Veterans Health Administration discharge telephone follow-up and 30-day hospital readmissions

Abstract Objective Among Veterans Health Administration (VHA) patients who undergo total knee arthroplasty (TKA) nationally, what are the underlying readmission rates and associations with perioperative opioid use, and are there associations with other factors such as preoperative health care utilization? Methods We retrospectively examined the records of 5,514 TKA patients (primary N = 4,955, 89.9%; revision N = 559, 10.1%) over one fiscal year (October 1, 2010–September 30, 2011) across VHA hospitals nationwide. Opioid use was classified into no opioids, tramadol only, short-acting only, or any long-acting. We measured readmission within 30 days and the number of days to readmission within 30 days. Extended Cox regression models were developed. Results The overall 30-day hospital readmission rate was 9.6% (N = 531; primary 9.5%, revision 11.1%). Both readmitted patients and the overall sample were similar on types of preoperative opioid use. Relative to patients without opioids, patients in the short-acting opioids only tier had the highest risk for 30-day hospital readmission (hazard ratio = 1.38, 95% confidence interval = 1.14–1.67). Preoperative opioid status was not associated with 30-day readmission. Other risk factors for 30-day readmission included older age (≥66 years), higher comorbidity and diagnosis-related group weights, greater preoperative health care utilization, an urban location, and use of preoperative anticonvulsants. Conclusions Given the current opioid epidemic, the routine prescribing of short-acting opioids after surgery should be carefully considered to avoid increasing risks of 30-day hospital readmissions and other negative outcomes, particularly in the context of other predisposing factors.

Download Full-text

Protocol for a mixed methods study of hospital readmissions: sensemaking in Veterans Health Administration healthcare system in the USA

BMJ Open ◽

10.1136/bmjopen-2017-020169 ◽

2018 ◽

Vol 8 (4) ◽

pp. e020169

Author(s):

Lauren S Penney ◽

Luci K Leykum ◽

Polly Noël ◽

Erin P Finley ◽

Holly Jordan Lanham ◽

...

Keyword(s):

Mixed Methods ◽

Healthcare System ◽

Hospital Readmissions ◽

Veterans Health Administration ◽

Mixed Methods Study ◽

Veterans Health ◽

Health Administration ◽

The Usa

Download Full-text

Mild TBI and risk of Parkinson disease

Neurology ◽

10.1212/wnl.0000000000005522 ◽

2018 ◽

Vol 90 (20) ◽

pp. e1771-e1779 ◽

Cited By ~ 65

Author(s):

Raquel C. Gardner ◽

Amy L. Byers ◽

Deborah E. Barnes ◽

Yixia Li ◽

John Boscardin ◽

...

Keyword(s):

Brain Injury ◽

Parkinson Disease ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Mild Tbi ◽

Psychiatric Comorbidities ◽

Increased Risk ◽

Severe Tbi

ObjectiveOur aim was to assess risk of Parkinson disease (PD) following traumatic brain injury (TBI), including specifically mild TBI (mTBI), among care recipients in the Veterans Health Administration.MethodsIn this retrospective cohort study, we identified all patients with a TBI diagnosis in Veterans Health Administration databases from October 2002 to September 2014 and age-matched 1:1 to a random sample of patients without TBI. All patients were aged 18 years and older without PD or dementia at baseline. TBI exposure and severity were determined via detailed clinical assessments or ICD-9 codes using Department of Defense and Defense and Veterans Brain Injury Center criteria. Baseline comorbidities and incident PD more than 1 year post-TBI were identified using ICD-9 codes. Risk of PD after TBI was assessed using Cox proportional hazard models adjusted for demographics and medical/psychiatric comorbidities.ResultsAmong 325,870 patients (half with TBI; average age 47.9 ± 17.4 years; average follow-up 4.6 years), 1,462 were diagnosed with PD during follow-up. Compared to no TBI, those with TBI had higher incidence of PD (no TBI 0.31%, all-severity TBI 0.58%, mTBI 0.47%, moderate-severe TBI 0.75%). In adjusted models, all-severity TBI, mTBI, and moderate-severe TBI were associated with increased risk of PD (hazard ratio [95% confidence interval]: all-severity TBI 1.71 [1.53–1.92]; mTBI 1.56 [1.35–1.80]; moderate-severe TBI 1.83 [1.61–2.07]).ConclusionsAmong military veterans, mTBI is associated with 56% increased risk of PD, even after adjusting for demographics and medical/psychiatric comorbidities. This study highlights the importance of TBI prevention, long-term follow-up of TBI-exposed veterans, and the need to determine mechanisms and modifiable risk factors for post-TBI PD.

Download Full-text

Examination of potential disparities in suicide risk identification and follow‐up care within the Veterans Health Administration

Suicide and Life-Threatening Behavior ◽

10.1111/sltb.12673 ◽

2020 ◽

Vol 50 (6) ◽

pp. 1127-1139

Author(s):

Sarah P. Carter ◽

Carol A. Malte ◽

Sasha M. Rojas ◽

Eric J. Hawkins ◽

Mark A. Reger

Keyword(s):

Suicide Risk ◽

Veterans Health Administration ◽

Risk Identification ◽

Veterans Health ◽

Health Administration ◽

Follow Up Care

Download Full-text

Improving Perceptions of Teamwork Climate With the Veterans Health Administration Medical Team Training Program

American Journal of Medical Quality ◽

10.1177/1062860611401653 ◽

2011 ◽

Vol 26 (6) ◽

pp. 480-484 ◽

Cited By ~ 22

Author(s):

Brian T. Carney ◽

Priscilla West ◽

Julia B. Neily ◽

Peter D. Mills ◽

James P. Bagian

Keyword(s):

Veterans Health Administration ◽

Team Training ◽

Medical Team ◽

Veterans Health ◽

Health Administration ◽

Safety Attitudes ◽

Safety Attitudes Questionnaire ◽

Physician Perceptions ◽

Nonparametric Testing

There are differences between nurse and physician perceptions of teamwork. The purpose of this study was to determine whether these differences would be reduced with medical team training (MTT). The Safety Attitudes Questionnaire was administered to nurses and physicians working in the operating rooms of 101 consecutive hospitals before and at the completion of an MTT program. Responses to the 6 teamwork climate items on the Safety Attitudes Questionnaire were analyzed using nonparametric testing. At baseline, physicians had more favorable perceptions on teamwork climate items than nurses. Physicians demonstrated improvement on all 6 teamwork climate items. Nurses demonstrated improvement in perceptions on all teamwork climate items except “Nurse input is well received.” Physicians still had a more favorable perception than nurses on all 6 teamwork climate items at follow-up. Despite an improvement in perceptions by physicians and nurses, baseline nurse–physician differences persisted at completion of the Veterans Health Administration MTT Program.

Download Full-text

Ambulatory Medical Follow-Up in the Year After Surgery and Subsequent Survival in a National Cohort of Veterans Health Administration Surgical Patients

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2015.12.019 ◽

2016 ◽

Vol 30 (3) ◽

pp. 671-679 ◽

Cited By ~ 2

Author(s):

Robert B. Schonberger ◽

Feng Dai ◽

Cynthia Brandt ◽

Matthew M. Burg

Keyword(s):

Veterans Health Administration ◽

Surgical Patients ◽

Veterans Health ◽

Health Administration ◽

National Cohort

Download Full-text

Teleoncology for Veterans: High Patient Satisfaction Coupled With Positive Financial and Environmental Impacts

JCO Oncology Practice ◽

10.1200/op.21.00317 ◽

2021 ◽

pp. OP.21.00317

Author(s):

Cindy Y. Jiang ◽

Garth W. Strohbehn ◽

Rachel M. Dedinsky ◽

Shelby M. Raupp ◽

Brittany M. Pannecouk ◽

...

Keyword(s):

Carbon Dioxide ◽

Patient Satisfaction ◽

Carbon Dioxide Emissions ◽

Financial Burden ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Medical Needs ◽

Strongly Agree

PURPOSE: There was rapid adoption of teleoncology care in the Veterans Health Administration during the COVID-19 pandemic. One third of 9 million Veterans Health Administration enrolled Veterans live in rural areas. Although digital solutions can expand capacity, enhance care access, and reduce financial burden, they may also exacerbate rural-urban health disparities. Careful evaluation of patients' perceptions and policy tradeoffs are necessary to optimize teleoncology postpandemic. METHODS: Patients with ≥ 1 teleoncology visit with medical, surgical, or radiation oncology between March 2020 and June 2020 were identified retrospectively. Validated, Likert-type survey assessing patient satisfaction was developed. Follow-up survey was conducted on patients with ≥ 1 teleoncology visit from August 2020 to January 2021. Travel distance, time, cost, and carbon dioxide emissions were calculated based on zip codes. RESULTS: A hundred surveys were completed (response rate, 62%). Patients overall were satisfied with teleoncology (83% Agree or Strongly Agree) but felt less satisfied than in-person visits (47% Agree or Strongly Agree). Audiovisual component improved patient perception of involvement in care, ability to self-manage health or medical needs, and comparability to in-person visits. Follow-up survey demonstrated similar satisfaction. Total travel-related savings are as follows: 86,470 miles, 84,374 minutes, $49,720 US dollars, and 35.5 metric tons of carbon dioxide. CONCLUSION: Veterans are broadly satisfied with teleoncology. Audiovisual capabilities are critical to satisfaction. This is challenging for rural populations with lack of technology access. Patients experienced financial and time savings, and society benefitted from reduced carbon emissions. Continued optimization is needed to enhance patient experience and address secondary effects.

Download Full-text

Hematocrit levels and thrombotic events in patients with polycythemia vera: an analysis of Veterans Health Administration data

Annals of Hematology ◽

10.1007/s00277-019-03793-w ◽

2019 ◽

Vol 98 (11) ◽

pp. 2533-2539

Author(s):

Shreekant Parasuraman ◽

Jingbo Yu ◽

Dilan Paranagama ◽

Sulena Shrestha ◽

Li Wang ◽

...

Keyword(s):

Polycythemia Vera ◽

Cox Regression ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Monitoring And Control ◽

The Difference ◽

And Control ◽

The Relationship

Abstract Patients with polycythemia vera (PV) have a high incidence of thrombotic events (TEs), contributing to a greater mortality risk than the general population. The relationship between hematocrit (HCT) levels and TE occurrence among patients with PV from the Veterans Health Administration (VHA) was evaluated to replicate findings of the CYTO-PV trial with a real-world patient population. This retrospective study used VHA medical record and claims data from the first claim with a PV diagnosis (index) until death, disenrollment, or end of study, collected between October 1, 2005, and September 30, 2012. Patients were aged ≥ 18 years at index, had ≥ 2 claims for PV (ICD-9-CM code, 238.4) ≥ 30 days apart during the identification period, continuous health plan enrollment from 12 months pre-index until end of study, and ≥ 3 HCT measurements per year during follow-up. This analysis focused on patients with no pre-index TE, and with all HCT values either < 45% or ≥ 45% during the follow-up period. The difference in TE risk between HCT groups was assessed using unadjusted Cox regression models based on time to first TE. Patients (N = 213) were mean (SD) age 68.9 (11.5) years, 98.6% male, and 61.5% white. TE rates for patients with HCT values < 45% versus ≥ 45% were 40.3% and 54.2%, respectively. Among patients with ≥ 1 HCT before TE, TE risk hazard ratio was 1.61 (95% CI, 1.03–2.51; P = 0.036). This analysis of the VHA population further supports effective monitoring and control of HCT levels < 45% to reduce TE risk in patients with PV.

Download Full-text

Incidence of Clostridioides difficile infections among young and middle-aged adults: Veterans Health Administration

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.160 ◽

2019 ◽

Vol 40 (9) ◽

pp. 997-1005 ◽

Cited By ~ 1

Author(s):

Ellyn M. Russo ◽

Jennifer Kuntz ◽

Holly Yu ◽

Jeremy Smith ◽

Ronald George Hauser ◽

...

Keyword(s):

Veterans Health Administration ◽

Health Concern ◽

Charlson Comorbidity Index Score ◽

Veterans Health ◽

Health Administration ◽

Middle Aged ◽

Clostridioides Difficile ◽

Using Data ◽

Middle Aged Adult

AbstractObjective:Clostridioides difficile infection (CDI) remains a significant public health concern, resulting in excess morbidity, mortality, and costs. Additional insight into the burden of CDI in adults aged <65 years is needed.Design/Setting:A 6-year retrospective cohort study was conducted using data extracted from United States Veterans Health Administration electronic medical records.Patients/Methods:Patients aged 18–64 years on January 1, 2011, were followed until incident CDI, death, loss-to-follow-up, or December 31, 2016. CDI was identified by a diagnosis code accompanied by metronidazole, vancomycin, or fidaxomicin therapy, or positive laboratory test. The clinical setting of CDI onset was defined according to 2017 SHEA-IDSA guidelines.Results:Of 1,073,900 patients, 10,534 had a CDI during follow-up. The overall incidence rate was 177 CDIs per 100,000 person years, rising steadily from 164 per 100,000 person years in 2011 to 189 per 100,000 person years in 2016. Those with a CDI were slightly older (55 vs 51 years) and sicker, with a higher baseline Charlson comorbidity index score (1.4 vs 0.5) than those without an infection. Nearly half (48%) of all incident CDIs were community associated, and this proportion rose from 41% in 2011 to 56% in 2016.Conclusions:The findings from this large retrospective study indicate that CDI incidence, driven primarily by increasing community-associated infection, is rising among young and middle-aged adult Veterans with high service-related disability. The increasing burden of community associated CDI in this vulnerable population warrants attention. Future studies quantifying the economic and societal burden of CDI will inform decisions surrounding prevention strategies.

Download Full-text