Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration

Abstract Objective Among Veterans Health Administration (VHA) patients who undergo total knee arthroplasty (TKA) nationally, what are the underlying readmission rates and associations with perioperative opioid use, and are there associations with other factors such as preoperative health care utilization? Methods We retrospectively examined the records of 5,514 TKA patients (primary N = 4,955, 89.9%; revision N = 559, 10.1%) over one fiscal year (October 1, 2010–September 30, 2011) across VHA hospitals nationwide. Opioid use was classified into no opioids, tramadol only, short-acting only, or any long-acting. We measured readmission within 30 days and the number of days to readmission within 30 days. Extended Cox regression models were developed. Results The overall 30-day hospital readmission rate was 9.6% (N = 531; primary 9.5%, revision 11.1%). Both readmitted patients and the overall sample were similar on types of preoperative opioid use. Relative to patients without opioids, patients in the short-acting opioids only tier had the highest risk for 30-day hospital readmission (hazard ratio = 1.38, 95% confidence interval = 1.14–1.67). Preoperative opioid status was not associated with 30-day readmission. Other risk factors for 30-day readmission included older age (≥66 years), higher comorbidity and diagnosis-related group weights, greater preoperative health care utilization, an urban location, and use of preoperative anticonvulsants. Conclusions Given the current opioid epidemic, the routine prescribing of short-acting opioids after surgery should be carefully considered to avoid increasing risks of 30-day hospital readmissions and other negative outcomes, particularly in the context of other predisposing factors.

Download Full-text

Reliability and Validity of a Person-Centered Care Staff Survey in Veterans Health Administration Community Living Centers

The Gerontologist ◽

10.1093/geront/gns140 ◽

2012 ◽

Vol 53 (4) ◽

pp. 596-607 ◽

Cited By ~ 13

Author(s):

J. L. Sullivan ◽

M. Meterko ◽

E. Baker ◽

K. Stolzmann ◽

O. Adjognon ◽

...

Keyword(s):

Reliability And Validity ◽

Veterans Health Administration ◽

Care Staff ◽

Community Living ◽

Veterans Health ◽

Health Administration ◽

Person Centered Care ◽

Centered Care ◽

Community Living Centers

Download Full-text

Concordance and Patient-Centered Care in Medicaid Enrollees’ Care Experience With Providers

Journal of Patient Experience ◽

10.1177/23743735211034028 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110340

Author(s):

Iwimbong Kum Ghabowen ◽

Neeraj Bhandari

Keyword(s):

Health Care ◽

Health Care Access ◽

Patient Centered Care ◽

Care Utilization ◽

Federal State ◽

Patient Centered ◽

Care Experience ◽

Centered Care ◽

State And Local ◽

Privately Insured

Patient-centered care is at the nexus of several overlapping institutional reforms to improve health care system performance. However, we know little regarding Medicaid patients’ experience with their doctors along several key dimensions of patient-centered care, and how their experience compares with Medicare and privately insured patients. We studied 4 outcomes using the 2017 National Health Interview Survey: patient–provider concordance on racial/sexual/cultural identity, respectful provider attitude, solicitation of patient opinion/beliefs during the care encounter, and patient-centered communication (PCC). The primary independent variable was Medicaid enrollee status. We dichotomized responses and ran multivariate logistic regressions for each type of care experience outcome, controlling for sociodemographic factors, health care access, and health care utilization of respondents. Compared to Medicare and privately insured enrollees, Medicaid enrollees reported much lower odds of seeing providers who treated them with respect (OR = 1.91, P < .001; OR = 1.62, P < .01) and who offered PCC (OR = 1.35, P < .05; OR = 1.35, P < .01), but similar odds of seeing concordant providers (OR = 0.78, P = .96; OR = 0.96, P = .72). Importantly, Medicaid enrollees reported higher odds of seeing providers who solicited their opinion/beliefs/preferences than their Medicare or privately insured counterparts (OR = 0.82, P < .05; OR = 0.87 P < .10). Medicaid enrollees report less patient-centered experiences in some important facets of their provider interaction than their Medicare or privately insured counterparts. Federal, state, and local policies and practices directed at improving these facets of patient–provider interaction are needed and should be aimed squarely at Medicaid providers, especially those working in geographic areas and settings with a disproportionate number of racial, gender, cultural, and linguistic minorities.

Download Full-text