Factors associated with internal medicine physician job attitudes in the Veterans Health Administration

Background: Carpal tunnel release (CTR) can be performed with a variety of anesthesia techniques. General anesthesia is associated with higher risk profile and increased resource utilization, suggesting it should not be routinely used for CTR. The purpose of this study was to examine the patient factors associated with surgeons’ requests for general anesthesia for CTR and the frequency of routine use of general anesthesia by Veterans Health Administration (VHA) surgeons and facilities. Methods: National VHA data for fiscal years 2015 and 2017 were used to identify patients receiving CTR. Mixed-effects logistic regression was used to evaluate patient, procedure, and surgeon factors associated with requests by the surgeon for general anesthesia versus other anesthesia techniques. Results: In all, 18 145 patients underwent CTR performed by 780 surgeons in 113 VHA facilities. Overall, there were 2218 (12.2%) requests for general anesthesia. Although some patient (eg, older age, obesity), procedure (eg, open vs endoscopic), and surgeon (eg, higher volume) factors were associated with lower odds of requests for general anesthesia, there was substantial facility- and surgeon-level variability. The percentage of patients with general anesthesia requested ranged from 0% to 100% across surgeons. Three facilities and 28 surgeons who performed at least 5 CTRs requested general anesthesia for more than 75% of patients. Conclusions: Where CTR is performed and by whom appear to influence requests for general anesthesia more than patient factors in this study. Avoidance of routine use of general anesthesia for CTR should be considered in future clinical practice guidelines and quality measures.

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Context Matters: Team and Organizational Factors Associated with Reach of Evidence-Based Psychotherapies for PTSD in the Veterans Health Administration

Administration and Policy in Mental Health and Mental Health Services Research ◽

10.1007/s10488-017-0809-y ◽

2017 ◽

Vol 44 (6) ◽

pp. 904-918 ◽

Cited By ~ 25

Author(s):

Nina A. Sayer ◽

Craig S. Rosen ◽

Nancy C. Bernardy ◽

Joan M. Cook ◽

Robert J. Orazem ◽

...

Keyword(s):

Organizational Factors ◽

Veterans Health Administration ◽

Evidence Based ◽

Veterans Health ◽

Health Administration ◽

Factors Associated

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Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

JAMA Network Open ◽

10.1001/jamanetworkopen.2021.30581 ◽

2021 ◽

Vol 4 (10) ◽

pp. e2130581

Author(s):

Linnaea Schuttner ◽

Bjarni Haraldsson ◽

Charles Maynard ◽

Christian D. Helfrich ◽

Ashok Reddy ◽

...

Keyword(s):

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Factors Associated ◽

Cancer Screenings

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Factors Associated With Missed and Cancelled Colonoscopy Appointments at Veterans Health Administration Facilities

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2015.07.051 ◽

2016 ◽

Vol 14 (2) ◽

pp. 259-267 ◽

Cited By ~ 25

Author(s):

Melissa R. Partin ◽

Amy Gravely ◽

Ziad F. Gellad ◽

Sean Nugent ◽

James F. Burgess ◽

...

Keyword(s):

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Factors Associated

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1353. Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1545 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S763-S764

Author(s):

Shimrit Keddem ◽

Marissa Maier ◽

Carolyn Gardella ◽

Joleen Borgerding ◽

Elliott Lowy ◽

...

Keyword(s):

Sexual Trauma ◽

Women Veterans ◽

Veterans Health Administration ◽

Military Sexual Trauma ◽

Veterans Health ◽

Health Administration ◽

Infection Rates ◽

Factors Associated ◽

Chlamydia Testing ◽

Case Rate

Abstract Background United States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans have many risk factors associated with STIs, including high rates of childhood sexual assault, military sexual trauma and intimate partner violence. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans. Methods We performed a retrospective cohort study of all women Veterans in Veterans Health Administration (VHA) care between January 1, 2018 and December 31, 2019 to examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the VHA in 2019. Results Among women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, predictors of testing in women under age 25 included Black race (aOR: 2.11 CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05 CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (Chlamydia case rate: 265, Gonorrhea case rate: 97/100,000) and those with mental health diagnoses (Chlamydia case rate: 263, Gonorrhea case rate: 72/100,000.) Over a third of chlamydia cases (35.2%) and gonorrhea cases (35.5%) occurred in women who resided in the South Atlantic census division. Chlamydia cases per 100,000 women Veterans seen in VHA (2019) Gonorrhea cases per 100,000 women Veterans seen in VHA (2019) Conclusion Gonorrhea and chlamydia testing remains underutilized among women in the VHA and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates. Disclosures All Authors: No reported disclosures

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