Palliative Radiotherapy Within the Veterans Health Administration: Barriers to Referral and Timeliness of Treatment

PURPOSE: Most Veterans Health Administration hospitals do not have radiation oncology (RO) departments on-site. The purpose of this study is to determine the impact of on-site RO on referral patterns and timeliness of palliative radiation therapy (PRT). MATERIALS AND METHODS: A survey was sent to medical directors at 149 Veterans Health Administration centers. Questions evaluated frequency of referral for PRT, timeliness of RO consults and treatment, and barriers to referral for PRT. Chi-square analysis was used to evaluate differences between centers that have on-site RO and centers that refer to outside facilities. RESULTS: Of 108 respondents, 33 (31%) have on-site RO. Chi-square analysis revealed that RO consult within 1 week is more likely at centers with on-site RO (68% v 31%; P = .01). Centers with on-site RO more frequently deliver PRT for spinal cord compression within 24 hours (94% v 70%; P = .01). Those without on-site RO were more likely to want increased radiation oncologist involvement (64% v 26%; P < .001). Barriers to referral for PRT included patient ability to travel (81%), patient noncompliance (31%), delays in consult and/or treatment (31%), difficulty contacting a radiation oncologist (14%), and concern regarding excessive number of treatments (13%). Respondents with on-site RO less frequently reported delays in consult and/or treatment (6% v 41%; P < .0001) and difficulty contacting a radiation oncologist (0% v 20%; P = .0056) as barriers. CONCLUSION: Respondents with on-site RO reported improved communication with radiation oncologists and more timely consultation and treatment initiation. Methods to improve timeliness of PRT for veterans at centers without on-site RO should be considered.

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The Veterans Health Administration: A Preliminary Analysis of the Influence of The Independent Budget and Bureaucratic Performance on Funding Trends

Policy Perspectives ◽

10.4079/pp.v15i1.4151 ◽

2008 ◽

Vol 15 (1) ◽

pp. 5

Author(s):

Elizabeth Kidder

Keyword(s):

Veterans Health Administration ◽

Service Organizations ◽

The Political ◽

Veterans Health ◽

Health Administration ◽

The Past ◽

Bureaucratic Performance ◽

The Cost ◽

The Impact

The Veterans Health Administration (VHA) is the largest integrated health system in the U.S. with 7.9 million U.S. veterans enrolled. Both the number of veterans seeking VHA health services and the cost of delivering such services continue to rise as a result of myriad factors. Kidder examines VHA funding outcomes over the past 10 years in light of the participation of veterans' service organizations (VSOs) in committee hearings; the reliance of lawmakers upon The Independent Budget (IB); and the impact of new performance-based management initiatives on budget outcomes. Her article highlights the political nature of the VHA budget and the influential role of VSOs in funding outcomes.

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Racial and ethnic disparities in use of a personal health record by veterans living with HIV

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocz024 ◽

2019 ◽

Vol 26 (8-9) ◽

pp. 696-702 ◽

Cited By ~ 4

Author(s):

Sarah J Javier ◽

Lara K Troszak ◽

Stephanie L Shimada ◽

D Keith McInnes ◽

Michael E Ohl ◽

...

Keyword(s):

Personal Health Record ◽

Ethnic Disparities ◽

Veterans Health Administration ◽

Personal Health ◽

Health Record ◽

Racial And Ethnic Disparities ◽

Veterans Health ◽

Health Administration ◽

Chi Square ◽

Living With Hiv

Abstract Objective To examine sociodemographic characteristics associated with use of My HealtheVet (MHV) by veterans living with HIV. Materials and Methods Veterans Health Administration administrative data were used to identify a cohort of veterans living with HIV in fiscal years 2011–2017. Descriptive analyses were conducted to examine demographic characteristics and racial/ethnic differences in MHV registration and tool use. Chi-Square tests were performed to assess associations between race/ethnicity and MHV registration and tool use. Results The highest proportion of registrants were non-Hispanic White veterans living with HIV (59%), followed by Hispanic/Latino (55%) and Black veterans living with HIV (40%). Chi-Square analyses revealed that: (1) MHV account registration was significantly lower for both Black and Hispanic/Latino veterans in comparison to White veterans and (2) Black MHV registrants were less likely to utilize any MHV tool compared with White MHV registrants including Blue Button record download, medication refills, secure messaging, lab, and appointment views. Discussion In line with prior research on personal health record (PHR) use among non-veteran populations, these findings show racial and ethnic inequities in MHV use among veterans living with HIV. Racial and ethnic minorities may be less likely to use PHRs for a myriad of reasons, including PHR privacy concerns, decreased educational attainment, and limited access to the internet. Conclusion This is the first study to examine racial and ethnic disparities in use of MHV tools by veterans living with HIV and utilizing Veterans Health Administration health care. Future research should examine potential moderating factors linked to decreased PHR use among racial and ethnic minority veterans, which could inform strategies to increase PHR use among vulnerable populations.

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The Impact of the 2004–2005 Influenza Vaccine Shortage in the Veterans Health Administration

Journal of General Internal Medicine ◽

10.1007/s11606-007-0249-6 ◽

2007 ◽

Vol 22 (8) ◽

pp. 1132-1138 ◽

Cited By ~ 1

Author(s):

Leila C. Kahwati ◽

John R. Elter ◽

Kristy A. Straits-Tröster ◽

Linda S. Kinsinger ◽

Victoria J. Davey

Keyword(s):

Influenza Vaccine ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

The Impact ◽

Vaccine Shortage

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The Veterans Health Administration Whole Health Model of Care: Early Implementation and Utilization at a Large Healthcare System

Military Medicine ◽

10.1093/milmed/usaa198 ◽

2020 ◽

Vol 185 (11-12) ◽

pp. e2150-e2157

Author(s):

William R Marchand ◽

Julie Beckstrom ◽

Elena Nazarenko ◽

Renn U Sweeny ◽

Tracy Herrmann ◽

...

Keyword(s):

Tertiary Care ◽

Treatment Engagement ◽

Veterans Health Administration ◽

Successful Implementation ◽

Veterans Health ◽

Health Administration ◽

Model Of Care ◽

Chi Square ◽

Early Implementation ◽

The Way

Abstract Introduction The U.S. Veterans Health Administration (VHA) is changing the way it provides healthcare to a model known as Whole Health (WH). The aim is to shift from a primarily medical/disease-oriented system to a model that focuses on health promotion and disease prevention; utilizes personalized, proactive, and patient-driven care; and emphasizes the use of complementary and integrative health. This investigation aimed to examine referral and utilization patterns in early implementation at tertiary care VHA medical care system. Specific aims were to evaluate (1) referral patterns, (2) initial treatment engagement, and (3) continuity of treatment engagement. Materials and methods This is an institutional review board-approved, retrospective study of the first 561 veterans referred to WH programming in the first 20 months of implementation. Data analyses included a chi-square goodness of fit to compare demographics of veterans who were referred to WH Services with those of local patient population. At this facility, WH offers services in three tracks (General WH, Mindfulness Center [MC], and WH Nutrition), which offer unique services to veterans. A chi-square test for independence was conducted to analyze differences in initial engagement among the WH components, in referrals and retention among WH components by time period, and in demographics or diagnoses among self-referred or veterans referred by a consult. Finally, a regression model was used to assess for predictive factors that might influence continuity of treatment engagement across all the WH tracks. Results Key findings indicated potential implementation challenges including disproportionate numbers of referrals from clinical services; poor initial and ongoing treatment engagement; and older, male, and non-service-connected Veterans being less likely to be referred. Conclusion Implementation of the WH model of care has the potential to transform the way VHA delivers healthcare and improve the health and lives of veterans. However, a shift of this magnitude is likely to face challenges during implementation. This article reports on initial barriers to implementation, which can guide implementation at other sites as well as future investigations. Further research is needed to replicate these results as well as to determine underlying causal factors. However, if replicated, these results indicate that successful implementation of WH, or similar models of care, will require extensive efforts focused on outreach to, and education of, facility providers and certain patient demographic groups. Finally, efforts will be required to enhance treatment engagement.

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