My HealtheVet Website Redesigned

Veterans Affairs takes steps to make using Web site more user-friendly 01/02/10. Veterans who haven’t used the Veterans Affairs Web site in a while to help manage health needs, might want to try it again. The My HealtheVet site, which can be accessed through www.myhealth.va.gov, added new features in the past six months that are designed to make managing health-care needs easier. GJSentinel.com

The Role of Veterans Health Administration Towards the Development of National Telehealth Services

Toward the Development of National Telehealth Services: The Role of Veterans Health Administration and Future Directions for Research. 01/02/10. Abstract The Veterans Health Administration (VHA) in the Department of Veteran Affairs (VA) has emerged as a national and international leader in the delivery and research of telehealth-based treatment. Several unique characteristics of care in VA settings intersect to create an ideal environment for telehealth modalities and research. However, the value of telehealth experience and initiatives in VA settings is limited if telehealth strategies cannot be widely exported to other public or private systems. Whereas a hierarchical organization, such as VA, can innovate and fund change relatively quickly based on provider and patient preferences and a growing knowledge base, other health provider organizations and third-party payers may likely require replicable scientific findings over time before incremental investments will be made to create infrastructure, reform regulatory barriers, and amend laws to accommodate expansion of telehealth modalities. Accordingly, large-scale scientifically rigorous telehealth research in VHA settings is essential not only to investigate the efficacy of existing and future telehealth practices in VHA, but also to hasten the development of telehealth infrastructure in private and other public health settings. We propose an expanded partnership between the VA, NIH, and other funding agencies to investigate creative and pragmatic uses of telehealth technology. To this end, we identify six specific areas of research we believe to be particularly relevant to the efficient development of telehealth modalities in civilian and military contexts outside VHA.  Telemedicine Journal and e-health via PubMed

Financial Incentives and Integrated Care Strategies for Veterans with Diabetes, Cardiovascular Risks, and Serious Mental Illness.

Financial Incentives and Accountability for Integrated Medical Care in Department of Veterans Affairs Mental Health Programs. 01/02/10.  CONCLUSIONS: Financial incentives to improve quality performance may promote accountability in monitoring diabetes and cardiovascular risk assessment within mental health programs. Integrated care strategies (co-location) might be needed to promote management of high-risk behaviors among patients with serious mental illness. Psychiatric Services via PubMed

Greater Availability of Mental Health Specialty Services Needed to Ensure Veterans Receive Minimally Adequatet Treatment After a PTSD Diagnosis.

Treatment Receipt by Veterans After a PTSD Diagnosis in PTSD, Mental Health, or General Medical Clinics. 01/02/10.  CONCLUSIONS: Greater availability of mental health specialty services, particularly PTSD services, may be needed to ensure that veterans receive minimally adequate treatment after a PTSD diagnosis. Psychiatric Services via PubMed

Rates of Testing Lower for HIV Than for HCV in Programs Serving Veterans with Substance Use Disorders

Program Characteristics Associated With Testing for HIV and Hepatitis C in Veterans Substance Use Disorder Clinics. 01/02/10.  CONCLUSIONS: Despite national emphasis on HIV testing, rates of testing were lower for HIV than for HCV in programs serving veterans with substance use disorders and at risk of both illnesses. System-level quality improvement initiatives may be effective at increasing rates of infectious disease screening. Psychiatric Services via PubMed

Transition Assistance Program (TAP)

Program Helps Servicemembers Transition to Civilian Life 01/01/10. The Department of Defense’s Transition Assistance Program (TAP) is working to prepare servicemembers and their families for a successful transition to civilian life. "We are trying to ensure that [servicemembers] transition from active duty back to the civilian community is a smooth and seamless one," Ron Horne, deputy director for the Transition Assistance Program at the Office of Wounded Warrior Care and Transition Policy told listeners during a “Dot Mil Docs” interview today. TAP also has a Web site, www.turbotap.org, which offers a timeline on the transitioning process and other resources that help with the entire process. “We are trying to get [servicemembers] started early enough so that they can plan to do things step by step.”  Military Health System

VAOIG Review of Cleveland VA

Combined Assessment Program Review of the Louis Stokes Cleveland VA Medical Center Cleveland, Ohio 01/01/10. The purpose of the review was to evaluate selected operations, focusing on patient care administration and quality management (QM). During the review, we provided fraud and integrity awareness training to 644 employees. This review focused on six operational activities. The medical center complied with selected standards in the following two activities (1) medication management and (2) physician privileging. We identified the patient transfer center, the Prosthetic/Orthotic Laboratory, and inpatient diabetes care as organizational strengths. We made recommendations for improvements in the following four activities: magnetic resonance imagining safety, QM, coordination of care, and environment of care. VAOIG

VAOIG Inspection of Salt Lake City VA

Healthcare Inspection Alleged Quality of Care Issues VA Salt Lake City Health Care System Salt Lake City, Utah 01/01/10. The purpose of the review was to determine the validity of the following allegations: (1) lack of collaboration, inappropriate care, and deaths; (2) unwarranted amputations; and (3) inappropriate management of vein patients. We substantiated poor collaboration between Interventional Radiology and Vascular Surgery for two of the four patients but concluded that this did not directly contribute to the fatal outcomes. We concluded that the system took appropriate actions to review the quality of care and make system improvements, which included conducting institutional disclosures in two of the four cases. However, we determined that the system needed to refer a case to Regional Counsel for guidance. We did not substantiate the occurrence of unwarranted amputations or inappropriate management of vein patients. We recommended that the system refer Patient Case 2 to Regional Counsel to determine whether the system has an obligation to report the providers to the National Practitioner Data Base. Since management had already addressed the issue, we consider this recommendation closed. VAOIG

NSAID Use May Increase Hospitalization Rate in Veterans

Differential impact of NSAIDs on rate of adverse events that require hospitalization in high-risk and general veteran populations: a retrospective cohort study. 01/01/10.  CONCLUSIONS: NSAID use is associated with an increased risk of hospitalization in all groups, with similar risk ratio estimates. However, the clinical implications were greater in the high-risk populations, in which more hospitalizations were observed. Consideration may need to be given to differential presentation of risk information to clinicians. Drugs & Aging via PubMed

Data Mining to Identify Depressed Veterans at Increased Risk of Suicide

Exploratory data mining analysis identifying subgroups of patients with depression who are at high risk for suicide. 01/01/10.  Using an empirically based decision tree analysis for a large national sample of Veterans Affairs (VA) health system patients treated for depression, we identified subgroups with particularly high or low rates of suicide. The Journal of Clinical Psychiatry via PubMed

Improving Hypertension Care in a Veteran Population

Quality improvement initiatives improve hypertension care among veterans. 01/01/10. CONCLUSIONS: After implementing small, focused, and inexpensive interventions, BP control improved 4.2%, thereby improving the quality of hypertension care. Circulation: Cardiovascular Quality and Outcomes via PubMed

ICD-9-CM Diagnostic Codes for Inflammatory Bowel Disease Among Veterans

Validation of ICD-9-CM Diagnostic Codes for Inflammatory Bowel Disease Among Veterans. 01/01/10.  BACKGROUND: Inflammatory bowel disease (IBD) is well described among young whites and less so among the elderly and non-whites. Population-level data is required to assess outcomes among minority groups. AIM: To validate diagnostic codes for IBD from the Department of Veterans Affairs. METHODS: National databases were used to identify local patients with Crohn's disease (CD) and ulcerative colitis (UC), the extra-intestinal manifestations and surgical procedures associated with IBD. Diagnosis was confirmed by manual chart abstraction. Multivariable logistic regression was used to derive diagnostic algorithms for CD and UC, which were then validated in an independent cohort. RESULTS: The test cohort of 3,827 patients (1,316 potential cases, 2,511 random controls) was predominantly male (94%), white (56%), and of age of 58 (standard deviation 15). The positive predictive value (PPV) of CD codes was superior (88-100%) to UC (50-93%). The accuracy of extra-intestinal manifestations and surgeries was poor (PPV 0-29%). ICD-9-CM code 555.x without 560.9 had a PPV of 91% for CD in the validation cohort. Code 556.x with age, gender, and race factors was highly predictive of UC (c-statistic 0.9, PPV of 81%). CONCLUSION: VA administrative data can diagnose elderly and non-white patients with IBD.  Digestive Diseases and Sciences via PubMed

The Department of Veterans Affairs (VA) National Quality Scholars Fellowship Program (VAQS) Successful in Improving Veterans Care

The Department of Veterans Affairs National Quality Scholars Fellowship Program: experience from 10 years of training quality scholars. 01/01/10.  The Department of Veterans Affairs (VA) National Quality Scholars Fellowship Program (VAQS) was established in 1998 as a postgraduate medical education fellowship to train physicians in new methods of improving the quality and safety of health care for veterans and the nation. The VAQS curriculum is based on adult learning theory, with a national core curriculum of face-to-face components, technologically mediated distance learning components, and a unique local curriculum that draws from the strengths of regional resources. VAQS has established strong ties with other VA programs. Fellows' research and quality improvement projects are integrated with local and regional VA leaders' priorities, enhancing the relevance and visibility of the fellows' efforts and promoting recruitment of fellows to VA positions. VAQS has enrolled 98 fellows since 1999; 75 have completed the program and 24 are currently enrolled. Fellowship graduates have pursued a variety of career paths: 17% are continuing training (most in VA), 31% hold a VA faculty/staff position, 66% are academic faculty, and 80% conduct clinical or research work related to health care improvement. Graduates have held leadership positions in VA, Department of Defense, academic medicine, and public health agencies. Combining knowledge about the improvement of health care with adult learning strategies, distance learning technologies, face-to-face meetings, local mentorship, and experiential projects has been successful in improving care in VA and preparing physicians to participate in, study, and lead the improvement of health care quality and safety.  Academic Medicine via PubMed

Teleconference Delivery of a Spiritually Based Caregiver Intervention for Caregivers of Demented Veterans

A spiritually based caregiver intervention with telephone delivery for family caregivers of veterans with dementia. 01/01/10.  Caring for veterans with dementia is burdensome for family caregivers. This exploratory study tested the efficacy of an innovative, spiritually based mantram caregiver intervention delivered using teleconference calls. A prospective, within-subjects, mixed-methods, and 3-time repeated-measures design with 36-week follow-up telephone interviews was conducted. Sixteen caregivers (94% women, 94% Whites with mean age 69.2 years, SD = 10.35 years) completed the intervention. Significant effects for time and linear terms were found for decreasing caregiver burden, perceived stress, depression, and rumination and for increasing quality of life enjoyment and satisfaction, all with large effect sizes. Findings suggest that teleconference delivery of a spiritually based caregiver intervention is feasible. Family & Community Health via PubMed