scholarly journals Differences in Syphilis Incidence Using a Laboratory Algorithm in People With and Without HIV in an 11-Year Nationwide Cohort Study

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Marissa M Maier ◽  
Ina Gylys-Colwell ◽  
Elliott Lowy ◽  
Joleen Borgerding ◽  
Puja Van Epps ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Demographic Data ◽  
Diagnostic Algorithm ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Hiv Status ◽  
Sexually Transmitted ◽  
Incidence Data

Abstract Background To measure the incidence of syphilis diagnoses among people with HIV vs those without HIV in a national multiyear retrospective cohort. Methods Treponemal and nontreponemal tests, HIV status, and demographic data were identified among all individuals receiving Veterans Health Administration (VHA) care between January 1, 2009, and December 31, 2019. Syphilis testing rates and incident syphilis diagnoses as defined by a laboratory algorithm were stratified by HIV status. Results Syphilis was diagnosed in 1.2% (n = 2283) of 194 322 tested individuals in VHA care in 2019. Among individuals with HIV tested for syphilis, 6.1% met criteria for syphilis compared with 0.7% without HIV. Syphilis incidence in 2019 was 35/100 000, a 17% increase from 2009 (30/100 000). In 2019, syphilis incidence was 3381 per 100 000 persons among individuals with HIV and 19 per 100 000 in those without HIV. Conclusions Using a laboratory-based diagnostic algorithm, a 178-fold difference in syphilis incidence was observed between individuals with and without HIV in 2019. US syphilis incidence data that incorporate HIV status are needed. Interventions to monitor and prevent sexually transmitted infections should address the role of HIV status.

Do You Get What You Measure? Research Opportunities Based on the Veterans Health Administration Experience

2014 ◽  
Vol 28 (2) ◽  
pp. 385-413 ◽  
Author(s):  
Nicole Thibodeau ◽  
John Harry Evans ◽  
Nandu J. Nagarajan
Keyword(s):  
Healthcare Delivery ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Performance Incentives ◽  
Healthcare Network ◽  
Similar Patient ◽  
Private And Public ◽  
The U.S

SYNOPSIS Starting in 1995, the Veterans Health Administration (VHA) transformed a bureaucratic healthcare system into a performance-driven, patient-focused integrated healthcare network. The VHA's experience may offer lessons for private and public sector providers as the U.S. explores alternative healthcare delivery systems and payment methods. Similar patient-focused integrated systems are one of the hallmarks of the latest U.S. attempt to improve the quality and efficiency of healthcare delivery. The use of performance incentives to promote cooperation and innovation is also central to both the VHA and the U.S. reform. This study reviews the VHA's experience with an eye to identifying issues and potential research avenues for accounting researchers interested in the role of accounting information for control, coordination, and organizational change.

Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: a retrospective cohort study

2021 ◽  
pp. bmjqs-2020-012975
Author(s):  
Peter J Kaboli ◽  
Matthew R Augustine ◽  
Bjarni Haraldsson ◽  
Nicholas M Mohr ◽  
M Bryant Howren ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Suicide Risk ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Bed Occupancy ◽  
Increased Risk

BackgroundVeteran suicides have increased despite mental health investments by the Veterans Health Administration (VHA).ObjectiveTo examine relationships between suicide and acute inpatient psychiatric bed occupancy and other community, hospital and patient factors.MethodsRetrospective cohort study using administrative and publicly available data for contextual community factors. The study sample included all veterans enrolled in VHA primary care in 2011–2016 associated with 111 VHA hospitals with acute inpatient psychiatric units. Acute psychiatric bed occupancy, as a measure of access to care, was the main exposure of interest and was categorised by quarter as per cent occupied using thresholds of ≤85%, 85.1%–90%, 90.1%–95% and >95%. Hospital-level analyses were conducted using generalised linear mixed models with random intercepts for hospital, modelling number of suicides by quarter with a negative binomial distribution.ResultsFrom 2011 to 2016, the national incidence of suicide among enrolled veterans increased from 39.7 to 41.6 per 100 000 person-years. VHA psychiatric bed occupancy decreased from a mean of 68.2% (IQR 56.5%–82.2%) to 65.4% (IQR 53.9%–79.9%). VHA hospitals with the highest occupancy (>95%) in a quarter compared with ≤85% had an adjusted incident rate ratio (IRR) for suicide of 1.10 (95% CI 1.01 to 1.19); no increased risk was observed for 85.1%–90% (IRR 0.96; 95% CI 0.89 to 1.03) or 90.1%–95% (IRR 0.96; 95% CI 0.89 to 1.04) compared with ≤85% occupancy. Of hospital and community variables, suicide risk was not associated with number of VHA or non-VHA psychiatric beds or amount spent on community mental health. Suicide risk increased by age categories, seasons, geographic regions and over time.ConclusionsHigh VHA hospital occupancy (>95%) was associated with a 10% increased suicide risk for veterans whereas absolute number of beds was not, suggesting occupancy is an important access measure. Future work should clarify optimal bed occupancy to meet acute psychiatric needs and ensure adequate bed distribution.

scholarly journals Testing practices and incidence of chlamydial and gonococcal infection in the Veterans Health Administration, 2009-2019

2020 ◽  
Author(s):  
Lauren A Beste ◽  
Marissa M Maier ◽  
Joleen Borgerding ◽  
Elliott Lowy ◽  
Ronald G Hauser ◽  
...  
Keyword(s):  
Risk Groups ◽  
Veterans Health Administration ◽  
The United States ◽  
Incidence Rates ◽  
Veterans Health ◽  
Health Administration ◽  
Hiv Status ◽  
Demographic Group ◽  
Immunodeficiency Virus ◽  
Testing Practices

Abstract Background Chlamydia trachomatis and Neisseria gonorrhoeae cases reached a record high in the United States in 2018. Although active duty military servicemembers have high rates of chlamydia and gonorrhea infection, trends in chlamydia and gonorrhea in the Veterans Health Administration (VHA) system have not been previously described, including among patients with human immunodeficiency virus (HIV) and young women. Methods We identified all Veterans in VHA care from 2009-2019. Tests and cases of chlamydia and gonorrhea were defined based on lab results in the electronic health record. Chlamydia and gonorrhea incidence rates were calculated each year by demographic group and HIV status. Results In 2019, testing for chlamydia and gonorrhea occurred in 2.3% of patients, 22.6% of women ages 18-24, and 34.1% of persons with HIV. 2019 incidence of chlamydia and gonorrhea was 100.8 and 56.3 cases per 100,000 VHA users, an increase of 267% and 294%, respectively, since 2009. Veterans aged <34 years accounted for 9.5% of the VHA population but 66.9% of chlamydia and 42.9% of gonorrhea cases. Chlamydia and gonorrhea incidence rates in persons with HIV were 1,432 and 1,687 per 100,000, respectively. Conclusions The incidence of chlamydia and gonorrhea rose dramatically from 2009-2019. Among tested persons, those with HIV had a 15.2-fold higher unadjusted incidence of chlamydia and 34.9-fold higher unadjusted incidence of gonorrhea compared to those without HIV. VHA-wide adherence to chlamydia and gonorrhea testing in high-risk groups merits improvement.

scholarly journals The Veterans Health Administration: A Preliminary Analysis of the Influence of The Independent Budget and Bureaucratic Performance on Funding Trends

2008 ◽  
Vol 15 (1) ◽  
pp. 5
Author(s):  
Elizabeth Kidder
Keyword(s):  
Veterans Health Administration ◽  
Service Organizations ◽  
The Political ◽  
Veterans Health ◽  
Health Administration ◽  
The Past ◽  
Bureaucratic Performance ◽  
The Cost ◽  
The Impact

The Veterans Health Administration (VHA) is the largest integrated health system in the U.S. with 7.9 million U.S. veterans enrolled.  Both the number of veterans seeking VHA health services and the cost of delivering such services continue to rise as a result of myriad factors. Kidder examines VHA funding outcomes over the past 10 years in light of the participation of veterans' service organizations (VSOs) in committee hearings; the reliance of lawmakers upon The Independent Budget (IB); and the impact of new performance-based management initiatives on budget outcomes.  Her article highlights the political nature of the VHA budget and the influential role of VSOs in funding outcomes.

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