scholarly journals Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1,307 Yale New Haven Hospital inpatients and 427,224 Medicare patients

2021 ◽  
Author(s):  
Joseph T. King ◽  
James S. Yoon ◽  
Zachary M. Bredl ◽  
Joseph P. Habboushe ◽  
Graham A. Walker ◽  
...  
Keyword(s):  
Veterans Health Administration ◽  
Sensitivity Analyses ◽  
Veterans Health ◽  
Health Administration ◽  
New Haven ◽  
Short Term ◽  
Short Term Mortality ◽  
Patient Subgroups ◽  
Haven Hospital ◽  
Over Time

AbstractBackgroundThe Veterans Health Administration COVID-19 (VACO) Index incorporates age, sex, and pre-existing comorbidity diagnoses readily available in the electronic health record (EHR) to predict 30-day all-cause mortality in both inpatients and outpatients infected with SARS-CoV-2. We examined the performance of the Index using data from Yale New Haven Hospital (YNHH) and national Medicare data overall, over time, and within important patient subgroups.Methods and findingsWith measures and weights previously derived and validated in a national Veterans Healthcare Administration (VA) sample, we evaluated the accuracy of the VACO Index for estimating inpatient (YNHH) and both inpatient and outpatient mortality (Medicare) using area under the receiver operating characteristic curve (AUC) and comparisons of predicted versus observed mortality by decile (calibration plots). The VACO Index demonstrated similar discrimination and calibration in both settings, over time, and among important patient subgroups including women, Blacks, Hispanics, Asians, and Native Americans. In sensitivity analyses, we allowed component variables to be re-weighted in the validation datasets and found that weights were largely consistent with those determined in VA data. Supplementing the VACO Index with body mass index and race/ethnicity had no effect on discrimination.ConclusionAmong COVID-19 positive individuals, the VACO Index accurately estimates risk of short-term mortality among a wide variety of patients. While it modestly over-estimates risk in recent intervals, the Index consistently identifies those at greatest relative risk. The VACO Index could identify individuals who should continue practicing social distancing, help determine who should be prioritized for vaccination, and among outpatients who test positive for SARS-CoV-2, indicate who should receive greater clinical attention or monoclonal antibodies.

scholarly journals Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1307 US academic medical centre inpatients and 427 224 US Medicare patients

2021 ◽  
pp. jech-2021-216697
Author(s):  
Joseph T King, Jr. ◽  
James S Yoon ◽  
Zachary M Bredl ◽  
Joseph P Habboushe ◽  
Graham A Walker ◽  
...  
Keyword(s):  
Characteristic Curve ◽  
Veterans Health Administration ◽  
Medical Centre ◽  
Veterans Health ◽  
Health Administration ◽  
Short Term ◽  
Academic Medical Centre ◽  
Academic Medical ◽  
All Cause Mortality ◽  
Short Term Mortality

BackgroundThe Veterans Health Administration COVID-19 (VACO) Index predicts 30-day all-cause mortality in patients with COVID-19 using age, sex and pre-existing comorbidity diagnoses. The VACO Index was initially developed and validated in a nationwide cohort of US veterans—we now assess its accuracy in an academic medical centre and a nationwide US Medicare cohort.MethodsWith measures and weights previously derived and validated in US national Veterans Health Administration (VA) inpatients and outpatients (n=13 323), we evaluated the accuracy of the VACO Index for estimating 30-day all-cause mortality using area under the receiver operating characteristic curve (AUC) and calibration plots of predicted versus observed mortality in inpatients at a single US academic medical centre (n=1307) and in Medicare inpatients and outpatients aged 65+ (n=427 224).Results30-day mortality varied by data source: VA 8.5%, academic medical centre 17.5%, Medicare 16.0%. The VACO Index demonstrated similar discrimination in VA (AUC=0.82) and academic medical centre inpatient population (AUC=0.80), and when restricted to patients aged 65+ in VA (AUC=0.69) and Medicare inpatient and outpatient data (AUC=0.67). The Index modestly overestimated risk in VA and Medicare data and underestimated risk in Yale New Haven Hospital data.ConclusionsThe VACO Index estimates risk of short-term mortality across a wide variety of patients with COVID-19 using data available prior to or at the time of diagnosis. The VACO Index could help inform primary and booster vaccination prioritisation, and indicate who among outpatients testing positive for SARS-CoV-2 should receive greater clinical attention or scarce treatments.

scholarly journals A national analysis of trends in COVID-19 infection and clinical management in Veterans Health Administration medical facilities

2021 ◽  
Author(s):  
Maya Aboumrad ◽  
Brian Shiner ◽  
Natalie Riblet ◽  
Hugh Huizenga ◽  
Nabin Neupane ◽  
...  
Keyword(s):  
Veterans Health Administration ◽  
Descriptive Statistics ◽  
Veterans Health ◽  
Health Administration ◽  
Laboratory Findings ◽  
National Health Care ◽  
Medical Facilities ◽  
Elevated Creatinine ◽  
National Analysis ◽  
Over Time

ABSTRACTOBJECTIVEWe explored longitudinal trends in sociodemographic characteristics, reported symptoms, laboratory findings, pharmacological and non-pharmacological treatment, comorbidities, and 30-day in-hospital mortality among hospitalized patients with coronavirus disease 2019 (COVID-19).METHODSThis retrospective cohort study included 43,267 patients diagnosed with COVID-19 in the Veterans Health Administration between 03/01/20 and 08/31/20 and followed until 09/30/20. We focused our analysis on patients that were subsequently hospitalized, and categorized them into groups based on the month of hospitalization. We summarized our findings through descriptive statistics. We used a nonparametric rank-sum test for trend to examine any differences in the distribution of our study variables across the six months.RESULTSDuring our study period, 8,240 patients were hospitalized, and 1,081 (13.1%) died within 30 days of admission. Hospitalizations increased over time, but the proportion of patients that died consistently declined from March (N=221/890, 24.8%) to August (N=111/1,396, 8.0%). Patients hospitalized in March compared to August were younger on average, mostly black, and symptomatic. They also had a higher frequency of baseline comorbidities, including hypertension and diabetes, and were more likely to present with abnormal laboratory findings including low lymphocyte counts and elevated creatinine. Lastly, receipt of mechanical ventilation and Hydroxychloroquine declined from March to August, while treatment with Dexamethasone and Remdesivir increased.CONCLUSIONWe found evidence of declining COVID-19 severity and fatality over time within a national health care system.

scholarly journals Surveillance for Opioid Overdose in the Veterans Health Administration, 2004-2014

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Carla Winston ◽  
Mark Holodniy
Keyword(s):  
Syndromic Surveillance ◽  
Veterans Health Administration ◽  
Surveillance Data ◽  
Opioid Overdose ◽  
Opioid Epidemic ◽  
Veterans Health ◽  
Health Administration ◽  
Trends Over Time ◽  
Us Census ◽  
Over Time

We analyzed VHA syndromic surveillance data to assess the opioid epidemic among Veterans in terms of trends over time by age and US Census region from 2004 through 2014.

scholarly journals National lung cancer screening utilization trends in the Veterans Health Administration.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6547-6547 ◽  
Author(s):  
Jennifer A. Lewis ◽  
Jason Denton ◽  
Michael E. Matheny ◽  
Christopher G. Slatore ◽  
Amelia W Maiga ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
Veterans Health Administration ◽  
Common Data Model ◽  
Veterans Health ◽  
Health Administration ◽  
Low Dose Ct ◽  
Over Time

6547 Background: Low-dose CT (LDCT) is an effective means for early lung cancer detection, but is often underutilized. An estimated 900,000 Veterans are eligible for lung cancer screening. We are the first to describe national lung cancer screening utilization trends in the Veterans Health Administration (VHA). Methods: We assembled a retrospective cohort of patients within the VHA’s Observational Medical Outcomes Partnership (OMOP) Common Data Model who underwent lung cancer screening. LDCT scans with Common Procedure Terminology (CPT) codes G0297 or 71250 from January 1, 2011 to May 31, 2018 were eligible for inclusion. We further selected exams described as “lung cancer screening,” “screening,” or “LCS.” We used descriptive statistics with frequencies and medians to calculate the total exams per Veteran and evaluate utilization trends over time and by region. Results: At initial screening, Veterans had a median age of 66 (IQR 61, 70), 95% were male, 76% Caucasian. From January 1, 2011 to May 31, 2018, 75 VHA facilities performed 129,363 LDCT exams for lung cancer screening; 87,950 (68%) initial and 41,413 (32%) subsequent exams. Screening has increased over time (226 in 2011-2012; 7848 in 2013-2014; 41,225 in 2015-2016; 80,064 in 2017 until May 31, 2018) in all regions. Providers in primary care/internal medicine (56%), family medicine (16%), pulmonology (6%), oncology (0.3%), other specialties (21%) ordered screening exams. Conclusions: Lung cancer screening with low-dose CT within the VHA increased over time within all geographic regions. Future strategies aimed at the Veteran, provider, and healthcare system levels are needed to increase lung cancer screening utilization among eligible Veterans. [Table: see text]

scholarly journals Trends in COVID-19 cases and clinical management in Veterans Health Administration medical facilities: A national cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0246217
Author(s):  
Maya Aboumrad ◽  
Brian Shiner ◽  
Natalie Riblet ◽  
Hugh Huizenga ◽  
Nabin Neupane ◽  
...  
Keyword(s):  
Cohort Study ◽  
Veterans Health Administration ◽  
The United States ◽  
Hospitalized Patients ◽  
Trend Test ◽  
Veterans Health ◽  
Health Administration ◽  
Laboratory Findings ◽  
National Cohort ◽  
Over Time

Objective We explored longitudinal trends in sociodemographic characteristics, reported symptoms, laboratory findings, pharmacological and non-pharmacological treatment, comorbidities, and 30-day in-hospital mortality among hospitalized patients with coronavirus disease 2019 (COVID-19). Methods This retrospective cohort study included patients diagnosed with COVID-19 in the United States Veterans Health Administration between 03/01/20 and 08/31/20 and followed until 09/30/20. We focused our analysis on patients that were subsequently hospitalized, and categorized them into groups based on the month of hospitalization. We summarized our findings through descriptive statistics. We used Cuzick’s Trend Test to examine any differences in the distribution of our study variables across the six months. Results During our study period, we identified 43,267 patients with COVID-19. A total of 8,240 patients were hospitalized, and 13.1% (N = 1,081) died within 30 days of admission. Hospitalizations increased over time, but the proportion of patients that died consistently declined from 24.8% (N = 221/890) in March to 8.0% (N = 111/1,396) in August. Patients hospitalized in March compared to August were younger on average, mostly black, urban-dwelling, febrile and dyspneic. They also had a higher frequency of baseline comorbidities, including hypertension and diabetes, and were more likely to present with abnormal laboratory findings including low lymphocyte counts and elevated creatinine. Lastly, there was a decline from March to August in receipt of mechanical ventilation (31.4% to 13.1%) and hydroxychloroquine (55.3% to <1.0%), while treatment with dexamethasone (3.7% to 52.4%) and remdesivir (1.1% to 38.9%) increased. Conclusion Among hospitalized patients with COVID-19, we observed a trend towards decreased disease severity and mortality over time.

An Intervention With Meaning

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 376-383 ◽  
Author(s):  
Brooke A. Levandowski ◽  
Constance M. Cass ◽  
Stephanie N. Miller ◽  
Janet E. Kemp ◽  
Kenneth R. Conner
Keyword(s):  
High Risk ◽  
Qualitative Methodology ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Safety Planning ◽  
Health Administration ◽  
Suicide Method ◽  
Treatment Providers ◽  
Interactive Nature ◽  
Behavioral Health Treatment

Abstract. Background: The Veterans Health Administration (VHA) health-care system utilizes a multilevel suicide prevention intervention that features the use of standardized safety plans with veterans considered to be at high risk for suicide. Aims: Little is known about clinician perceptions on the value of safety planning with veterans at high risk for suicide. Method: Audio-recorded interviews with 29 VHA behavioral health treatment providers in a southeastern city were transcribed and analyzed using qualitative methodology. Results: Clinical providers consider safety planning feasible, acceptable, and valuable to veterans at high risk for suicide owing to the collaborative and interactive nature of the intervention. Providers identified the types of veterans who easily engaged in safety planning and those who may experience more difficulty with the process. Conclusion: Additional research with VHA providers in other locations and with veteran consumers is needed.

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