scholarly journals IMPLEMENTING HOME SAFETY TOOLKIT TO CAREGIVERS OF VETERANS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S243-S243
Author(s):  
Scott A Trudeau
Keyword(s):  
Formative Evaluation ◽  
Veterans Health ◽  
Health Administration ◽  
Home Safety ◽  
Structured Interviews ◽  
Potential Benefits ◽  
Facilitators And Barriers ◽  
Key Staff ◽  
Type 3 ◽  
Selection Of

Abstract The purpose of this project was to study the processes necessary to make a Home Safety Toolkit (HST) for Veterans with dementia accessible to veterans and their caregivers. This Type 3 Implementation–Effectiveness Hybrid Research Design, included diagnostic analyses of the current processes by which Veterans receive home safety items, and identification of modifications necessary in order to provide the HST to Veterans with dementia. Two Veterans Health Administration Networks, one in the Northeast and one in the Mid-Atlantic region, participated. A formative evaluation used semi-structured interviews with key staff informants and caregivers identified facilitators and barriers to successful acquisition and use of home safety items. Qualitative data analysis reveals key barriers of time and cost, selection of best items, and caregiver reluctance to change. There was resounding support from caregivers regarding the potential benefits of self-paced toolkit including education and home safety items to implement for their veteran.

scholarly journals Evaluation of Mobile Tablet Computers for Use in the Veterans Health Administration

2019 ◽  
Vol 8 (1) ◽  
pp. 18-22
Author(s):  
Jennifer Herout ◽  
Kathleen L. Frisbee ◽  
Nancy R. Wilck ◽  
Margo Kabel ◽  
Deyne Bentt ◽  
...  
Keyword(s):  
Veterans Health Administration ◽  
Clinical Settings ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Clinical Environment ◽  
Healthcare Organizations ◽  
Advantages And Disadvantages ◽  
Facilitators And Barriers ◽  
Device Use

The Veterans Health Administration (VHA) within the Department of Veterans Affairs (VA) was interested in determining how mobile tablets may be perceived by clinicians for use in clinical settings. Therefore, we conducted an evaluation to assess how performance might differ between two devices and to gather feedback on device use. We conducted a within-subject comparison with 32 clinicians involving a usability test and two questionnaires. Qualitative data was organized around eight themes: facilitators and barriers to tablet use, observations of physical use, device specific advantages and disadvantages, and the Patient Viewer mobile application. Clinicians envisioned many facilitators to tablet use, but also voiced some concerns. Participants rated one device significantly better than the other for questionnaire items related to ‘Access and Efficiency’, ‘Introduction into the Clinical Environment’, ‘Usability and Usefulness’, and ‘Desire to Use’. Results can be used by mobile health app developers, healthcare organizations considering device purchases, and researchers conducting studies on tablets to inform respective work.

Facilitators and barriers in implementing buprenorphine in the Veterans Health Administration.

2011 ◽  
Vol 25 (2) ◽  
pp. 215-224 ◽  
Author(s):  
Adam J. Gordon ◽  
Greg Kavanagh ◽  
Margaret Krumm ◽  
Rajeev Ramgopal ◽  
Sanjay Paidisetty ◽  
...  
Keyword(s):  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Facilitators And Barriers

Abstract 137: Anticoagulation clinic provider’s perspective on management of patients on target specific oral anticoagulants: insights from the Veterans Affairs Health Care System

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Supriya Shore ◽  
P. Michael Ho ◽  
Anne Lambert-Kerzner ◽  
Fran Cunningham ◽  
Madeline McCarren ◽  
...  
Keyword(s):  
Side Effects ◽  
Patient Adherence ◽  
Comparative Method ◽  
Oral Anticoagulants ◽  
Anticoagulation Clinic ◽  
Veterans Health ◽  
Health Administration ◽  
Structured Interviews ◽  
High Performing

Background: Patients on target specific anticoagulants (TSOACs) such as dabigatran do not require routine laboratory testing and dose adjustment. In the Veterans Health Administration (VHA), anticoagulation clinics (ACCs) may elect to follow and manage patients on TSOACs, but whether it is needed or the optimal duration of follow-up is unknown. Our objective was to assess the perspective of anticoagulation clinic providers on follow-up care for dabigatran patients and to identify site-level practices associated with improved adherence to dabigatran. Methods: We ascertained ACC providers’ perspectives through semi-structured interviews by a single, trained internist. Purposive sampling was utilized to recruit senior ACC providers or supervisors at VHA sites with over 20 patients on dabigatran. We stratified sites into high and low performing sites based on whether sites had ≥ 75% of their patients adherent, based on a proportion-of-days-covered calculation. Data from the interviews was analyzed by 2 reviewers in an iterative process to identify recurrent and unifying themes. Constant comparative method of qualitative data analysis was used to identify best practices across various sites. Results: We interviewed ACC providers from 39 sites - including 18 providers at 16 high-performing sites and 25 providers at 23 low-performing sites. Follow-up practices for dabigatran varied across sites, with 6 sites not providing any follow-up, 14 sites following-up patients for less than 3 months, 9 sites following-up patients for 6 months, and 10 sites following-up patients indefinitely. During these follow-up visits, patients were contacted at regular intervals, mostly via telephone, by ACC providers to provide education, assess side-effects and adherence. Key strategies implemented at high-performing sites compared to low-performing sites included (1) examining adherence to other twice daily medications prior to approving dabigatran (2) education of patients by ACC providers prior to dabigatran initiation (3) continued telephone follow up by ACC staff despite no need for INR checks. Over a third of ACC providers expressed concerns regarding patient adherence to dabigatran. Most common reasons for this concern included its special storage requirements and high incidence of gastrointestinal side effects leading to high discontinuation rates. Conclusion: Dedicated follow-up of patients on dabigatran is associated with improved adherence. A multi-disciplinary approach involving anti-coagulation clinic providers to provide education and follow-up may be beneficial in management of TSOACs. Future work should compare the apparent benefit of this strategy with its non-trivial cost.

scholarly journals Feasibility of Telehealth-Delivered Home Safety Evaluations for Caregivers of Clients With Dementia

2019 ◽  
Vol 40 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Megan E. Gately ◽  
Scott A. Trudeau ◽  
Lauren R. Moo
Keyword(s):  
Safety Evaluation ◽  
Functional Independence ◽  
Veterans Health ◽  
Health Administration ◽  
Home Safety ◽  
Cognitive Changes ◽  
Age In Place ◽  
Home Based ◽  
Resource Requirements ◽  
Videoconferencing Technology

Video telehealth can increase access to home-based care, thus allowing older adults to maintain functional independence and age-in-place. This is particularly salient for persons with dementia whose cognitive changes increase home safety risk. Little is known about the technological and safety challenges of in-home assessment via video. This feasibility study explored the process and resource requirements of a remotely delivered telehealth occupational therapy home safety evaluation from a Veterans Health Administration (VHA) site. A total of 10 caregivers of veterans with dementia received home safety evaluations using videoconferencing technology using a variety of portable computing devices. Most telehealth evaluations experienced technological difficulties, but formal technical support was only required twice. Videoconferencing is a feasible service delivery option for home safety evaluations; however, infrastructure must support technological needs and client or provider gaps in knowledge. Implications for non-VHA settings and other interventions using videoconferencing are discussed.

Patient, caregiving partner, and clinician recommendations for improving heart failure care in the Veterans Health Administration

2020 ◽  
pp. 174239532096636
Author(s):  
Cindie Slightam ◽  
Rashmi Risbud ◽  
Timothy C Guetterman ◽  
Andrea L Nevedal ◽  
Karin M Nelson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Learning Style ◽  
Self Care ◽  
Secondary Data ◽  
Veterans Health ◽  
Health Administration ◽  
Structured Interviews ◽  
Patient Centered ◽  
Heart Failure Care ◽  
Centered Care

Objective Heart Failure (HF) care requires substantial care coordination between patients, patients’ informal caregivers, and clinicians, but few studies have examined recommendations from all three perspectives. The objective of this study was to understand and identify shared recommendations to improve HF self-care from the perspective of VA persons with HF, their caregiving partners, and clinicians. Methods Secondary data analysis from a study of semi-structured interviews with 16 couples (persons with HF and their caregiving partners) and 13 clinicians (physicians, nurses, other specialists) from a large Veterans Affairs (VA) hospital. Interviews were double-coded, and analyzed for themes around commonly used or recommended self-care strategies. Results Three themes emerged: (1) Couples and clinicians believe that improvements are still needed to existing HF education, especially the need to be tailored to learning style and culture, (2) Couples and clinicians believe that technology can facilitate better HF self-care, and (3) Couples and clinicians believe that caregiving partners are part of the self-care team, and should be involved in care management to support the person with HF. Discussion Recommendations from couples and clinicians address barriers to HF self-care and encourage patient-centered care.

scholarly journals Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261921
Author(s):  
Summer Newell ◽  
Lauren Denneson ◽  
Annabelle Rynerson ◽  
Sarah Rabin ◽  
Victoria Elliott ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Suicidal Ideation ◽  
Health Staff ◽  
Veterans Health ◽  
Health Administration ◽  
Structured Interviews ◽  
Mental Health Staff ◽  
Populations At Risk ◽  
Mental Health Settings

Universal screening for suicidal ideation in primary care and mental health settings has become a key prevention tool in many healthcare systems, including the Veterans Healthcare Administration (VHA). In response to the coronavirus pandemic, healthcare providers faced a number of challenges, including how to quickly adapt screening practices. The objective of this analyses was to learn staff perspectives on how the pandemic impacted suicide risk screening in primary care and mental health settings. Forty semi-structured interviews were conducted with primary care and mental health staff between April-September 2020 across 12 VHA facilities. A multi-disciplinary team employed a qualitative thematic analysis using a hybrid inductive/deductive approach. Staff reported multiple concerns for patients during the crisis, especially regarding vulnerable populations at risk for social isolation. Lack of clear protocols at some sites on how to serve patients screening positive for suicidal ideation created confusion for staff and led some sites to temporarily stop screening. Sites had varying degrees of adaptability to virtual based care, with the biggest challenge being completion of warm hand-offs to mental health specialists. Unanticipated opportunities that emerged during this time included increased ability of patients and staff to conduct virtual care, which is expected to continue benefit post-pandemic.

BPI19-021: Medical Oncologist Perspectives of the Veterans Affairs National Precision Oncology Program

2019 ◽  
Vol 17 (3.5) ◽  
pp. BPI19-021
Author(s):  
Vishal Vashistha ◽  
Pradeep J. Poonnen ◽  
Vimla L. Patel ◽  
Halcyon G. Skinner ◽  
Jane L. Snowdon ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Genomic Sequencing ◽  
Precision Oncology ◽  
Veterans Health ◽  
Health Administration ◽  
Structured Interviews ◽  
Improved Outcomes ◽  
Medical Oncologists ◽  
Next Generation Sequencing Ngs

Background: Genomic sequencing of tumor samples is often considered for patients diagnosed with metastatic malignancies. In July 2016, the Veterans Health Administration (VHA) created the VA National Precision Oncology Program (NPOP) to offer next generation sequencing (NGS) multigene panels for veterans with advanced solid tumors. We sought to assess the perceptions of NPOP among medical oncologists across VHA. Methods: Semi-structured interviews were designed to evaluate the following concepts: expectations for NGS testing, required workflow to conduct testing, applicability of testing results, and summative views of genomic sequencing. VHA medical oncologists who had previously sent at least one sample for testing through NPOP were solicited to participate for an in-person or telephonic conversation. Interviews were analyzed by an inductive narrative approach to code responses, which was then followed by thematic analysis for key findings that emerged. Results: 17 medical oncologists were interviewed from 16 different VA medical centers (VAMCs) in 12 states. 16 (94.1%) oncologists reported sending at least 5 samples for NGS testing; 4 (23.5%) oncologists practiced at VAMCs that sent over 100 samples. Clinicians collectively expected that testing would determine all clinically relevant genomic alterations in a reasonable time. Testing was expedited for oncologists who maintained a collaborative relationship with their local pathologists and proceduralists. 8 (47.1%) oncologists felt that testing reports should provide greater insight into the clinical significance of uncommon gene variants. 6 (35.3%) respondents expressed that educational efforts are warranted to describe optimal sample processing, indications for testing, and/or relevance of rare mutations. Twelve (70.6%) respondents felt strongly that NGS testing would improve outcomes for their patients, while 3 (17.6%) oncologists were wary that the current number of actionable mutations is too limited to offer widespread benefit. Conclusions: VHA medical oncologists opined that NGS testing through VA NPOP improved outcomes. The testing process is expedited with multidisciplinary involvement. Designed approaches to semi-algorithmically report testing results may improve efficiency of clinical decision-making. More education is warranted to detail the procedural requirements to conduct testing, indications for test ordering, and interpretation of results.

Facilitators and barriers to the Lean Enterprise Transformation program at the Veterans Health Administration

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kathryn J. Azevedo ◽  
Caroline P. Gray ◽  
Randall C. Gale ◽  
Tracy H. Urech ◽  
Jeremy C. Ramirez ◽  
...  
Keyword(s):  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Lean Enterprise ◽  
Enterprise Transformation ◽  
Facilitators And Barriers

scholarly journals Implementing a Telehospitalist Program Between Veterans Health Administration Hospitals: Outcomes, Acceptance, and Barriers to Implementation

2021 ◽  
Vol 16 (3) ◽  
pp. 156-163
Author(s):  
Jeydith Gutierrez ◽  
Jane Moeckli, ◽  
Andrea Holcombe ◽  
Amy MJ O’Shea ◽  
George Bailey ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Program Implementation ◽  
Readmission Rate ◽  
Low Complexity ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Structured Interviews ◽  
Improvement Program ◽  
Process Measures

BACKGROUND: Telehospitalist services are an innovative alternative approach to address staffing issues in rural and small hospitals. OBJECTIVE: To determine clinical outcomes and staff and patient satisfaction with a novel telehospitalist program among Veterans Health Administration (VHA) hospitals. DESIGN, SETTING, AND PARTICIPANTS: We conducted a mixed-methods evaluation of a quality improvement program with pre- and postimplementation measures. The hub site was a tertiary (high-complexity) VHA hospital, and the spoke site was a 10-bed inpatient medical unit at a rural (low-complexity) VHA hospital. All patients admitted during the study period were assigned to the spoke site. INTERVENTION: Real-time videoconferencing was used to connect a remote hospitalist physician with an on-site advanced practice provider and patients. Encounters were documented in the electronic health record. MAIN OUTCOMES: Process measures included workload, patient encounters, and daily census. Outcome measures included length of stay (LOS), readmission rate, mortality, and satisfaction of providers, staff, and patients. Surveys measured satisfaction. Qualitative analysis included unstructured and semi-structured interviews with spoke-site staff. RESULTS: Telehospitalist program implementation led to a significant reduction in LOS (3.0 [SD, 0.7] days vs 2.3 [SD, 0.3] days). The readmission rate was slightly higher in the telehospitalist group, with no change in mortality rate. Satisfaction among teleproviders was very high. Hub staff perceived the service as valuable, though satisfaction with the program was mixed. Technology and communication challenges were identified, but patient satisfaction remained mostly unchanged. CONCLUSION: Telehospitalist programs are a feasible and safe way to provide inpatient coverage and address rural hospital staffing needs. Ensuring adequate technological quality and addressing staff concerns in a timely manner can enhance program performance.

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