Suicide among Veterans receiving Veterans Health Administration Home Based Primary Care and following discharge from Community Living Centers

2021 ◽  
Author(s):  
Samantha A. Cooper ◽  
Benjamin R. Szymanski ◽  
Michele J. Karel ◽  
Ira R. Katz ◽  
John F. McCarthy
Keyword(s):  
Primary Care ◽  
Veterans Health Administration ◽  
Community Living ◽  
Veterans Health ◽  
Health Administration ◽  
Home Based Primary Care ◽  
Home Based ◽  
Community Living Centers

Disaster Preparedness in Home-based Primary Care: Policy and Training

2015 ◽  
Vol 30 (4) ◽  
pp. 337-343 ◽  
Author(s):  
Maria L. Claver ◽  
Tamar Wyte-Lake ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Disaster Preparedness ◽  
Community Dwelling ◽  
Veterans Health ◽  
Health Administration ◽  
Care Policy ◽  
Home Based Primary Care ◽  
Home Based ◽  
Increased Risk ◽  
And Training

AbstractIntroductionVeterans served by Veterans Health Administration (VHA) home-based primary care (HBPC) are an especially vulnerable population due to high rates of physical, functional, and psychological limitations. Home-bound patients tend to be an older population dealing with normal changes that accompany old age, but may not adequately be prepared for the increased risk that often occurs during disasters. Home health programs are in an advantageous position to address patient preparedness as they may be one of the few outside resources that reach community-dwelling adults.ProblemThis study further explores issues previously identified from an exploratory study of a single VHA HBPC program regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support the routine assessment of disaster preparedness for patients, including patient education activities.MethodsThis project involved semi-structured interviews with 31 practitioners and leadership at five VHA HBPC programs; three urban and two rural. Transcripts of the interviews were analyzed using content analysis techniques.ResultsPractitioners reported a need for further training regarding how to assess properly patient disaster preparedness and patient willingness to prepare. Four themes emerged, validating themes identified in a prior exploratory project and identifying additional issues regarding patient disaster preparedness: (1) individual HBPC programs generally are tasked with developing their disaster preparedness policies; (2) practitioners receive limited training about HBPC program preparedness; (3) practitioners receive limited training about how to prepare their patients for a disaster; and (4) the role of HBPC programs is focused on fostering patient self-sufficiency rather than presenting practitioners as first responders. There was significant variability across the five sites in terms of which staff have responsibility for preparedness policies and training.ConclusionVariability across and within sites regarding how patient needs are addressed by preparedness policies, and in terms of preparedness training for HBPC providers, could place patients at heightened risk of morbidity or mortality following a disaster. Despite the diversity and uniqueness of HBPC programs and the communities they serve, there are basic aspects of preparedness that should be addressed by these programs. The incorporation of resources in assessment and preparedness activities, accompanied by increased communication among directors of HBPC programs across the country, may improve HBPC programs’ abilities to assist their patients and their caregivers in preparing for a disaster.ClaverML, Wyte-LakeT, DobalianA. Disaster preparedness in home-based primary care: policy and training. Prehosp Disaster Med. 2015;30(4):17.

Assessing Patients' Disaster Preparedness in Home-Based Primary Care

Gerontology ◽  
2016 ◽  
Vol 62 (3) ◽  
pp. 263-274 ◽  
Author(s):  
Tamar Wyte-Lake ◽  
Maria Claver ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Disaster Preparedness ◽  
Assessment Tools ◽  
High Rate ◽  
Veterans Health ◽  
Health Administration ◽  
Caregiver Support ◽  
Medical Needs ◽  
Home Based Primary Care ◽  
Home Based

Background: Chronic conditions paired with normal aging put home-bound individuals at risk of harm during a disaster. Because of their high rate of comorbidities, veterans receiving care from the Veterans Health Administration (VHA)'s home-based primary care (HBPC) program are especially vulnerable, which may prevent them from being prepared for disaster. With intimate knowledge of their patients' home environments, medical needs, resources, and limitations, HBPC practitioners are uniquely positioned to assess and improve disaster preparedness of patients. Objective: This study explored issues regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support routine assessment of disaster preparedness for patients as well as patient education activities. Methods: This project involved 32 semi-structured interviews with practitioners and leadership at 5 VHA HBPC programs - 3 urban and 2 rural. Transcripts of the interviews were analyzed using content analysis techniques. Results: Three themes emerged regarding the assessment of a patient's disaster preparedness: (1) assessment tools are rudimentary and, in some cases, individually developed by practitioners; (2) comprehension of criteria for assigning risk categories varies among practitioners, and (3) patients' cognitive impairment, limited resources, and out-of-date or inaccessible materials are the primary challenges to their preparedness. A fourth additional theme emerged as well: (4) the interdisciplinary nature of the HBPC team allows for unique innovative practices, such as a central focus on caregiver support and personal safety, as it relates to assessment and preparedness of the patient. Conclusion: Health and functional limitations may prevent home-bound patients from being adequately prepared for disasters. Standardized strategies and tools concerning disaster preparedness assessment for HBPC patients, which allow flexibility in consideration of factors such as local hazards, could assist in creating more comprehensive planning approaches and, in turn, more prepared persons. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel

Developing a Home-Based Primary Care Disaster Preparedness Toolkit

2016 ◽  
Vol 11 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Tamar Wyte-Lake ◽  
Maria Claver ◽  
Claudia Der-Martirosian ◽  
Darlene Davis ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Disaster Preparedness ◽  
Online Survey ◽  
Vital Role ◽  
Clinical Expertise ◽  
Veterans Health ◽  
Health Administration ◽  
Preparedness Plan ◽  
Home Based Primary Care ◽  
Home Based

AbstractObjectiveHealth agencies working with the homebound play a vital role in bolstering a community’s resiliency by improving the preparedness of this vulnerable population. Nevertheless, this role is one for which agencies lack training and resources, which leaves many homebound at heightened risk. This study examined the utility of an evidence-based Disaster Preparedness Toolkit in Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) programs.MethodsWe conducted an online survey of all VHA HBPC program managers (N=77/146; 53% response rate).ResultsRespondents with fewer years with the HBPC program rated the toolkit as being more helpful (P<0.05). Of those who implemented their program’s disaster protocol most frequently, two-thirds strongly agreed that the toolkit was relevant. Conversely, of those who implemented their disaster protocols very infrequently or never, 23% strongly agreed that the topics covered in the toolkit were relevant to their work (P<0.05).ConclusionThis toolkit helps support programs as they fulfill their preparedness requirements, especially practitioners who are new to their position in HBPC. Programs that implement disaster protocols infrequently may require additional efforts to increase understanding of the toolkit’s utility. Engaging all members of the team with their diverse clinical expertise could strengthen a patient’s personal preparedness plan. (Disaster Med Public Health Preparedness. 2017;11:56–63)

Perceived Effectiveness of Home-Based Primary Care Teams in Veterans Health Administration

2019 ◽  
Vol 60 (3) ◽  
pp. 494-502 ◽  
Author(s):  
Helena Temkin-Greener ◽  
Jill Szydlowski ◽  
Orna Intrator ◽  
Tobie Olsan ◽  
Jurgis Karuza ◽  
...  
Keyword(s):  
Primary Care ◽  
Team Effectiveness ◽  
Primary Care Providers ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Data Set ◽  
Indirect Measure ◽  
Home Based Primary Care ◽  
Home Based

Abstract Background and Objectives Previous studies have shown that staff perception of team effectiveness is related to better health outcomes in various care settings. This study focused on the Veterans Health Administration’s Home-Based Primary Care (HBPC) program. We examined variations in HBPC interdisciplinary teamwork (IDT) and identified modifiable team and program characteristics that may influence staff perceptions of team effectiveness. Research Design We used a broadly validated survey instrument to measure perceived team effectiveness, workplace conditions/resources, group culture, and respondents’ characteristics. Surveys were initiated in January and completed in July, 2016. Methods Team membership rosters (n = 249) included 2,852 IDT members. The final analytical data set included 1,403 surveys (49%) from 221 (89%) teams. A generalized estimating equation model with logit link function, weighted by survey response rates, was used to examine factors associated with perceived team effectiveness. Results Respondents who served as primary care providers (PCPs) were 8% more likely (p = .0044) to view team’s performance as highly effective compared to other team members. Teams with nurse practitioners serving as team leader reported 6% higher likelihood of high-perceived team effectiveness (p = .0234). High team effectiveness was 13% more likely in sites where the predominant culture was characterized as group/developmental, and 7%–8% more likely in sites with lower environmental stress and better resources and staffing, respectively. Conclusions and Implications Team effectiveness is an important indirect measure of HBPC teams’ function. HBPC teams should examine their predominant culture, workplace stress, resources and staffing, and PCP leadership model as part of their quality improvement efforts.

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 Hurricanes Harvey, Irma, and Maria: Exploring the Role of Home-Based Care Programs

2020 ◽  
Vol 14 (1) ◽  
pp. 119-124 ◽  
Author(s):  
Tamar Wyte-Lake ◽  
Maria Claver ◽  
Rachel Johnson-Koenke ◽  
Darlene Davis ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Disaster Preparedness ◽  
Veterans Health ◽  
Health Administration ◽  
Home Based Primary Care ◽  
Home Based ◽  
Complex Patients ◽  
Effective Program ◽  
Home Based Care

ABSTRACTObjective:The aim of this study is to determine the response of home-based primary care programs to the fall 2017 Atlantic hurricane season.Methods:This study examines the experiences of 9 Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) programs in their responses to Hurricanes Harvey, Irma, and Maria. Thirty-four phone interviews with HBPC leadership and staff were conducted from April to July 2018.Results:The total census of impacted HBPC programs was 3118. No program reported loss of life due to these hurricanes. Early preparedness was key to an effective program response. Response included prompt tracking of the patients. In the most affected areas, respondents noted limited resources to support basic patient needs.Conclusions:Medically complex patients served by programs such as the VHA’s HBPC program represent a subset of the population, yet they have an outsized impact on health care resources that could be exacerbated by inadequate disaster preparedness. HBPC programs serve a unique role in supporting the “older old.” They are tasked with supporting disaster preparedness activities of patients. Understanding what is involved in actualizing their requirements shows communities how to effectively engage with these programs.

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