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.

453 Cost-Effectiveness of Requalifying for Positive Airway Pressure Treatment After Initial Nonadherence

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A179-A179
Author(s):  
Anna May ◽  
Lu Wang ◽  
Mendel Singer
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cost Effective ◽  
The United States ◽  
Veterans Affairs ◽  
United States Government ◽  
Department Of Veterans Affairs ◽  
Current Policy

Abstract Introduction Obstructive sleep apnea (OSA) is effectively treated with continuous positive airway pressure (CPAP). However, many people are not able to become adherent in the initial 90-day trial window for this therapy. Medicare requires a polysomnography and repeat trial documenting adherence before continuing payment for these services. Oral appliance therapy (OAT) is also an OSA first-line therapy but is less effective than CPAP. Methods We created a decision tree to model 4 strategies over a 5-year time horizon: (1) current policy, (2) direct referral for CPAP equipment, (3) OAT followed by CPAP under current policy, and (4) OAT followed by direct CPAP referral in a the Medicare population with mild-moderate OSA and nonadherence to a first attempt at CPAP therapy. Medicare fee schedules in 2020 defined costs. Incremental cost-effectiveness (ICER) was used to identify the supreme strategy Results The current policy was the most expensive. Both the current policy and direct DME referral were dominated by starting with OAT. OAT followed by titration was the most cost-effective strategy with an ICER of $42,586.47. The ICER was sensitive to adherence in the direct CPAP strategy and probability of getting CPAP equipment (vs. lost to follow-up). Conclusion Starting with OAT therapy in those that were CPAP nonadherent on first attempt is cost-effective. Despite decreased effectiveness, the increase adherence to OAT make it an attractive option for retrial of OSA therapy. If OAT therapy fails, the current policy is more cost-effective than direct CPAP referral. Support (if any) This study was supported Career Development Award IK2CX001882 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development Service. The contents of this work do not represent the views of the Department of Veterans Affairs or the United States government.

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).

scholarly journals Non-health Care Facility Medication Errors Associated with Hormones and Hormone Antagonists in the United States

2017 ◽  
Vol 13 (4) ◽  
pp. 293-302
Author(s):  
Pranav Magal ◽  
Henry A. Spiller ◽  
Marcel J. Casavant ◽  
Thitphalak Chounthirath ◽  
Nichole L. Hodges ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Medication Errors ◽  
Care Facility ◽  
Health Care Facility ◽  
The United States ◽  
Hormone Antagonists

scholarly journals Adapting Caring Contacts for Veterans in a Department of Veterans Affairs Emergency Department: Results From a Type 2 Hybrid Effectiveness-Implementation Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Sara J. Landes ◽  
Susan M. Jegley ◽  
JoAnn E. Kirchner ◽  
John P. Areno ◽  
Jeffery A. Pitcock ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Planning Process ◽  
Qualitative Interviews ◽  
Care Program ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Implementation Planning ◽  
Increased Risk

Transitions in care, such as discharge from an emergency department (ED), are periods of increased risk for suicide and effective interventions that target these periods are needed. Caring Contacts is an evidence-based suicide prevention intervention that targets transitions, yet it has not been widely implemented. This pilot study adapted Caring Contacts for a Department of Veterans Affairs (VA) ED setting and population, created an implementation toolkit, and piloted implementation and evaluation of effectiveness. To inform adaptation, qualitative interviews were conducted with stakeholders. Data were used by an advisory board comprised of stakeholders, experts, and veterans to make adaptations and develop an implementation planning guide to delineate steps needed to implement. Key decisions about how to adapt Caring Contacts included recipients, author, content, and the schedule for sending. Pilot implementation occurred at one VA ED. Caring Contacts involved sending patients at risk of suicide brief, non-demanding expressions of care. Program evaluation of the pilot used a type 2 hybrid effectiveness-implementation design to both pilot an implementation strategy and evaluate effectiveness of Caring Contacts. Evaluation included qualitative interviews with veteran patients during implementation. VA electronic health records were used to evaluate VA service utilization in the 6-month periods immediately before and after veterans were delivered their first Caring Contact. Hundred and seventy-five veterans were mailed Caring Contacts and the facility continued adoption after the pilot. Participants were positive about the intervention and reported feeling cared about and connected to VA as a result of receiving Caring Contacts. This project developed an implementation planning process that successfully implemented Caring Contacts at one site. This can be used to further implement Caring Contacts at additional VA or community EDs.

scholarly journals Preparedness and response activities of the US Department of Veterans Affairs (VA) home-based primary care program around the fall 2017 hurricane season

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tamar Wyte-Lake ◽  
Claudia Der-Martirosian ◽  
Karen Chu ◽  
Rachel Johnson-Koenke ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Large Scale ◽  
Care Program ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Home Based Primary Care ◽  
Home Based ◽  
Early Implementation ◽  
Hurricane Season ◽  
At Risk Populations

Abstract Background Large-scale natural disasters disproportionally affect both the medically complex and the older old, groups that are responsible for most medical surge after a disaster. To understand how to ameliorate this surge, we examined the activities of the nine US Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) programs impacted during the 2017 Fall Hurricane Season. Methods Convergent mixed methods design, incorporating independently conducted qualitative and quantitative analyses. Phase One: 34 clinical staff were interviewed from the nine VA HBPC programs impacted by Hurricanes Harvey, Irma, and Maria to examine the experiences of their HBPC programs in response to the Hurricanes. Phase Two: Secondary quantitative data analysis used the VA’s Corporate Data Warehouse (CDW) to examine the electronic health records of patients for these same nine sites. Results The emergency management activities of the HBPC programs emerged as two distinct phases: preparedness, and response and recovery. The early implementation of preparedness procedures, and coordinated post-Hurricane patient tracking, limited disruption in care and prevented significant hospitalizations among this population. Conclusions Individuals aged 75 or older, who often present with multiple comorbidities and decreased functional status, typically prefer to age in their homes. Additionally, as in-home medical equipment evolves, more medically vulnerable individuals are able to receive care at home. HBPC programs, and similar programs under Medicare, connect the homebound, medically complex, older old to the greater healthcare community. Engaging with these programs both pre- and post-disasters is central to bolstering community resilience for these at-risk populations.

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