scholarly journals Transforming Virtual Team-Based Learning for Rural Healthcare Staff: What the Pandemic Taught Us

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 739-740
Author(s):  
Eve Gottesman ◽  
Helen Fernandez ◽  
Judith Howe
Keyword(s):  
Rural Areas ◽  
Healthcare Providers ◽  
Veterans Health ◽  
Health Administration ◽  
Web Based ◽  
Virtual Training ◽  
Team Members ◽  
Medical Centers ◽  
History Of

Abstract During COVID-19, many training programs pivoted to virtual formats. For the Rural Interdisciplinary Team Training (RITT) Program, funded by the Veterans Health Administration as part of the Geriatric Scholars Program, there were unique challenges. Given a history of successful accredited in-person, team-based workshops for staff at rural and remote clinics, program developers needed to quickly devise a plan for an effective virtual training for team members working separately from each other. Without the ability to provide in-person education and training, rapid pivoting to virtual modalities was essential for ongoing education of those providing care for older adults. Using a web-based platform, team members and expert trainer facilitation, participants engaged in lively discussions and reflection using the chat feature. RITT adapted the curriculum to better meet the needs of busy healthcare providers working during the pandemic, including increased discussion of how COVID affects older Veterans. Three virtual RITT workshops were held between March 2020 and February 2021 with 64 participants from 12 rural clinics and medical centers. Over 90% of participants agreed or strongly agreed that they were satisfied with the virtual workshop, comparable to those participating in the in-person workshop in earlier years. Similar to others, we have found that the ability to flex a curriculum has benefits to both learners and educators and increases the reach of educational opportunities in gerontology and geriatrics. Particularly in rural areas where travel may be challenging, a virtual format may be a desirable long-term solution for the RITT program.

scholarly journals Regional and Rural–Urban Variation in Opioid Prescribing in the Veterans Health Administration

2019 ◽  
Vol 184 (11-12) ◽  
pp. 894-900 ◽  
Author(s):  
Brian C Lund ◽  
Michael E Ohl ◽  
Katherine Hadlandsmyth ◽  
Hilary J Mosher
Keyword(s):  
Rural Areas ◽  
Regional Variation ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Opioid Prescribing ◽  
Rural And Urban ◽  
Per Capita

Abstract Introduction Opioid prescribing is heterogenous across the US, where 3- to 5-fold variation has been observed across states or other geographical units. Residents of rural areas appear to be at greater risk for opioid misuse, mortality, and high-risk prescribing. The Veterans Health Administration (VHA) provides a unique setting for examining regional and rural–urban differences in opioid prescribing, as a complement and contrast to extant literature. The objective of this study was to characterize regional variation in opioid prescribing across Veterans Health Administration (VHA) and examine differences between rural and urban veterans. Materials and Methods Following IRB approval, this retrospective observational study used national administrative VHA data from 2016 to assess regional variation and rural–urban differences in schedule II opioid prescribing. The primary measure of opioid prescribing volume was morphine milligram equivalents (MME) dispensed per capita. Secondary measures included incidence, prevalence of any use, and prevalence of long-term use. Results Among 4,928,195 patients, national VHA per capita opioid utilization in 2016 was 1,038 MME. Utilization was lowest in the Northeast (894 MME), highest in the West (1,368 MME), and higher among rural (1,306 MME) than urban (988 MME) residents (p < 0.001). Most of the difference between rural and urban veterans (318 MME) was attributable to differences in long-term opioid use (312 MME), with similar rates of short-term use. Conclusion There is substantial regional and rural–urban variation in opioid prescribing in VHA. Rural veterans receive over 30% more opioids than their urban counterparts. Further research is needed to identify and address underlying causes of these differences, which could include access barriers for non-pharmacologic treatments for chronic pain.

scholarly journals “Availability of healthcare providers for rural veterans eligible for purchased care under the veterans choice act”

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Michael E. Ohl ◽  
Margaret Carrell ◽  
Andrew Thurman ◽  
Mark Vander Weg ◽  
Teresa Hudson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Rural Areas ◽  
Adult Population ◽  
Healthcare Providers ◽  
The United States ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Level Data

Abstract Background Military Veterans in the United States are more likely than the general population to live in rural areas, and often have limited geographic access to Veterans Health Administration (VHA) facilities. In an effort to improve access for Veterans living far from VHA facilities, the recently-enacted Veterans Choice Act directed VHA to purchase care from non-VHA providers for Veterans who live more than 40 miles from the nearest VHA facility. To explore potential impacts of these reforms on Veterans and healthcare providers, we identified VHA-users who were eligible for purchased care based on distance to VHA facilities, and quantified the availability of various types of non-VHA healthcare providers in counties where these Veterans lived. Methods We combined 2013 administrative data on VHA-users with county-level data on rurality, non-VHA provider availability, population, household income, and population health status. Results Most (77.9%) of the 416,338 VHA-users who were eligible for purchased care based on distance lived in rural counties. Approximately 16% of these Veterans lived in primary care shortage areas, while the majority (70.2%) lived in mental health care shortage areas. Most lived in counties that lacked specialized health care providers (e.g. cardiologists, pulmonologists, and neurologists). Counterintuitively, VHA played a greater role in delivering healthcare for the overall adult population in counties that were farther from VHA facilities (30.7 VHA-users / 1000 adults in counties over 40 miles from VHA facilities, vs. 22.4 VHA-users / 1000 adults in counties within 20 miles of VHA facilities, p < 0.01). Conclusions Initiatives to purchase care for Veterans living more than 40 miles from VHA facilities may not significantly improve their access to care, as these areas are underserved by non-VHA providers. Non-VHA providers in the predominantly rural areas more than 40 miles from VHA facilities may be asked to assume care for relatively large numbers of Veterans, because VHA has recently cared for a greater proportion of the population in these areas, and these Veterans are now eligible for purchased care.

Telehealth During COVID-19 for Remote Vision Rehabilitation of a Patient with mTBI

2020 ◽  
pp. 191-198
Keyword(s):  
Veterans Health ◽  
Health Administration ◽  
Web Based ◽  
Home Setting ◽  
Therapeutic Goals ◽  
Vision Rehabilitation ◽  
Novel Coronavirus ◽  
Performance Challenges ◽  
Perception Of Performance

Background: Binocular and accommodative vision problems are common after mild traumatic brain injury (mTBI). Traditionally, the management of visual dysfunctions following mTBI included in-office vision rehabilitation with a trained eye care provider. The concept of providing telehealth for remote vision rehabilitation in mTBI patients is a relatively novel practice that has not been widely utilized until the recent outbreak of the 2019 novel coronavirus (COVID-19) pandemic. Case Report: We describe the implementation of telehealth for remote vision rehabilitation during COVID-19 within the Veterans’ Health Administration (VHA) system in an adult patient with multiple confirmed histories of mTBI. Conclusion: Our telehealth remote vision rehabilitation was successfully implemented utilizing established VHA’s web-based videoconferencing tools. Therapeutic goals identified prior to COVID 19 were addressed without any challenges. The delivery of vision rehabilitation intervention via telehealth allowed for the continuance of services within the home setting that led to improvements in functional vision, decreased perception of performance challenges, and improved quality of life.

scholarly journals AGHE as an Incubator for Interdisciplinary Education

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 543-544
Author(s):  
Thomas Teasdale ◽  
Judith Howe ◽  
Carol Rogers
Keyword(s):  
Interprofessional Education ◽  
Training Programs ◽  
Health Resources ◽  
Veterans Health Administration ◽  
Interdisciplinary Education ◽  
Veterans Health ◽  
Health Administration ◽  
Federal Funds ◽  
Interprofessional Cooperation ◽  
History Of

Abstract For several decades, the history of interdisciplinary education and the development of AGHE initiatives have been closely linked. The need to educate colleagues on methods and benefits of interdisciplinary/ interprofessional cooperation toward service and research of aging has never waned. In this presentation we (a) highlight how AGHE has performed as a potent incubator for progress in this area and (b) use a few examples to illustrate how notable resulting efforts have improved geriatric care. For example, early and significant infusion of federal funds for gerontology training programs supported multi-disciplinary university-based centers, the Veterans Health Administration created interprofessional geriatric training programs, foundations such as John A. Hartford and Josiah Macy founded team training and interprofessional education programs, and the Health Resources and Services Administration funded Geriatric Education Centers and Geriatric Workforce Enhancement Programs. Efforts to advance interdisciplinary/interprofessional education have been fruitful and AGHE’s role as an incubator continues to evolve.

scholarly journals Impacts of a web-based educational program for veterans who read their mental health notes online

2018 ◽  
Vol 26 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Lauren M Denneson ◽  
Maura Pisciotta ◽  
Elizabeth R Hooker ◽  
Amira Trevino ◽  
Steven K Dobscha
Keyword(s):  
Mental Health ◽  
Mental Health Treatment ◽  
Educational Program ◽  
Patient Activation ◽  
Patient Portal ◽  
Veterans Health ◽  
Health Administration ◽  
Perceived Efficacy ◽  
Web Based ◽  
User Input

Abstract Objective This study evaluates whether a web-based educational program for patients who read their mental health notes online improves patient-clinician communication and increases patient activation. Methods The web-based educational program, developed with end-user input, was designed to educate patients on the content of mental health notes, provide guidance on communicating with clinicians about notes, and facilitate patients’ safe and purposeful use of their health information. Eligible patients were engaged in mental health treatment (≥1 visit in the prior 6 months) and had logged into the Veterans Health Administration (VHA) patient portal at least twice. Participants completed measures of patient activation, perceived efficacy in healthcare interactions, patient trust in their clinicians, and patient assessment of the therapeutic relationship before and after participating in the program. A total of 247 participants had complete data and engaged with the program for 5 minutes or more, comprising the analytic sample. Multivariate analysis using mixed effects models were used to examine pre-post changes in outcomes. Results In bivariate analyses, patient activation, perceived efficacy in healthcare interactions, and trust in clinicians increased significantly between pre- and post-training assessments. In fully adjusted models, changes in patient activation [b = 2.71 (1.41, 4.00), P &lt; 0.01] and perceived efficacy in healthcare interactions [b = 1.27 (0.54, 2.01), P &lt; 0.01)] remained significant. Conclusions Findings suggest that this educational program may help empower mental health patients who read their notes online to be active participants in their care, while also providing information and tools that may facilitate better relationships with their clinicians.

scholarly journals Automated Nationwide Benchmarking Dashboard for Antimicrobial Stewardship Programs within the Veterans’ Health Administration

2021 ◽  
Vol 1 (S1) ◽  
pp. s23-s24
Author(s):  
Michihiko Goto ◽  
Eli Perencevich ◽  
Alexandre Marra ◽  
Bruce Alexander ◽  
Brice Beck ◽  
...  
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Risk Adjustment ◽  
Long Term Care ◽  
Antimicrobial Use ◽  
Veterans Health ◽  
Health Administration ◽  
Term Care ◽  
Patient Level

Group Name: VHA Center for Antimicrobial Stewardship and Prevention of Antimicrobial Resistance (CASPAR) Background: Antimicrobial stewardship programs (ASPs) are advised to measure antimicrobial consumption as a metric for audit and feedback. However, most ASPs lack the tools necessary for appropriate risk adjustment and standardized data collection, which are critical for peer-program benchmarking. We created a system that automatically extracts antimicrobial use data and patient-level factors for risk-adjustment and a dashboard to present risk-adjusted benchmarking metrics for ASP within the Veterans’ Health Administration (VHA). Methods: We built a system to extract patient-level data for antimicrobial use, procedures, demographics, and comorbidities for acute inpatient and long-term care units at all VHA hospitals utilizing the VHA’s Corporate Data Warehouse (CDW). We built baseline negative binomial regression models to perform risk-adjustments based on patient- and unit-level factors using records dated between October 2016 and September 2018. These models were then leveraged both retrospectively and prospectively to calculate observed-to-expected ratios of antimicrobial use for each hospital and for specific units within each hospital. Data transformation and applications of risk-adjustment models were automatically performed within the CDW database server, followed by monthly scheduled data transfer from the CDW to the Microsoft Power BI server for interactive data visualization. Frontline antimicrobial stewards at 10 VHA hospitals participated in the project as pilot users. Results: Separate baseline risk-adjustment models to predict days of therapy (DOT) for all antibacterial agents were created for acute-care and long-term care units based on 15,941,972 patient days and 3,011,788 DOT between October 2016 and September 2018 at 134 VHA hospitals. Risk adjustment models include month, unit types (eg, intensive care unit [ICU] vs non-ICU for acute care), specialty, age, gender, comorbidities (50 and 30 factors for acute care and long-term care, respectively), and preceding procedures (45 and 24 procedures for acute care and long-term care, respectively). We created additional models for each antimicrobial category based on National Healthcare Safety Network definitions. For each hospital, risk-adjusted benchmarking metrics and a monthly ranking within the VHA system were visualized and presented to end users through the dashboard (an example screenshot in Figure 1). Conclusions: Developing an automated surveillance system for antimicrobial consumption and risk-adjustment benchmarking using an electronic medical record data warehouse is feasible and can potentially provide valuable tools for ASPs, especially at hospitals with no or limited local informatics expertise. Future efforts will evaluate the effectiveness of dashboards in these settings.Funding: NoDisclosures: None

Assessment of patient satisfaction, financial, and environmental impacts of teleoncology.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 278-278
Author(s):  
Cindy Jiang ◽  
Garth William Strohbehn ◽  
Rachel Dedinsky ◽  
Shelby Raupp ◽  
Brittany Pannecouk ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Rural Areas ◽  
Financial Burden ◽  
Veterans Health ◽  
Health Administration ◽  
Secondary Effects ◽  
Medical Needs ◽  
Care Access ◽  
Strongly Agree

278 Background: There was rapid adoption of teleoncology at Veterans Health Administration (VHA) during the COVID-19 pandemic. One-third of 9 million VHA-enrolled Veterans live in rural areas. While digital solutions can expand capacity, enhance care access, and reduce financial burden, they may also exacerbate rural-urban health disparities. Careful evaluation of patients’ perceptions and policy tradeoffs are necessary to optimize teleoncology post-pandemic. Methods: Patients with ≥1 teleoncology visit with medical, surgical, or radiation oncology between March 2020 and June 2020 identified retrospectively. Validated, Likert-type survey assessing patient satisfaction developed. Follow-up survey conducted on patients with ≥1 teleoncology visit from August 2020 to January 2021. Travel distance, time, cost, and carbon dioxide (CO2) emissions calculated based on zip codes. Results: 100 surveys completed (response rate, 62%). Table with demographics. Patients overall satisfied with teleoncology (83% ‘Agree’ or ‘Strongly Agree’) but felt less satisfied than in-person visits (47% ‘Agree’ or ‘Strongly Agree’). Audiovisual component improved patient perception of involvement in care (two-sided, p = 0.0254), ability to self-manage health/medical needs (p = 0.0167), and comparability to in person visits (p = 0.0223). Follow-up survey demonstrated similar satisfaction. Total travel-related savings: 86,470 miles, 84,374 minutes, $49,720, and 35.5 metric tons of CO2. Conclusions: Veterans are broadly satisfied with teleoncology. Audiovisual capabilities are critical to satisfaction. This is challenging for rural populations with lack of technology access. Patients experienced financial and time savings, and society benefitted from reduced carbon emissions. Continued optimization needed to enhance patient experience and address secondary effects.[Table: see text]

Improving Knowledge and Information Sharing to Promote Best Practices in Stroke Care

2013 ◽  
Vol 2 (1) ◽  
pp. 11-25 ◽  
Author(s):  
Elizabeth Sternke ◽  
Nicholas Burrus ◽  
Virginia Daggett ◽  
Laurie Plue ◽  
Katherine Carlson ◽  
...  
Keyword(s):  
Best Practices ◽  
Qualitative Interviews ◽  
Stroke Care ◽  
Care Quality ◽  
Veterans Health ◽  
Health Administration ◽  
Web Based ◽  
Geographically Dispersed ◽  
User Friendly

Despite many advances in stroke care treatment, there is substantial room for improvement in quality of care for stroke patients. In an attempt to disseminate up-to-date quality information and evidence-based best practices of stroke care, the Veterans Health Administration (VHA)and the VHA Stroke QUERI implemented an innovative web-based toolkit tailored for providers and program planners interested in improving stroke care quality. This study evaluated the VA Stroke QUERI Toolkit to determine its most useful aspects and those that require improvement. In-depth qualitative interviews (n = 48) were conducted with a geographically dispersed sample of clinicians and program planners throughout the VHA system. Findings suggest the Stroke QUERI toolkit was perceived as an effective, efficient and user-friendly site but knowledge of the toolkit continues to be initiated and shared mainly through individuals and small groups. To achieve greater impact a comprehensive set of strategies designed to encourage broader uptake is required.

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