Consensus and Tools Needed to Measure Health Care Emergency Management Capabilities

2009 ◽  
Vol 3 (S1) ◽  
pp. S45-S51 ◽  
Author(s):  
Melissa L. McCarthy ◽  
Peter Brewster ◽  
Edbert B. Hsu ◽  
Anthony G. Macintyre ◽  
Gabor D. Kelen
Keyword(s):  
Health Care ◽  
Emergency Management ◽  
Homeland Security ◽  
Reliability And Validity ◽  
Institute Of Medicine ◽  
Veterans Health ◽  
Health Administration ◽  
Specific Element ◽  
Medical Response ◽  
Management Capabilities

ABSTRACTThere is no widely accepted, validated framework of health care emergency management capabilities (HEMCs) that can be used by facilities to guide their disaster preparedness and response efforts. We reviewed the HEMCs and the evaluation methods used by the Veterans Health Administration, The Joint Commission, the Institute of Medicine Metropolitan Medical Response System committee, the Department of Homeland Security, and the Department of Health and Human Services to determine whether a core set of HEMCs and evaluative methods could be identified.Despite differences in the conceptualization of health care emergency management, there is considerable overlap among the agencies regarding major capabilities and capability-specific elements. Of the 5 agencies, 4 identified occupant safety and continuity of operations as major capabilities. An additional 5 capabilities were identified as major by 3 agencies. Most often the differences were related to whether a capability should be a major one versus a capability-specific element (eg, decontamination, management of resources). All of the agencies rely on multiple indicators and data sources to evaluate HEMCs. Few performance-based tools have been developed and none have been fully tested for their reliability and validity. Consensus on a framework and tools to measure HEMCs is needed. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S45–S51)

scholarly journals Development of Predictive Informatics Tool Using Electronic Health Records to Inform Personalized Evidence-Based Pressure Injury Management for Veterans with Spinal Cord Injury

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 651-658
Author(s):  
Kath M Bogie ◽  
Steven K Roggenkamp ◽  
Ningzhou Zeng ◽  
Jacinta M Seton ◽  
Katelyn R Schwartz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
User Interface ◽  
Veterans Health Administration ◽  
Study Cohort ◽  
Veterans Health ◽  
Health Administration ◽  
Cord Injury

ABSTRACT Background Pressure injuries (PrI) are serious complications for many with spinal cord injury (SCI), significantly burdening health care systems, in particular the Veterans Health Administration. Clinical practice guidelines (CPG) provide recommendations. However, many risk factors span multiple domains. Effective prioritization of CPG recommendations has been identified as a need. Bioinformatics facilitates clinical decision support for complex challenges. The Veteran’s Administration Informatics and Computing Infrastructure provides access to electronic health record (EHR) data for all Veterans Health Administration health care encounters. The overall study objective was to expand our prototype structural model of environmental, social, and clinical factors and develop the foundation for resource which will provide weighted systemic insight into PrI risk in veterans with SCI. Methods The SCI PrI Resource (SCI-PIR) includes three integrated modules: (1) the SCIPUDSphere multidomain database of veterans’ EHR data extracted from October 2010 to September 2015 for ICD-9-CM coding consistency together with tissue health profiles, (2) the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) developed from the cohort’s free text clinical note (Text Integration Utility) notes, and (3) the clinical user interface for direct SCI-PIR query. Results The SCI-PIR contains relevant EHR data for a study cohort of 36,626 veterans with SCI, representing 10% to 14% of the U.S. population with SCI. Extracted datasets include SCI diagnostics, demographics, comorbidities, rurality, medications, and laboratory tests. Many terminology variations for non-coded input data were found. SCIPUDO facilitates robust information extraction from over six million Text Integration Utility notes annually for the study cohort. Visual widgets in the clinical user interface can be directly populated with SCIPUDO terms, allowing patient-specific query construction. Conclusion The SCI-PIR contains valuable clinical data based on CPG-identified risk factors, providing a basis for personalized PrI risk management following SCI. Understanding the relative impact of risk factors supports PrI management for veterans with SCI. Personalized interactive programs can enhance best practices by decreasing both initial PrI formation and readmission rates due to PrI recurrence for veterans with SCI.

scholarly journals Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rachel Sayko Adams ◽  
Esther L. Meerwijk ◽  
Mary Jo Larson ◽  
Alex H. S. Harris
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Chronic Pain ◽  
Veterans Health Administration ◽  
First Year ◽  
Veterans Health ◽  
Health Administration ◽  
Military Health System ◽  
Military Health ◽  
The Military

Abstract Background Chronic pain presents a significant burden for both federal health care systems designed to serve combat Veterans in the United States (i.e., the Military Health System [MHS] and Veterans Health Administration [VHA]), yet there have been few studies of Veterans with chronic pain that have integrated data from both systems of care. This study examined 1) health care utilization in VHA as an enrollee (i.e., linkage to VHA) after military separation among soldiers with postdeployment chronic pain identified in the MHS, and predictors of linkage, and 2) persistence of chronic pain among those utilizing the VHA. Methods Observational, longitudinal study of soldiers returning from a deployment in support of the Afghanistan/Iraq conflicts in fiscal years 2008–2014. The analytic sample included 138,206 active duty soldiers for whom linkage to VHA was determined through FY2019. A Cox proportional hazards model was estimated to examine the effects of demographic characteristics, military history, and MHS clinical characteristics on time to linkage to VHA after separation from the military. Among the subpopulation of soldiers who linked to VHA, we described whether they met criteria for chronic pain in the VHA and pain management treatments received during the first year in VHA. Results The majority (79%) of soldiers within the chronic pain cohort linked to VHA after military separation. Significant predictors of VHA linkage included: VHA utilization as a non-enrollee prior to military separation, separating for disability, mental health comorbidities, and being non-Hispanic Black or Hispanic. Soldiers that separated because of misconduct were less likely to link than other soldiers. Soldiers who received nonpharmacological treatments, opioids/tramadol, or mental health treatment in the MHS linked earlier to VHA than soldiers who did not receive these treatments. Among those who enrolled in VHA, during the first year after linking to the VHA, 49.7% of soldiers met criteria for persistent chronic pain in VHA. Conclusions The vast majority of soldiers identified with chronic pain in the MHS utilized care within VHA after military separation. Careful coordination of pain management approaches across the MHS and VHA is required to optimize care for soldiers with chronic pain.

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).

P52. Health care use after incident visits for low back conditions in the Veterans Health Administration

2021 ◽  
Vol 21 (9) ◽  
pp. S165
Author(s):  
Anthony J. Lisi ◽  
Lori Bastian ◽  
Vivian T. Ly ◽  
Joseph Lucien Goulet
Keyword(s):  
Health Care ◽  
Veterans Health Administration ◽  
Health Care Use ◽  
Low Back ◽  
Veterans Health ◽  
Health Administration

scholarly journals Engaging African American Veterans with Health Care Access Challenges in a Community Partnered Care Coordination Initiative: A Qualitative Needs Assessment

2018 ◽  
Vol 28 (Supp) ◽  
pp. 475-484
Author(s):  
Adriana Izquierdo ◽  
Michael Ong ◽  
Felica Jones ◽  
Loretta Jones ◽  
David Ganz ◽  
...  
Keyword(s):  
Health Care ◽  
African American ◽  
Los Angeles ◽  
Health Care System ◽  
Health Care Access ◽  
Veterans Health ◽  
Health Administration ◽  
Health Care Environment ◽  
Care Access ◽  
Care System

Background: Little has been written about engaging potentially eligible members of a health care system who are not accessing the care to which they are entitled. Know­ing more about the experiences of African American Veterans who regularly experi­ence health care access challenges may be an important step toward equitable, coordi­nated Veterans Health Administration (VHA) care. This article explores the experiences of African American Veterans who are at risk of experiencing poor care coordination.Design: We partnered with a community organization to recruit and engage Veterans in three exploratory engagement workshops between October 2015 and February 2016.Participants and Setting: Veterans living in South Los Angeles, CaliforniaMain Outcome Measures: Veterans were asked to describe their experiences with community care and the VHA, a division of the US Department of Veterans Affairs (VA). Field notes taken during the workshops were analyzed by community and academic partners using grounded theory methodol­ogy to identify emergent themes.Results: 12 Veterans and 3 family members of Veterans participated in one or more en­gagement workshops. Their trust in the VA was generally low. Positive themes included: Veterans have knowledge to share and want to help other Veterans; and connecting to VA services can result in positive experi­ences. Negative themes included: functional barriers to accessing VA health care services; insensitive VA health care environment; lack of trust in the VA health care system; and Veteran status as disadvantageous for accessing non-VA community services.Conclusions: Veterans living in underserved areas who have had difficulty accessing VA care have unique perspectives on VA services. Partnering with trusted local com­munity organizations to engage Veterans in their home communities is a promising strategy to inform efforts to improve care access and coordination for vulnerable Vet­erans.Ethn Dis. 2018;28(Suppl 2):475-484; doi:10.18865/ed.28.S2.475.

scholarly journals Health Care Utilization Among Texas Veterans Health Administration Enrollees Before and After Hurricane Harvey, 2016-2018

2021 ◽  
Vol 4 (12) ◽  
pp. e2138535
Author(s):  
Margaret Carrel ◽  
Gosia S. Clore ◽  
Seungwon Kim ◽  
Mary Vaughan Sarrazin ◽  
Eric Tate ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Veterans Health Administration ◽  
Care Utilization ◽  
Veterans Health ◽  
Health Administration ◽  
Before And After

Evaluation of a Care Coordination/Home-Telehealth Program for Veterans with Diabetes

2005 ◽  
Vol 28 (4) ◽  
pp. 464-478 ◽  
Author(s):  
Neale R. Chumbler ◽  
Britta Neugaard ◽  
Rita Kobb ◽  
Patricia Ryan ◽  
Haijing Qin ◽  
...  
Keyword(s):  
Health Care ◽  
Care Coordination ◽  
Care Service ◽  
Controlled Trial ◽  
Health Care Service ◽  
Bodily Pain ◽  
Future Research ◽  
Veterans Health ◽  
Health Administration ◽  
Regression To The Mean

We evaluated a Veterans Health Administration (VHA) care coordination/ hometelehealth (CC/HT) programon the utilization of health care services and health-related quality of life (HRQL) in veterans with diabetes. Administrative records of 445 veterans with diabetes were reviewed to compare health care service utilization in the 1-year period before and 1-year period postenrollment and also examined self-reported HRQL at enrollment and 1 year later. Multivariate analyses indicated a statistically significant reduction in the proportion of patients who were hospitalized (50% reduction), emergency room use (11% reduction), reduction in the average number of bed days of care (decreased an average of 3.0 days), and improvement in the HRQL role-physical functioning, bodily pain, and social functioning. The results need to be interpreted with caution because we used a single-group study design that may be influenced by regression to the mean. Ideally, future research should use a randomized controlled trial design.

Mental health care integration and primary care patient experience in the Veterans Health Administration

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 100587
Author(s):  
Lucinda B. Leung ◽  
Danielle Rose ◽  
Rong Guo ◽  
Catherine E. Brayton ◽  
Lisa V. Rubenstein ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Patient Experience ◽  
Primary Care Patient ◽  
Veterans Health Administration ◽  
Care Patient ◽  
Veterans Health ◽  
Health Administration ◽  
Care Integration
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