scholarly journals Trends in COVID-19 cases and clinical management in Veterans Health Administration medical facilities: A national cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0246217
Author(s):  
Maya Aboumrad ◽  
Brian Shiner ◽  
Natalie Riblet ◽  
Hugh Huizenga ◽  
Nabin Neupane ◽  
...  
Keyword(s):  
Cohort Study ◽  
Veterans Health Administration ◽  
The United States ◽  
Hospitalized Patients ◽  
Trend Test ◽  
Veterans Health ◽  
Health Administration ◽  
Laboratory Findings ◽  
National Cohort ◽  
Over Time

Objective We explored longitudinal trends in sociodemographic characteristics, reported symptoms, laboratory findings, pharmacological and non-pharmacological treatment, comorbidities, and 30-day in-hospital mortality among hospitalized patients with coronavirus disease 2019 (COVID-19). Methods This retrospective cohort study included patients diagnosed with COVID-19 in the United States Veterans Health Administration between 03/01/20 and 08/31/20 and followed until 09/30/20. We focused our analysis on patients that were subsequently hospitalized, and categorized them into groups based on the month of hospitalization. We summarized our findings through descriptive statistics. We used Cuzick’s Trend Test to examine any differences in the distribution of our study variables across the six months. Results During our study period, we identified 43,267 patients with COVID-19. A total of 8,240 patients were hospitalized, and 13.1% (N = 1,081) died within 30 days of admission. Hospitalizations increased over time, but the proportion of patients that died consistently declined from 24.8% (N = 221/890) in March to 8.0% (N = 111/1,396) in August. Patients hospitalized in March compared to August were younger on average, mostly black, urban-dwelling, febrile and dyspneic. They also had a higher frequency of baseline comorbidities, including hypertension and diabetes, and were more likely to present with abnormal laboratory findings including low lymphocyte counts and elevated creatinine. Lastly, there was a decline from March to August in receipt of mechanical ventilation (31.4% to 13.1%) and hydroxychloroquine (55.3% to <1.0%), while treatment with dexamethasone (3.7% to 52.4%) and remdesivir (1.1% to 38.9%) increased. Conclusion Among hospitalized patients with COVID-19, we observed a trend towards decreased disease severity and mortality over time.

scholarly journals A national analysis of trends in COVID-19 infection and clinical management in Veterans Health Administration medical facilities

2021 ◽  
Author(s):  
Maya Aboumrad ◽  
Brian Shiner ◽  
Natalie Riblet ◽  
Hugh Huizenga ◽  
Nabin Neupane ◽  
...  
Keyword(s):  
Veterans Health Administration ◽  
Descriptive Statistics ◽  
Veterans Health ◽  
Health Administration ◽  
Laboratory Findings ◽  
National Health Care ◽  
Medical Facilities ◽  
Elevated Creatinine ◽  
National Analysis ◽  
Over Time

ABSTRACTOBJECTIVEWe explored longitudinal trends in sociodemographic characteristics, reported symptoms, laboratory findings, pharmacological and non-pharmacological treatment, comorbidities, and 30-day in-hospital mortality among hospitalized patients with coronavirus disease 2019 (COVID-19).METHODSThis retrospective cohort study included 43,267 patients diagnosed with COVID-19 in the Veterans Health Administration between 03/01/20 and 08/31/20 and followed until 09/30/20. We focused our analysis on patients that were subsequently hospitalized, and categorized them into groups based on the month of hospitalization. We summarized our findings through descriptive statistics. We used a nonparametric rank-sum test for trend to examine any differences in the distribution of our study variables across the six months.RESULTSDuring our study period, 8,240 patients were hospitalized, and 1,081 (13.1%) died within 30 days of admission. Hospitalizations increased over time, but the proportion of patients that died consistently declined from March (N=221/890, 24.8%) to August (N=111/1,396, 8.0%). Patients hospitalized in March compared to August were younger on average, mostly black, and symptomatic. They also had a higher frequency of baseline comorbidities, including hypertension and diabetes, and were more likely to present with abnormal laboratory findings including low lymphocyte counts and elevated creatinine. Lastly, receipt of mechanical ventilation and Hydroxychloroquine declined from March to August, while treatment with Dexamethasone and Remdesivir increased.CONCLUSIONWe found evidence of declining COVID-19 severity and fatality over time within a national health care system.

Transformation of the US Veterans Health Administration

2006 ◽  
Vol 1 (2) ◽  
pp. 99-105 ◽  
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).

Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: a retrospective cohort study

2021 ◽  
pp. bmjqs-2020-012975
Author(s):  
Peter J Kaboli ◽  
Matthew R Augustine ◽  
Bjarni Haraldsson ◽  
Nicholas M Mohr ◽  
M Bryant Howren ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Suicide Risk ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Bed Occupancy ◽  
Increased Risk

BackgroundVeteran suicides have increased despite mental health investments by the Veterans Health Administration (VHA).ObjectiveTo examine relationships between suicide and acute inpatient psychiatric bed occupancy and other community, hospital and patient factors.MethodsRetrospective cohort study using administrative and publicly available data for contextual community factors. The study sample included all veterans enrolled in VHA primary care in 2011–2016 associated with 111 VHA hospitals with acute inpatient psychiatric units. Acute psychiatric bed occupancy, as a measure of access to care, was the main exposure of interest and was categorised by quarter as per cent occupied using thresholds of ≤85%, 85.1%–90%, 90.1%–95% and >95%. Hospital-level analyses were conducted using generalised linear mixed models with random intercepts for hospital, modelling number of suicides by quarter with a negative binomial distribution.ResultsFrom 2011 to 2016, the national incidence of suicide among enrolled veterans increased from 39.7 to 41.6 per 100 000 person-years. VHA psychiatric bed occupancy decreased from a mean of 68.2% (IQR 56.5%–82.2%) to 65.4% (IQR 53.9%–79.9%). VHA hospitals with the highest occupancy (>95%) in a quarter compared with ≤85% had an adjusted incident rate ratio (IRR) for suicide of 1.10 (95% CI 1.01 to 1.19); no increased risk was observed for 85.1%–90% (IRR 0.96; 95% CI 0.89 to 1.03) or 90.1%–95% (IRR 0.96; 95% CI 0.89 to 1.04) compared with ≤85% occupancy. Of hospital and community variables, suicide risk was not associated with number of VHA or non-VHA psychiatric beds or amount spent on community mental health. Suicide risk increased by age categories, seasons, geographic regions and over time.ConclusionsHigh VHA hospital occupancy (>95%) was associated with a 10% increased suicide risk for veterans whereas absolute number of beds was not, suggesting occupancy is an important access measure. Future work should clarify optimal bed occupancy to meet acute psychiatric needs and ensure adequate bed distribution.

scholarly journals Implementation evaluation of academic detailing on naloxone prescribing trends at the United States Veterans Health Administration

2019 ◽  
Vol 54 (5) ◽  
pp. 1055-1064 ◽  
Author(s):  
Mark Bounthavong ◽  
Emily Beth Devine ◽  
Melissa L. D. Christopher ◽  
Michael A. Harvey ◽  
David L. Veenstra ◽  
...  
Keyword(s):  
United States ◽  
Veterans Health Administration ◽  
The United States ◽  
Veterans Health ◽  
Academic Detailing ◽  
Health Administration ◽  
Implementation Evaluation ◽  
Prescribing Trends

Cataract surgery practice patterns in the United States Veterans Health Administration

2012 ◽  
Vol 38 (4) ◽  
pp. 705-709 ◽  
Author(s):  
Paul B. Greenberg ◽  
Annika Havnaer ◽  
Thomas A. Oetting ◽  
Francisco J. Garcia-Ferrer
Keyword(s):  
United States ◽  
Cataract Surgery ◽  
Practice Patterns ◽  
Veterans Health Administration ◽  
The United States ◽  
Veterans Health ◽  
Health Administration

scholarly journals Testing practices and incidence of chlamydial and gonococcal infection in the Veterans Health Administration, 2009-2019

2020 ◽  
Author(s):  
Lauren A Beste ◽  
Marissa M Maier ◽  
Joleen Borgerding ◽  
Elliott Lowy ◽  
Ronald G Hauser ◽  
...  
Keyword(s):  
Risk Groups ◽  
Veterans Health Administration ◽  
The United States ◽  
Incidence Rates ◽  
Veterans Health ◽  
Health Administration ◽  
Hiv Status ◽  
Demographic Group ◽  
Immunodeficiency Virus ◽  
Testing Practices

Abstract Background Chlamydia trachomatis and Neisseria gonorrhoeae cases reached a record high in the United States in 2018. Although active duty military servicemembers have high rates of chlamydia and gonorrhea infection, trends in chlamydia and gonorrhea in the Veterans Health Administration (VHA) system have not been previously described, including among patients with human immunodeficiency virus (HIV) and young women. Methods We identified all Veterans in VHA care from 2009-2019. Tests and cases of chlamydia and gonorrhea were defined based on lab results in the electronic health record. Chlamydia and gonorrhea incidence rates were calculated each year by demographic group and HIV status. Results In 2019, testing for chlamydia and gonorrhea occurred in 2.3% of patients, 22.6% of women ages 18-24, and 34.1% of persons with HIV. 2019 incidence of chlamydia and gonorrhea was 100.8 and 56.3 cases per 100,000 VHA users, an increase of 267% and 294%, respectively, since 2009. Veterans aged &lt;34 years accounted for 9.5% of the VHA population but 66.9% of chlamydia and 42.9% of gonorrhea cases. Chlamydia and gonorrhea incidence rates in persons with HIV were 1,432 and 1,687 per 100,000, respectively. Conclusions The incidence of chlamydia and gonorrhea rose dramatically from 2009-2019. Among tested persons, those with HIV had a 15.2-fold higher unadjusted incidence of chlamydia and 34.9-fold higher unadjusted incidence of gonorrhea compared to those without HIV. VHA-wide adherence to chlamydia and gonorrhea testing in high-risk groups merits improvement.

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