Surgical Quality Programs in the Veterans Health Administration

This review describes the development, implementation, and current status of programs that promote and maintain surgical quality performance within the Department of Veterans Affairs, Veterans Health Administration (VHA). It also considers evolving initiatives to improve surgical outcomes and enhance patient safety. The VHA is a nationwide health care system operated and funded by the federal government. It consists of 154 federal hospitals and 875 clinics staffed by 16,000 nurses, 33,000 other health care professionals, 15,000 doctors, and 25,000 university-affiliated faculty physicians. The VHA trains 90,000 health care professionals, and additionally its activities are supported by 140,000 dedicated volunteers. More than 1000 surgeons in all specialties serve in its facilities. Since these programs began more than 19 years ago, there has been a steady decrease in both risk-adjusted and actual mortality rates tracked annually.

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Transformation of the US Veterans Health Administration

Health Economics Policy and Law ◽

10.1017/s1744133105001222 ◽

2006 ◽

Vol 1 (2) ◽

pp. 99-105 ◽

Cited By ~ 12

Author(s):

Jonathan B. Perlin

Keyword(s):

United States ◽

Health Care ◽

Veterans Health Administration ◽

The United States ◽

Veterans Affairs ◽

United States Department ◽

Veterans Health ◽

Department Of Veterans Affairs ◽

Health Administration ◽

The Us

Ten years ago, it would have been hard to imagine the publication of an issue of a scholarly journal dedicated to applying lessons from the transformation of the United States Department of Veterans Affairs Health System to the renewal of other countries' national health systems. Yet, with the recent publication of a dedicated edition of the Canadian journal Healthcare Papers (2005), this actually happened. Veterans Affairs health care also has been similarly lauded this past year in the lay press, being described as ‘the best care anywhere’ in the Washington Monthly, and described as ‘top-notch healthcare’ in US News and World Report's annual health care issue enumerating the ‘Top 100 Hospitals’ in the United States (Longman, 2005; Gearon, 2005).

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Adaptive Control of Modular Ankle Exoskeletons in Neurologically Disabled Populations#This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, VA Maryland Health Care System, Baltimore VA Medical Center.

Adaptive Control for Robotic Manipulators ◽

10.1201/9781315166056-10 ◽

2016 ◽

pp. 172-207

Author(s):

Roy Anindo ◽

Larry Forrester ◽

Richard Macko

Keyword(s):

Health Care ◽

Adaptive Control ◽

Research And Development ◽

Health Care System ◽

Medical Center ◽

Veterans Health Administration ◽

Veterans Affairs ◽

Veterans Health ◽

Department Of Veterans Affairs ◽

Health Administration

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Development of Predictive Informatics Tool Using Electronic Health Records to Inform Personalized Evidence-Based Pressure Injury Management for Veterans with Spinal Cord Injury

Military Medicine ◽

10.1093/milmed/usaa469 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 651-658

Author(s):

Kath M Bogie ◽

Steven K Roggenkamp ◽

Ningzhou Zeng ◽

Jacinta M Seton ◽

Katelyn R Schwartz ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Spinal Cord ◽

Spinal Cord Injury ◽

User Interface ◽

Veterans Health Administration ◽

Study Cohort ◽

Veterans Health ◽

Health Administration ◽

Cord Injury

ABSTRACT Background Pressure injuries (PrI) are serious complications for many with spinal cord injury (SCI), significantly burdening health care systems, in particular the Veterans Health Administration. Clinical practice guidelines (CPG) provide recommendations. However, many risk factors span multiple domains. Effective prioritization of CPG recommendations has been identified as a need. Bioinformatics facilitates clinical decision support for complex challenges. The Veteran’s Administration Informatics and Computing Infrastructure provides access to electronic health record (EHR) data for all Veterans Health Administration health care encounters. The overall study objective was to expand our prototype structural model of environmental, social, and clinical factors and develop the foundation for resource which will provide weighted systemic insight into PrI risk in veterans with SCI. Methods The SCI PrI Resource (SCI-PIR) includes three integrated modules: (1) the SCIPUDSphere multidomain database of veterans’ EHR data extracted from October 2010 to September 2015 for ICD-9-CM coding consistency together with tissue health profiles, (2) the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) developed from the cohort’s free text clinical note (Text Integration Utility) notes, and (3) the clinical user interface for direct SCI-PIR query. Results The SCI-PIR contains relevant EHR data for a study cohort of 36,626 veterans with SCI, representing 10% to 14% of the U.S. population with SCI. Extracted datasets include SCI diagnostics, demographics, comorbidities, rurality, medications, and laboratory tests. Many terminology variations for non-coded input data were found. SCIPUDO facilitates robust information extraction from over six million Text Integration Utility notes annually for the study cohort. Visual widgets in the clinical user interface can be directly populated with SCIPUDO terms, allowing patient-specific query construction. Conclusion The SCI-PIR contains valuable clinical data based on CPG-identified risk factors, providing a basis for personalized PrI risk management following SCI. Understanding the relative impact of risk factors supports PrI management for veterans with SCI. Personalized interactive programs can enhance best practices by decreasing both initial PrI formation and readmission rates due to PrI recurrence for veterans with SCI.

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Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System

BMC Health Services Research ◽

10.1186/s12913-021-06536-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rachel Sayko Adams ◽

Esther L. Meerwijk ◽

Mary Jo Larson ◽

Alex H. S. Harris

Keyword(s):

Mental Health ◽

Health Care ◽

Chronic Pain ◽

Veterans Health Administration ◽

First Year ◽

Veterans Health ◽

Health Administration ◽

Military Health System ◽

Military Health ◽

The Military

Abstract Background Chronic pain presents a significant burden for both federal health care systems designed to serve combat Veterans in the United States (i.e., the Military Health System [MHS] and Veterans Health Administration [VHA]), yet there have been few studies of Veterans with chronic pain that have integrated data from both systems of care. This study examined 1) health care utilization in VHA as an enrollee (i.e., linkage to VHA) after military separation among soldiers with postdeployment chronic pain identified in the MHS, and predictors of linkage, and 2) persistence of chronic pain among those utilizing the VHA. Methods Observational, longitudinal study of soldiers returning from a deployment in support of the Afghanistan/Iraq conflicts in fiscal years 2008–2014. The analytic sample included 138,206 active duty soldiers for whom linkage to VHA was determined through FY2019. A Cox proportional hazards model was estimated to examine the effects of demographic characteristics, military history, and MHS clinical characteristics on time to linkage to VHA after separation from the military. Among the subpopulation of soldiers who linked to VHA, we described whether they met criteria for chronic pain in the VHA and pain management treatments received during the first year in VHA. Results The majority (79%) of soldiers within the chronic pain cohort linked to VHA after military separation. Significant predictors of VHA linkage included: VHA utilization as a non-enrollee prior to military separation, separating for disability, mental health comorbidities, and being non-Hispanic Black or Hispanic. Soldiers that separated because of misconduct were less likely to link than other soldiers. Soldiers who received nonpharmacological treatments, opioids/tramadol, or mental health treatment in the MHS linked earlier to VHA than soldiers who did not receive these treatments. Among those who enrolled in VHA, during the first year after linking to the VHA, 49.7% of soldiers met criteria for persistent chronic pain in VHA. Conclusions The vast majority of soldiers identified with chronic pain in the MHS utilized care within VHA after military separation. Careful coordination of pain management approaches across the MHS and VHA is required to optimize care for soldiers with chronic pain.

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Evaluation of Mobile Tablet Computers for Use in the Veterans Health Administration

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857919081004 ◽

2019 ◽

Vol 8 (1) ◽

pp. 18-22

Author(s):

Jennifer Herout ◽

Kathleen L. Frisbee ◽

Nancy R. Wilck ◽

Margo Kabel ◽

Deyne Bentt ◽

...

Keyword(s):

Veterans Health Administration ◽

Clinical Settings ◽

Veterans Health ◽

Department Of Veterans Affairs ◽

Health Administration ◽

Clinical Environment ◽

Healthcare Organizations ◽

Advantages And Disadvantages ◽

Facilitators And Barriers ◽

Device Use

The Veterans Health Administration (VHA) within the Department of Veterans Affairs (VA) was interested in determining how mobile tablets may be perceived by clinicians for use in clinical settings. Therefore, we conducted an evaluation to assess how performance might differ between two devices and to gather feedback on device use. We conducted a within-subject comparison with 32 clinicians involving a usability test and two questionnaires. Qualitative data was organized around eight themes: facilitators and barriers to tablet use, observations of physical use, device specific advantages and disadvantages, and the Patient Viewer mobile application. Clinicians envisioned many facilitators to tablet use, but also voiced some concerns. Participants rated one device significantly better than the other for questionnaire items related to ‘Access and Efficiency’, ‘Introduction into the Clinical Environment’, ‘Usability and Usefulness’, and ‘Desire to Use’. Results can be used by mobile health app developers, healthcare organizations considering device purchases, and researchers conducting studies on tablets to inform respective work.

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