scholarly journals Validation of an algorithm to identify heart failure hospitalisations in patients with diabetes within the veterans health administration

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020455 ◽  
Author(s):  
Caroline A Presley ◽  
Jea Young Min ◽  
Jonathan Chipman ◽  
Robert A Greevy ◽  
Carlos G Grijalva ◽  
...  
Keyword(s):  
Heart Failure ◽  
Healthcare System ◽  
Predictive Value ◽  
Decompensated Heart Failure ◽  
Veterans Health Administration ◽  
Secondary Outcome ◽  
Discharge Diagnosis ◽  
Veterans Health ◽  
Health Administration ◽  
Patients With Diabetes

ObjectivesWe aimed to validate an algorithm using both primary discharge diagnosis (International Classification of Diseases Ninth Revision (ICD-9)) and diagnosis-related group (DRG) codes to identify hospitalisations due to decompensated heart failure (HF) in a population of patients with diabetes within the Veterans Health Administration (VHA) system.DesignValidation study.SettingVeterans Health Administration—Tennessee Valley Healthcare SystemParticipantsWe identified and reviewed a stratified, random sample of hospitalisations between 2001 and 2012 within a single VHA healthcare system of adults who received regular VHA care and were initiated on an antidiabetic medication between 2001 and 2008. We sampled 500 hospitalisations; 400 hospitalisations that fulfilled algorithm criteria, 100 that did not. Of these, 497 had adequate information for inclusion. The mean patient age was 66.1 years (SD 11.4). Majority of patients were male (98.8%); 75% were white and 20% were black.Primary and secondary outcome measuresTo determine if a hospitalisation was due to HF, we performed chart abstraction using Framingham criteria as the referent standard. We calculated the positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity for the overall algorithm and each component (primary diagnosis code (ICD-9), DRG code or both).ResultsThe algorithm had a PPV of 89.7% (95% CI 86.8 to 92.7), NPV of 93.9% (89.1 to 98.6), sensitivity of 45.1% (25.1 to 65.1) and specificity of 99.4% (99.2 to 99.6). The PPV was highest for hospitalisations that fulfilled both the ICD-9 and DRG algorithm criteria (92.1% (89.1 to 95.1)) and lowest for hospitalisations that fulfilled only DRG algorithm criteria (62.5% (28.4 to 96.6)).ConclusionsOur algorithm, which included primary discharge diagnosis and DRG codes, demonstrated excellent PPV for identification of hospitalisations due to decompensated HF among patients with diabetes in the VHA system.

Outcomes of Ambulatory Upper Extremity Surgery Patients Discharged Home with Perineural Catheters from a Veterans Health Administration Medical Center

Pain Medicine ◽  
2019 ◽  
Vol 20 (11) ◽  
pp. 2256-2262 ◽  
Author(s):  
Roderick King ◽  
Edward R Mariano ◽  
Meghana Yajnik ◽  
Alex Kou ◽  
T Edward Kim ◽  
...  
Keyword(s):  
Health Care ◽  
Upper Extremity ◽  
Veterans Health Administration ◽  
Related Issue ◽  
Secondary Outcome ◽  
Veterans Health ◽  
Health Administration ◽  
Telephone Contact ◽  
Health Care Intervention ◽  
Care Intervention

Abstract Objective The feasibility and safety of managing ambulatory continuous peripheral nerve blocks (CPNB) in Veterans Health Administration (VHA) patients are currently unknown. We aimed to characterize the outcomes of a large VHA cohort of ambulatory upper extremity surgery patients discharged with CPNB and identify differences, if any, between catheter types. Methods With institutional review board approval, we reviewed data for consecutive patients from a single VHA hospital who had received ambulatory CPNB for upper extremity surgery from March 2011 to May 2017. The composite primary outcome was the occurrence of any catheter-related issue or additional all-cause health care intervention after discharge. Our secondary outcome was the ability to achieve regular daily telephone contact. Results Five hundred one patients formed the final sample. The incidence of any issue or health care intervention was 104/274 (38%) for infraclavicular, 58/185 (31%) for interscalene, and 14/42 (33%) for supraclavicular; these rates did not differ between groups. Higher ASA status was associated with greater odds of having any issue, whereas increasing age was slightly protective. Distance was associated with an increase in catheter-related issues (P < 0.01) but not additional health care interventions (P = 0.51). Only interscalene catheter patients (3%) reported breathing difficulty. Infraclavicular catheter patients had the most emergency room visits but rarely for CPNB issues. Consistent daily telephone contact was not achieved. Conclusions For VHA ambulatory CPNB patients, the combined incidence of a catheter-related issue or additional health care intervention was approximately one in three patients and did not differ by brachial plexus catheter type. Serious adverse events were generally uncommon.

scholarly journals Protocol for a mixed methods study of hospital readmissions: sensemaking in Veterans Health Administration healthcare system in the USA

BMJ Open ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. e020169
Author(s):  
Lauren S Penney ◽  
Luci K Leykum ◽  
Polly Noël ◽  
Erin P Finley ◽  
Holly Jordan Lanham ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Healthcare System ◽  
Hospital Readmissions ◽  
Veterans Health Administration ◽  
Mixed Methods Study ◽  
Veterans Health ◽  
Health Administration ◽  
The Usa

Predicting Risk of Hospitalization or Death Among Patients With Heart Failure in the Veterans Health Administration

2012 ◽  
Vol 110 (9) ◽  
pp. 1342-1349 ◽  
Author(s):  
Li Wang ◽  
Brian Porter ◽  
Charles Maynard ◽  
Christopher Bryson ◽  
Haili Sun ◽  
...  
Keyword(s):  
Heart Failure ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Patients With Heart Failure

Predicting outcomes among patients with atrial fibrillation and heart failure receiving anticoagulation with warfarin

2015 ◽  
Vol 114 (07) ◽  
pp. 70-77 ◽  
Author(s):  
Al Ozonoff ◽  
Elaine M. Hylek ◽  
Dan R. Berlowitz ◽  
Arlene S. Ash ◽  
Donald R. Miller ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Veterans Health Administration ◽  
Major Haemorrhage ◽  
Adverse Outcomes ◽  
Veterans Health ◽  
Health Administration ◽  
Hazard Ratios ◽  
Patients With Heart Failure ◽  
Risk Categories

SummaryAmong patients receiving oral anticoagulation for atrial fibrillation (AF), heart failure (HF) is associated with poor anticoagulation control. However, it is not known which patients with heart failure are at greatest risk of adverse outcomes. We evaluated 62,156 Veterans Health Administration (VA) patients receiving warfarin for AF between 10/1/06–9/30/08 using merged VA-Medicare dataset. We predicted time in therapeutic range (TTR) and rates of adverse events by categorising patients into those with 0, 1, 2, or 3+ of five putative markers of HF severity such as aspartate aminotransferase (AST)> 80 U/l, alkaline phosphatase> 150 U/l, serum sodium< 130 mEq/l, any receipt of metolazone, and any inpatient admission for HF exacerbation. These risk categories predicted TTR: patients without HF (referent) had a mean TTR of 65.0 %, while HF patients with 0, 1, 2, 3 or more markers had mean TTRs of 62.2 %, 57.2 %, 53.5 %, and 50.7 %, respectively (p< 0.001). These categories also discriminated for major haemorrhage well; compared to patients without HF, HF patients with increasing severity had hazard ratios of 1.84, 3.06, 3.52 and 5.14 respectively (p< 0.001). However, although patients with HF had an elevated hazard for bleeding compared to those without HF, these categories did not effectively discriminate risk of ischaemic stroke across HF. In conclusion, we developed a HF severity model using easily available clinical characteristics that performed well to risk-stratify patients with HF who are receiving anticoagulation for AF with regard to major haemorrhage.

scholarly journals Congestive heart failure information extraction framework for automated treatment performance measures assessment

2016 ◽  
Vol 24 (e1) ◽  
pp. e40-e46 ◽  
Author(s):  
Stéphane M Meystre ◽  
Youngjun Kim ◽  
Glenn T Gobbel ◽  
Michael E Matheny ◽  
Andrew Redd ◽  
...  
Keyword(s):  
Heart Failure ◽  
Veterans Health Administration ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Veterans Health ◽  
Health Administration ◽  
Reference Standard ◽  
Ventricular Ejection Fraction ◽  
High Recall ◽  
Treatment Performance

Objective: This paper describes a new congestive heart failure (CHF) treatment performance measure information extraction system – CHIEF – developed as part of the Automated Data Acquisition for Heart Failure project, a Veterans Health Administration project aiming at improving the detection of patients not receiving recommended care for CHF. Design: CHIEF is based on the Apache Unstructured Information Management Architecture framework, and uses a combination of rules, dictionaries, and machine learning methods to extract left ventricular function mentions and values, CHF medications, and documented reasons for a patient not receiving these medications. Measurements: The training and evaluation of CHIEF were based on subsets of a reference standard of various clinical notes from 1083 Veterans Health Administration patients. Domain experts manually annotated these notes to create our reference standard. Metrics used included recall, precision, and the F1-measure. Results: In general, CHIEF extracted CHF medications with high recall (&gt;0.990) and good precision (0.960–0.978). Mentions of Left Ventricular Ejection Fraction were also extracted with high recall (0.978–0.986) and precision (0.986–0.994), and quantitative values of Left Ventricular Ejection Fraction were found with 0.910–0.945 recall and with high precision (0.939–0.976). Reasons for not prescribing CHF medications were more difficult to extract, only reaching fair accuracy with about 0.310–0.400 recall and 0.250–0.320 precision. Conclusion: This study demonstrated that applying natural language processing to unlock the rich and detailed clinical information found in clinical narrative text notes makes fast and scalable quality improvement approaches possible, eventually improving management and outpatient treatment of patients suffering from CHF.

scholarly journals A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative

2017 ◽  
Vol 38 (5) ◽  
pp. 513-520 ◽  
Author(s):  
Allison A. Kelly ◽  
Makoto M. Jones ◽  
Kelly L. Echevarria ◽  
Stephen M. Kralovic ◽  
Matthew H. Samore ◽  
...  
Keyword(s):  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Antimicrobial Utilization ◽  
Before And After ◽  
Gram Negative Organisms ◽  
Proportional Distribution

OBJECTIVETo detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program.DESIGNObservational analysis.SETTINGThe VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities.METHODSUtilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities.RESULTSNationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection.CONCLUSIONSThe VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs.Infect Control Hosp Epidemiol 2017;38:513–520

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