scholarly journals The Relationship between Costs and Quality in Veterans Health Administration Community Living Centers: An Analysis Using Longitudinal Data

2018 ◽  
Vol 53 (5) ◽  
pp. 3881-3897 ◽  
Author(s):  
James F. Burgess ◽  
Michael Shwartz ◽  
Kelly Stolzmann ◽  
Jennifer L. Sullivan
Keyword(s):  
Longitudinal Data ◽  
Veterans Health Administration ◽  
Community Living ◽  
Veterans Health ◽  
Health Administration ◽  
Community Living Centers ◽  
The Relationship

scholarly journals Is Variation in Resident-Centered Care and Quality Performance Related to Health System Factors in Veterans Health Administration Nursing Homes?

2018 ◽  
Vol 55 ◽  
pp. 004695801878703 ◽  
Author(s):  
Jennifer L. Sullivan ◽  
Ryann L. Engle ◽  
Denise Tyler ◽  
Melissa K. Afable ◽  
Katelyn Gormley ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Health System ◽  
Veterans Health Administration ◽  
Community Living ◽  
Veterans Health ◽  
Health Administration ◽  
Staff Members ◽  
Centered Care ◽  
Community Living Centers ◽  
System Factors

The purpose of this research was to explore and compare common health system factors for 5 Community Living Centers (ie Veterans Health Administration nursing homes) with high performance on both resident-centered care and clinical quality and for 5 Community Living Centers (CLC) with low performance on both resident-centered care and quality. In particular, we were interested in “how” and “why” some Community Living Centers were able to deliver high levels of resident-centered care and high quality of care, whereas others did not demonstrate this ability. Sites were identified based on their rankings on a composite quality measure calculated from 28 Minimum Data Set version 2.0 quality indicators and a resident-centered care summary score calculated from 6 domains of the Artifacts of Culture Change Tool. Data were from fiscal years 2009-2012. We selected high- and low-performing sites on quality and resident-centered care and conducted 12 in-person site visits in 2014-2015. We used systematic content analysis to code interview transcripts for a priori and emergent health system factor domains. We then assessed variations in these domains across high and low performers using cross-site summaries and matrixes. Our final sample included 108 staff members at 10 Veterans Health Administration CLCs. Staff members included senior leaders, middle managers, and frontline employees. Of the health system factors identified, high and low performers varied in 5 domains, including leadership support, organizational culture, teamwork and communication, resident-centered care recognition and awards, and resident-centered care training. Organizations must recognize that making improvements in the factors identified in this article will require dedicated resources from leaders and support from staff throughout the organization.

scholarly journals Nursing Home Referral Within the Veterans Health Administration: Practice Variation by Payment Source and Facility Type

2017 ◽  
Vol 40 (7) ◽  
pp. 687-711
Author(s):  
Edward Alan Miller ◽  
Stefanie Gidmark ◽  
Emily Gadbois ◽  
James L. Rudolph ◽  
Orna Intrator
Keyword(s):  
Nursing Home ◽  
Discharge Planning ◽  
Veterans Health Administration ◽  
Practice Variation ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Staff Perceptions ◽  
Medical Centers ◽  
Community Living Centers

Veterans enrolled within the Veterans Health Administration (VHA) of the U.S. Department of Veterans Affairs (VA) may receive nursing home (NH) care in VHA-operated Community Living Centers (CLCs), State Veterans Homes (SVHs), or community NHs, which may or may not be under contract with the VHA. This study examined VHA staff perceptions of how Veterans’ eligibility for VA and other payment impacts NH referrals within VA Medical Centers (VAMCs). Thirty-five semistructured interviews were performed with discharge planning and contracting staff from 12 VAMCs from around the country. VA staff highlights the preeminent role that VA priority status played in determining placement in VA-paid NH care. VHA staff reported that Veterans’ placement in a CLC, community NH, or SVH was contingent, in part, on potential payment source (VA, Medicare, Medicaid, and other) and anticipated length of stay. They also reported that variation in Veteran referral to VA-paid NH care across VAMCs derived, in part, from differences in local and regional policies and markets. Implications for NH referral within the VHA are drawn.

scholarly journals Hematocrit levels and thrombotic events in patients with polycythemia vera: an analysis of Veterans Health Administration data

2019 ◽  
Vol 98 (11) ◽  
pp. 2533-2539
Author(s):  
Shreekant Parasuraman ◽  
Jingbo Yu ◽  
Dilan Paranagama ◽  
Sulena Shrestha ◽  
Li Wang ◽  
...  
Keyword(s):  
Polycythemia Vera ◽  
Cox Regression ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Monitoring And Control ◽  
The Difference ◽  
And Control ◽  
The Relationship

Abstract Patients with polycythemia vera (PV) have a high incidence of thrombotic events (TEs), contributing to a greater mortality risk than the general population. The relationship between hematocrit (HCT) levels and TE occurrence among patients with PV from the Veterans Health Administration (VHA) was evaluated to replicate findings of the CYTO-PV trial with a real-world patient population. This retrospective study used VHA medical record and claims data from the first claim with a PV diagnosis (index) until death, disenrollment, or end of study, collected between October 1, 2005, and September 30, 2012. Patients were aged ≥ 18 years at index, had ≥ 2 claims for PV (ICD-9-CM code, 238.4) ≥ 30 days apart during the identification period, continuous health plan enrollment from 12 months pre-index until end of study, and ≥ 3 HCT measurements per year during follow-up. This analysis focused on patients with no pre-index TE, and with all HCT values either < 45% or ≥ 45% during the follow-up period. The difference in TE risk between HCT groups was assessed using unadjusted Cox regression models based on time to first TE. Patients (N = 213) were mean (SD) age 68.9 (11.5) years, 98.6% male, and 61.5% white. TE rates for patients with HCT values < 45% versus ≥ 45% were 40.3% and 54.2%, respectively. Among patients with ≥ 1 HCT before TE, TE risk hazard ratio was 1.61 (95% CI, 1.03–2.51; P = 0.036). This analysis of the VHA population further supports effective monitoring and control of HCT levels < 45% to reduce TE risk in patients with PV.

scholarly journals Addressing Behavioral Symptoms of Dementia Through STAR-VA Implementation: Do Outcomes Vary by Behavior Type?

2020 ◽  
Vol 35 ◽  
pp. 153331752091157
Author(s):  
Jenefer M. Jedele ◽  
Kim Curyto ◽  
Brian M. Ludwin ◽  
Michele J. Karel
Keyword(s):  
Veterans Health Administration ◽  
Behavioral Symptoms ◽  
Veterans Health ◽  
Health Administration ◽  
Target Behavior ◽  
Target Behaviors ◽  
Multicomponent Intervention ◽  
Community Living Centers ◽  
Behavior Frequency ◽  
And Behavior

Objectives: The STAR-VA program in Veterans Health Administration Community Living Centers (CLCs, nursing home settings) trains teams to implement a psychosocial intervention with residents with behavioral symptoms of dementia (BSD). Methods: Across 71 CLCs, 302 residents selected as training cases had target behaviors categorized into one of 5 types: physically aggressive (PA), physically nonaggressive, verbally aggressive, verbally nonaggressive, and behavior deficit (BD). Results: Across all groups, there were significant declines in team-rated behavior frequency (36%) and severity (44%), agitation (10%), distress behaviors (42%), depression (17%), and anxiety (20%). The magnitude of changes varied across behavior category. For example, those with a PA target behavior experienced a greater percentage decline in agitation and distress behavior scores, and those with a BD target behavior experienced a greater percentage decline in depressive and anxiety symptoms. Conclusions: STAR-VA, a multicomponent intervention, is generally effective across various types of behavioral symptoms associated with dementia.

scholarly journals COVID-19 Impacts on Mental Health Care in Veterans Health Administration Community Living Centers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 729-729
Author(s):  
Jenefer Jedele ◽  
Cameron Griffin ◽  
Michele Karel ◽  
Kim Curyto
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Community Living ◽  
Veterans Health ◽  
Health Administration ◽  
Complex Population ◽  
Future Care ◽  
Community Living Centers ◽  
The Impact

Abstract COVID-19 forced VHA Community Living Centers (CLC) to adjust how mental health (MH) care is provided. Beginning March 2020, admissions and staff entering CLC space were restricted in response to the pandemic. Some care shifted from in-person to virtual. Veterans were more isolated due to visitor restrictions and cancellation of communal activities. Pre-COVID, CLC teams cared for an already complex population – 80% of residents had a MH diagnosis (24% with serious mental illness). Changing resident composition and increased isolation may intensify challenges in providing MH care. Using VHA administrative data, we assess the impact of the changing CLC environment during the pandemic by comparing monthly average rates of MH diagnoses and provision of MH care and as-needed psychotropics to CLC residents pre-COVID (Oct 2019 – Feb 2020) to the COVID period (Mar 2020 – Feb 2021). CLCs experienced a 26% decline in the monthly resident census. However, the monthly percentage of residents with a serious mental illness increased 13%. Pre-COVID, virtual MH encounters were received by 2% of residents; 35% received an in-person MH encounter. During COVID, 8% received a virtual MH encounter and 33% received in-person. As-needed antipsychotics remained unchanged, while as-needed benzodiazepine prescriptions decreased 15%. Despite increased MH concerns, CLC teams did not appear to respond with increased pharmacological interventions. Rather, teams seem to have maintained clinical service connection for those with MH concerns. Documenting successful approaches for addressing MH needs during this challenging time will be instructive for future care during times of crisis.

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