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Kim B, Petrakis BA, Griesemer I, Sliwinski SK, Midboe AM, Raciborski RA, Byrne TH, Gingell MB, Blue-Howells J, Clark SC, Tsai J, Harvey KLL, McInnes DK. Legal Services for Veterans (LSV): Protocol for evaluating the grant-based LSV initiative supporting community organizations' delivery of legal services to veterans. PLoS One 2024; 19:e0297424. [PMID: 38625878 PMCID: PMC11020365 DOI: 10.1371/journal.pone.0297424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND 1.8 million Veterans are estimated to need legal services, such as for housing eviction prevention, discharge upgrades, and state and federal Veterans benefits. While having one's legal needs met is known to improve one's health and its social determinants, many Veterans' legal needs remain unmet. Public Law 116-315 enacted in 2021 authorizes VA to fund legal services for Veterans (LSV) by awarding grants to legal service providers including nonprofit organizations and law schools' legal assistance programs. This congressionally mandated LSV initiative will award grants to about 75 competitively selected entities providing legal services. This paper describes the protocol for evaluating the initiative. The evaluation will fulfill congressional reporting requirements, and inform continued implementation and sustainment of LSV over time. METHODS Our protocol calls for a prospective, mixed-methods observational study with a repeated measures design, aligning to the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) and Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) frameworks. In 2023, competitively selected legal services-providing organizations will be awarded grants to implement LSV. The primary outcome will be the number of Veterans served by LSV in the 12 months after the awarding of the grant. The evaluation has three Aims. Aim 1 will focus on measuring primary and secondary LSV implementation outcomes aligned to RE-AIM. Aim 2 will apply the mixed quantitative-qualitative Matrixed Multiple Case Study method to identify patterns in implementation barriers, enablers, and other i-PARIHS-aligned factors that relate to observed outcomes. Aim 3 involves a mixed-methods economic evaluation to understand the costs and benefits of LSV implementation. DISCUSSION The LSV initiative is a new program that VA is implementing to help Veterans who need legal assistance. To optimize ongoing and future implementation of this program, it is important to rigorously evaluate LSV's outcomes, barriers and enablers, and costs and benefits. We have outlined the protocol for such an evaluation, which will lead to recommending strategies and resource allocation for VA's LSV implementation.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
| | - Ida Griesemer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Samantha K. Sliwinski
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Amanda M. Midboe
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, United States of America
- University of California at Davis School of Medicine, Sacramento, California, United States of America
| | - Rebecca A. Raciborski
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, United States of America
- Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, United States of America
| | - Thomas H. Byrne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Boston University School of Social Work, Boston, Massachusetts, United States of America
| | - Madolyn B. Gingell
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
| | - Jessica Blue-Howells
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
| | - Sean C. Clark
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
| | - Jack Tsai
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
- University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Kim L. L. Harvey
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - D. Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Boston University School of Public Health, Boston, Massachusetts, United States of America
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Pyne JM, Seal KH, Manuel JK, DeRonne B, Oliver KA, Bertenthal D, Esserman D, Purcell N, Petrakis BA, Elwy AR. Developing and testing a COVID-19 vaccination acceptance intervention: A pragmatic trial comparing vaccine acceptance intervention vs usual care - Rationale, methods, and implementation. Contemp Clin Trials 2023; 133:107325. [PMID: 37652356 DOI: 10.1016/j.cct.2023.107325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND COVID-19 has resulted in significant disability and loss of life. COVID-19 vaccines effectively prevent severe illness, hospitalization, and death. Nevertheless, many people remain hesitant to accept vaccination. Veterans perceive healthcare providers (HCP) and staff as trusted vaccine information sources and thereby are well suited to initiate vaccine discussions. The overall objective of this study is to implement and test a virtual COVID-19 Vaccine Acceptance Intervention (VAI) training that is informed by motivational interviewing (MI) techniques. METHODS The VAI training is being delivered to VA HCPs and staff within a Hybrid Type 2 pragmatic implementation-effectiveness trial using Implementation Facilitation as the implementation strategy. The implementation team includes external facilitators paired with VA Healthcare System (VAHCS)-level internal facilitators. The trial has three aims: 1) Examine the effectiveness of the VAI versus usual care on unvaccinated veterans' vaccination rates in a one-year cluster randomized controlled trial, with randomization at the level of VAHCS. 2) Determine factors associated with veterans' decisions to accept or decline primary COVID-19 vaccination, and better understand how these factors influence vaccination decisions, through survey and qualitative data; and 3) Use qualitative interviews with HCPs and staff from clinics with high and low vaccination rates to learn what was helpful and not helpful about the VAI and implementation strategies. CONCLUSION This is the first multisite randomized controlled trial to test an MI-informed vaccine acceptance intervention to improve COVID-19 vaccine acceptance. Information gained can be used to inform healthcare systems' approaches to improve future vaccination and other public health campaigns. CLINICALTRIALS gov Identifier: NCT05027464.
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Affiliation(s)
- Jeffrey M Pyne
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, United States of America; South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, United States of America; Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Karen H Seal
- Integrative Health Service, San Francisco VA Healthcare System, 4150 Clement Street, San Francisco, CA, United States of America; Departments of Medicine and Psychiatry, University of California San Francisco, San Francisco, CA, United States of America
| | - Jennifer K Manuel
- Integrative Health Service, San Francisco VA Healthcare System, 4150 Clement Street, San Francisco, CA, United States of America; Department of Psychiatry, University of California, 675 18th Street San Francisco, San Francisco, CA, United States of America
| | - Beth DeRonne
- Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, United States of America; Center for Care Delivery and Outcomes Research, 5445 Minnehaha Avenue South, Building 9, Minneapolis, MN, United States of America
| | - Karen Anderson Oliver
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, United States of America
| | - Dan Bertenthal
- Integrative Health Service, San Francisco VA Healthcare System, 4150 Clement Street, San Francisco, CA, United States of America
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Natalie Purcell
- Integrative Health Service, San Francisco VA Healthcare System, 4150 Clement Street, San Francisco, CA, United States of America; Department of Social and Behavioral Sciences, University of California, 490 Illinois St., San Francisco, CA, United States of America
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, United States of America
| | - A Rani Elwy
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, United States of America; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI, United States of America
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Winograd DM, Hyde JK, Bloeser K, Santos SL, Anastasides N, Petrakis BA, Pigeon WR, Litke DR, Helmer DA, McAndrew LM. Exploring the acceptability of behavioral interventions for veterans with persistent "medically unexplained" physical symptoms. J Psychosom Res 2023; 167:111193. [PMID: 36822031 DOI: 10.1016/j.jpsychores.2023.111193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE This study evaluated the factors that led to enrollment in, and satisfaction with, behavioral interventions for Veterans living with Gulf War Illness (GWI). METHODS One-on-one interviews were conducted pre- and post-intervention with participants randomized to receive either telephone delivered problem-solving treatment (n = 51) or health education (N = 49). A total of 99 Veterans were interviewed pre-intervention and 60 post-intervention. Qualitative data were thematically coded and similarities in themes across the two interventions were examined. RESULTS Before the study began, participants reported desiring to learn new information about their GWI, learn symptom-management strategies, and support improvements to care for other patients with GWI. After the intervention, Veterans felt positively about both interventions because they built strong therapeutic relationships with providers, their experiences were validated by providers, and they were provided GWI information and symptom-management strategies. Results also suggested that interventions do not have to be designed to meet all of the needs held by patients to be acceptable. A minority of participants described that they did not benefit from the interventions. CONCLUSION The results suggest that satisfaction with behavioral interventions for GWI is driven by a strong therapeutic relationship, validating patient's experiences with GWI, and the intervention meeting some of the patient's needs, particularly increasing knowledge of GWI and improving symptom management.
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Affiliation(s)
- Darren M Winograd
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA; University at Albany, State University of New York, Albany, NY, USA
| | - Justeen K Hyde
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA; Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Katharine Bloeser
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA; Silberman School of Social Work at Hunter College, The City University of New York, New York, NY, USA
| | - Susan L Santos
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA
| | - Nicole Anastasides
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Veterans Affairs Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - David R Litke
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA; Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX 77030, USA
| | - Lisa M McAndrew
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA.
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Kim B, Petrakis BA, Sliwinski SK, McInnes DK, Gifford AL, Smelson DA. Staff and Veteran Perspectives on Residential Treatment Programs' Responses to COVID-19: A Qualitative Study Guided by the WHO's After Action Review Framework. Community Ment Health J 2023; 59:600-608. [PMID: 36318435 PMCID: PMC9628288 DOI: 10.1007/s10597-022-01038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Healthcare must rapidly and systematically learn from earlier COVID-19 responses to prepare for future crises. This is critical for VA's Mental Health Residential Rehabilitation and Treatment Programs (RRTPs), offering 24/7 care to Veterans for behavioral health and/or homelessness. We adapted the World Health Organization's After Action Review (AAR) to conduct semi-structured small-group discussions with staff from two RRTPs and Veterans who received RRTP care during COVID-19, to examine COVID-19's impact on these programs. Six thematic categories emerged through qualitative analysis (participant-checked and contextualized with additional input from program leadership), representing participants' recommendations including: Keep RRTPs open (especially when alternative programs are inaccessible), convey reasons for COVID-19 precautions and programming changes to Veterans, separate recovery-oriented programming from COVID-19-related information-sharing, ensure Wi-Fi availability for telehealth and communication, provide technology training during orientation, and establish safe procedures for off-site appointments. AAR is easily applicable for organizations to debrief and learn from past experiences.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, 02130, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA.
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, 01730, Bedford, MA, USA
| | - Samantha K Sliwinski
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, 02130, Boston, MA, USA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, 01730, Bedford, MA, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, 02118, Boston, MA, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, 02130, Boston, MA, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, 02118, Boston, MA, USA
- Section of General Internal Medicine, Boston University School of Medicine, 72 East Concord Street, 02118, Boston, MA, USA
| | - David A Smelson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, 01730, Bedford, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, 55 North Lake Avenue, 01655, Worcester, MA, USA
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LoBrutto LR, Elwy AR, Miano D, Ann Petrakis B, Kyrish A, Javier S, Erhardt T, Midboe AM, Carbonaro R, Jasuja GK, McInnes DK, Maguire EM, Asch SM, Gifford AL, Clayman ML. Antecedents to COVID-19 vaccine uptake among patients and employees in the Veterans Health Administration. Transl Behav Med 2023; 13:73-84. [PMID: 36448882 DOI: 10.1093/tbm/ibac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The present study sought to understand the antecedents to COVID-19 vaccination among those reporting a change in vaccine intention in order to improve COVID-19 vaccine uptake in the United States. We employed semi-structured interviews and one focus group discussion with vaccinated and unvaccinated Veterans Health Administration (VHA) employees and Veterans at three Veterans' Affairs medical centers between January and June 2021. A subset of these participants (n=21) self-reported a change in COVID-19 vaccine intention and were selected for additional analysis. We combined thematic analysis using the 5C scale (confidence, collective responsibility, complacency, calculation, constraints) as our theoretical framework with a constant comparative method from codes based on the SAGE Working Group on Vaccine Hesitancy. We generated 13 themes distributed across the 5C constructs that appeared to be associated with a change in COVID-19 vaccine intention. Themes included a trusted family member, friend or colleague in a healthcare field, a trusted healthcare professional, distrust of government or politics (confidence); duty to family and protection of others (collective responsibility); perceived health status and normative beliefs (complacency); perceived vaccine safety, perceived risk-benefit, and orientation towards deliberation (calculation); and ease of process (constraints). Key factors in promoting vaccine uptake included a desire to protect family; and conversations with as key factors in promoting vaccine uptake. Constructs from the 5C scale are useful in understanding intrapersonal changes in vaccine intentions over time, which may help public health practitioners improve future vaccine uptake.
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Affiliation(s)
- Lara R LoBrutto
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, MA 02130, USA
| | - A Rani Elwy
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Danielle Miano
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Beth Ann Petrakis
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Angela Kyrish
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Sarah Javier
- Bridge QUERI Program, Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA.,Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Taryn Erhardt
- Bridge QUERI Program, Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA
| | - Amanda M Midboe
- Bridge QUERI Program, Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA.,Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Richard Carbonaro
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Guneet K Jasuja
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - D Keith McInnes
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA
| | - Elizabeth M Maguire
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Steven M Asch
- Bridge QUERI Program, Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA.,Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Allen L Gifford
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, MA 02130, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA
| | - Marla L Clayman
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan School of Medicine, Worcester, MA 01655, USA
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Kaitz J, Robinson SA, Petrakis BA, Reilly ED, Chamberlin ES, Wiener RS, Quigley KS. Veteran Acceptance of Sleep Health Information Technology: a Mixed-Method Study. J Technol Behav Sci 2022; 8:57-68. [PMID: 36530383 PMCID: PMC9745770 DOI: 10.1007/s41347-022-00287-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/07/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022]
Abstract
Sleep disturbances, including chronic insomnia and sleep apnea, are major concerns for US veterans, with rising rates and detrimental effects on physical, mental, and social well-being. Sleep disturbances in veterans are also underdiagnosed and undertreated for reasons that include limited sleep clinician availability, long wait times, and the time commitment for treatment. Greater use of sleep health information technologies could improve access to assessment and treatment of sleep disturbances. However, the assessment of acceptance of these technologies among veterans is still ongoing. This mixed-method study combines data from two separate but similar randomized controlled trials to assess acceptance of sleep health information technologies for veterans with chronic insomnia. Sleep health information technologies included in these trials were the following: (1) a WatchPAT sleep monitor for home-based sleep assessment, including detection of sleep apnea, and (2) the VA mobile app Cognitive Behavioral Therapy for Insomnia (CBT-i Coach), which supports self-management of insomnia. The combined sample of 37 veterans receiving care within one New England VA medical center completed a six-week trial using both health information technology tools. Participants completed a survey and interview at the end of the 6 weeks. Overall, participants found the tools acceptable, easy to use, and useful and reported they would use them in the future. Thus, these sleep health information technologies appear to provide an acceptable remote option for assessing and managing sleep issues for veterans. ClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000 and ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354.
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Affiliation(s)
- Jenesse Kaitz
- CHOIR/Bedford VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford Healthcare System, Bedford, MA USA
| | - Stephanie A. Robinson
- CHOIR/Bedford VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford Healthcare System, Bedford, MA USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA USA
| | - Beth Ann Petrakis
- CHOIR/Bedford VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford Healthcare System, Bedford, MA USA
| | - Erin D. Reilly
- Mental Illness Research, Education, and Clinical Center (MIRECC), Bedford Healthcare System, Bedford, USA
- University of Massachusetts Medical School, Worcester, MA USA
| | - Elizabeth S. Chamberlin
- Geriatric Research Education and Clinical Center (GRECC), Bedford Healthcare System, Bedford, MA USA
| | - Renda Soylemez Wiener
- The Pulmonary Center, Boston University School of Medicine, Boston, MA USA
- Center for Healthcare Organization & Implementation Research and Medical Service, Boston Healthcare System, Boston, MA USA
| | - Karen S. Quigley
- Department of Psychology, Northeastern University, Boston, MA USA
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7
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McAndrew LM, Quigley KS, Lu SE, Litke D, Rath JF, Lange G, Santos SL, Anastasides N, Petrakis BA, Greenberg L, Helmer DA, Pigeon WR. Effect of Problem-solving Treatment on Self-reported Disability Among Veterans With Gulf War Illness: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2245272. [PMID: 36472870 PMCID: PMC9856484 DOI: 10.1001/jamanetworkopen.2022.45272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Few evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions. OBJECTIVE To examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI. DESIGN, SETTING, AND PARTICIPANTS This multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to September 1, 2019); outcomes were assessed at 12 weeks and 6 months. Statistical analysis was conducted between January 1, 2019, and December 31, 2020. INTERVENTIONS Problem-solving treatment taught skills to improve problem-solving. Health education provided didactic health information. Both were delivered by telephone weekly for 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was reduction from baseline to 12 weeks in self-report of disability (World Health Organization Disability Assessment Schedule). Secondary outcomes were reductions in self-report of problem-solving impairment and objective problem-solving. Exploratory outcomes were reductions in pain, pain disability, and fatigue. RESULTS A total of 268 veterans (mean [SD] age, 52.9 [7.3] years; 88.4% male; 66.8% White) were randomized to PST (n = 135) or health education (n = 133). Most participants completed all 12 sessions of PST (114 of 135 [84.4%]) and health education (120 of 133 [90.2%]). No difference was found between groups in reductions in disability at the end of treatment. Results suggested that PST reduced problem-solving impairment (moderate effect, 0.42; P = .01) and disability at 6 months (moderate effect, 0.39; P = .06) compared with health education. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of the efficacy of PST for GWI, no difference was found between groups in reduction in disability at 12 weeks. Problem-solving treatment had high adherence and reduced problem-solving impairment and potentially reduced disability at 6 months compared with health education. These findings should be confirmed in future studies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02161133.
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Affiliation(s)
- Lisa M. McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | - Karen S. Quigley
- Bedford VA Medical Center, Bedford, Massachusetts
- Department of Psychology, Northeastern University, Boston, Massachusetts
| | - Shou-En Lu
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - David Litke
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
- Department of Rehabilitation Medicine, New York University School of Medicine, New York
| | - Joseph F. Rath
- Department of Rehabilitation Medicine, New York University School of Medicine, New York
| | - Gudrun Lange
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | - Susan L. Santos
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | - Nicole Anastasides
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | | | - Lauren Greenberg
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
- VA Palo Alto Health Care System, Palo Alto, California
| | - Drew A. Helmer
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
- Center for Innovations in Quality, Effectiveness and Safety at Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
| | - Wilfred R. Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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Hyde J, Byrne T, Petrakis BA, Yakovchenko V, Kim B, Fincke G, Bolton R, Visher C, Blue-Howells J, Drainoni ML, McInnes DK. Enhancing community integration after incarceration: findings from a prospective study of an intensive peer support intervention for veterans with an historical comparison group. Health Justice 2022; 10:33. [PMID: 36348203 PMCID: PMC9644600 DOI: 10.1186/s40352-022-00195-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The transition to the community after incarceration presents challenges for returning citizens, including the immediate need to secure housing, employment, and income. Additionally, health care is essential for this population due to high rates of chronic physical health and mental health problems and substance use disorders. There is growing recognition of the need for interventions that support returning citizens as they navigate community reintegration while simultaneously tending to physical and behavioral health needs. We developed and pilot tested a peer support intervention designed to provide social, emotional, and logistic support and promote linkage and engagement in healthcare for returning citizens. We tested the intervention with US military veterans in Massachusetts who were being released from prison and jail. Outcomes related to linkage to and engagement in healthcare were evaluated using an historical comparison group. Engagement in peer support, housing status, and reincarceration rates were monitored for the intervention group. RESULTS There were 43 veterans in the intervention group, and 36 in the historical comparison group. For linkage to primary care within 90 days of release, there were no statistically significant differences between the intervention and comparison groups (58% versus 67%). Intervention participants were significantly more likely to receive substance use treatment than the comparison group (86% versus 19%, p < .0001) and the mean monthly substance use visits was greater in the intervention group (0.96 versus 0.34, p < .007). Engagement in mental health services was greater for the intervention group than the comparison group (93% versus 64%, p < .003). There were no significant differences between groups for emergency department use and hospitalization. At the end of the study period, the majority of intervention participants who had been released for over a year were living in permanent housing (84%). Recidivism among the was low, with 7% re-arrested during the study period. CONCLUSIONS Augmenting reentry support through intensive peer support appears to have substantial benefits for veterans in terms of engaging them in health care and contributing to their longer-term stability, including housing and recidivism. Flexible reentry support such as this intervention may be well suited to meet the widely varying needs of returning citizens.
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Affiliation(s)
- Justeen Hyde
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA.
- General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Thomas Byrne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- School of Social Work, Boston University, Boston, MA, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
| | - Vera Yakovchenko
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Bo Kim
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, USA
| | - Graeme Fincke
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Rendelle Bolton
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Christy Visher
- Center for Drug & Health Studies, Department of Sociology and Criminal Justice, University of Delaware, Wilmington, DE, USA
| | - Jessica Blue-Howells
- VA Healthcare for Re-Entry Veterans, U.S. Department of Veteran Affairs, Washington, USA
| | - Mari-Lynn Drainoni
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
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9
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Kim B, Petrakis BA, McInnes DK, Gifford AL, Sliwinski SK, Smelson DA. Applying after action review to examine residential treatment programs' responses to COVID-19. Int J Health Plann Manage 2022; 37:2461-2467. [PMID: 35419883 PMCID: PMC9087400 DOI: 10.1002/hpm.3475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/12/2022] [Accepted: 03/27/2022] [Indexed: 11/15/2022] Open
Abstract
Resurgences of COVID‐19 cases are a grave public health concern. Hence, there is an urgent need for health care systems to rapidly and systematically learn from their responses to earlier waves of COVID‐19. To meet this need, this article delineates how we adapted the World Health Organization's After Action Review (AAR) framework to use within our health care system of the United States Department of Veterans Affairs. An AAR is a structured, methodical evaluation of actions taken in response to an event (e.g., recent waves of COVID‐19). It delivers an actionable report regarding (i) what was expected, (ii) what actually happened, (iii) what went well, and (iv) what could have been done differently, and thus what changes are needed for future situations. We share as an example our examination of Mental Health Residential Rehabilitation and Treatment Programs in Massachusetts (a COVID‐19 hotspot). Our work can be further adapted, beyond residential treatment, as a consistent framework for reviewing COVID‐19 responses across multiple health care programs. This will identify both standardized and tailored preparations that the programs can make for future waves of the pandemic. Given the expected resurgences of COVID‐19 cases, the time to apply AAR is now. For health care programs around the world to better respond to future waves of the pandemic, there is an urgent need for them to rapidly and systematically learn from their responses to earlier waves of COVID‐19. This article delineates an adaptation of the World Health Organization’s After Action Review (AAR) framework, applied to examining residential treatment programs’ responses to COVID‐19. Even beyond residential treatment programs, the outlined AAR can be further adapted as a consistent approach for reviewing COVID‐19 responses across multiple health care programs, bringing to light key commonalities and heterogeneities among programs that operate in widely varying contexts.
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Affiliation(s)
- Bo Kim
- VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Beth Ann Petrakis
- VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - D Keith McInnes
- VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Allen L Gifford
- VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Samantha K Sliwinski
- VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - David A Smelson
- VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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10
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Reilly ED, Robinson SA, Petrakis BA, Gardner MM, Wiener RS, Castaneda-Sceppa C, Quigley KS. Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial. JMIR Form Res 2021; 5:e29573. [PMID: 34889746 PMCID: PMC8704109 DOI: 10.2196/29573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 01/14/2023] Open
Abstract
Background Insomnia is a prevalent and debilitating disorder among veterans. Cognitive behavioral therapy for insomnia (CBTI) can be effective for treating insomnia, although many cannot access this care. Technology-based solutions and lifestyle changes, such as physical activity (PA), offer affordable and accessible self-management alternatives to in-person CBTI. Objective This study aims to extend and replicate prior pilot work to examine whether the use of a mobile app for CBTI (cognitive behavioral therapy for insomnia coach app [CBT-i Coach]) improves subjective and objective sleep outcomes. This study also aims to investigate whether the use of the CBT-i Coach app with adjunctive PA improves sleep outcomes more than CBT-i Coach alone. Methods A total of 33 veterans (mean age 37.61 years, SD 9.35 years) reporting chronic insomnia were randomized to use either the CBT-i Coach app alone or the CBT-i Coach app with a PA intervention over 6 weeks, with outcome measures of objective and subjective sleep at pre- and posttreatment. Results Although the PA manipulation was unsuccessful, both groups of veterans using the CBT-i Coach app showed significant improvement from baseline to postintervention on insomnia (P<.001), sleep quality (P<.001), and functional sleep outcomes (P=.002). Improvements in subjective sleep outcomes were similar in those with and without posttraumatic stress disorder and mild-to-moderate sleep apnea. We also observed a significant but modest increase in objective sleep efficiency (P=.02). Conclusions These findings suggest that the use of a mobile app–delivered CBTI is feasible and beneficial for improving sleep outcomes in veterans with insomnia, including those with comorbid conditions such as posttraumatic stress disorder or mild-to-moderate sleep apnea. Trial Registration ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354
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Affiliation(s)
- Erin Dawna Reilly
- Mental Illness Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, United States.,Social and Community Reintegration Research, VA Bedford Healthcare System, Bedford, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States
| | - Stephanie A Robinson
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Pulmonary Division, Boston University School of Medicine, Boston, MA, United States
| | - Beth Ann Petrakis
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | | | - Renda Soylemez Wiener
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Pulmonary Division, Boston University School of Medicine, Boston, MA, United States
| | | | - Karen S Quigley
- Social and Community Reintegration Research, VA Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Northeastern University, Boston, MA, United States
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11
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Elwy A, Clayman ML, LoBrutto L, Miano D, Ann Petrakis B, Javier S, Erhardt T, Midboe AM, Carbonaro R, Jasuja GK, Maguire EM, Kyrish A, Asch SM, Gifford AL, McInnes DK. Vaccine hesitancy as an opportunity for engagement: A rapid qualitative study of patients and employees in the U.S. Veterans Affairs healthcare system. Vaccine X 2021; 9:100116. [PMID: 34580652 PMCID: PMC8457639 DOI: 10.1016/j.jvacx.2021.100116] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/06/2021] [Accepted: 09/19/2021] [Indexed: 12/01/2022] Open
Abstract
Although COVID-19 vaccines have been available to many U.S. Veterans Affairs (VA) healthcare system employees and Veteran patients since early 2021, vaccine receipt data indicates some groups are not receiving them. Our objective was to conduct a rapid qualitative assessment of Veterans' and VA employees' views on COVID-19 vaccination to inform clinical leaders' ongoing efforts to increase vaccine uptake across the VA. We employed semi-structured interviews and a focus group involving employees and Veterans as part of a quality improvement project between January and June 2021 at three VA medical centers. Thirty-one employees and 27 Veterans participated in semi-structured interviews; 5 Veterans from a national stakeholder organization participated in a focus group. Data were analyzed using directed content analysis, involving an a priori coding framework comprised of four domains with subcodes under each: contextual influences, barriers and facilitators, vaccine-specific issues, and VA/military experiences. We then classified initial codes into five categories of hesitancy: vaccine deliberation, dissent, distrust, indifference and skepticism. A subset of Veterans (n = 14) and employees (n = 8) identified as vaccine hesitant. Vaccine hesitancy categories were represented by subcodes of religion, culture, gender or socio-economic factors, perceptions of politics and policies, role of healthcare providers, and historical influences; (contextual influences); knowledge or awareness of vaccines, perceived susceptibility to COVID-19, and beliefs and attitudes about health and illness (barriers and facilitators); vaccine development process (vaccine-specific issues) and military experiences (VA/military factors). Facilitators involved talking with trusted others, ease of vaccine access, and perceptions of family and societal benefits of vaccines. Vaccine hesitancy is multi-faceted and likely requires multiple strategies for engaging in conversations to address Veteran and VA employee concerns. Messages should involve patient-centered communication strategies delivered by trusted healthcare providers and peers and should focus on addressing expected benefits for family, friends, and society.
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Affiliation(s)
- A.Rani Elwy
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Marla L. Clayman
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Lara LoBrutto
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, MA 02130, USA
| | - Danielle Miano
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Beth Ann Petrakis
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Sarah Javier
- Bridge QUERI Program, Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Taryn Erhardt
- Bridge QUERI Program, Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA
| | - Amanda M. Midboe
- Bridge QUERI Program, Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Richard Carbonaro
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Guneet K. Jasuja
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Elizabeth M. Maguire
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Angela Kyrish
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
| | - Steven M. Asch
- Bridge QUERI Program, Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Allen L. Gifford
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, MA 02130, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA
| | - D. Keith McInnes
- Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA
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12
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Yakovchenko V, McInnes DK, Petrakis BA, Gillespie C, Lipschitz JM, McCullough MB, Richardson L, Vetter B, Hogan TP. Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework. JMIR Mhealth Uhealth 2021; 9:e31037. [PMID: 34779779 PMCID: PMC8663696 DOI: 10.2196/31037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/23/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. Conclusions VHA’s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. Trial Registration ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349
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Affiliation(s)
- Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Chris Gillespie
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Jessica M Lipschitz
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Megan B McCullough
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Department of Public Health, University of Massachusetts, Lowell, MA, United States
| | - Lorilei Richardson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Brian Vetter
- Office of Connected Care, Veterans Health Administration, Washington, DC, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
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13
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Robinson SA, Reilly ED, Petrakis BA, Wiener RS, Castaneda-Sceppa C, Quigley KS. Daily physical activity and sleep in veterans: the role of insomnia severity. J Behav Med 2021; 45:318-323. [PMID: 34718912 DOI: 10.1007/s10865-021-00260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/02/2021] [Indexed: 11/24/2022]
Abstract
Physical activity (PA) is suggested as an easily accessible adjunctive lifestyle intervention for insomnia. It is not clear if PA is equally beneficial across different levels of insomnia severity. The current study examined the relationship between daily PA (steps) and sleep (duration, efficiency, and quality) across the spectrum of insomnia severity. Multilevel models estimated day-to-night relationships between PA and sleep, and if insomnia severity moderated these relationships. Days with greater PA were associated with nights with longer sleep duration. This was moderated by insomnia severity; PA was associated with longer sleep that night in participants with mild insomnia and associated with less sleep in those with severe insomnia. PA was not associated with sleep efficiency or quality. PA is potentially an easily accessible and impactful intervention to promote sleep duration in participants who are experiencing less severe sleep disturbance. More complex, resource-intensive interventions may be needed as insomnia severity increases.
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Affiliation(s)
- S A Robinson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA. .,The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
| | - E D Reilly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | - B A Petrakis
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - R S Wiener
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA.,The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | | | - K S Quigley
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA.,Northeastern University, Boston, MA, USA
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14
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Bloeser K, McCarron KK, Merker VL, Hyde J, Bolton RE, Anastasides N, Petrakis BA, Helmer DA, Santos S, Litke D, Pigeon WR, McAndrew LM. "Because the country, it seems though, has turned their back on me": Experiences of institutional betrayal among veterans living with Gulf War Illness. Soc Sci Med 2021; 284:114211. [PMID: 34271400 DOI: 10.1016/j.socscimed.2021.114211] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/24/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
People living with medically unexplained symptoms (MUS) often have poor quality of life and health outcomes. Many struggle to engage with and trust in healthcare systems. This qualitative study examined how experiences with institutions influence perceptions of medical care for MUS by applying the theoretical framework of institutional betrayal to narratives of U.S. military Veterans living with Gulf War Illness (GWI). Institutional betrayal refers to situations in which the institutions people depend upon for safety and well-being cause them harm. Experiences of institutional betrayal both during active military service and when first seeking treatment appeared to shape perceptions of healthcare in this sample. Veterans expressed the belief that the military failed to protect them from environmental exposures. Veterans' concerns regarding subsequent quality of healthcare were intrinsically linked to a belief that, despite official documentation to the contrary, the predominant paradigm of both the U.S. Department of Defense and the U.S. Department of Veterans Affairs (VA) is that GWI does not exist. Veterans reported that providers are not adequately trained on treatment of GWI and do not believe Veterans' descriptions of their illness. Veterans reported taking up self-advocacy, doing their own research on their condition, and resigning themselves to decrease engagement with VA healthcare or seek non-VA care. The study's findings suggest institutional level factors have a profound impact on perceptions of care and the patient-provider relationship. Future research and policy aimed at improving healthcare for people living with MUS should consider the concept of institutional betrayal.
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Affiliation(s)
- Katharine Bloeser
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA; Silberman School of Social Work at Hunter College, The City University of New York, NY, USA.
| | - Kelly K McCarron
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Vanessa L Merker
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA; Boston University, Department of Medicine, Section General Internal Medicine, Boston, MA, USA
| | - Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA; Brandeis University, Heller School for Social Policy and Management, MA, USA
| | - Nicole Anastasides
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA
| | - Drew A Helmer
- VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA
| | - Susan Santos
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - David Litke
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Wilfred R Pigeon
- VA Center of Excellence for Suicide Prevention, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Lisa M McAndrew
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA; Department of Educational and Counseling Psychology, University at Albany, State University of New York, NY, USA
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15
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Kalver EH, McInnes DK, Yakovchenko V, Hyde J, Petrakis BA, Kim B. The CORE (Consensus on Relevant Elements) Approach to Determining Initial Core Components of an Innovation. Front Health Serv 2021; 1:752177. [PMID: 36926486 PMCID: PMC10012682 DOI: 10.3389/frhs.2021.752177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022]
Abstract
Identifying an intervention's core components is indispensable to gauging whether an intervention is implemented with fidelity and/or is modified; it is often a multi-stage process, starting with the first stage of identifying an initial set of core components that are gradually refined. This first stage of identifying initial core components has not been thoroughly examined. Without a clear set of steps to follow, interventions may vary in the rigor and thought applied to identifying their initial core components. We devised the CORE (Consensus on Relevant Elements) approach to synthesize opinions of intervention developers/implementers to identify an intervention's initial core components, particularly applicable to innovative interventions. We applied CORE to a peer-based intervention that aids military veterans with post-incarceration community reintegration. Our CORE application involved four intervention developers/implementers and two moderators to facilitate the seven CORE steps. Our CORE application had two iterations, moving through Steps 1 (individual core component suggestions) through 7 (group discussion for consensus), then repeating Steps 4 (consolidation of component definitions) through 7. This resulted in 18 consensus-reached initial core components of the peer-based intervention, down from the 60 that the developers/implementers individually suggested at Step 1. Removed components were deemed to not threaten the intervention's effectiveness even if absent. CORE contributes to filling a critical gap regarding identifying an intervention's initial core components (so that the identified components can be subsequently refined), by providing concrete steps for synthesizing the knowledge of an intervention's developers/implementers. Future research should examine CORE's utility across various interventions and implementation settings.
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Affiliation(s)
- Emily H Kalver
- Department of Psychology, Montclair State University, Montclair, NJ, United States
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, Veterans Health Administration, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, Veterans Health Administration, Bedford, MA, United States
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research, Veterans Health Administration, Bedford, MA, United States.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, Veterans Health Administration, Bedford, MA, United States
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, Veterans Health Administration, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Kim B, Bolton RE, Hyde J, Fincke BG, Drainoni ML, Petrakis BA, Simmons MM, McInnes DK. Coordinating across correctional, community, and VA systems: applying the Collaborative Chronic Care Model to post-incarceration healthcare and reentry support for veterans with mental health and substance use disorders. Health Justice 2019; 7:18. [PMID: 31832790 PMCID: PMC6909453 DOI: 10.1186/s40352-019-0099-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/20/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Between 12,000 and 16,000 veterans leave incarceration annually. As is known to be the case for justice-involved populations in general, mental health disorders (MHDs) and substance use disorders (SUDs) are highly prevalent among incarcerated veterans, and individuals with MHDs and SUDs reentering the community are at increased risk of deteriorating health and recidivism. We sought to identify opportunities to better coordinate care/services across correctional, community, and VA systems for reentry veterans with MHDs and SUDs. METHODS We interviewed 16 veterans post-incarceration and 22 stakeholders from reentry-involved federal/state/community organizations. We performed a grounded thematic analysis, and recognizing consistencies between the emergent themes and the evidence-based Collaborative Chronic Care Model (CCM), we mapped findings to the CCM's elements - work role redesign (WRR), patient self-management support (PSS), provider decision support (PDS), clinical information systems (CIS), linkages to community resources (LCR), and organizational/leadership support (OLS). RESULTS Emergent themes included (i) WRR - coordination challenges among organizations involved in veterans' reentry; (ii) PSS - veterans' fear of reentering society; (iii) PDS - uneven knowledge by reentry support providers regarding available services when deciding which services to connect a reentry veteran to and whether he/she is ready and/or willing to receive services; (iv) CIS - lapses in MHD/SUD medications between release and a first scheduled health care appointment, as well as challenges in transfer of medical records; (v) LCR - inconsistent awareness of existing services and resources available across a disparate reentry system; and (vi) OLS - reentry plans designed to address only immediate transitional needs upon release, which do not always prioritize MHD/SUD needs. CONCLUSIONS Applying the CCM to coordinating cross-system health care and reentry support may contribute to reductions in mental health crises and overdoses in the precarious first weeks of the reentry period.
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Affiliation(s)
- Bo Kim
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Rendelle E. Bolton
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Brandeis University The Heller School for Social Policy and Management, Waltham, MA USA
| | - Justeen Hyde
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
| | - B. Graeme Fincke
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
| | - Mari-Lynn Drainoni
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
| | - Beth Ann Petrakis
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
| | | | - D. Keith McInnes
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
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17
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Yakovchenko V, Hogan TP, Houston TK, Richardson L, Lipschitz J, Petrakis BA, Gillespie C, McInnes DK. Automated Text Messaging With Patients in Department of Veterans Affairs Specialty Clinics: Cluster Randomized Trial. J Med Internet Res 2019; 21:e14750. [PMID: 31444872 PMCID: PMC6729116 DOI: 10.2196/14750] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 01/26/2023] Open
Abstract
Background Acceptability of mobile phone text messaging as a means of asynchronous communication between health care systems and patients is growing. The US Department of Veterans Affairs (VA) has adopted an automated texting system (aTS) for national rollout. The aTS allows providers to develop clinical texting protocols to promote patient self-management and allows clinical teams to monitor patient progress between in-person visits. Texting-supported hepatitis C virus (HCV) treatment has not been previously tested. Objective Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), we developed an aTS HCV protocol and conducted a mixed methods, hybrid type 2 effectiveness implementation study comparing two programs supporting implementation of the aTS HCV protocol for medication adherence in patients with HCV. Methods Seven VA HCV specialty clinics were randomized to usual aTS implementation versus an augmented implementation facilitation program. Implementation process measures included facilitation metrics, usability, and usefulness. Implementation outcomes included provider and patient use of the aTS HCV protocol, and effectiveness outcomes included medication adherence, health perceptions and behaviors, and sustained virologic response (SVR). Results Across the seven randomized clinics, there were 293 facilitation events using a core set of nine implementation strategies (157 events in augmented implementation facilitation, 136 events in usual implementation). Providers found the aTS appropriate with high potential for scale-up but not without difficulties in startup, patient selection and recruitment, and clinic workflow integration. Patients largely found the aTS easy to use and helpful; however, low perceived need for self-management support contributed to high declination. Reach and use was modest with 197 patients approached, 71 (36%) enrolled, 50 (25%) authenticated, and 32 (16%) using the aTS. In augmented implementation facilitation clinics, more patients actively used the aTS HCV protocol compared with usual clinic patients (20% vs 12%). Patients who texted reported lower distress about failing HCV treatment (13/15, 87%, vs 8/15, 53%; P=.05) and better adherence to HCV medication (11/15, 73%, reporting excellent adherence vs 6/15, 40%; P=.06), although SVR did not differ by group. Conclusions The aTS is a promising intervention for improving patient self-management; however, augmented approaches to implementation may be needed to support clinician buy-in and patient engagement. Considering the behavioral, social, organizational, and technical scale-up challenges that we documented, successful and sustained implementation of the aTS may require implementation strategies that operate at the clinic, provider, and patient levels. Trial Registration Retrospectively registered at ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349
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Affiliation(s)
- Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Thomas K Houston
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Amherst, MA, United States
| | - Lorilei Richardson
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States
| | - Jessica Lipschitz
- Brigham and Women's Hospital Department of Psychiatry, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States
| | - Chris Gillespie
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, Bedford Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Bedford, MA, United States.,Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, United States
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18
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Reilly ED, Robinson SA, Petrakis BA, Kuhn E, Pigeon WR, Wiener RS, McInnes DK, Quigley KS. Mobile App Use for Insomnia Self-Management: Pilot Findings on Sleep Outcomes in Veterans. Interact J Med Res 2019; 8:e12408. [PMID: 31342904 PMCID: PMC6685127 DOI: 10.2196/12408] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/21/2018] [Accepted: 04/09/2019] [Indexed: 01/20/2023] Open
Abstract
Background Sleep disturbance is a major health concern among US veterans who have served since 2001 in a combat theater in Iraq or Afghanistan. We report subjective and objective sleep results from a pilot trial assessing self-management–guided use of a mobile app (CBT-i Coach, which is based on cognitive behavioral therapy for insomnia) as an intervention for insomnia in military veterans. Objective The primary aim of this study was to evaluate changes in subjective and objective sleep outcomes from pre to postintervention. Methods Subjective outcomes included the Insomnia Severity Index, the Pittsburgh Sleep Quality Inventory, and sleep-related functional status. A wearable sleep monitor (WatchPAT) measured objective sleep outcomes, including sleep efficiency, percent rapid eye movement (REM) during sleep, sleep time, and sleep apnea. A total of 38 participants were enrolled in the study, with 18 participants being withdrawn per the protocol because of moderate or severe sleep apnea and 9 others who dropped out or withdrew. Thus, 11 participants completed the full 6-week CBT-i Coach self-management intervention (ie, completers). Results Completer results indicated significant changes in subjective sleep measures, including reduced reports of insomnia (Z=–2.68, P=.007) from pre (mean 16.63, SD 5.55) to postintervention (mean 12.82, SD 3.74), improved sleep quality (Z=–2.37, P=.02) from pre (mean 12.82, SD 4.60) to postintervention (mean 10.73, SD 3.32), and sleep-related functioning (Z=2.675, P=.007) from pre (mean 13.86, SD 3.69) to postintervention (mean 15.379, SD 2.94). Among the objective measures, unexpectedly, objective sleep time significantly decreased from pre to postintervention (χ22=7.8, P=.02). There were no significant changes in percent REM sleep or sleep efficiency. Conclusions These findings suggest that the CBT-i Coach app can improve subjective sleep and that incorporating objective sleep measures into future, larger clinical trials or clinical practice may yield important information, particularly by detecting previously undetected sleep apnea. Trial Registration ClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000
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Affiliation(s)
- Erin D Reilly
- Center for Social and Community Reintegration Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States
| | - Stephanie A Robinson
- Center for Healthcare Outcomes and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States
| | - Beth Ann Petrakis
- Center for Healthcare Outcomes and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States
| | - Eric Kuhn
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.,Stanford University School of Medicine, Standford, CA, United States
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States.,University of Rochester Medical Center, Rochester, NY, United States
| | - Renda Soylemez Wiener
- Center for Healthcare Outcomes and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States.,Boston University School of Medicine, Boston, MA, United States
| | - D Keith McInnes
- Center for Healthcare Outcomes and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States.,Boston University School of Public Health, Boston, MA, United States
| | - Karen S Quigley
- Center for Social and Community Reintegration Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States.,Center for Healthcare Outcomes and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States.,Northeastern University, Boston, MA, United States
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Gillespie C, Rose AJ, Petrakis BA, Jones EA, Park A, McCullough MB. Qualitative study of patient experiences of responsibility in warfarin therapy. Am J Health Syst Pharm 2018; 75:1798-1804. [DOI: 10.2146/ajhp170736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Chris Gillespie
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA
| | | | | | - Ellen A. Jones
- Central Western Massachusetts VA Medical Center, Leeds, MA
| | - Angela Park
- Central Western Massachusetts VA Medical Center, Leeds, MA
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Shimada SL, Petrakis BA, Rothendler JA, Zirkle M, Zhao S, Feng H, Fix GM, Ozkaynak M, Martin T, Johnson SA, Tulu B, Gordon HS, Simon SR, Woods SS. An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging. J Am Med Inform Assoc 2018; 24:942-949. [PMID: 28371896 DOI: 10.1093/jamia/ocx021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/24/2017] [Indexed: 11/14/2022] Open
Abstract
Objective We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities. Methods We coded 1000 threads of SM communication sampled from 40 primary care teams. Results Most threads (94.5%) were initiated by patients (90.4%) or caregivers (4.1%); only 5.5% were initiated by primary care team members proactively reaching out to patients. Medication renewals and refills (47.2%), scheduling requests (17.6%), medication issues (12.9%), and health issues (12.7%) were the most common patient-initiated requests, followed by referrals (7.0%), administrative issues (6.5%), test results (5.4%), test issues (5.2%), informing messages (4.9%), comments about the patient portal or SM (4.1%), appreciation (3.9%), self-reported data (2.8%), life issues (1.5%), and complaints (1.5%). Very few messages were clinically urgent (0.7%) or contained other potentially challenging content. Message threads were mostly short (2.7 messages), comprising an average of 1.35 discrete content types. A substantial proportion of issues (24.2%) did not show any evidence of being resolved through SM. Time to response and extent of resolution via SM varied by message content. Proactive SM use by teams varied, but was most often for test results (32.7%), medication-related issues (21.8%), medication renewals (16.4%), or scheduling issues (18.2%). Conclusions The majority of messages were transactional and initiated by patients or caregivers. Not all content categories were fully addressed over SM. Further education and training for both patients and clinical teams could improve the quality and efficiency of SM communication.
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Affiliation(s)
- Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Bedford, MA, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | - James A Rothendler
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | - Maryan Zirkle
- Portland VA Medical Center, Department of Veterans Affairs, Portland, OR, USA
| | - Shibei Zhao
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | - Hua Feng
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | | | - Tracey Martin
- VISN1, Department of Veterans Affairs, Bedford, MA, USA
| | - Sharon A Johnson
- School of Business, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Bengisu Tulu
- School of Business, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Howard S Gordon
- Center for Innovation for Complex Chronic Healthcare, Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, IL, USA.,Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | - Susan S Woods
- VA Maine Healthcare System, Connected Care Office, Veterans Health Administration, Augusta, ME, USA
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Chambers D, Simpson L, Neta G, Schwarz UVT, Percy-Laurry A, Aarons GA, Neta G, Brownson R, Vogel A, Stirman SW, Sherr K, Sturke R, Norton WE, Varley A, Chambers D, Vinson C, Klesges L, Heurtin-Roberts S, Massoud MR, Kimble L, Beck A, Neely C, Boggs J, Nichols C, Wan W, Staab E, Laiteerapong N, Moise N, Shah R, Essock S, Handley M, Jones A, Carruthers J, Davidson K, Peccoralo L, Sederer L, Molfenter T, Scudder A, Taber-Thomas S, Schaffner K, Herschell A, Woodward E, Pitcock J, Ritchie M, Kirchner J, Moore JE, Khan S, Rashid S, Park J, Courvoisier M, Straus S, Blonigen D, Rodriguez A, Manfredi L, Nevedal A, Rosenthal J, Smelson D, Timko C, Stadnick N, Regan J, Barnett M, Lau A, Brookman-Frazee L, Guerrero E, Fenwick K, Kong Y, Aarons G, Lengnick-Hall R, Fenwick K, Henwood B, Sayer N, Rosen C, Orazem R, Smith B, Rosen C, Zimmerman L, Lounsbury D, Rosen C, Kimerling R, Trafton JA, Lindley S, Bhargava R, Roberts H, Gibson L, Escobar GJ, Liu V, Turk B, Ragins A, Kipnis P, Gruszkowski AK, Kennedy MW, Drobek ER, Turgeman L, Milicevic AS, Hubert TL, Myaskovsky L, Tjader YC, Monte RJ, Sapnas KG, Ramly E, Lauver DR, Bartels CM, Elnahal S, Ippolito A, Peabody H, Clancy C, Cebul R, Love T, Einstadter D, Bolen S, Watts B, Yakovchenko V, Park A, Lukesh W, Miller DR, Thornton D, Drainoni ML, Gifford AL, Smith S, Kyle J, Bauer MS, Eisenberg D, Liebrecht C, Barbaresso M, Kilbourne A, Park E, Perez G, Ostroff J, Greene S, Parchman M, Austin B, Larson E, Ferreri S, Shea C, Smith M, Turner K, Bacci J, Bigham K, Curran G, Ferreri S, Frail C, Hamata C, Jankowski T, Lantaff W, McGivney MS, Snyder M, McCullough M, Gillespie C, Petrakis BA, Jones E, Park A, Lukas CV, Rose A, Shoemaker SJ, Curran G, Thomas J, Teeter B, Swan H, Teeter B, Thomas J, Curran G, Balamurugan A, Lane-Fall M, Beidas R, Di Taranti L, Buddai S, Hernandez ET, Watts J, Fleisher L, Barg F, Miake-Lye I, Olmos T, Chuang E, Rodriguez H, Kominski G, Yano B, Shortell S, Hook M, Fleisher L, Fiks A, Halkyard K, Gruver R, Sykes E, Vesco K, Beadle K, Bulkley J, Stoneburner A, Leo M, Clark A, Smith J, Smyser C, Wolf M, Trivedi S, Hackett B, Rao R, Cole FS, McGonigle R, Donze A, Proctor E, Mathur A, Sherr K, Gakidou E, Gloyd S, Audet C, Salato J, Vermund S, Amico R, Smith S, Nyirandagijimana B, Mukasakindi H, Rusangwa C, Franke M, Raviola G, Cummings M, Goldberg E, Mwaka S, Kabajaasi O, Cattamanchi A, Katamba A, Jacob S, Kenya-Mugisha N, Davis JL, Reed J, Ramaswamy R, Parry G, Sax S, Kaplan H, Huang KY, Cheng S, Yee S, Hoagwood K, McKay M, Shelley D, Ogedegbe G, Brotman LM, Kislov R, Humphreys J, Harvey G, Wilson P, Lieberthal R, Payton C, Sarfaty M, Valko G, Bolton R, Lukas CV, Hartmann C, Mueller N, Holmes SK, Bokhour B, Ono S, Crabtree B, Gordon L, Miller W, Balasubramanian B, Solberg L, Cohen D, McGraw K, Blatt A, Pittman D, McCullough M, Hartmann C, Kales H, Berlowitz D, Hudson T, Gillespie C, Helfrich C, Finley E, Garcia A, Rosen K, Tami C, McGeary D, Pugh MJ, Potter JS, Helfrich C, Stryczek K, Au D, Zeliadt S, Sayre G, Gillespie C, Leeman J, Myers A, Grant J, Wangen M, Queen T, Morshed A, Dodson E, Tabak R, Brownson RC, Sheldrick RC, Mackie T, Hyde J, Leslie L, Yanovitzky I, Weber M, Gesualdo N, Kristensen T, Stanick C, Halko H, Dorsey C, Powell B, Weiner B, Lewis C, Powell B, Weiner B, Stanick C, Halko H, Dorsey C, Lewis C, Weiner B, Dorsey C, Stanick C, Halko H, Powell B, Lewis C, Stirman SW, Carreno P, Mallard K, Masina T, Monson C, Swindle T, Curran G, Patterson Z, Whiteside-Mansell L, Hanson R, Saunders B, Schoenwald S, Moreland A, Birken S, Powell B, Presseau J, Miake-Lye I, Ganz D, Mittman B, Delevan D, Finley E, Hill JN, Locatelli S, Bokhour B, Fix G, Solomon J, Mueller N, Lavela SL, Scott V, Scaccia J, Alia K, Skiles B, Wandersman A, Wilson P, Sales A, Roberts M, Kennedy A, Chambers D, Khoury MJ, Sperber N, Orlando L, Carpenter J, Cavallari L, Denny J, Elsey A, Fitzhenry F, Guan Y, Horowitz C, Johnson J, Madden E, Pollin T, Pratt V, Rakhra-Burris T, Rosenman M, Voils C, Weitzel K, Wu R, Damschroder L, Lu C, Ceccarelli R, Mazor KM, Wu A, Rahm AK, Buchanan AH, Schwartz M, McCormick C, Manickam K, Williams MS, Murray MF, Escoffery NC, Lebow-Skelley E, Udelson H, Böing E, Fernandez ME, Wood RJ, Mullen PD, Parekh J, Caldas V, Stuart EA, Howard S, Thomas G, Jennings JM, Torres J, Markham C, Shegog R, Peskin M, Rushing SC, Gaston A, Gorman G, Jessen C, Williamson J, Ward D, Vaughn A, Morris E, Mazzucca S, Burney R, Ramanadhan S, Minsky S, Martinez-Dominguez V, Viswanath K, Barker M, Fahim M, Ebnahmady A, Dragonetti R, Selby P, Farrell M, Tompkins J, Norton W, Rapport K, Hargreaves M, Lee R, Ramanadhan S, Kruse G, Deutsch C, Lanier E, Gray A, Leppin A, Christiansen L, Schaepe K, Egginton J, Branda M, Gaw C, Dick S, Montori V, Shah N, Korn A, Hovmand P, Fullerton K, Zoellner N, Hennessy E, Tovar A, Hammond R, Economos C, Kay C, Gazmararian J, Vall E, Cheung P, Franks P, Barrett-Williams S, Weiss P, Kay C, Gazmararian J, Hamilton E, Cheung P, Kay C, Vall E, Gazmararian J, Marques L, Dixon L, Ahles E, Valentine S, Monson C, Shtasel D, Stirman SW, Parra-Cardona R, Northridge M, Kavathe R, Zanowiak J, Wyatt L, Singh H, Islam N, Monteban M, Freedman D, Bess K, Walsh C, Matlack K, Flocke S, Baily H, Harden S, Ramalingam N, Alia K, Scaccia J, Scott V, Ramaswamy R, Wandersman A, Gold R, Cottrell E, Hollombe C, Dambrun K, Bunce A, Middendorf M, Dearing M, Cowburn S, Mossman N, Melgar G, Hopfer S, Hecht M, Ray A, Miller-Day M, BeLue R, Zimet G, Nelson EL, Kuhlman S, Doolittle G, Krebill H, Spaulding A, Levin T, Sanchez M, Landau M, Escobar P, Minian N, Selby P, Noormohamed A, Zawertailo L, Baliunas D, Giesbrecht N, Le Foll B, Samokhvalov A, Meisel Z, Polsky D, Schackman B, Mitchell J, Sevarino K, Gimbel S, Mwanza M, Nisingizwe MP, Michel C, Hirschhorn L, Lane-Fall M, Beidas R, Di Taranti L, Choudhary M, Thonduparambil D, Fleisher L, Barg F, Meissner P, Pinnock H, Barwick M, Carpenter C, Eldridge S, Grandes-Odriozola G, Griffiths C, Rycroft-Malone J, Murray E, Patel A, Sheikh A, Taylor SJC, Mittman B, Guilliford M, Pearce G, Korngiebel D, West K, Burke W, Hannon P, Harris J, Hammerback K, Kohn M, Chan GKC, Mafune R, Parrish A, Helfrich C, Beresford S, Pike KJ, Shelton R, Jandorf L, Erwin D, Charles TA, Parchman M, Baldwin LM, Ike B, Fickel J, Lind J, Cowper D, Fleming M, Sadler A, Dye M, Katzburg J, Ong M, Tubbesing S, McCullough M, Simmons M, Yakovchenko V, Harnish A, Gabrielian S, McInnes K, Smith J, Smelson D, Ferrand J, Torres E, Green A, Aarons G, Bradbury AR, Patrick-Miller LJ, Egleston BL, Domchek SM, Olopade OI, Hall MJ, Daly MB, Fleisher L, Grana G, Ganschow P, Fetzer D, Brandt A, Chambers R, Clark DF, Forman A, Gaber RS, Gulden C, Horte J, Long J, Lucas T, Madaan S, Mattie K, McKenna D, Montgomery S, Nielsen S, Powers J, Rainey K, Rybak C, Seelaus C, Stoll J, Stopfer J, Yao XS, Savage M, Miech E, Damush T, Rattray N, Myers J, Homoya B, Winseck K, Klabunde C, Langer D, Aggarwal A, Neilson E, Gunderson L, Escobar GJ, Gardner M, O’Sulleabhain L, Kroenke C, Liu V, Kipnis P. Proceedings from the 9th annual conference on the science of dissemination and implementation. Implement Sci 2017. [PMCID: PMC5414666 DOI: 10.1186/s13012-017-0575-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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McCullough MB, Gillespie C, Petrakis BA, Jones EA, Park AM, Lukas CV, Rose AJ. Forming and activating an internal facilitation group for successful implementation: A qualitative study. Res Social Adm Pharm 2017; 13:1014-1027. [PMID: 28434918 DOI: 10.1016/j.sapharm.2017.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 03/19/2017] [Accepted: 04/07/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study focuses on an implementation facilitation strategy to improve the delivery of anticoagulation care within pharmacy-run clinics across 8 Veterans Health Administration (VA) medical centers. Other studies have explored various models of implementation facilitation, including external facilitation (EF), internal facilitation (IF), and blended facilitation (BF) combining both approaches. This study focuses on the use of an internal facilitation team of anticoagulation coordinators representing 8 VA anticoagulation clinics to enhance the implementation process. This study examines how the team became instrumental in the successful implementation of evidence-based practice change. METHODS Semi-structured interviews were conducted annually over 4 years with representatives from each site, the internal facilitators (site champions), at 8 VA hospitals (47 interviews). Additionally, five external facilitators, experts in quality improvement and anticoagulation care who guided the implementation, were interviewed. Analysis drew on a deductive approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model and emergent thematic analysis to identify factors related to effectiveness of the internal facilitation team. RESULTS Key findings are that the following factors enhanced successful uptake of the anticoagulation initiative: 1) Regular participation by the site champion in the internal facilitation team; 2) Champion strongly committed to being an agent of change; and 3) Champion received greater support from their supervisors. The first and second factors are interrelated, as internal facilitators who actively and regularly participated in the internal facilitation team often became truly committed to the improvement project. Both factors relate to the third, as supervisor support not only facilitated changes in practice, but also facilitated regular team attendance and stronger participation. CONCLUSIONS Our study adds to implementation science by detailing how internal facilitators learn their skills over time, and how a group of internal facilitators can help each other succeed. These findings can guide those who wish to incorporate internal facilitation teams as an implementation strategy, and demonstrate how sites can build capacity for implementation efforts. SYNOPSIS This study focuses on an implementation facilitation strategy to improve the delivery of anticoagulation care within pharmacy-run clinics across 8 Veterans Health Administration medical centers. Internal facilitators (IFs) guided by and supported by an external facilitators (EF), successfully implemented the clinical innovation. This study examines how the IF group became instrumental in the successful implementation of evidence-based practice change.
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Affiliation(s)
- Megan B McCullough
- VA HSR&D Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital, 200 Springs Road, Bedford, MA, 01730, USA; Boston University School of Public Health, Department of Health Law, Policy and Management, 715 Albany St # 358w, Boston, MA, 02118, USA.
| | - Chris Gillespie
- VA HSR&D Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital, 200 Springs Road, Bedford, MA, 01730, USA
| | - Beth Ann Petrakis
- VA HSR&D Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital, 200 Springs Road, Bedford, MA, 01730, USA
| | - Ellen A Jones
- Central Western Massachusetts VA Healthcare System, 421 North Main Street, Leeds, MA, 01053, USA
| | - Angela M Park
- New England VERC, Boston VA Healthcare System, 1400 VFW Parkway, West Roxbury, MA, 02132, USA
| | - Carol VanDeusen Lukas
- VA HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Medical Center, 1400 VFW Parkway, West Roxbury, MA, 02132, USA; Boston University School of Public Health, Department of Health Law, Policy and Management, 715 Albany St # 358w, Boston, MA, 02118, USA
| | - Adam J Rose
- VA HSR&D Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital, 200 Springs Road, Bedford, MA, 01730, USA; Department of Internal Medicine, Section of General Internal Medicine, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA
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Rose AJ, Park A, Gillespie C, Van Deusen Lukas C, Ozonoff A, Petrakis BA, Reisman JI, Borzecki AM, Benedict AJ, Lukesh WN, Schmoke TJ, Jones EA, Morreale AP, Ourth HL, Schlosser JE, Mayo-Smith MF, Allen AL, Witt DM, Helfrich CD, McCullough MB. Results of a Regional Effort to Improve Warfarin Management. Ann Pharmacother 2016; 51:373-379. [PMID: 28367699 DOI: 10.1177/1060028016681030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Improved anticoagulation control with warfarin reduces adverse events and represents a target for quality improvement. No previous study has described an effort to improve anticoagulation control across a health system. OBJECTIVE To describe the results of an effort to improve anticoagulation control in the New England region of the Veterans Health Administration (VA). METHODS Our intervention encompassed 8 VA sites managing warfarin for more than 5000 patients in New England (Veterans Integrated Service Network 1 [VISN 1]). We provided sites with a system to measure processes of care, along with targeted audit and feedback. We focused on processes of care associated with site-level anticoagulation control, including prompt follow-up after out-of-range international normalized ratio (INR) values, minimizing loss to follow-up, and use of guideline-concordant INR target ranges. We used a difference-in-differences (DID) model to examine changes in anticoagulation control, measured as percentage time in therapeutic range (TTR), as well as process measures and compared VISN 1 sites with 116 VA sites located outside VISN 1. RESULTS VISN 1 sites improved on TTR, our main indicator of quality, from 66.4% to 69.2%, whereas sites outside VISN 1 improved from 65.9% to 66.4% (DID 2.3%, P < 0.001). Improvement in TTR correlated strongly with the extent of improvement on process-of-care measures, which varied widely across VISN 1 sites. CONCLUSIONS A regional quality improvement initiative, using performance measurement with audit and feedback, improved TTR by 2.3% more than control sites, which is a clinically important difference. Improving relevant processes of care can improve outcomes for patients receiving warfarin.
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Affiliation(s)
- Adam J Rose
- 1 Bedford VA Medical Center, MA, USA.,2 Boston University School of Medicine, MA, USA
| | - Angela Park
- 3 New England Veterans Engineering Resource Center, Boston, MA, USA
| | | | - Carol Van Deusen Lukas
- 1 Bedford VA Medical Center, MA, USA.,4 Boston University School of Public Health, MA, USA
| | - Al Ozonoff
- 1 Bedford VA Medical Center, MA, USA.,5 Boston Children's Hospital, MA, USA.,6 Harvard Medical School, Boston, MA, USA
| | | | | | - Ann M Borzecki
- 1 Bedford VA Medical Center, MA, USA.,2 Boston University School of Medicine, MA, USA.,4 Boston University School of Public Health, MA, USA
| | | | - William N Lukesh
- 3 New England Veterans Engineering Resource Center, Boston, MA, USA
| | | | - Ellen A Jones
- 8 VA Central Western Massachusetts Healthcare System, Northampton, MA, USA
| | | | | | | | | | | | - Daniel M Witt
- 14 University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Christian D Helfrich
- 15 VA Portland Healthcare System, OR, USA.,16 VA Center for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - Megan B McCullough
- 1 Bedford VA Medical Center, MA, USA.,4 Boston University School of Public Health, MA, USA
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McInnes DK, Fix GM, Solomon JL, Petrakis BA, Sawh L, Smelson DA. Preliminary needs assessment of mobile technology use for healthcare among homeless veterans. PeerJ 2015; 3:e1096. [PMID: 26246964 PMCID: PMC4525686 DOI: 10.7717/peerj.1096] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 06/19/2015] [Indexed: 12/19/2022] Open
Abstract
Background. Homeless veterans have complex healthcare needs, but experience many barriers to treatment engagement. While information technologies (IT), especially mobile phones, are used to engage patients in care, little is known about homeless veterans' IT use. This study examines homeless veterans' access to and use of IT, attitudes toward health-related IT use, and barriers to IT in the context of homelessness. Methods. Qualitative interviews were conducted with 30 homeless veterans in different housing programs in Boston, MA, ranging from emergency shelters to supportive transitional housing that allow stays of up to 2 years. Interviews were conducted in person, audio recorded and then transcribed. Three researchers coded transcripts. Inductive thematic analysis was used. Results. Most participants (90%) had a mobile phone and were receptive to IT use for health-related communications. A common difficulty communicating with providers was the lack of a stable mailing address. Some participants were using mobile phones to stay in touch with providers. Participants felt mobile-phone calls or text messages could be used to remind patients of appointments, prescription refills, medication taking, and returning for laboratory results. Mobile phone text messaging was seen as convenient, and helped participants stay organized because necessary information was saved in text messages. Some reported concerns about the costs associated with mobile phone use (calls and texting), the potential to be annoyed by too many text messages, and not knowing how to use text messaging. Conclusion. Homeless veterans use IT and welcome its use for health-related purposes. Technology-assisted outreach among this population may lead to improved engagement in care.
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Affiliation(s)
- D. Keith McInnes
- Department of Veterans Affairs, Edith Nourse Rogers VA Hospital, Bedford, MA, USA
- Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Gemmae M. Fix
- Department of Veterans Affairs, Edith Nourse Rogers VA Hospital, Bedford, MA, USA
- Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey L. Solomon
- Department of Veterans Affairs, Edith Nourse Rogers VA Hospital, Bedford, MA, USA
| | - Beth Ann Petrakis
- Department of Veterans Affairs, Edith Nourse Rogers VA Hospital, Bedford, MA, USA
| | - Leon Sawh
- VA National Center on Homelessness among Veterans, Philadelphia, PA and Bedford, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
- School of Criminology and Justice Studies, University of Massachusetts, Lowell, MA, USA
| | - David A. Smelson
- Department of Veterans Affairs, Edith Nourse Rogers VA Hospital, Bedford, MA, USA
- VA National Center on Homelessness among Veterans, Philadelphia, PA and Bedford, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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25
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McCullough MB, Chou AF, Solomon JL, Petrakis BA, Kim B, Park AM, Benedict AJ, Hamilton AB, Rose AJ. The interplay of contextual elements in implementation: an ethnographic case study. BMC Health Serv Res 2015; 15:62. [PMID: 25890333 PMCID: PMC4345021 DOI: 10.1186/s12913-015-0713-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 01/19/2015] [Indexed: 11/17/2022] Open
Abstract
Background Contextual elements have significant impact on uptake of health care innovations. While existing conceptual frameworks in implementation science suggest contextual elements interact with each other, little research has described how this might look in practice. To bridge this gap, this study identifies the interconnected patterns among contextual elements that influence uptake of an anticoagulation clinic improvement initiative. Methods We completed 51 semi-structured interviews and ethnographic observations across five case study sites involved in an evidence-based practice (EBP) quality improvement initiative. We analyzed data in NVivo 10 using an a priori approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model and an emergent thematic analysis. Results Key contextual elements, such as leadership, teamwork, and communication, interacted with each other in contributing to site-level uptake of the EBP, often yielding results that could not be predicted by looking at just one of these elements alone. Sites with context conducive to change in these areas predictably had high uptake, while sites with uniformly weak contextual elements had low uptake. Most sites presented a mixed picture, with contextual elements being strongly supportive of change in some areas and weak or moderate in others. In some cases, we found that sites with strong context in at least one area only needed to have adequate context in other areas to yield high uptake. At other sites, weak context in just one area had the potential to contribute to low uptake, despite countervailing strengths. Even a site with positive views of EBPs could not succeed when context was weak. Conclusion Interrelationships among different contextual elements can act as barriers to uptake at some sites and as facilitators at others. Accounting for interconnections among elements enables PARIHS to more fully describe the determinants of successful implementation as they operate in real-world settings.
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Affiliation(s)
- Megan B McCullough
- VA HSR&D Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital, Bedford, MA, USA.
| | - Ann F Chou
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Jeffrey L Solomon
- VA HSR&D Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital, Bedford, MA, USA.
| | - Beth Ann Petrakis
- VA HSR&D Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital, Bedford, MA, USA.
| | - Bo Kim
- VA HSR&D Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital, Bedford, MA, USA.
| | | | | | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, Los Angeles, CA, USA. .,University of California, LA, Los Angeles, CA, USA.
| | - Adam J Rose
- VA HSR&D Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital, Bedford, MA, USA. .,Boston University School of Medicine, Boston, MA, USA.
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26
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McCullough MB, Solomon JL, Petrakis BA, Park AM, Ourth H, Morreale AP, Rose AJ. Balancing collaborative and independent practice roles in clinical pharmacy: a qualitative research study. Ann Pharmacother 2014; 49:189-95. [PMID: 25429093 DOI: 10.1177/1060028014561473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Clinical pharmacists (CPs) with a scope of practice operate as direct care providers and health care team members. Research often focuses on one role or the other; little is understood about the dynamic relationship between roles in practice settings. OBJECTIVE To identify the challenges CPs face in balancing dual roles as direct care providers and health care team members and the implications for CP effectiveness and quality of care. METHODS Pharmacists were interviewed with a primary purpose of informing an implementation effort. Besides the implementation, there were emergent themes regarding the challenges posed for CPs in negotiating dual roles. This study is, therefore, a secondary analysis of semistructured interviews and direct observation of 48 CPs, addressing this phenomenon. Interview data were entered into NVivo 10 and systematically analyzed using an emergent thematic coding strategy. RESULTS Pharmacists describe role ambiguity, where they perform as direct providers or team members simultaneously or in quick succession. They note the existence of a "transaction cost," where switching causes loss of momentum or disruption of work flow. Additionally, pharmacists feel that fellow providers lack an understanding of what they do and that CP contributions are not evaluated accurately by other health professionals. CONCLUSION It is a challenge for CPs to balance the distinct roles of serving as collaborators and primary providers. Frequent role switching is not conducive to optimal work efficiency or patient care. Our findings suggest concrete steps that medical centers can take to improve both CP worklife and quality of patient care.
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Affiliation(s)
- Megan B McCullough
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA
| | - Jeffrey L Solomon
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA
| | - Angela M Park
- VA New England Healthcare System, ENRM VAMC, Bedford, MA, USA
| | - Heather Ourth
- Clinical Pharmacy Practice Program and Outcomes Assessment, VA Pharmacy Benefits Management Services VACO, Ackworth, IA, USA
| | - Anthony P Morreale
- Clinical Pharmacy Services and Healthcare Services Research, VA Pharmacy Benefits Management Services VACO, San Diego, CA, USA
| | - Adam J Rose
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM VAMC, Bedford, MA, USA Boston University School of Medicine, Boston, MA, USA
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Ozkaynak M, Johnson S, Shimada S, Petrakis BA, Tulu B, Archambeault C, Fix G, Schwartz E, Woods S. Examining the Multi-level Fit between Work and Technology in a Secure Messaging Implementation. AMIA Annu Symp Proc 2014; 2014:954-962. [PMID: 25954403 PMCID: PMC4419966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Secure messaging (SM) allows patients to communicate with their providers for non-urgent health issues. Like other health information technologies, the design and implementation of SM should account for workflow to avoid suboptimal outcomes. SM may present unique workflow challenges because patients add a layer of complexity, as they are also direct users of the system. This study explores SM implementation at two Veterans Health Administration facilities. We interviewed twenty-nine members of eight primary care teams using semi-structured interviews. Questions addressed staff opinions about the integration of SM with daily practice, and team members' attitudes and experiences with SM. We describe the clinical workflow for SM, examining complexity and variability. We identified eight workflow issues directly related to efficiency and patient satisfaction, based on an exploration of the technology fit with multilevel factors. These findings inform organizational interventions that will accommodate SM implementation and lead to more patient-centered care.
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Affiliation(s)
| | | | - Stephanie Shimada
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA
| | | | | | - Gemmae Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA
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McInnes DK, Petrakis BA, Gifford AL, Rao SR, Houston TK, Asch SM, O'Toole TP. Retaining homeless veterans in outpatient care: a pilot study of mobile phone text message appointment reminders. Am J Public Health 2014; 104 Suppl 4:S588-94. [PMID: 25100425 DOI: 10.2105/ajph.2014.302061] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the feasibility of using mobile phone text messaging with homeless veterans to increase their engagement in care and reduce appointment no-shows. METHODS We sent 2 text message reminders to participants (n = 20) before each of their outpatient appointments at an urban Veterans Affairs medical center. Evaluation included pre- and postsurvey questionnaires, open-ended questions, and review of medical records. We estimated costs and savings of large-scale implementation. RESULTS Participants were satisfied with the text-messaging intervention, had very few technical difficulties, and were interested in continuing. Patient-cancelled visits and no-shows trended downward from 53 to 37 and from 31 to 25, respectively. Participants also experienced a statistically significant reduction in emergency department visits, from 15 to 5 (difference of 10; 95% confidence interval [CI] = 2.2, 17.8; P = .01), and a borderline significant reduction in hospitalizations, from 3 to 0 (difference of 3; 95% CI = -0.4, 6.4; P = .08). CONCLUSIONS Text message reminders are a feasible means of reaching homeless veterans, and users consider it acceptable and useful. Implementation may reduce missed visits and emergency department use, and thus produce substantial cost savings.
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Affiliation(s)
- D Keith McInnes
- D. Keith McInnes, Beth Ann Petrakis, Allen L. Gifford, Sowmya R. Rao, and Thomas K. Houston are with the Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA. Steven M. Asch is with VA Palo Alto Center for Innovation to Implementation, Palo Alto, CA. Thomas P. O'Toole is with the National Center on Homelessness among Veterans, Providence VA Medical Center, Providence, RI
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McInnes DK, Sawh L, Petrakis BA, Rao S, Shimada SL, Eyrich-Garg KM, Gifford AL, Anaya HD, Smelson DA. The potential for health-related uses of mobile phones and internet with homeless veterans: results from a multisite survey. Telemed J E Health 2014; 20:801-9. [PMID: 25046280 DOI: 10.1089/tmj.2013.0329] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Addressing the health needs of homeless veterans is a priority in the United States, and, although information technologies can potentially improve access to and engagement in care, little is known about this population's use of information technologies or their willingness to use technologies to communicate with healthcare providers and systems. MATERIALS AND METHODS This study fills this gap through a survey of homeless veterans' use of information technologies and their attitudes about using these technologies to assist with accessing needed healthcare services. RESULTS Among the 106 homeless veterans surveyed, 89% had a mobile phone (one-third were smartphones), and 76% used the Internet. Among those with a mobile phone, 71% used text messaging. Nearly all respondents (93%) were interested in receiving mobile phone reminders (text message or phone call) about upcoming medical appointments, and a similar proportion (88%) wanted mobile phone outreach asking if they would like to schedule an appointment if they had not been seen by a health provider in over a year. In addition, respondents already used these technologies for information and communication related to health, housing, and jobs. CONCLUSIONS These findings suggest new avenues for communication and health interventions for hard-to-reach homeless veterans.
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Affiliation(s)
- D Keith McInnes
- 1 Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs , Edith Nourse Rogers VA Hospital, Bedford, Massachusetts
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Rose AJ, Petrakis BA, Callahan P, Mambourg S, Patel D, Hylek EM, Bokhour BG. Organizational characteristics of high- and low-performing anticoagulation clinics in the Veterans Health Administration. Health Serv Res 2012; 47:1541-60. [PMID: 22299722 DOI: 10.1111/j.1475-6773.2011.01377.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Anticoagulation clinics (ACCs) can improve anticoagulation control and prevent adverse events. However, ACCs vary widely in their performance on anticoagulation control. Our objective was to compare the organization and management of top-performing with that of bottom-performing ACCs. DATA SOURCES/STUDY SETTING Three high outlier and three low outlier ACCs in the Veterans Health Administration (VA). STUDY DESIGN Site visits with qualitative data collection and analysis. DATA COLLECTION/EXTRACTION METHODS We conducted semi-structured interviews with ACC staff regarding work flow, staffing, organization, and quality assurance efforts. We also observed ACC operations and collected documents, such as the clinic protocol. We used grounded thematic analysis to examine site-level factors associated with high and low outlier status. PRINCIPAL FINDINGS High outlier sites were characterized by (1) adequate (pharmacist) staffing and effective use of (nonpharmacist) support personnel; (2) innovation to standardize clinical practice around evidence-based guidelines; (3) the presence of a quality champion for the ACC; (4) higher staff qualifications; (5) a climate of ongoing group learning; and (6) internal efforts to measure performance. Although high outliers had all of these features, no low outlier had more than two of them. CONCLUSIONS The top-performing ACCs in the VA system shared six relatively recognizable characteristics. Efforts to improve performance should focus on these domains.
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Affiliation(s)
- Adam J Rose
- Center for Health Quality, Outcomes, and Economic Research, Bedford VA Medical Center, Bedford, MA 01730, USA.
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