facilities and 28 surgeons who performed at least 5 CTRs requested general anesthesia for more than 75% of patients. Conclusions: Where CTR is performed and by whom appear to influence requests for general anesthesia more than patient factors in this study. Avoidance of routine use of general anesthesia for CTR should be considered in future clinical practice guidelines and quality measures.

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 Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

2021 ◽  
Vol 4 (10) ◽  
pp. e2130581
Author(s):  
Linnaea Schuttner ◽  
Bjarni Haraldsson ◽  
Charles Maynard ◽  
Christian D. Helfrich ◽  
Ashok Reddy ◽  
...  
Keyword(s):  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Factors Associated ◽  
Cancer Screenings

scholarly journals Barriers to Accessing Health Care for People with Chronic Conditions: A Qualitative Study

2021 ◽  
Author(s):  
Tanja Schwarz ◽  
Andrea E. Schmidt ◽  
Julia Bobek ◽  
Joy Ladurner
Keyword(s):  
Health Services ◽  
Conceptual Framework ◽  
Healthcare System ◽  
Chronic Conditions ◽  
Chronic Back Pain ◽  
Service Providers ◽  
Healthcare Services ◽  
Coordination Of Care ◽  
Health Administration ◽  
Patient Pathways

Abstract Background: There is a growing interest in redesigning healthcare systems to increase access to and coordination across care settings for people with chronic conditions. We aim to promote patient-centredness by gaining a better understanding of the barriers faced by (1) children with chronic bronchial asthma, (2) adults with non-specific chronic back pain, and (3) older people with pre-existing mental illness/es while addressing the problem of fragmentation in Austria’s healthcare system.Methods: Using a qualitative design, we conducted semi-structured interviews face-to-face and by telephone with health service providers, researchers, experts by experience (e.g., patient advocates, family members/carers), and employees in public health administration between July and October 2019. The analysis and interpretation of data were guided by Levesque’s model of access, a conceptual framework used to evaluate access broadly according to five dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability, and appropriateness.Results: The findings from the 25 expert interviews were organised within Levesque’s conceptual framework in four dimensions of barriers. They highlight the lack of coordination and defined patient pathways, particularly at the onset of the condition, when seeking a diagnosis, but also later on. Barriers related to issues such as geography (e.g., longer distances and travel times as well as fewer healthcare services in remote rural regions), coordination of care (e.g., structural barriers and inconsistent care pathways), socioeconomic status (e.g., the ability to pay for healthcare services but also basic health literacy), and comorbidity (e.g., consideration of the patients’ state of mental health and holistic therapy approaches).Conclusions: Barriers to healthcare access are of particular concern for patients with chronic conditions, resulting in an urgent need to improve health services according to patients’ specific needs. For health services to be properly accessible, timely and integrated care independent of social and economic resources, continuity of care, and significant improvements in patient-centred communication and coordination of care are paramount. This study has important implications for policy and practice as it highlights provider, expert, and researcher perspectives on access to the healthcare system in Austria and offers a broader look at the changes required by stakeholders in the future.

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