Population genealogy resource shows evidence of familial clustering for Alzheimer disease

ObjectiveTo show the potential of a resource consisting of a genealogy of the US record linked to National Veterans Health Administration (VHA) patient data for investigation of the genetic contribution to health-related phenotypes, we present an analysis of familial clustering of VHA patients diagnosed with Alzheimer disease (AD).MethodsPatients with AD were identified by the International Classification of Diseases code. The Genealogical Index of Familiality method was used to compare the average relatedness of VHA patients with AD with expected relatedness. Relative risks for AD were estimated in first- to fifth- degree relatives of patients with AD using population rates for AD.ResultsEvidence for significant excess relatedness and significantly elevated risks for AD in relatives was observed; multiple pedigrees with a significant excess of VHA patients with AD were identified.ConclusionsThis analysis of AD shows the nascent power of the US Veterans Genealogy Resource, in early stages, to provide evidence for familial clustering of multiple phenotypes, and shows the utility of this VHA genealogic resource for future genetic studies.

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Modern Look at Transverse Myelitis and Inflammatory Myelopathy

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000001071 ◽

2021 ◽

Vol 8 (6) ◽

pp. e1071

Author(s):

Justin R. Abbatemarco ◽

Jonathan R. Galli ◽

Michael L. Sweeney ◽

Noel G. Carlson ◽

Verena C. Samara ◽

...

Keyword(s):

Transverse Myelitis ◽

Population Level ◽

International Classification Of Diseases ◽

Mortality Data ◽

Veterans Health ◽

Health Administration ◽

Level Data ◽

High Prevalence ◽

Classification Of Diseases

Background and ObjectivesTo characterize population-level data associated with transverse myelitis (TM) within the US Veterans Health Administration (VHA).MethodsThis retrospective review used VHA electronic medical record from 1999 to 2015. We analyzed prevalence, disease characteristics, modified Rankin Scale (mRS) scores, and mortality data in patients with TM based on the 2002 Diagnostic Criteria.ResultsWe identified 4,084 patients with an International Classification of Diseases (ICD) code consistent with TM and confirmed the diagnosis in 1,001 individuals (90.7% males, median age 64.2, 67.7% Caucasian, and 31.4% smokers). The point prevalence was 7.86 cases per 100,000 people. Less than half of the cohort underwent a lumbar puncture, whereas only 31.8% had a final, disease-associated TM diagnosis. The median mRS score at symptom onset was 3 (interquartile range 2–4), which remained unchanged at follow-up, although less than half (43.2%) of the patients received corticosteroids, IVIg, or plasma exchange. Approximately one-quarter of patients (24.3%) had longitudinal extensive TM, which was associated with poorer outcomes (p = 0.002). A total of 108 patients (10.8%) died during our review (94.4% males, median age 66.5%, and 70.4% Caucasian). Mortality was associated with a higher mRS score at follow-up (OR 1.94, 95% CI, 1.57–2.40) and tobacco use (OR 1.87, 95% CI, 1.17–2.99).DiscussionThis national TM review highlights the relatively high prevalence of TM in a modern cohort. It also underscores the importance of a precise and thorough workup in this disabling disorder to ensure diagnostic precision and ensure optimal management for patients with TM in the future.

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Development and validation of an electronic medical record (EMR)-based computed phenotype of HIV-1 infection

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocx061 ◽

2017 ◽

Vol 25 (2) ◽

pp. 150-157 ◽

Cited By ~ 4

Author(s):

Devon W Paul ◽

Nigel B Neely ◽

Meredith Clement ◽

Isaretta Riley ◽

Mashael Al-Hegelan ◽

...

Keyword(s):

Hiv Infection ◽

Medical Record ◽

Electronic Medical Record ◽

Sensitivity And Specificity ◽

International Classification Of Diseases ◽

Veterans Health ◽

Health Administration ◽

Classification Of Diseases ◽

Novel Algorithms ◽

Sensitivity Specificity

Abstract Background Electronic medical record (EMR) computed algorithms allow investigators to screen thousands of patient records to identify specific disease cases. No computed algorithms have been developed to detect all cases of human immunodeficiency virus (HIV) infection using administrative, laboratory, and clinical documentation data outside of the Veterans Health Administration. We developed novel EMR-based algorithms for HIV detection and validated them in a cohort of subjects in the Duke University Health System (DUHS). Methods We created 2 novel algorithms to identify HIV-infected subjects. Algorithm 1 used laboratory studies and medications to identify HIV-infected subjects, whereas Algorithm 2 used International Classification of Diseases, Ninth Revision (ICD-9) codes, medications, and laboratory testing. We applied the algorithms to a well-characterized cohort of patients and validated both against the gold standard of physician chart review. We determined sensitivity, specificity, and prevalence of HIV between 2007 and 2011 in patients seen at DUHS. Results A total of 172 271 patients were detected with complete data; 1063 patients met algorithm criteria for HIV infection. In all, 970 individuals were identified by both algorithms, 78 by Algorithm 1 alone, and 15 by Algorithm 2 alone. The sensitivity and specificity of each algorithm were 78% and 99%, respectively, for Algorithm 1 and 77% and 100% for Algorithm 2. The estimated prevalence of HIV infection at DUHS between 2007 and 2011 was 0.6%. Conclusions EMR-based phenotypes of HIV infection are capable of detecting cases of HIV-infected adults with good sensitivity and specificity. These algorithms have the potential to be adapted to other EMR systems, allowing for the creation of cohorts of patients across EMR systems.

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Association between hemoglobin A1c variability and hypoglycemia-related hospitalizations in veterans with diabetes mellitus

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001797 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001797

Author(s):

Molly J Y Zhao ◽

Julia C Prentice ◽

David C Mohr ◽

Paul R Conlin

Keyword(s):

Diabetes Mellitus ◽

Hemoglobin A1c ◽

Severe Hypoglycemia ◽

International Classification Of Diseases ◽

Baseline Period ◽

Veterans Health ◽

Health Administration ◽

Classification Of Diseases ◽

The Impact

IntroductionTo study the impact of hemoglobin A1c (A1c) variability on the risk of hypoglycemia-related hospitalization (HRH) in veterans with diabetes mellitus.Research design and methods342 059 veterans with diabetes aged 65 years or older were identified for a retrospective cohort study. All participants had a 3-year baseline period from January 1, 2005 to December 31, 2016, during which they had at least four A1c tests. A1c variability measures included coefficient of variation (A1c CV), A1c SD, and adjusted A1c SD. HRH was identified during a 2-year follow-up period from Medicare and the Veterans Health Administration through validated algorithms of International Classification of Diseases (ICD)-9 and ICD-10 codes. Logistic regression modeling was used to evaluate the relationship between A1c variability and HRH risk while controlling for relevant clinical covariates.Results2871 patients had one or more HRH in the 2-year follow-up period. HRH risk increased with greater A1c variability, and this was consistent across A1c CV, A1c SD, and adjusted A1c SD. Average A1c levels were also independently associated with HRH, with levels <7.0% (53 mmol/mol) having lower risk and >9% (75 mmol/mol) with greater risk. The relationships between A1c variability remained significant after controlling for average A1c levels and prior HRH during the baseline period.ConclusionIncreasing A1c variability and elevated A1c levels are associated with a greater risk of HRH in older adults with diabetes. Clinicians should consider A1c variability when assessing patients for risk of severe hypoglycemia.

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Recidivism Treatment for Justice-Involved Veterans: Evaluating Adoption and Sustainment of Moral Reconation Therapy in the US Veterans Health Administration

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

10.1007/s10488-021-01113-x ◽

2021 ◽

Author(s):

Daniel M. Blonigen ◽

Paige M. Shaffer ◽

Jennifer S. Smith ◽

Michael A. Cucciare ◽

Christine Timko ◽

...

Keyword(s):

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Moral Reconation Therapy ◽

The Us ◽

Us Veterans

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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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PDB18 ASSESSMENT OF THE HEALTH CARE UTILIZATION AND ECONOMIC BURDEN ON DIABETES PATIENTS WITH CHRONIC KIDNEY DISEASE IN THE US VETERANS HEALTH ADMINISTRATION POPULATION

Value in Health ◽

10.1016/j.jval.2020.04.206 ◽

2020 ◽

Vol 23 ◽

pp. S111

Author(s):

R. Delinger ◽

A. Ratiu ◽

L. Xie ◽

A. Keshishian

Keyword(s):

Health Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Health Care Utilization ◽

Economic Burden ◽

Veterans Health Administration ◽

Care Utilization ◽

Veterans Health ◽

Health Administration ◽

The Us

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High Variability of Opioid Prescribing Within and Across Emergency Departments in the US Veterans Health Administration

Journal of General Internal Medicine ◽

10.1007/s11606-018-4588-2 ◽

2018 ◽

Vol 33 (11) ◽

pp. 1831-1832

Author(s):

Timothy Joseph Sowicz ◽

Adam J. Gordon ◽

Walid F. Gellad ◽

Xinhua Zhao ◽

Hongwei Zhang ◽

...

Keyword(s):

Emergency Departments ◽

Veterans Health Administration ◽

High Variability ◽

Veterans Health ◽

Health Administration ◽

Opioid Prescribing ◽

The Us ◽

Us Veterans

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Modelling care quality for patients after a transient ischaemic attack within the US Veterans Health Administration

BMJ Open Quality ◽

10.1136/bmjoq-2019-000641 ◽

2019 ◽

Vol 8 (4) ◽

pp. e000641

Author(s):

Greg Arling ◽

Jason J Sico ◽

Mathew J Reeves ◽

Laura Myers ◽

Fitsum Baye ◽

...

Keyword(s):

Preventive Care ◽

Transient Ischaemic Attack ◽

Veterans Health Administration ◽

Care Quality ◽

Inpatient Admission ◽

Veterans Health ◽

Health Administration ◽

The Us ◽

Ischaemic Attack ◽

Us Veterans

ObjectiveTimely preventive care can substantially reduce risk of recurrent vascular events or death after a transient ischaemic attack (TIA). Our objective was to understand patient and facility factors influencing preventive care quality for patients with TIA in the US Veterans Health Administration (VHA).MethodsWe analysed administrative data from a retrospective cohort of 3052 patients with TIA cared for in the emergency department (ED) or inpatient setting in 110 VHA facilities from October 2010 to September 2011. A composite quality indicator (QI score) pass rate was constructed from four process-related quality measures—carotid imaging, brain imaging, high or moderate potency statin and antithrombotic medication, associated with the ED visit or inpatient admission after the TIA. We tested a multilevel structural equation model where facility and patient characteristics, inpatient admission, and neurological consultation were predictors of the resident’s composite QI score.ResultsPresenting with a speech deficit and higher Charlson Comorbidity Index (CCI) were positively related to inpatient admission. Being admitted increased the likelihood of neurology consultation, whereas history of dementia, weekend arrival and a higher CCI score made neurological consultation less likely. Speech deficit, higher CCI, inpatient admission and neurological consultation had direct positive effects on the composite quality score. Patients in facilities with fewer full-time equivalent neurology staff were less likely to be admitted or to have a neurology consultation. Facilities having greater organisational complexity and with a VHA stroke centre designation were more likely to provide a neurology consultation.ConclusionsBetter TIA preventive care could be achieved through increased inpatient admissions, or through enhanced neurology and other care resources in the ED and during follow-up care.

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