A cross-sectional view of radiation fractionation schemes used for painful bone metastases (PBM) cases within the Veterans Health Administration Radiation Oncology Centers.

177 Background: Though the use of single fraction (SF) radiotherapy in the treatment of PBM is an integral component of frontline palliative radiotherapy in Canada and Europe ((Popovic - Radiotherapy and Oncology 111 (2014) 11–17), its use in the United States is only now gaining clinical acceptance. Recently, VHA Radiation Oncologists reported that roughly 76% offer SF to patients with a limited life expectancy (J Palliat Med. 2014 Nov;17(11):1221-5). In this cross-sectional report, we examine the actual dose fractionation schemes used for PBM cases by VHA Radiation Oncologists. Methods: METHOD: An electronic request was sent to 38 of 39 active VHA RO centers asking them to provide the radiation dose fractionation scheme used in the last 10 of their cases of PBM - (International Classification of Diseases (ICD) 198.5 - secondary malignancy of bone and or bone marrow). The study period: 03/01/2015 to 03/16/2015; Response rate: 100%. Data was provided for 382 cases . The survey results were divided by regions, and the 18 Veterans Integrated Service Networks (VISN) w/ VHA RO Centers. Results: RESULTS: According to the 382 cases analyzed, the top 3 fractionation schemes used were: 1st 300cGy x 10 (169); 2nd 800cGy x 1 (69); 3rd 400cGy x5 (63). Overall, SFRT was used in 18% of cases reviewed. There was, however, substantial variation across Veterans Health Administration. While radiation oncology practices in four Veterans Integrated Service Networks (VISN) used SFRT in 50% or more of their reported cases, practices in seven VISNs used SFRT in only 10% or fewer cases. Single fractions and Hypofractionation (3-7) was more common, comprising 45% of the cases. Conclusions: Compared to prior published data, these results suggest that in addition to our previously reported wide availability of hypofractionation for Veterans receiving palliation, actual increased use of Single Fraction and Hypofractionated radiotherapy for PBM is now common within the VHA. VHA RO are using SFRT per the ASTRO 2013 Choosing Wisely Campaign. [Table: see text]

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Use of risk-adjusted change in health status to assess the performance of integrated service networks in the Veterans Health Administration

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzi080 ◽

2005 ◽

Vol 18 (1) ◽

pp. 43-50 ◽

Cited By ~ 4

Author(s):

Alfredo J. Selim ◽

Dan Berlowitz ◽

Graeme Fincke ◽

William Rogers ◽

Shirley Qian ◽

...

Keyword(s):

Health Status ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Service Networks ◽

Integrated Service

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Supporting the Implementation of Connected Care Technologies in the Veterans Health Administration: Cross-Sectional Survey Findings from the Veterans Engagement with Technology Collaborative (VET-C) Cohort

Journal of Participatory Medicine ◽

10.2196/21214 ◽

2020 ◽

Vol 12 (3) ◽

pp. e21214

Author(s):

Bella Etingen ◽

Daniel J Amante ◽

Rachael N Martinez ◽

Bridget M Smith ◽

Stephanie L Shimada ◽

...

Keyword(s):

Health Care ◽

Quality Improvement ◽

Veterans Health Administration ◽

Advanced Degree ◽

Patient Portal ◽

Veterans Health ◽

Health Administration ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Clinical Records

Background Widespread adoption, use, and integration of patient-facing technologies into the workflow of health care systems has been slow, thus limiting the realization of their potential. A growing body of work has focused on how best to promote adoption and use of these technologies and measure their impacts on processes of care and outcomes. This body of work currently suffers from limitations (eg, cross-sectional analyses, limited patient-generated data linked with clinical records) and would benefit from institutional infrastructure to enhance available data and integrate the voice of the patient into implementation and evaluation efforts. Objective The Veterans Health Administration (VHA) has launched an initiative called the Veterans Engagement with Technology Collaborative cohort to directly address these challenges. This paper reports the process by which the cohort was developed and describes the baseline data being collected from cohort members. The overarching goal of the Veterans Engagement with Technology Collaborative cohort is to directly engage veterans in the evaluation of new VHA patient-facing technologies and in so doing, to create new infrastructure to support related quality improvement and evaluation activities. Methods Inclusion criteria for veterans to be eligible for membership in the cohort included being an active user of VHA health care services, having a mobile phone, and being an established user of existing VHA patient-facing technologies as represented by use of the secure messaging feature of VHA’s patient portal. Between 2017 and 2018, we recruited veterans who met these criteria and administered a survey to them over the telephone. Results The majority of participants (N=2727) were male (2268/2727, 83.2%), White (2226/2727, 81.6%), living in their own apartment or house (2519/2696, 93.4%), and had completed some college (1176/2701, 43.5%) or an advanced degree (1178/2701, 43.6%). Cohort members were 59.9 years old, on average. The majority self-reported their health status as being good (1055/2725, 38.7%) or very good (524/2725, 19.2%). Most cohort members owned a personal computer (2609/2725, 95.7%), tablet computer (1616/2716, 59.5%), and/or smartphone (2438/2722, 89.6%). Conclusions The Veterans Engagement with Technology Collaborative cohort is an example of a VHA learning health care system initiative designed to support the data-driven implementation of patient-facing technologies into practice and measurement of their impacts. With this initiative, VHA is building capacity for future, rapid, rigorous evaluation and quality improvement efforts to enhance understanding of the adoption, use, and impact of patient-facing technologies.

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Doctoral-prepared nurses in the Veterans Health Administration: A cross-sectional survey

Journal of Professional Nursing ◽

10.1016/j.profnurs.2019.06.008 ◽

2020 ◽

Vol 36 (1) ◽

pp. 62-68 ◽

Cited By ~ 3

Author(s):

Deborah Rugs ◽

Blake Barrett ◽

Margeaux Chavez ◽

Linda Cowan ◽

Christine Melillo ◽

...

Keyword(s):

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Cross Sectional Survey ◽

Cross Sectional

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Lung Cancer Staging at Diagnosis in the Veterans Health Administration: Is Rurality an Influencing Factor? A Cross‐Sectional Study

The Journal of Rural Health ◽

10.1111/jrh.12429 ◽

2020 ◽

Vol 36 (4) ◽

pp. 484-495

Author(s):

Rolando Sanchez ◽

Yunshu Zhou ◽

Mary S. Vaughan Sarrazin ◽

Peter J. Kaboli ◽

Mary Charlton ◽

...

Keyword(s):

Lung Cancer ◽

Influencing Factor ◽

Cancer Staging ◽

Veterans Health Administration ◽

Cross Sectional Study ◽

Veterans Health ◽

Health Administration ◽

Sectional Study ◽

Cross Sectional

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Personal Health Record Reach in the Veterans Health Administration: A Cross-Sectional Analysis

Journal of Medical Internet Research ◽

10.2196/jmir.3751 ◽

2014 ◽

Vol 16 (12) ◽

pp. e272 ◽

Cited By ~ 23

Author(s):

Stephanie Leah Shimada ◽

Cynthia A Brandt ◽

Hua Feng ◽

D Keith McInnes ◽

Sowmya R Rao ◽

...

Keyword(s):

Personal Health Record ◽

Veterans Health Administration ◽

Personal Health ◽

Health Record ◽

Veterans Health ◽

Health Administration ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions

Kidney360 ◽

10.34067/kid.0000642021 ◽

2021 ◽

Vol 2 (12) ◽

pp. 1928-1944

Author(s):

Lindsey A. Jones ◽

Elisa J. Gordon ◽

Timothy P. Hogan ◽

Cindi A. Fiandaca ◽

Bridget M. Smith ◽

...

Keyword(s):

Cognitive Skills ◽

Informal Caregivers ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Psychosocial Effects ◽

Cross Sectional ◽

Content Type ◽

Home Dialysis ◽

Data Feedback

BackgroundHome dialysis confers similar survival and greater quality of life than in-center hemodialysis for adults with ESKD but remains underutilized. We examined challenges and facilitators to implementation of home dialysis and identified stakeholder-centered strategies for improving it.MethodsWe conducted a qualitative, cross-sectional, multisite evaluation that included five geographically dispersed Veterans Health Administration (VHA) home dialysis programs. Participants included patients with ESKD receiving home dialysis, their informal caregivers, and home dialysis staff. Semistructured telephone interviews were conducted and audio-recorded from 2017 through 2018, to assess perceived barriers and facilitators to patient home dialysis use in VHA. Transcribed interviews were analyzed thematically by each participant group.ResultsParticipants included 22 patients receiving home dialysis (18 on peritoneal dialysis [PD] and four hemodialysis [HD]); 20 informal caregivers, and 19 home dialysis program staff. Ten themes emerged as challenges to implementing home dialysis, of which six (60%) spanned all groups: need for sterility, burden of home dialysis tasks, lack of suitable home environment, physical side effects of home dialysis, negative psychosocial effects of home dialysis, and loss of freedom. Four themes (40%), identified only by staff, were insufficient self-efficacy, diminished peer socialization, geographic barriers, and challenging health status. Twelve themes emerged as facilitators to implementing home dialysis, of which seven (58%) spanned all groups: convenience, freedom, avoidance of in-center HD, preservation of autonomy, adequate support, favorable disposition, and perceptions of improved health. Two themes (17%) common among patients and staff were adequate training and resources, and physical and cognitive skills for home dialysis. Recommendations to promote implementation of home dialysis common to all participant groups entailed incorporating mental health care services, offering peer-to-peer coaching, increasing home visits, providing health data feedback, and reducing patient burden.ConclusionsStakeholder-centered challenges were rigorously identified. Facilitators and recommendations can inform efforts to support home dialysis implementation.

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