scholarly journals Ascertainment of Patient Suicides by Veterans Affairs Facilities and Associations With Veteran, Clinical, and Suicide Characteristics

2021 ◽  
Vol 111 (S2) ◽  
pp. S116-S125
Author(s):  
Kristen M. Palframan ◽  
Benjamin R. Szymanski ◽  
John F. McCarthy
Keyword(s):  
Suicide Prevention ◽  
Death Certificate ◽  
Care Facility ◽  
Health Care Facility ◽  
Veterans Affairs ◽  
Veterans Health ◽  
Health Administration ◽  
Cross Sectional ◽  
Clinical Utilization ◽  
Multivariable Analyses

Objectives. To evaluate the sensitivity of health care facility documentation of suicide deaths among US veterans with recent Veterans Health Administration (VHA) care and assess variation in identification by veteran, clinical, and suicide death characteristics. Methods. Cross-sectional analyses included 11 148 veterans who died by suicide in 2013 to 2017, per National Death Index death certificate information, with VHA encounters in the year of death or the previous year. Facility suicide ascertainment was assessed per site reports in the VHA Suicide Prevention Applications Network. Bivariate and multivariable analyses assessed ascertainment by decedent demographic, clinical, utilization, and method of suicide characteristics. Results. Site reports identified 3667 suicide decedents (32.9%). Veteran suicide decedents identified by facilities were more likely to be younger and with clinical risk factors and more recent VHA encounters. Suicide deaths involving poisoning were less likely to be identified than deaths involving other methods. Conclusions. VHA facility ascertainment of suicide deaths among recent patients was neither comprehensive nor representative. Findings will inform efforts to enhance facility suicide surveillance and veteran suicide prevention.

scholarly journals Barriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration

Neurology ◽  
2017 ◽  
Vol 89 (24) ◽  
pp. 2422-2430 ◽  
Author(s):  
Teresa M. Damush ◽  
Edward J. Miech ◽  
Jason J. Sico ◽  
Michael S. Phipps ◽  
Greg Arling ◽  
...  
Keyword(s):  
Care Facility ◽  
Clinical Staff ◽  
Barriers And Facilitators ◽  
Audit And Feedback ◽  
System Level ◽  
Evidence Based ◽  
Veterans Health ◽  
Health Administration ◽  
Cross Sectional

Objective:To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA).Methods:We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers.Results:Identified barriers to providing timely acute and follow-up TIA care included difficulties accessing brain imaging, a constantly rotating pool of housestaff, lack of care coordination, resource constraints, and inadequate staff education. Key informants revealed that both stroke nurse coordinators and system-level factors facilitated the provision of TIA care. Few facilities had specific TIA protocols. However, stroke nurse coordinators often expanded upon their role to include TIA. They facilitated TIA care by (1) coordinating patient care across services, communicating across service lines, and educating clinical staff about facility policies and evidence-based practices; (2) tracking individual patients from emergency departments to inpatient settings and to discharge for timely follow-up care; (3) providing and referring TIA patients to risk factor management programs; and (4) performing regular audit and feedback of quality performance data. System-level facilitators included clinical service leadership engagement and use of electronic tools for continuous care across services.Conclusions:The local organization within a health care facility may be targeted to cultivate internal facilitators and a systemic infrastructure to provide evidence-based TIA care.

scholarly journals Purchasing Quality Nursing Home Care in the Veterans Health Administration

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Orna Intrator ◽  
Edward Alan Miller ◽  
Portia Y Cornell ◽  
Cari Levy ◽  
Christopher W Halladay ◽  
...  
Keyword(s):  
The United States ◽  
Veterans Affairs ◽  
Nursing Home Care ◽  
Veterans Health ◽  
Health Administration ◽  
Star Rating ◽  
For Profit ◽  
Veterans Affairs Medical Centers ◽  
And Performance

Abstract Background and Objectives U.S. Department of Veterans Affairs Medical Centers (VAMCs) contract with nursing homes (NHs) in their community to serve Veterans. This study compares the characteristics and performance of Veterans Affairs (VA)-paid and non-VA-paid NHs both nationally and within local VAMC markets. Research Design and Methods VA-paid NHs were identified, characterized, and linked to VAMC markets using data drawn from VA administrative files. NHs in the United States in December 2015 were eligible for the analysis, including. 1,307 VA-paid NHs and 14,253 non-VA-paid NHs with NH Compare measures in 128 VAMC markets with any VA-paid NHs. Measurements were derived from the Centers for Medicare and Medicaid Services (CMS) five-star rating system, NH Compare. Results VA-paid NHs had more beds, residents per day, and were more likely to be for-profit relative to non-VA-paid NHs. Nationally, the average CMS NH Compare star rating was slightly lower among VA-paid NHs than non-VA-paid NHs (3.05 vs. 3.21, p = .04). This difference was seen in all 3 domains: inspection (3.11 vs. 3.23, p < .001), quality (2.68 vs. 2.83, p < .001), and total nurse staffing (3.36 vs. 3.42, p < .10). There was wide variability across VAMC markets in the ratio of average star rating of VA-paid and non-VA-paid NHs (mean ratio = 0.93, interquartile range = 0.78–1.08). Discussion and Implications With increased community NH use expected following the implementation of the MISSION Act, comparison of the quality of purchased services to other available services becomes critical for ensuring quality, including for NH care. Methods presented in this article can be used to examine the quality of purchased care following the MISSION Act implementation. In particular, dashboards such as that for VA-paid NHs that compare to similar non-VA-paid NHs can provide useful information to quality improvement efforts.

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).

Program Review of Community Residential Care

2000 ◽  
Vol 86 (1) ◽  
pp. 21-24
Author(s):  
Annie R. Pope ◽  
Daniel E. Rodell ◽  
Ron L. Evans
Keyword(s):  
Residential Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Care Program ◽  
Cost Effective ◽  
The United States ◽  
Veterans Affairs ◽  
Program Review ◽  
Department Of Veterans Affairs ◽  
Client Characteristics

This article provides an overview of the Department of Veterans Affairs Community Residential Care Program and summarizes key literature about programs developed in the United States Descriptive data for 1995 and 1996 are provided to assist program planners in comparing and contrasting client characteristics and services. The authors conclude that, in addition to being cost effective, the residential care program strengthens relationships between the health care facility and the community it serves.

scholarly journals Knowledge and perception about the ongoing COVID-19 pandemic among patients attending a rural primary health care facility in Delhi

2021 ◽  
Vol 8 (3) ◽  
pp. 1494
Author(s):  
Ekta Arora ◽  
Nidhi Budh ◽  
Rohit Katre ◽  
Bratati Banerjee
Keyword(s):  
Public Perception ◽  
Statistical Tests ◽  
Care Facility ◽  
Health Care Facility ◽  
Primary Health Care Facility ◽  
Preventive Strategies ◽  
Cross Sectional ◽  
Modes Of Transmission ◽  
Correct Knowledge ◽  
Novel Coronavirus

Another decade is suffering from the wrath of another coronavirus. Currently, this pandemic has spread to almost all countries of the world taking lives of millions of people globally. This study has uncovered the perceived facts about COVID-19 by general population as well as the effect of IEC in modulating their perception and presenting right amount of information in a scientific manner. A cross-sectional, descriptive study was carried out at rural health training center, Barwala on patients attending out-patient department at RHTC, for a duration of 2 months. Pre-tested questionnaire for assessing public perception and awareness were used to collect data. Appropriate statistical tests were applied to find out association between different variables. Majority of study subjects (98.5%) were aware about the ongoing pandemic of COVID-19. Out of the total study subjects, 90% of them had correct knowledge about various preventive strategies undertaken to break the chain of transmission. However, only about half of the study subjects (53.1%) had correct knowledge regarding various modes of transmission of novel coronavirus. Motivating the people to report any possible infection and to follow the preventive strategies being recommended by experts on timely basis is an important aspect to curb the ongoing menace of COVID-19.

Retrospective analysis of reported suicide deaths and attempts on veterans health administration campuses and inpatient units

2020 ◽  
pp. bmjqs-2020-011312
Author(s):  
Peter D Mills ◽  
Christina Soncrant ◽  
William Gunnar
Keyword(s):  
Mental Health ◽  
Suicide Prevention ◽  
Veterans Health Administration ◽  
Outpatient Clinics ◽  
Veterans Health ◽  
Health Administration ◽  
Residential Units ◽  
Anchor Points ◽  
Suicidal Patients ◽  
Inpatient Units

IntroductionSuicide is the 10th leading cause of death in the USA. Inpatient suicide is the fourth most common sentinel event reported to the Joint Commission. This study reviewed root cause analysis (RCA) reports of suicide events by hospital unit to provide suicide prevention recommendations for each area.MethodsThis is a retrospective analysis of reported suicide deaths and attempts in the US Veterans Health Administration (VHA) hospitals. We searched the VHA National Center for Patient Safety RCA database for suicide deaths and attempts on inpatient units, outpatient clinics and hospital grounds, between December 1999 and December 2018.ResultsWe found 847 RCA reports of suicide attempts (n=758) and deaths (n=89) in VHA hospitals, hanging accounted for 71% of deaths on mental health units and 50% of deaths on medical units. Overdose accounted for 55% of deaths and 68% of attempts in residential units and the only method resulting in death in emergency departments. In VHA community living centres, hanging, overdose and asphyxiation accounted for 64% of deaths. Gunshot accounted for 59% of deaths on hospital grounds and 100% of deaths in clinic areas. All inpatient locations cited issues in assessment and treatment of suicidal patients and environmental risk evaluation.ConclusionsInpatient mental health and medical units should remove anchor points for hanging where possible. On residential units and emergency departments, assessing suicide risk, conducting thorough contraband searches and maintaining observation of suicidal patients is critical. In community living centres, suicidal patients should be under supervision in an environment free of anchor points, medications and means of asphyxiation. Suicide prevention on hospital grounds and outpatient clinics can be achieved through the control of firearms.

scholarly journals The Relationship Between Body Mass Index and Pain Intensity Among Veterans with Musculoskeletal Disorders: Findings from the MSD Cohort Study

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2563-2572 ◽  
Author(s):  
Diana M Higgins ◽  
Eugenia Buta ◽  
Alicia A Heapy ◽  
Mary A Driscoll ◽  
Robert D Kerns ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Pain Intensity ◽  
Body Mass ◽  
Negative Binomial ◽  
Low Back ◽  
Veterans Health ◽  
Health Administration ◽  
Electronic Health Record Data ◽  
Cross Sectional ◽  
The Relationship

Abstract Objective To examine the relationship between body mass index (BMI) and pain intensity among veterans with musculoskeletal disorder diagnoses (MSDs; nontraumatic joint disorder; osteoarthritis; low back, back, and neck pain). Setting Administrative and electronic health record data from the Veterans Health Administration (VHA). Subjects A national cohort of US military veterans with MSDs in VHA care during 2001–2012 (N = 1,759,338). Methods These cross-sectional data were analyzed using hurdle negative binomial models of pain intensity as a function of BMI, adjusted for comorbidities and demographics. Results The sample had a mean age of 59.4, 95% were male, 77% were white/Non-Hispanic, 79% were overweight or obese, and 42% reported no pain at index MSD diagnosis. Overall, there was a J-shaped relationship between BMI and pain (nadir = 27 kg/m2), with the severely obese (BMI ≥ 40 kg/m2) being most likely to report any pain (OR vs normal weight = 1.23, 95% confidence interval = 1.21–1.26). The association between BMI and pain varied by MSD, with a stronger relationship in the osteoarthritis group and a less pronounced relationship in the back and low back pain groups. Conclusions There was a high prevalence of overweight/obesity among veterans with MSD. High levels of BMI (>27 kg/m2) were associated with increased odds of pain, most markedly among veterans with osteoarthritis.

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