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Wadhwa A, Balbale SN, Palleti SK, Samra M, Lopez-Soler RI, Stroupe KT, Markossian TW, Huisingh-Scheetz M. Prevalence and feasibility of assessing the frailty phenotype among hemodialysis patients in a dialysis unit. BMC Nephrol 2023; 24:371. [PMID: 38093284 PMCID: PMC10720194 DOI: 10.1186/s12882-023-03413-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Frailty increases risk of morbidity and mortality in hemodialysis patients. Frailty assessments could trigger risk reduction interventions if broadly adopted in clinical practice. We aimed to assess the clinical feasibility of frailty assessment among Veteran hemodialysis patients. METHODS Hemodialysis patients' ≥50 years were recruited from a single dialysis unit between 9/1/2021 and 3/31/2022.Patients who consented underwent a frailty phenotype assessment by clinical staff. Five criteria were assessed: unintentional weight loss, low grip strength, self-reported exhaustion, slow gait speed, and low physical activity. Participants were classified as frail (3-5 points), pre-frail (1-2 points) or non-frail (0 points). Feasibility was determined by the number of eligible participants completing the assessment. RESULTS Among 82 unique dialysis patients, 45 (52%) completed the assessment, 13 (16%) refused, 18 (23%) were not offered the assessment due to death, transfers, or switch to transplant or peritoneal dialysis, and 6 patients were excluded because they did not meet mobility criteria. Among assessed patients, 40(88%) patients were identified as pre-frail (46.6%) or frail (42.2%). Low grip strength was most common (90%). Those who refused were more likely to have peripheral vascular disease (p = 0.001), low albumin (p = 0.0187), low sodium (p = 0.0422), and ineligible for kidney transplant (p = 0.005). CONCLUSIONS Just over half of eligible hemodialysis patients completed the frailty assessment suggesting difficulty with broad clinical adoption expectations. Among those assessed, frailty and pre-frailty prevalence was high. Given patients who were not tested were clinically high risk, our reported prevalence likely underestimates true frailty prevalence. Providing frailty reduction interventions to all hemodialysis patients could have high impact for this group.
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Affiliation(s)
- Anuradha Wadhwa
- Department of Medicine/ Nephrology, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA.
- Department of Medicine/ Nephrology, Loyola University Chicago, Maywood, IL, USA.
| | - Salva N Balbale
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Sujith K Palleti
- Department of Medicine/ Nephrology, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA
- Department of Medicine/ Nephrology, Loyola University Chicago, Maywood, IL, USA
| | - Manpreet Samra
- Department of Medicine/ Nephrology, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA
- Department of Medicine/ Nephrology, Loyola University Chicago, Maywood, IL, USA
| | - Reynold I Lopez-Soler
- Department of Surgery and Renal Transplant, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA
- Department of Surgery and Renal Transplant, Loyola University Chicago, Maywood, IL, USA
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Public Health Sciences, Parkinson School of Health Science and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Talar W Markossian
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Public Health Sciences, Parkinson School of Health Science and Public Health, Loyola University Chicago, Maywood, IL, USA
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Hatch MN, Etingen B, Raad J, Siddiqui S, Stroupe KT, Smith BM. Dual utilization of Medicare and VA outpatient care among Veterans with spinal cord injuries and disorders. J Spinal Cord Med 2023; 46:716-724. [PMID: 35108176 PMCID: PMC10446768 DOI: 10.1080/10790268.2022.2027321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Veterans with spinal cord injuries and disorders (SCI/D) utilizing Veterans Affairs healthcare facilities are also Medicare eligible. Use of multiple health care systems potentially duplicates or fragments care in this population; yet little is known about those using multiple systems. This study describes dual use of services paid for by VA and Medicare among Veterans with SCI/D. DESIGN Retrospective, cross-sectional, observational study. PARTICIPANTS Veterans with SCI/D (n = 13,902) who received healthcare services within the VA SCI System of Care and were eligible for or enrolled in Medicare in 2011. INTERVENTIONS N/A. OUTCOME MEASURES Patient characteristics, average number of visits and patient level frequencies of reasons for visits were determined for individuals within healthcare utilization (VA only, Medicare only, or dual VA/Medicare) groups. Multinomial logistic regression analyses were used to investigate associations of patient variables on dual use. RESULTS 65.3% of Veterans with SCI/D were VA only users for outpatient encounters, 4.4% had encounters paid for by Medicare only, and 30.3% were dual users. Veterans were less likely to be VA only users if they were older than 69 and if they had been injured for greater than ten years. African American Veterans with SCI (compared to white) were more likely to be VA only users. CONCLUSION A substantial number (∼30%) of Veterans with SCI/D are dual users. These numbers highlight the importance of improved strategies to coordinate care and increase health information sharing across systems.
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Affiliation(s)
- Maya N Hatch
- Spinal Cord Injury/Disorder Center, Long Beach Veterans Affairs (VA) Medical Center, Long Beach, California, USA
- Physical Medicine & Rehabilitation Department, UC Irvine School of Medicine, Irvine, California, USA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of VA Hospital, Chicago, Illinois, USA
| | - Jason Raad
- Econometrica, Inc, Bethesda, Massachusetts, USA
| | - Sameer Siddiqui
- Spinal Cord Injury/Disorder Center, Louis Stokes Cleveland (VA) Medical Center, Cleveland, Ohio, USA
- Department of Physical Medicine & Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of VA Hospital, Chicago, Illinois, USA
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of VA Hospital, Chicago, Illinois, USA
- Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Goldman SM, Weaver FM, Stroupe KT, Cao L, Gonzalez B, Colletta K, Brown EG, Tanner CM. Risk of Parkinson Disease Among Service Members at Marine Corps Base Camp Lejeune. JAMA Neurol 2023:2805037. [PMID: 37184848 DOI: 10.1001/jamaneurol.2023.1168] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Importance An increased risk of Parkinson disease (PD) has been associated with exposure to the solvent trichloroethylene (TCE), but data are limited. Millions of people in the US and worldwide are exposed to TCE in air, food, and water. Objective To test whether the risk of PD is higher in veterans who served at Marine Corps Base Camp Lejeune, whose water supply was contaminated with TCE and other volatile organic compounds (VOCs), compared with veterans who did not serve on that base. Design, Setting, and Participants This population-based cohort study examined the risk for PD among all Marines and Navy personnel who resided at Camp Lejeune, North Carolina (contaminated water) (n = 172 128), or Camp Pendleton, California (uncontaminated water) (n = 168 361), for at least 3 months between 1975 and 1985, with follow-up from January 1, 1997, until February 17, 2021. Veterans Health Administration and Medicare databases were searched for International Classification of Diseases diagnostic codes for PD or other forms of parkinsonism and related medications and for diagnostic codes indicative of prodromal disease. Parkinson disease diagnoses were confirmed by medical record review. Exposures Water supplies at Camp Lejeune were contaminated with several VOCs. Levels were highest for TCE, with monthly median values greater than 70-fold the permissible amount. Main Outcome and Measures Risk of PD in former residents of Camp Lejeune relative to residents of Camp Pendleton. In those without PD or another form of parkinsonism, the risk of being diagnosed with features of prodromal PD were assessed individually and cumulatively using likelihood ratio tests. Results Health data were available for 158 122 veterans (46.4%). Demographic characteristics were similar between Camp Lejeune (5.3% women, 94.7% men; mean [SD] attained age of 59.64 [4.43] years; 29.7% Black, 6.0% Hispanic, 67.6% White; and 2.7% other race and ethnicity) and Camp Pendleton (3.8% women, 96.2% men; mean [SD] age, 59.80 [4.62] years; 23.4% Black, 9.4% Hispanic, 71.1% White, and 5.5% other race and ethnicity). A total of 430 veterans had PD, with 279 from Camp Lejeune (prevalence, 0.33%) and 151 from Camp Pendleton (prevalence, 0.21%). In multivariable models, Camp Lejeune veterans had a 70% higher risk of PD (odds ratio, 1.70; 95% CI, 1.39-2.07; P < .001). No excess risk was found for other forms of neurodegenerative parkinsonism. Camp Lejeune veterans also had a significantly increased risk of prodromal PD diagnoses, including tremor, anxiety, and erectile dysfunction, and higher cumulative prodromal risk scores. Conclusions and Relevance The study's findings suggest that the risk of PD is higher in persons exposed to TCE and other VOCs in water 4 decades ago. Millions worldwide have been and continue to be exposed to this ubiquitous environmental contaminant.
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Affiliation(s)
- Samuel M Goldman
- Division of Occupational and Environmental Medicine, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, Hines, Illinois
- Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, Illinois
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, Hines, Illinois
- Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, Illinois
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, Hines, Illinois
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, Hines, Illinois
| | - Kalea Colletta
- Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, Hines, Illinois
| | - Ethan G Brown
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco
| | - Caroline M Tanner
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco
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Jordan N, Stroupe KT, Richman J, Pogoda TK, Cao L, Kertesz S, Kyriakides TC, Bond GR, Davis LL. Comparing Service Use and Costs of Individual Placement and Support With Usual Vocational Services for Veterans With PTSD. Psychiatr Serv 2022; 73:1109-1116. [PMID: 35538744 DOI: 10.1176/appi.ps.202100197] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Among veterans with posttraumatic stress disorder (PTSD), supported employment that utilizes the individual placement and support (IPS) model has resulted in consistently better employment and functional outcomes than usual vocational rehabilitation services. This study aimed to compare these two approaches in terms of health services use and associated costs. METHODS A secondary analysis of a multisite randomized controlled trial of 541 unemployed veterans with PTSD used archival data from electronic medical records to assess the use and costs of health services of IPS and usual care (i.e., a transitional work [TW] program) over 18 months. Comparisons were also made to an 18-month postintervention period. RESULTS The two study groups did not differ in number of inpatient days or in utilization or cost of high-intensity services. Annual per-person costs of health services were approximately 20% higher for IPS than for TW participants (mean difference=$4,910 per person per year, p<0.05) during the intervention period, largely driven by higher utilization and costs for vocational services in the IPS group (p<0.001). These costs declined postintervention to nonsignificant differences. The mean annual per-person vocational service cost was $6,388 for IPS and $2,549 for TW (mean difference=$3,839, p<0.001) during the intervention period. CONCLUSIONS In keeping with IPS’s intensive case management approach, veterans receiving IPS used more vocational services and had correspondingly higher costs than veterans receiving TW. The two groups did not differ in use or cost of other types of health services. Future research should examine whether higher short-term costs associated with IPS relative to usual care result in long-term cost savings or higher quality of life for persons with PTSD.
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Affiliation(s)
- Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Joshua Richman
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Terri K Pogoda
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Stefan Kertesz
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Tassos C Kyriakides
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Gary R Bond
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Lori L Davis
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
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Martinez RN, Smith BM, French DD, Hogan TP, Gonzalez B, Osteen CM, Hatch M, Anderson V, Tarlov E, Silva A, Goldstein B, Stroupe KT. Effect of the Affordable Care Act on healthcare utilization for Veterans with spinal cord injuries and disorders. J Spinal Cord Med 2022; 45:575-584. [PMID: 33085584 PMCID: PMC9246208 DOI: 10.1080/10790268.2020.1829419] [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] [Indexed: 10/23/2022] Open
Abstract
Context/Objective: Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. We examined Veterans with spinal cord injuries and disorders (SCI/D) to assess whether the ACA was associated with changes in healthcare utilization from Department of Veterans Affairs (VA) healthcare facilities.Design: Using national VA data, we investigated impacts on VA healthcare utilization pre- (2012/13) and post-ACA (2014/15) implementation with negative binomial regression models.Setting: VA healthcare facilities.Participants: 8,591 VA users with SCI/D. Veterans with acute myelitis, Guillain-Barré syndrome, multiple sclerosis, or amyotrophic lateral sclerosis were excluded as were patients who died during the study period.Interventions: We assessed VA healthcare utilization before and after ACA implementation.Outcome Measures: Total numbers of VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care, and VA admissions.Results: The number of VA admissions was 7% higher in the post than pre-ACA implementation period (P < 0.01). The number of VA visits post-implementation increased for SCI/D care (8%; P < 0.01) and specialty care (12%; P < 0.001). Conversely, the number of mental health visits was 17% lower in the post-ACA period (P < 0.001). Veterans with SCI/D who live <5 miles from their nearest VA facility received VA care more frequently than those ≥40 miles from VA (P < 0.001).Conclusion: Counter to expectations, results suggest that Veterans with SCI/D sought more frequent VA care after ACA implementation, indicating Veterans with SCI/D continue to utilize the lifelong, comprehensive care provided at VA.
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Affiliation(s)
- Rachael N. Martinez
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, Hines, Illinois, USA
| | - Bridget M. Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, Hines, Illinois, USA,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dustin D. French
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, Hines, Illinois, USA,Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Timothy P. Hogan
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, Hines, Illinois, USA
| | - Chad M. Osteen
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, Hines, Illinois, USA
| | - Maya Hatch
- Spinal Cord Injury/Disorders Center at Long Beach, Tibor Rubin Long Beach VAMC, Long Beach, California, USA,Physical Medicine & Rehabilitation Department, University of California Irvine School of Medicine, Orange, California, USA
| | - Vicki Anderson
- Spinal Cord Injury/Disorders Center at Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Elizabeth Tarlov
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, Hines, Illinois, USA,College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abigail Silva
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, Hines, Illinois, USA,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Barry Goldstein
- Spinal Cord Injuries and Disorders System of Care National Program Office, Veterans Health Administration, U.S. Department of Veterans Affairs, Seattle, Washington, USA,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Kevin T. Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, Hines, Illinois, USA,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA,Correspondence to: Kevin T. Stroupe Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H) Bldg 1, B260, Hines, IL60141-5151, USA.
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6
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Stroupe KT, Jordan N, Richman J, Bond GR, Pogoda TK, Cao L, Kertesz SG, Kyriakides TC, Davis LL. Cost-Effectiveness of Individual Placement and Support Compared to Transitional Work Program for Veterans with Post-traumatic Stress Disorder. Adm Policy Ment Health 2021; 49:429-439. [PMID: 34677786 DOI: 10.1007/s10488-021-01173-z] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
Post-traumatic stress disorder (PTSD) leads to significant disability, unemployment, and substantial healthcare costs. The cost-effectiveness of vocational rehabilitation (VR) interventions is important to consider when determining which services to offer. This study assesses the cost-effectiveness and return on investment of Individual Placement and Support (IPS) compared to transitional work (TW) programs. Employment outcomes from a multisite randomized trial comparing IPS to TW in military veterans with PTSD (n = 541) were linked to Veterans Health Administration (VHA) archival medical record databases to examine the comparative cost-effectiveness and return on investment. Effectiveness was defined as hours worked and income earned in competitive jobs. Costs for VR, mental health, and medical care and income earned from competitive sources were annualized and adjusted to 2019 US dollars. The annualized mean cost per person of outpatient (including vocational services) were $3970 higher for IPS compared to TW ($23,245 vs. $19,276, respectively; P = 0.004). When TW income was included in costs, mean grand total costs per person per year were similar between groups ($29,828 IPS vs. $26,772 TW; P = 0.17). The incremental cost-effectiveness analysis showed that while IPS is more costly, it is also more effective. The return on investment (excluding TW income) was 32.9% for IPS ($9762 mean income/$29,691 mean total costs) and 29.6% for TW ($7326 mean income/$24,781 mean total costs). IPS significantly improves employment outcomes for individuals with PTSD with negligible increase in healthcare costs and yields very good return on investment compared to non-IPS VR services.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA. .,Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua Richman
- Birmingham VA Medical Center, Birmingham, AL, USA.,Department of Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Building 9, Office 218, 150 South Huntington Avenue (152M), Boston, MA, 02130, USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA
| | - Stefan G Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA.,Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Tassos C Kyriakides
- West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Health Care System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Lori L Davis
- Research and Development Service, Tuscaloosa VA Medical Center-Psychiatry, 3701 Loop Rd, Tuscaloosa, AL, 35404, USA.,Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham, AL, USA
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Stroupe KT, Martinez R, Hogan TP, Gordon EJ, Gonzalez B, Tarlov E, Silva A, Huo Z, Kale I, Ippolito D, Osteen C, Jordan N, French DD, Gordon H, Fischer MJ, Smith BM. Health Insurance Coverage Among Veterans Receiving Care From VA Health Care Facilities. Med Care Res Rev 2021; 79:511-524. [PMID: 34622682 DOI: 10.1177/10775587211048661] [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: 11/15/2022]
Abstract
Reasons for acquiring insurance outside Department of Veterans Affairs (VA) health care coverage among VA enrollees are incompletely understood. To assess Veterans' decision-making and acquisition of non-VA health care insurance in the Affordable Care Act era, we used mailed questionnaires and semistructured interviews in a stratified random sample of VA enrollees <65 years in the Midwest. Of the 3,666 survey participants, 32.1% reported non-VA insurance. Frequently reported reasons included wanting coverage for emergency situations or family members. Those without non-VA insurance cited unaffordability as the main obstacle. Analysis of the semistructured interview data revealed similar findings. In multivariable logistic regression analyses, characteristics associated with non-VA insurance included higher income (>$50,000 vs. <$10,000, odds ratio [OR] = 5.95, 95% confidence interval [CI]: 3.45-10.3, p < .001). As financial barriers exist for acquisition of non-VA insurance and hence community care, it is critically important that VA enrollees' health care needs are met through VA or community providers financed through VA.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,Loyola University Chicago, Maywood, IL, USA
| | - Rachael Martinez
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Timothy P Hogan
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,The University of Texas Southwestern Medical Center, Dallas, USA
| | | | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Elizabeth Tarlov
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,University of Illinois at Chicago, USA
| | - Abigail Silva
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,Loyola University Chicago, Maywood, IL, USA
| | - Zhiping Huo
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Ibuola Kale
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Dolores Ippolito
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Chad Osteen
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,Northwestern University, Chicago, IL, USA
| | - Dustin D French
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,Northwestern University, Chicago, IL, USA
| | - Howard Gordon
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,University of Illinois at Chicago, USA.,Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
| | - Michael J Fischer
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,University of Illinois at Chicago, USA.,Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,Northwestern University, Chicago, IL, USA
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Jones LA, Gordon EJ, Hogan TP, Fiandaca CA, Smith BM, Stroupe KT, Fischer MJ. Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions. Kidney360 2021; 2:1928-1944. [PMID: 35419547 PMCID: PMC8986044 DOI: 10.34067/kid.0000642021] [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] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 09/21/2021] [Indexed: 02/04/2023]
Abstract
Background Home dialysis confers similar survival and greater quality of life than in-center hemodialysis for adults with ESKD but remains underutilized. We examined challenges and facilitators to implementation of home dialysis and identified stakeholder-centered strategies for improving it. Methods We conducted a qualitative, cross-sectional, multisite evaluation that included five geographically dispersed Veterans Health Administration (VHA) home dialysis programs. Participants included patients with ESKD receiving home dialysis, their informal caregivers, and home dialysis staff. Semistructured telephone interviews were conducted and audio-recorded from 2017 through 2018, to assess perceived barriers and facilitators to patient home dialysis use in VHA. Transcribed interviews were analyzed thematically by each participant group. Results Participants included 22 patients receiving home dialysis (18 on peritoneal dialysis [PD] and four hemodialysis [HD]); 20 informal caregivers, and 19 home dialysis program staff. Ten themes emerged as challenges to implementing home dialysis, of which six (60%) spanned all groups: need for sterility, burden of home dialysis tasks, lack of suitable home environment, physical side effects of home dialysis, negative psychosocial effects of home dialysis, and loss of freedom. Four themes (40%), identified only by staff, were insufficient self-efficacy, diminished peer socialization, geographic barriers, and challenging health status. Twelve themes emerged as facilitators to implementing home dialysis, of which seven (58%) spanned all groups: convenience, freedom, avoidance of in-center HD, preservation of autonomy, adequate support, favorable disposition, and perceptions of improved health. Two themes (17%) common among patients and staff were adequate training and resources, and physical and cognitive skills for home dialysis. Recommendations to promote implementation of home dialysis common to all participant groups entailed incorporating mental health care services, offering peer-to-peer coaching, increasing home visits, providing health data feedback, and reducing patient burden. Conclusions Stakeholder-centered challenges were rigorously identified. Facilitators and recommendations can inform efforts to support home dialysis implementation.
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Affiliation(s)
- Lindsey A. Jones
- Veterans Affairs Information Resource Center, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Elisa J. Gordon
- Department of Surgery-Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Timothy P. Hogan
- Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Hospital, Bedford Veterans Affairs Medical Center, Bedford, Massachusetts,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cindi A. Fiandaca
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Bridget M. Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Kevin T. Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Michael J. Fischer
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois,Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois,Medicine/Nephrology, University of Illinois at Chicago, Chicago, Illinois
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Stroupe KT, Nazi K, Hogan TP, Poggensee L, Wakefield B, Martinez RN, Etingen B, Shimada S, Suda KJ, Huo Z, Cao L, Smith BM. Web-based patient portal use and medication overlap from VA and private-sector pharmacies among older veterans. J Manag Care Spec Pharm 2021; 27:983-994. [PMID: 34337984 PMCID: PMC10391010 DOI: 10.18553/jmcp.2021.27.8.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: The availability of Medicare Part D pharmacy coverage may increase veterans' options for obtaining medications outside of the Department of Veterans Affairs (VA) pharmacies. However, availability of Part D coverage raises the potential that veterans may be receiving similar medications from VA and non-VA pharmacies. The VA's personal health record portal, My HealtheVet, allows veterans to self-enter the non-VA medications that they obtained from community-based pharmacies, including those reimbursed by Medicare Part D. The Blue Button medication view feature of My HealtheVet allows veterans to view and download their VA and self-entered non-VA medication history. OBJECTIVE: To examine whether the use by veterans of the Blue Button feature of My HealtheVet was associated with less acquisition of similar medications from VA and community-based pharmacies reimbursed by Medicare Part D. METHODS: This study included a national sample of veterans who were new My HealtheVet users during fiscal year 2013 (October 1, 2012-September 30, 2013) and who used the Blue Button medication view feature of My HealtheVet at least once (users). We compared these veterans with a random sample of veterans who were not registered to use My HealtheVet (nonusers). From these groups, we identified veterans who were enrolled in Part D. We used multiple logistic regression analysis to assess the association of Blue Button medication view use with obtaining medications from the same drug classes (with overlap of 7 or more days) from VA and Part D-reimbursed pharmacies. RESULTS: There were 7,973 My HealtheVet medication view users and 65,985 nonusers. During a 12-month period, medication view users received more 30-day supplies of medications (one 90-day supply equals three 30-day supplies) than nonusers, on average (152.1 vs 71.3, P < 0.001). A larger percentage of users than nonusers obtained medications from VA and Part D-reimbursed pharmacies with overlapping days supply from the same drug classes (30% vs 23%, P < 0.001). However, for veterans who obtained greater numbers of 30-day supplies (82 or more), a significantly smaller percentage of users than nonusers obtained overlapping medications from VA and Part D-reimbursed pharmacies. Moreover, controlling for the total number of 30-day supplies that veterans received, the odds of obtaining medications from VA and Part D-reimbursed pharmacies with days supply that overlapped by at least 7 days for the same drug classes was 18% lower for users than nonusers (P=0.002). CONCLUSIONS: Veterans who used the Blue Button medication view feature of My HealtheVet obtained a larger number of 30-day supplies of medications from VA pharmacies than nonusers. For veterans who obtained a larger number of 30-day supplies of medications, use of the Blue Button medication view feature of My HealtheVet was associated with less overlap in days supply of medication from the same drug class from VA and Part D-reimbursed pharmacies. DISCLOSURES: This study was funded by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service project IIR 14-041-2. The sponsor provided funding but was not involved in the development of the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the Health Services Research and Development Service. All authors are employed in some capacity with the Department of Veterans Affairs and have no conflicts of interest to disclose.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL, and Department of Public Health Sciences, Loyola University Chicago, Maywood, IL
| | - Kim Nazi
- Independent Consultant, Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Coxsackie, NY
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, US Department of Veterans Affairs, Bedford, MA, and Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Linda Poggensee
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL
| | - Bonnie Wakefield
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, IA, and Sinclair School of Nursing, University of Missouri, Columbia
| | - Rachael N Martinez
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL
| | - Stephanie Shimada
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, US Department of Veterans Affairs, Bedford, MA, and Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, and Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Zhiping Huo
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL, and Feinberg School of Medicine, Northwestern University, Chicago, IL
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10
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Etingen B, Patrianakos J, Wirth M, Hogan TP, Smith BM, Tarlov E, Stroupe KT, Kartje R, Weaver FM. TeleWound Practice Within the Veterans Health Administration: Protocol for a Mixed Methods Program Evaluation. JMIR Res Protoc 2020; 9:e20139. [PMID: 32706742 PMCID: PMC7399961 DOI: 10.2196/20139] [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: 05/11/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic wounds, such as pressure injuries and diabetic foot ulcers, are a significant predictor of mortality. Veterans who reside in rural areas often have difficulty accessing care for their wounds. TeleWound Practice (TWP), a coordinated effort to incorporate telehealth into the provision of specialty care for patients with skin wounds, has the potential to increase access to wound care by allowing veterans to receive this care at nearby outpatient clinics or in their homes. The Veterans Health Administration (VA) is championing the rollout of the TWP, starting with regional implementation. OBJECTIVE This paper aims to describe the protocol for a mixed-methods program evaluation to assess the implementation and outcomes of TWP in VA. METHODS We are conducting a mixed-methods evaluation of 4 VA medical centers and their community-based outpatient clinics that are participating in the initial implementation of the TWP. Data will be collected from veterans, VA health care team members, and other key stakeholders (eg, clinical leadership). We will use qualitative methods (ie, semistructured interviews), site visits, and quantitative methods (ie, surveys, national VA administrative databases) to assess the process and reach of TWP implementation and its impact on veterans' clinical outcomes and travel burdens and costs. RESULTS This program evaluation was funded in October 2019 as a Partnered Evaluation Initiative by the US Department of Veterans Affairs, Diffusion of Excellence Office, and Office of Research and Development, Health Services Research and Development Service, Quality Enhancement Research Initiative Program (PEC 19-310). CONCLUSIONS Evaluation of the TWP will identify barriers and solutions to TeleWound implementation in a small number of sites that can be used to inform successful rollout of the TWP nationally. Our evaluation work will inform future efforts to scale up the TWP across VA and optimize reach of the program to veterans across the nation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20139.
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Affiliation(s)
- Bella Etingen
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Jamie Patrianakos
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Marissa Wirth
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elizabeth Tarlov
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
| | - Rebecca Kartje
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
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11
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Stroupe KT, Martinez R, Hogan TP, Gordon EJ, Gonzalez B, Kale I, Osteen C, Tarlov E, Weaver FM, Hynes DM, Smith BM. Experiences with the Veterans' Choice Program. J Gen Intern Med 2019; 34:2141-2149. [PMID: 31388916 PMCID: PMC6816746 DOI: 10.1007/s11606-019-05224-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/20/2019] [Accepted: 07/03/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND To address concerns about Veterans' access to care at US Department of Veterans Affairs (VA) healthcare facilities, the Veterans Access, Choice, and Accountability Act was enacted to facilitate Veterans' access to care in non-VA settings, resulting in the "Veterans Choice Program" (VCP). OBJECTIVES To assess the characteristics of Veterans who used or planned to use the VCP, reasons for using or planning to use the VCP, and experiences with the VCP. DESIGN Mixed-methods. SUBJECTS After sampling Veterans in the Midwest census region receiving care at VA healthcare facilities, we included 4521 Veterans in the analyses. Of these, 60 Veterans participated in semi-structured qualitative interviews. APPROACH Quantitative data were derived from VA's administrative and clinical data and a survey of Veterans including Veteran characteristics and self-reported use of VCP. Associations between Veterans' characteristics and use or planned use of the VCP were assessed using logistic regression analysis. Interview data were analyzed using thematic analysis. KEY RESULTS Veterans with a higher odds of reporting use or intended use of the VCP were women, lived further distances from VA facilities, or had worse health status than other Veterans (P ≤ 0.01). Key themes included positive experiences with the VCP (timeliness of care, location of care, access to services, scheduling improvements, and coverage of services), and negative experiences with the VCP (complicated scheduling processes, inconveniently located appointments, delays securing appointments, billing confusion, and communication breakdowns). DISCUSSION Our findings suggest that Veterans value access to care close to their home and care that addresses the needs of women and Veterans with poor health status. The Mission Act was passed in June 2018 to restructure the VCP and consolidate community care into a single program, continuing VA's commitment to support access to community care into the future.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA.
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
| | - Rachael Martinez
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Elisa J Gordon
- Department of Surgery, and Center for Health Care Studies, and Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
| | - Ibuola Kale
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
| | - Chad Osteen
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
| | - Elizabeth Tarlov
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Denise M Hynes
- Center of Innovation to Improve Veterans Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Oregon State University, Corvallis, OR, USA
- Oregon Health and Sciences University, Portland, OR, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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12
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Stroupe KT, Stelmack JA, Tang XC, Wei Y, Sayers S, Reda DJ, Kwon E, Massof RW. Economic Evaluation of Low-Vision Rehabilitation for Veterans With Macular Diseases in the US Department of Veterans Affairs. JAMA Ophthalmol 2019; 136:524-531. [PMID: 29800250 DOI: 10.1001/jamaophthalmol.2018.0797] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Examining costs and consequences of different low-vision (LV) programs provides important information about resources needed to expand treatment options efficiently. Objective To examine the costs and consequences of LV rehabilitation or basic LV services. Design, Setting, and Participants The US Department of Veterans Affairs (VA) Low Vision Intervention Trial (LOVIT) II was conducted from September 27, 2010, to July 31, 2014, at 9 VA facilities and included 323 veterans with macular diseases and a best-corrected distance visual acuity of 20/50 to 20/200. Veterans were randomized to receive basic LV services that provided LV devices without therapy, or LV rehabilitation that added a therapist to LV services who provided instruction and homework on using LV devices, eccentric viewing, and environmental modification. We compared costs and consequences between these groups. Interventions Low-vision devices without therapy and LV devices with therapy. Main Outcomes and Measures Costs of providing basic LV services or LV rehabilitation were assessed. We measured consequences as changes in functional visual ability from baseline to follow-up 4 months after randomization using the VA Low Vision Visual Functioning Questionnaire. Visual ability was measured in dimensionless log odds units (logits). Results Of 323 randomized patients, the mean (SD) age was 80 (10.5) years, 314 (97.2%) were men, and 292 (90.4%) were white. One hundred sixty (49.5%) received basic LV services and 163 (50.1%) received LV rehabilitation. The mean (SD) total direct health care costs per patient were similar between patients who were randomized to receive basic LV services ($1662 [$671]) or LV rehabilitation ($1788 [$864]) (basic LV services, $126 lower; 95% CI, $299 lower to $35 higher; P = .15). However, basic LV services required less time and had lower transportation costs. Patients receiving LV rehabilitation had greater improvements in overall visual ability, reading ability, visual information processing, and visual motor skill scores.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois.,Department of Public Health Sciences, Loyola University-Chicago, Maywood, Illinois
| | - Joan A Stelmack
- Blind Rehabilitation Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois.,Illinois College of Optometry, Chicago.,Department of Ophthalmology and Visual Science, University of Illinois at Chicago, School of Medicine, Chicago
| | - X Charlene Tang
- Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois
| | - Yongliang Wei
- Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois
| | - Scott Sayers
- Blind Rehabilitation Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois.,Department of Ophthalmology and Visual Science, University of Illinois at Chicago, School of Medicine, Chicago
| | - Domenic J Reda
- Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois
| | - Ellen Kwon
- Washington DC Medical Center, Washington
| | - Robert W Massof
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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13
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Markossian TW, Kramer HJ, Burge NJ, Pacold IV, Leehey DJ, Huo Z, Schneider J, Ling B, Stroupe KT. Low statin use in nondialysis-dependent chronic kidney disease in the absence of clinical atherosclerotic cardiovascular disease or diabetes. Clin Kidney J 2019; 12:530-537. [PMID: 31384445 DOI: 10.1093/ckj/sfy131] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Indexed: 11/13/2022] Open
Abstract
Background Both reduced glomerular filtration rate and increased urine albumin excretion, markers of chronic kidney disease (CKD), are associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). However, CKD is not recognized as an ASCVD risk equivalent by most lipid guidelines. Statin medications, especially when combined with ezetimibe, significantly reduce ASCVD risk in patients with nondialysis-dependent CKD. Unless physicians recognize the heightened ASCVD risk in this population, statins may not be prescribed in the absence of clinical cardiovascular disease or diabetes, a recognized ASCVD risk equivalent. We examined statin use in adults with nondialysis-dependent CKD and examined whether the use differed in the presence of clinical ASCVD and diabetes. Methods This study ascertained statin use from pharmacy dispensing records during fiscal years 2012 and 2013 from the US Department of Veterans Affairs Healthcare System. The study included 581 344 veterans aged ≥50 years with nondialysis-dependent CKD Stages 3-5 with no history of kidney transplantation or dialysis. The 10-year predicted ASCVD risk was calculated with the pooled risk equation. Results Of veterans with CKD, 62.1% used statins in 2012 and 55.4% used statins continuously over 2 years (2012-13). Statin use in 2012 was 76.2 and 75.5% among veterans with CKD and ASCVD or diabetes, respectively, but in the absence of ASCVD, diabetes or a diagnosis of hyperlipidemia, statin use was 21.8% (P < 0.001). The 10-year predicted ASCVD risk was ≥7.5% in 95.1% of veterans with CKD, regardless of diabetes status. Conclusions Statin use is low in veterans with nondialysis-dependent CKD in the absence of ASCVD or diabetes despite high-predicted ASCVD risk. Future studies should examine other populations.
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Affiliation(s)
- Talar W Markossian
- Center for Innovation in Complex Chronic Healthcare, Hines Veterans Administration Hospital, Hines, IL, USA.,Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, USA
| | - Holly J Kramer
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, USA.,Department of Medicine, Loyola University Chicago, Maywood, IL, USA.,Medicine Service Line, Hines Veterans Administration Hospital, Hines, IL, USA
| | - Nicholas J Burge
- Medicine Service Line, Hines Veterans Administration Hospital, Hines, IL, USA
| | - Ivan V Pacold
- Department of Medicine, Loyola University Chicago, Maywood, IL, USA.,Medicine Service Line, Hines Veterans Administration Hospital, Hines, IL, USA
| | - David J Leehey
- Department of Medicine, Loyola University Chicago, Maywood, IL, USA.,Medicine Service Line, Hines Veterans Administration Hospital, Hines, IL, USA
| | - Zhiping Huo
- Center for Innovation in Complex Chronic Healthcare, Hines Veterans Administration Hospital, Hines, IL, USA
| | - Julia Schneider
- Department of Medicine, Loyola University Chicago, Maywood, IL, USA.,Medicine Service Line, Hines Veterans Administration Hospital, Hines, IL, USA
| | - Benjamin Ling
- Department of Medicine, Loyola University Chicago, Maywood, IL, USA.,Medicine Service Line, Hines Veterans Administration Hospital, Hines, IL, USA
| | - Kevin T Stroupe
- Center for Innovation in Complex Chronic Healthcare, Hines Veterans Administration Hospital, Hines, IL, USA.,Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, USA
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14
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Weaver FM, Binns-Calvey A, Gonzalez B, Kostovich C, LaVela S, Stroupe KT, Kelly B, Ashley N, Miskevics S, Gerber B, Burkhart L, Schwartz A, Weiner SJ. Alerting Doctors About Patient Life Challenges: A Randomized Control Trial of a Previsit Inventory of Contextual Factors. MDM Policy Pract 2019; 4:2381468319852334. [PMID: 31192310 PMCID: PMC6540506 DOI: 10.1177/2381468319852334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/02/2018] [Accepted: 04/13/2019] [Indexed: 11/15/2022] Open
Abstract
Objective. Effective care attends to relevant patient life context. We tested whether a patient-completed inventory helps providers contextualize care and increases patients’ perception of patient-centered care (PCC). Method. The inventory listed six red flags (e.g., emergency room visits) and if the patient checked any, prompted for related contextual factors (e.g., transportation difficulties). Patients were randomized to complete the inventory or watch health videos prior to their visit. Patients presented their inventory results to providers during audio-recorded encounters. Audios were coded for physician probing and incorporating context in care plans. Patients completed the Consultation and Relational Empathy (CARE) instrument after the encounter. Results. A total of 272 Veterans were randomized. Adjusting for covariates and clustering within providers, inventory patients rated visits as more patient-centered (44.5; standard error = 1.1) than controls (42.7, standard error = 1.1, P = 0.04, CARE range = 10–50). Providers were more likely to probe red flags (odds ratio = 1.54; confidence interval = 1.07–2.22; P = 0.02) when receiving the inventory, but not incorporating context into care planning. Conclusion. A previsit inventory of life context increased perceptions of PCC and providers’ likelihood of exploring context but not contextualizing care. Information about patients’ life challenges is not sufficient to assure that context informs provider decision making even when provided at the point of care by patients themselves.
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Affiliation(s)
- Frances M Weaver
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Amy Binns-Calvey
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Beverly Gonzalez
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Carol Kostovich
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Sherri LaVela
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Kevin T Stroupe
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Brendan Kelly
- Jesse Brown VA Medical Center, Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois
| | - Naomi Ashley
- Jesse Brown VA Medical Center, Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois
| | - Scott Miskevics
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Ben Gerber
- Department of Medicine, College of Medicine
| | - Lisa Burkhart
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Alan Schwartz
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Saul J Weiner
- Jesse Brown VA Medical Center, Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois
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Abstract
BACKGROUND Elective endovascular repair of an abdominal aortic aneurysm results in lower perioperative mortality than traditional open repair, but after 4 years this survival advantage is not seen; in addition, results of two European trials have shown worse long-term outcomes with endovascular repair than with open repair. Long-term results of a study we conducted more than a decade ago to compare endovascular repair with open repair are unknown. METHODS We randomly assigned patients with asymptomatic abdominal aortic aneurysms to either endovascular repair or open repair of the aneurysm. All the patients were candidates for either procedure. Patients were followed for up to 14 years. RESULTS A total of 881 patients underwent randomization: 444 were assigned to endovascular repair and 437 to open repair. The primary outcome was all-cause mortality. A total of 302 patients (68.0%) in the endovascular-repair group and 306 (70.0%) in the open-repair group died (hazard ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.13). During the first 4 years of follow-up, overall survival appeared to be higher with endovascular repair than with open repair; from year 4 through year 8, overall survival was higher in the open-repair group; and after 8 years, overall survival was once again higher in the endovascular-repair group (hazard ratio for death, 0.94; 95% CI, 0.74 to 1.18). None of these trends were significant. There were 12 aneurysm-related deaths (2.7%) in the endovascular-repair group and 16 (3.7%) in the open-repair group (between-group difference, -1.0 percentage point; 95% CI, -3.3 to 1.4); most deaths occurred during the perioperative period. Aneurysm rupture occurred in 7 patients (1.6%) in the endovascular-repair group, and rupture of a thoracic aneurysm occurred in 1 patient (0.2%) in the open-repair group (between-group difference, 1.3 percentage points; 95% CI, 0.1 to 2.6). Death from chronic obstructive lung disease was just over 50% more common with open repair (5.4% of patients in the endovascular-repair group and 8.2% in the open-repair group died from chronic obstructive lung disease; between-group difference, -2.8 percentage points; 95% CI, -6.2 to 0.5). More patients in the endovascular-repair group underwent secondary procedures. CONCLUSIONS Long-term overall survival was similar among patients who underwent endovascular repair and those who underwent open repair. A difference between groups was noted in the number of patients who underwent secondary therapeutic procedures. Our results were not consistent with the findings of worse performance of endovascular repair with respect to long-term survival that was seen in the two European trials. (Funded by the Department of Veteran Affairs Office of Research and Development; OVER ClinicalTrials.gov number, NCT00094575.).
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Affiliation(s)
- Frank A Lederle
- From the Veterans Affairs (VA) Medical Center, Minneapolis (F.A.L.); VA Healthcare System, West Haven, CT (T.C.K., G.R.J.); Edward Hines, Jr. VA Hospital, Hines, IL (K.T.S., Z.H.); Wake Forest Baptist Health, Winston-Salem, NC (J.A.F.); VA Medical Center, East Orange, NJ (F.T.P.); and VA Medical Center, Madison, WI (J.S.M.)
| | - Tassos C Kyriakides
- From the Veterans Affairs (VA) Medical Center, Minneapolis (F.A.L.); VA Healthcare System, West Haven, CT (T.C.K., G.R.J.); Edward Hines, Jr. VA Hospital, Hines, IL (K.T.S., Z.H.); Wake Forest Baptist Health, Winston-Salem, NC (J.A.F.); VA Medical Center, East Orange, NJ (F.T.P.); and VA Medical Center, Madison, WI (J.S.M.)
| | - Kevin T Stroupe
- From the Veterans Affairs (VA) Medical Center, Minneapolis (F.A.L.); VA Healthcare System, West Haven, CT (T.C.K., G.R.J.); Edward Hines, Jr. VA Hospital, Hines, IL (K.T.S., Z.H.); Wake Forest Baptist Health, Winston-Salem, NC (J.A.F.); VA Medical Center, East Orange, NJ (F.T.P.); and VA Medical Center, Madison, WI (J.S.M.)
| | - Julie A Freischlag
- From the Veterans Affairs (VA) Medical Center, Minneapolis (F.A.L.); VA Healthcare System, West Haven, CT (T.C.K., G.R.J.); Edward Hines, Jr. VA Hospital, Hines, IL (K.T.S., Z.H.); Wake Forest Baptist Health, Winston-Salem, NC (J.A.F.); VA Medical Center, East Orange, NJ (F.T.P.); and VA Medical Center, Madison, WI (J.S.M.)
| | - Frank T Padberg
- From the Veterans Affairs (VA) Medical Center, Minneapolis (F.A.L.); VA Healthcare System, West Haven, CT (T.C.K., G.R.J.); Edward Hines, Jr. VA Hospital, Hines, IL (K.T.S., Z.H.); Wake Forest Baptist Health, Winston-Salem, NC (J.A.F.); VA Medical Center, East Orange, NJ (F.T.P.); and VA Medical Center, Madison, WI (J.S.M.)
| | - Jon S Matsumura
- From the Veterans Affairs (VA) Medical Center, Minneapolis (F.A.L.); VA Healthcare System, West Haven, CT (T.C.K., G.R.J.); Edward Hines, Jr. VA Hospital, Hines, IL (K.T.S., Z.H.); Wake Forest Baptist Health, Winston-Salem, NC (J.A.F.); VA Medical Center, East Orange, NJ (F.T.P.); and VA Medical Center, Madison, WI (J.S.M.)
| | - Zhiping Huo
- From the Veterans Affairs (VA) Medical Center, Minneapolis (F.A.L.); VA Healthcare System, West Haven, CT (T.C.K., G.R.J.); Edward Hines, Jr. VA Hospital, Hines, IL (K.T.S., Z.H.); Wake Forest Baptist Health, Winston-Salem, NC (J.A.F.); VA Medical Center, East Orange, NJ (F.T.P.); and VA Medical Center, Madison, WI (J.S.M.)
| | - Gary R Johnson
- From the Veterans Affairs (VA) Medical Center, Minneapolis (F.A.L.); VA Healthcare System, West Haven, CT (T.C.K., G.R.J.); Edward Hines, Jr. VA Hospital, Hines, IL (K.T.S., Z.H.); Wake Forest Baptist Health, Winston-Salem, NC (J.A.F.); VA Medical Center, East Orange, NJ (F.T.P.); and VA Medical Center, Madison, WI (J.S.M.)
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16
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Radomski TR, Zhao X, Hanlon JT, Thorpe JM, Thorpe CT, Naples JG, Sileanu FE, Cashy JP, Hale JA, Mor MK, Hausmann LRM, Donohue JM, Suda KJ, Stroupe KT, Good CB, Fine MJ, Gellad WF. Use of a medication-based risk adjustment index to predict mortality among veterans dually-enrolled in VA and medicare. Healthc (Amst) 2019; 7:S2213-0764(18)30230-6. [PMID: 31031120 DOI: 10.1016/j.hjdsi.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/09/2019] [Accepted: 04/13/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is systemic undercoding of medical comorbidities within administrative claims in the Department of Veterans Affairs (VA). This leads to bias when applying claims-based risk adjustment indices to compare outcomes between VA and non-VA settings. Our objective was to compare the accuracy of a medication-based risk adjustment index (RxRisk-VM) to diagnostic claims-based indices for predicting mortality. METHODS We modified the RxRisk-V index (RxRisk-VM) by incorporating VA and Medicare pharmacy and durable medical equipment claims in Veterans dually-enrolled in VA and Medicare in 2012. Using the concordance (C) statistic, we compared its accuracy in predicting 1 and 3-year all-cause mortality to the following models: demographics only, demographics plus prescription count, or demographics plus a diagnostic claims-based risk index (e.g., Charlson, Elixhauser, or Gagne). We also compared models containing demographics, RxRisk-VM, and a claims-based index. RESULTS In our cohort of 271,184 dually-enrolled Veterans (mean age = 70.5 years, 96.1% male, 81.7% non-Hispanic white), RxRisk-VM (C = 0.773) exhibited greater accuracy in predicting 1-year mortality than demographics only (C = 0.716) or prescription counts (C = 0.744), but was less accurate than the Charlson (C = 0.794), Elixhauser (C = 0.80), or Gagne (C = 0.810) indices (all P < 0.001). Combining RxRisk-VM with claims-based indices enhanced its accuracy over each index alone (all models C ≥ 0.81). Relative model performance was similar for 3-year mortality. CONCLUSIONS The RxRisk-VM index exhibited a high level of, but slightly less, accuracy in predicting mortality in comparison to claims-based risk indices. IMPLICATIONS Its application may enhance the accuracy of studies examining VA and non-VA care and enable risk adjustment when diagnostic claims are not available or biased. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Thomas R Radomski
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA.
| | - Xinhua Zhao
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA
| | - Joseph T Hanlon
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of Geriatrics, Department of Medicine, University of Pittsburgh School of Medicine, 3471 5th Ave, Kaufmann Building Suite 500, Pittsburgh, PA, 15213, USA
| | - Joshua M Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Jennifer G Naples
- Division of Geriatrics, Department of Medicine, University of Pittsburgh School of Medicine, 3471 5th Ave, Kaufmann Building Suite 500, Pittsburgh, PA, 15213, USA
| | - Florentina E Sileanu
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA
| | - John P Cashy
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA
| | - Jennifer A Hale
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Katie J Suda
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, PO Box 1033, 5000 S. 5th Ave, Hines, IL, USA; Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago College of Pharmacy, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Kevin T Stroupe
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago College of Pharmacy, 833 S. Wood Street, Chicago, IL, 60612, USA
| | - Chester B Good
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA; Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Michael J Fine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place Suite 600, Pittsburgh, PA, 15213, USA; Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
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17
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Stroupe KT, Smith B, Weaver FM, Gonzalez B, Huo Z, Cao L, Ippolito D, Follett KA. Healthcare Utilization and Costs for Patients With Parkinson's Disease After Deep Brain Stimulation. Mov Disord Clin Pract 2019; 6:369-378. [PMID: 31286006 DOI: 10.1002/mdc3.12765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/16/2019] [Revised: 03/05/2019] [Accepted: 03/15/2019] [Indexed: 11/06/2022] Open
Abstract
Objective To compare the complications, healthcare utilization and costs following DBS or medical management for patients with Parkinson's disease (PD). Methods We examined healthcare utilization and costs for up to 5 years between veterans with DBS and those with medical management for PD. Veterans who received DBS between 2007 and 2013 were matched with veterans who received medical management using propensity score approaches. Healthcare utilization and costs were obtained from national VA and Medicare data sources and compared using procedures to adjust for potential differences in length of follow-up. Results We identified 611 veterans who had received DBS and a matched group of 611 veterans who did not undergo DBS. Among DBS patients, 59% had the electrodes and generator implanted during separate admissions. After 5 years of follow-up, average total healthcare costs, including DBS procedures and complications, were $77,131 (95% confidence interval: $66,095-$88,168; P < 0.001) higher per person for patients who received DBS ($162,489) than patients who received medical management ($85,358). In contrast, excluding the costs of the DBS procedures and complications, average total costs were not significantly different between patients who received DBS and patients who received medical management after 5 years of follow-up. Conclusions Healthcare costs over 5 years were higher for veterans who received DBS. These higher healthcare costs may reflect the costs of DBS procedures and any follow-up required plus greater surveillance by healthcare professionals following DBS as well as unobserved differences in the patients who received medical management or DBS.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare Hines VA Hospital Hines IL.,Loyola University Stritch School of Medicine Maywood IL
| | - Bridget Smith
- Center of Innovation for Complex Chronic Healthcare Hines VA Hospital Hines IL.,Northwestern University Feinberg School of Medicine Chicago IL
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare Hines VA Hospital Hines IL.,Loyola University Stritch School of Medicine Maywood IL
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare Hines VA Hospital Hines IL
| | - Zhiping Huo
- Center of Innovation for Complex Chronic Healthcare Hines VA Hospital Hines IL
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare Hines VA Hospital Hines IL
| | - Dolores Ippolito
- Center of Innovation for Complex Chronic Healthcare Hines VA Hospital Hines IL
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18
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Stroupe KT, Martinez R, Hogan TP, Evans CT, Scholten J, Bidelspach D, Osteen C, Taylor BC, Smith BM. Health Care Utilization and Costs of Veterans Evaluated for Traumatic Brain Injury Through Telehealth. Telemed J E Health 2019; 25:1144-1153. [PMID: 30874499 DOI: 10.1089/tmj.2018.0182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/12/2022] Open
Abstract
Background: Mild traumatic brain injury (TBI) is prevalent among Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]) Veterans. With clinical video telehealth (CVT), Veterans screening positive for potential deployment-related TBI can receive comprehensive TBI evaluations by providers at specialized centers through interactive video communication. Introduction: We examined health care utilization and costs for Veterans during the 12 months before and after being evaluated through CVT versus in-person. Materials and Methods: We examined OEF/OIF Veterans receiving comprehensive evaluations at specialized Veterans Affairs facilities from October 2012 to September 2014. Veterans evaluated through CVT and in-person at the same facilities were included. We used a difference-in-difference analysis with propensity score weighted regression models to examine health care utilization and costs between TBI evaluation groups. Results: There were 554 Veterans with comprehensive evaluations through CVT (380 with and 174 without confirmed TBI) and 7,159 with in-person evaluations (4,899 with and 2,260 without confirmed TBI). Veterans in the in-person group with confirmed TBI had similar increases in outpatient, inpatient, and total health care costs as Veterans who had TBI confirmed through CVT. However, Veterans with a confirmed TBI evaluated in-person had greater increases in rehabilitation and other specialty costs. Discussion: When visits are in-person, Veterans may have opportunities to discuss more issues and concerns, whether TBI-related or not. Thus, providers might make more referrals to rehabilitation and specialty care after in-person visits. Conclusion: Veterans receiving in-person evaluations who were diagnosed with TBI had similar increases in health care costs as Veterans with TBI confirmed through evaluations through CVT.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois.,Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Rachael Martinez
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois.,Department of Preventive Medicine and Center for Health Care Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joel Scholten
- Physical Medicine and Rehabilitation, Rehabilitation and Prosthetics Service, VA Central Office, Washington, District of Columbia
| | - Douglas Bidelspach
- Physical Medicine and Rehabilitation, Rehabilitation and Prosthetics Service, VA Central Office, Washington, District of Columbia
| | - Chad Osteen
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois
| | - Brent C Taylor
- Department of Veterans Affairs Health Care System, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota.,Division of Epidemiology, Department of Medicine, Community Health University of Minnesota, Minneapolis, Minnesota
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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19
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Markossian TW, Kramer HJ, Burge NJ, Pacold IV, Leehey DJ, Huo Z, Schneider J, Ling B, Stroupe KT. Statin use among Veterans with dialysis-dependent chronic kidney disease. Hemodial Int 2019; 23:206-213. [PMID: 30779455 DOI: 10.1111/hdi.12730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/13/2018] [Revised: 11/26/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The benefits of statin medications in patients receiving maintenance dialysis remains controversial and clinical trials overall have shown no benefit. Potential side effects of statin medications include myalgias, myopathy, and memory loss and risk of side effects associated with statin medications increase with higher statin doses. We examined statin use and statin dose among Veterans with dialysis dependent CKD. Such information may help clinicians modulate medication use and reduce pill burden in appropriate patients. METHODS This cross-sectional analysis ascertained medication utilization by linking records from the U.S. Department of Veteran's Affairs (VA) Managerial Cost Accounting Pharmacy National Data Extracts and Medicare Part D during calendar year 2013 for Veterans with dialysis-dependent CKD enrolled in and/or using VA healthcare. The venue of dialysis and patient characteristics were ascertained by linking VA Medical SAS datasets, VA Fee Basis datasets (for non-VA care paid for by VA), Medicare claims and the United States Renal Data Systems patient core files. FINDINGS We identified 18,494 Veterans with dialysis-dependent CKD who were enrolled in and/or used VA healthcare, had no history of kidney transplantation, and were alive on January 1, 2014. More than half (58.1%) of Veterans with dialysis-dependent CKD used statins and 35.7% of statin utilization was high dose. Statins were the third most commonly prescribed medication after beta blockers (64.8%) and phosphate binders (64.5%). DISCUSSION Statins are a commonly prescribed medication among Veterans receiving maintenance dialysis and approximately one-third of statin utilization is high dose in this population. Future studies should examine patient preferences, comorbidities, and dialysis characteristics that impact the risks and benefits of statin use in order to identify those patients who will or will not benefit from continued statin use.
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Affiliation(s)
- Talar W Markossian
- Center for Innovation in Complex Chronic Healthcare, Veterans Administration Hospital, Hines, Illinois, USA.,Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA
| | - Holly J Kramer
- Medicine Service Line, Hines Veterans Administration Hospital, Hines, Illinois, USA.,Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA.,Department of Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, Illinois, USA
| | - Nicholas J Burge
- Medicine Service Line, Hines Veterans Administration Hospital, Hines, Illinois, USA
| | - Ivan V Pacold
- Medicine Service Line, Hines Veterans Administration Hospital, Hines, Illinois, USA.,Department of Cardiology, Loyola University Chicago, Maywood, Illinois, USA
| | - David J Leehey
- Medicine Service Line, Hines Veterans Administration Hospital, Hines, Illinois, USA.,Department of Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, Illinois, USA
| | - Zhiping Huo
- Center for Innovation in Complex Chronic Healthcare, Veterans Administration Hospital, Hines, Illinois, USA
| | - Julia Schneider
- Medicine Service Line, Hines Veterans Administration Hospital, Hines, Illinois, USA.,Department of Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, Illinois, USA
| | - Benjamin Ling
- Medicine Service Line, Hines Veterans Administration Hospital, Hines, Illinois, USA.,Department of Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, Illinois, USA
| | - Kevin T Stroupe
- Center for Innovation in Complex Chronic Healthcare, Veterans Administration Hospital, Hines, Illinois, USA.,Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA
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20
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Freischlag JA, Kyriakides TC, Stroupe KT, Padberg FT, Matsumura JS, Huo Z, Johnson GR. Extended Follow-Up of Open vs Endovascular Repair for Abdominal Aortic Aneurysm: the OVER Trial. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Radomski TR, Bixler FR, Zickmund SL, Roman KM, Thorpe CT, Hale JA, Sileanu FE, Hausmann LRM, Thorpe JM, Suda KJ, Stroupe KT, Gordon AJ, Good CB, Fine MJ, Gellad WF. Physicians' Perspectives Regarding Prescription Drug Monitoring Program Use Within the Department of Veterans Affairs: a Multi-State Qualitative Study. J Gen Intern Med 2018. [PMID: 29520747 PMCID: PMC6082216 DOI: 10.1007/s11606-018-4374-1] [Citation(s) in RCA: 19] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Department of Veterans Affairs (VA) has implemented robust strategies to monitor prescription opioid dispensing, but these strategies have not accounted for opioids prescribed by non-VA providers. State-based prescription drug monitoring programs (PDMPs) are a potential tool to identify VA patients' receipt of opioids from non-VA prescribers, and recent legislation requires their use within VA. OBJECTIVE To evaluate VA physicians' perspectives and experiences regarding use of PDMPs to monitor Veterans' receipt of opioids from non-VA prescribers. DESIGN Qualitative study using semi-structured interviews. PARTICIPANTS Forty-two VA primary care physicians who prescribed opioids to 15 or more Veterans in 2015. We sampled physicians from two states with PDMPs (Massachusetts and Illinois) and one without prescriber access to a PDMP at the time of the interviews (Pennsylvania). APPROACH From February to August 2016, we conducted semi-structured telephone interviews that addressed the following topics regarding PDMPs: overall experiences, barriers to optimal use, and facilitators to improve use. KEY RESULTS VA physicians broadly supported use of PDMPs or desired access to one, while exhibiting varying patterns of PDMP use dictated by state laws and their clinical judgment. Physicians noted administrative burdens and incomplete or unavailable prescribing data as key barriers to PDMP use. To facilitate use, physicians endorsed (1) linking PDMPs with the VA electronic health record, (2) using templated notes to document PDMP use, and (3) delegating routine PDMP queries to ancillary staff. CONCLUSIONS Despite the time and administrative burdens associated with their use, VA physicians in our study broadly supported PDMPs. The application of our findings to ongoing PDMP implementation efforts may strengthen PDMP use both within and outside VA and improve the safe prescribing of opioids.
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Affiliation(s)
- Thomas R Radomski
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. .,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Center for Research on Healthcare, Pittsburgh, PA, USA.
| | - Felicia R Bixler
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - KatieLynn M Roman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Jennifer A Hale
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Florentina E Sileanu
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joshua M Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | | | | | - Adam J Gordon
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Chester B Good
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Michael J Fine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Markossian TW, Suda KJ, Abderhalden L, Huo Z, Smith BM, Stroupe KT. Characteristics and medication use of veterans in Medicare Advantage plans. Am J Manag Care 2018; 24:247-255. [PMID: 29851441] [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: 06/08/2023]
Abstract
OBJECTIVES To compare characteristics, health conditions, and medication acquisition patterns by fee-for-service (FFS) or Medicare Advantage (MA) plan enrollment status for Medicare-eligible veterans. STUDY DESIGN Retrospective analysis of all female and a random 10% sample of male veterans. METHODS Data were derived from the US Department of Veterans Affairs (VA) and Medicare administrative databases. Demographic, geographic, and RxRisk-V risk classes were ascertained in 2008. Medicare Part D enrollment, medication acquisition, and use of high-risk medications (HRMs) were examined in 2009. A veteran was classified as an MA enrollee if he or she was enrolled in an MA plan for at least 1 month in 2008-2009. Descriptive and regression analyses were conducted to compare veterans' characteristics and medication acquisition patterns by plan enrollment type controlling for veterans' characteristics. RESULTS Veterans who resided in urban settings and in the West or Northeast and who had co-payments for their VA medications had greater odds of enrolling in MA programs compared with their counterparts. MA-enrolled veterans were more likely to be dual (32.3% vs 7.0%) or Medicare-reimbursed (31.1% vs 14.5%) pharmacy users and less likely to be VA-only pharmacy users (29.4% vs 48.7%) than FFS enrollees. Higher proportions of MA-enrolled veterans received HRMs compared with those in the FFS sector (17.0% vs 14.3%). CONCLUSIONS Providers both inside and outside of the VA should consider that substantial information about the medication use of veterans may be unavailable in their healthcare systems' electronic records.
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Affiliation(s)
- Talar W Markossian
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, 2160 S First Ave, CTRE 554, Maywood, IL 60153.
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23
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Hatch MN, Raad J, Suda K, Stroupe KT, Hon AJ, Smith BM. Evaluating the Use of Medicare Part D in the Veteran Population With Spinal Cord Injury/Disorder. Arch Phys Med Rehabil 2018; 99:1099-1107. [PMID: 29425699 DOI: 10.1016/j.apmr.2017.12.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 07/14/2017] [Revised: 12/05/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the different sources of medications, the most common drug classes filled, and the characteristics associated with Medicare Part D pharmacy use in veterans with spinal cord injury/disorder (SCI/D). DESIGN Retrospective, cross-sectional, observational study. SETTING Outpatient clinics and pharmacies. PARTICIPANTS Veterans (N=13,442) with SCI/D using Medicare or Veteran Affairs pharmacy benefits. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Characteristics and top 10 most common drug classes were examined in veterans who (1) used VA pharmacies only; (2) used both VA and Medicare Part D pharmacies; or (3) used Part D pharmacies only. Chi-square tests and multinomial logistic regression analyses were used to determine associations between various patient variables and source of medications. Patient level frequencies were used to determine the most common drug classes. RESULTS A total of 13,442 veterans with SCI/D were analyzed in this study: 11,788 (87.7%) used VA pharmacies only, 1281 (9.5%) used both VA and Part D pharmacies, and 373 (2.8%) used Part D pharmacies only. Veterans older than 50 years were more likely to use Part D pharmacies, whereas those with traumatic injury, or secondary conditions, were less associated with the use of Part D pharmacies. Opioids were the most frequently filled drug class across all groups. Other frequently used drug classes included skeletal muscle relaxants, gastric medications, antidepressants (other category), anticonvulsants, and antilipemics. CONCLUSIONS Approximately 12% of veterans with SCI/D are receiving medication outside the VA system. Polypharmacy in this population of veterans is relatively high, emphasizing the importance of health information exchange between systems for improved care for this medically complex population.
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Affiliation(s)
- Maya N Hatch
- Spinal Cord Injury and Disorders Center, Long Beach Veterans Affairs Medical Center, Long Beach, CA
| | - Jason Raad
- Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Chicago, IL
| | - Katie Suda
- Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Chicago, IL
| | - Kevin T Stroupe
- Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Chicago, IL
| | - Alice J Hon
- Spinal Cord Injury and Disorders Center, Long Beach Veterans Affairs Medical Center, Long Beach, CA
| | - Bridget M Smith
- Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Chicago, IL; Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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24
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Gellad WF, Thorpe JM, Zhao X, Thorpe CT, Sileanu FE, Cashy JP, Hale JA, Mor MK, Radomski TR, Hausmann LRM, Donohue JM, Gordon AJ, Suda KJ, Stroupe KT, Hanlon JT, Cunningham FE, Good CB, Fine MJ. Impact of Dual Use of Department of Veterans Affairs and Medicare Part D Drug Benefits on Potentially Unsafe Opioid Use. Am J Public Health 2017; 108:248-255. [PMID: 29267065 DOI: 10.2105/ajph.2017.304174] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To estimate the prevalence and consequences of receiving prescription opioids from both the Department of Veterans Affairs (VA) and Medicare Part D. METHODS Among US veterans enrolled in both VA and Part D filling 1 or more opioid prescriptions in 2012 (n = 539 473), we calculated 3 opioid safety measures using morphine milligram equivalents (MME): (1) proportion receiving greater than 100 MME for 1 or more days, (2) mean days receiving greater than 100 MME, and (3) proportion receiving greater than 120 MME for 90 consecutive days. We compared these measures by opioid source. RESULTS Overall, 135 643 (25.1%) veterans received opioids from VA only, 332 630 (61.7%) from Part D only, and 71 200 (13.2%) from both. The dual-use group was more likely than the VA-only group to receive greater than 100 MME for 1 or more days (34.3% vs 10.9%; adjusted risk ratio [ARR] = 3.0; 95% confidence interval [CI] = 2.9, 3.1), have more days with greater than 100 MME (42.5 vs 16.9 days; adjusted difference = 16.4 days; 95% CI = 15.7, 17.2), and to receive greater than 120 MME for 90 consecutive days (7.8% vs 3.1%; ARR = 2.2; 95% CI = 2.1, 2.3). CONCLUSIONS Among veterans dually enrolled in VA and Medicare Part D, dual use of opioids was associated with more than 2 to 3 times the risk of high-dose opioid exposure.
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Affiliation(s)
- Walid F Gellad
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Joshua M Thorpe
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Xinhua Zhao
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Carolyn T Thorpe
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Florentina E Sileanu
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - John P Cashy
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Jennifer A Hale
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Maria K Mor
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Thomas R Radomski
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Leslie R M Hausmann
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Julie M Donohue
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Adam J Gordon
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Katie J Suda
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Kevin T Stroupe
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Joseph T Hanlon
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Francesca E Cunningham
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Chester B Good
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
| | - Michael J Fine
- Walid F. Gellad, Joshua M. Thorpe, Xinhua Zhao, Carolyn T. Thorpe, Florentina E. Sileanu, John P. Cashy, Jennifer A. Hale, Maria K. Mor, Thomas R. Radomski, Leslie R. M. Hausmann, Adam J. Gordon, Joseph T. Hanlon, and Michael J. Fine are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Julie M. Donohue is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh. Katie J. Suda and Kevin T. Stroupe are with the Center of Innovation for Complex Chronic Care, Hines VA Hospital, Chicago, IL. Francesca E. Cunningham and Chester B. Good are with the Department of Veterans Affairs, Pharmacy Benefits Management Services, VA Center for Medication Safety, Chicago
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25
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Weaver FM, Stroupe KT, Smith B, Gonzalez B, Huo Z, Cao L, Ippolito D, Follett KA. Survival in patients with Parkinson's disease after deep brain stimulation or medical management. Mov Disord 2017; 32:1756-1763. [PMID: 29150873 DOI: 10.1002/mds.27235] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Deep brain stimulation has been shown to have a significant long-term beneficial effect on motor function. However, whether it affects survival is not clear. In this study, we compared survival rates for Parkinson's disease (PD) patients who underwent deep brain stimulation (DBS) with those who were medically managed. METHODS A retrospective analysis of Veterans Affairs and Medicare administrative data of veterans with PD who received DBS and were propensity score matched to a cohort of veterans with PD who did not receive DBS between 2007-2013. RESULTS Veterans with PD who received DBS had a longer survival measured in days than a matched group of veterans who did not undergo DBS (mean = 2291.1 [standard error = 46.4] days [6.3 years] vs 2063.8 [standard error = 47.7] days [5.7 years]; P = .006; hazard ratio = 0.69 [95% confidence interval 0.56-0.85]). Mean age at death was similar for both groups (76.5 [standard deviation = 7.2] vs 75.9 [standard deviation = 8.4] years, P = .67), respectively, and the most common cause of death was PD. CONCLUSIONS DBS is associated with a modest survival advantage when compared with a matched group of patients who did not undergo DBS. Whether the survival advantage reflects a moderating influence of DBS on PD or on comorbidities that might shorten life or whether differences may be a result of unmeasured differences between groups is not known. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Frances M Weaver
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA.,Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Kevin T Stroupe
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA.,Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Bridget Smith
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Beverly Gonzalez
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA
| | - Zhiping Huo
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA
| | - Lishan Cao
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA
| | - Dolores Ippolito
- Hines Veterans Affairs Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA
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26
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Silva A, Tarlov E, French DD, Huo Z, Martinez RN, Stroupe KT. Veterans Affairs Health System Enrollment and Health Care Utilization After the Affordable Care Act: Initial Insights. Mil Med 2017; 181:469-75. [PMID: 27136655 DOI: 10.7205/milmed-d-15-00094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The Affordable Care Act (ACA) was signed into law in 2010 and its individual mandate and expanded health care coverage options were implemented in 2014. These provisions may affect Veterans Affairs (VA) enrollment and health care utilization. Using data from two VA regional networks, we examined recent patterns in the number of new VA enrollees and their primary care use. Trends were assessed by enrollment priority group (based on the veteran's severity of service-connected disabilities, exposures, and income level) and a state's Medicaid expansion status. Compared to the same time period in the previous year, the number of new enrollees from low-income priority groups was higher during the open enrollment period and the increase was sharper in Medicaid non-expansion states (25-42%) than in expansion states (20-32%). In addition, low-income patients with a copay requirement who enrolled in the VA during the ACA open enrollment had a lower average number of primary care visits than counterparts who had enrolled in prior time periods (1.73 versus 1.87, p < 0.0001). Although this study is an initial step, more research is required to better understand veterans' decision making and behavior in regard to health care coverage through the ACA and related impacts on VA and non-VA health care utilization and care coordination.
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Affiliation(s)
- Abigail Silva
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141
| | - Elizabeth Tarlov
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141
| | - Dustin D French
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141
| | - Zhiping Huo
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141
| | - Rachael N Martinez
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141
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27
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Taylor BC, Hagel Campbell E, Nugent S, Bidelspach DE, Kehle-Forbes SM, Scholten J, Stroupe KT, Sayer NA. Three Year Trends in Veterans Health Administration Utilization and Costs after Traumatic Brain Injury Screening among Veterans with Mild Traumatic Brain Injury. J Neurotrauma 2017; 34:2567-2574. [PMID: 28482747 DOI: 10.1089/neu.2016.4910] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 11/12/2022] Open
Abstract
Examination of trends in Veterans Health Administration (VHA) healthcare utilization and costs among veterans with mild traumatic brain injury (mTBI) is needed to inform policy, resource allocation, and treatment planning. The objective of this study was to assess the patterns of VHA healthcare utilization and costs in the 3 years following TBI screening among veterans with mTBI, compared with veterans without TBI. A retrospective cohort study of veterans who underwent TBI screening in fiscal year 2010 was conducted. We used VHA healthcare utilization and associated costs by categories of care to compare veterans diagnosed with mTBI (n = 7318) with those who screened negative (n = 75,294) and those who screened positive but had TBI ruled out (n = 3324). Utilization and costs were greatest in year 1, dropped in year 2, and then leveled off. mTBI diagnosis was associated with high rates of utilization. Each year, healthcare costs for those with mTBI were two to three times higher than for those who screened negative, and 20-25% higher than for those who screened positive but had TBI ruled out. A significant proportion of healthcare use and costs for veterans with mTBI were associated with mental health service utilization. The relatively high rate of VHA utilization and costs associated with mTBI over time demonstrates the importance of long-term planning to meet these veterans' needs. Identifying and engaging patients with mTBI in effective mental health treatments should be considered a critical component of treatment planning.
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Affiliation(s)
- Brent C Taylor
- 1 Center for Chronic Disease Outcomes Research , Department of Veterans Affairs Health Care System, Minneapolis, Minnesota.,2 Department of Medicine, University of Minnesota , Minneapolis, Minnesota.,3 Division of Epidemiology and Community Health, University of Minnesota , Minneapolis, Minnesota
| | - Emily Hagel Campbell
- 1 Center for Chronic Disease Outcomes Research , Department of Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Sean Nugent
- 1 Center for Chronic Disease Outcomes Research , Department of Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Douglas E Bidelspach
- 4 Physical Medicine and Rehabilitation Services, Veterans Health Administration, VA Medical Center , Lebanon , Pennsylvania.,5 Physical Medicine and Rehabilitation Program Office , Department of Veterans Affairs, Washington, DC
| | - Shannon M Kehle-Forbes
- 1 Center for Chronic Disease Outcomes Research , Department of Veterans Affairs Health Care System, Minneapolis, Minnesota.,2 Department of Medicine, University of Minnesota , Minneapolis, Minnesota
| | - Joel Scholten
- 5 Physical Medicine and Rehabilitation Program Office , Department of Veterans Affairs, Washington, DC.,6 Department of Physical Medicine and Rehabilitation, Washington DC VA Medical Center , Washington, DC
| | - Kevin T Stroupe
- 7 Center of Innovation for Complex Chronic Healthcare , Hines VA Hospital, Hines, Illinois.,8 Department of Public Health Sciences, Loyola University Chicago , Maywood, Illinois
| | - Nina A Sayer
- 1 Center for Chronic Disease Outcomes Research , Department of Veterans Affairs Health Care System, Minneapolis, Minnesota.,2 Department of Medicine, University of Minnesota , Minneapolis, Minnesota.,9 Department of Psychiatry, University of Minnesota , Minneapolis, Minnesota
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Martinez RN, Gordon EJ, Tully S, Silva A, Tarlov E, French DD, Huo Z, Smith BM, Gordon HS, Stroupe KT. A Mixed-Methods Study of Veterans Affairs Providers' Experiences Communicating With Patients About the Affordable Care Act. Mil Med 2017; 182:e1715-e1723. [DOI: 10.7205/milmed-d-16-00354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Rachael N. Martinez
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
| | - Elisa J. Gordon
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
- Comprehensive Transplant Center and the Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 633 North Saint Clair, Chicago, IL 60611
| | - Sean Tully
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
| | - Abigail Silva
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
- Stritch School of Medicine, Loyola University Chicago, 2160 South 1st Avenue, Maywood, IL 60153
| | - Elizabeth Tarlov
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
- College of Nursing, University of Illinois at Chicago, 845 South Damen Avenue, Chicago, IL 60612
| | - Dustin D. French
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
- Department of Ophthalmology and the Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, 633 North Saint Clair, Chicago, IL 60611
| | - Zhiping Huo
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
| | - Bridget M. Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue No. 86, Chicago, IL 60611
| | - Howard S. Gordon
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Medical Center, Department of Veterans Affairs, 820 South Damen Avenue, Chicago, IL 60612
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago College of Medicine, 808 South Wood Street, Chicago, IL 60612
| | - Kevin T. Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
- Stritch School of Medicine, Loyola University Chicago, 2160 South 1st Avenue, Maywood, IL 60153
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Suda KJ, Smith BM, Bailey L, Gellad WF, Huo Z, Burk M, Cunningham F, Stroupe KT. Opioid dispensing and overlap in veterans with non-cancer pain eligible for Medicare Part D. J Am Pharm Assoc (2003) 2017; 57:333-340.e3. [DOI: 10.1016/j.japh.2017.02.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/12/2017] [Accepted: 02/13/2017] [Indexed: 10/19/2022]
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Spencer SH, Suda KJ, Smith BM, Huo Z, Bailey L, Stroupe KT. Erectile Dysfunction Medication Use in Veterans Eligible for Medicare Part D. J Manag Care Spec Pharm 2017; 22:818-24. [PMID: 27348283 PMCID: PMC10398145 DOI: 10.18553/jmcp.2016.22.7.818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) medications are therapeutically effective and associated with satisfaction. Medicare Part D included ED medications on the formulary during 2006 and inadvertently in 2007-2008. OBJECTIVE To characterize phosphodiesterase-5 inhibitor (PDE-5) medication use among veterans who were dually eligible for Veterans Affairs (VA) and Medicare Part D benefits. METHODS Veterans aged > 66 years who received PDE-5 inhibitors between 2005 and 2009 were included. Veterans were categorized by PDE-5 inhibitor claims: VA-only, Part D-only, or dual users of VA and Part D-reimbursed pharmacies. T-tests and chi-square tests were applied as appropriate. RESULTS From 2005 to 2009, the majority (85.2%) of veterans used VA benefits exclusively for their PDE-5 inhibitors; 11.4% used Medicare Part D exclusively; and 3.4% were dual users. The Part D-only group was older, more frequently not black, had a VA copay, and had a higher income (P < 0.03). The VA group was more likely to have comorbidities, smoke, and have a history of substance abuse (P < 0.001). With the inception of Medicare Part D in 2006, the number of patients filling prescriptions for PDE-5 inhibitors (-68%) and total number of PDE-5 inhibitor 30-day equivalents dispensed (-86.7%) from the VA decreased. Part D prescriptions increased through 2006 (full coverage period) and 2007 (accidental partial coverage) and decreased in 2008. While Part D accounted for only 10% of PDE-5 inhibitor 30-day equivalents, it equaled 29.2% of dispensed tablets. In October 2007, VA PDE-5 inhibitor use returned to 2005 levels. CONCLUSIONS Implementation of Medicare Part D reduced VA PDE-5 inhibitor acquisition. However, after removal of PDE-5 inhibitors from the Part D formulary, use of VA pharmacies for PDE-5 inhibitors resumed. Medication policies outside the VA can affect medication use. Veterans with access to non-VA health care may obtain medications from the private sector because of VA restrictions. This may be especially true for nonformulary and lifestyle medications. DISCLOSURES The authors received funding support for this research project from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service as grant IIR 07-165-2. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or Health Services Research and Development Service. Study concept and design were contributed by Smith and Stroupe, assisted by the other authors. Huo, Bailey, and Stroupe took the lead in data collection, assisted by the other authors. Data interpretation was performed by Spencer and Suda, along with Smith and Stroupe and assisted by Huo and Bailey. The manuscript was primarily written by Spencer and Suda, with assistance from the other authors, and revised by Spencer, along with the other authors.
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Affiliation(s)
- Samantha H Spencer
- 1 College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Katie J Suda
- 2 Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, and College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Bridget M Smith
- 3 Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Zhiping Huo
- 4 Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois
| | - Lauren Bailey
- 5 Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, and Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Kevin T Stroupe
- 6 Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, and Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
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Stroupe KT, Smith BM, Bailey L, Adas J, Gellad WF, Suda K, Huo Z, Tully S, Burk M, Cunningham F. Medication acquisition by veterans dually eligible for Veterans Affairs and Medicare Part D pharmacy benefits. Am J Health Syst Pharm 2017; 74:140-150. [DOI: 10.2146/ajhp150800] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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)
- Kevin T. Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, and Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Bridget M. Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, and Smith Child Health Research Program, Stanley Manne Children’s Research Institute, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Lauren Bailey
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, and Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Jamal Adas
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Walid F. Gellad
- Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA, and University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Katie Suda
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, and Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Zhiping Huo
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Administration Hospital, Hines, IL
| | - Sean Tully
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Administration Hospital, Hines, IL
| | - Muriel Burk
- Veterans Administration Pharmacy Benefit Management Services, Edward Hines Jr. Veterans Administration Hospital, Hines, IL
| | - Francesca Cunningham
- Veterans Administration Pharmacy Benefit Management Services, Edward Hines Jr. Veterans Administration Hospital, Hines, IL
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Lederle FA, Stroupe KT, Kyriakides TC, Ge L, Freischlag JA. Long-term Cost-effectiveness in the Veterans Affairs Open vs Endovascular Repair Study of Aortic Abdominal Aneurysm. JAMA Surg 2016; 151:1139-1144. [DOI: 10.1001/jamasurg.2016.2783] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Frank A. Lederle
- Department of Medicine, Veterans Affairs (VA) Medical Center, Minneapolis, Minnesota
| | - Kevin T. Stroupe
- Center of Innovation for Complex Chronic Healthcare, VA Medical Center, Hines, Illinois
| | - Tassos C. Kyriakides
- VA Cooperative Studies Program Coordinating Center, VA Medical Center, West Haven, Connecticut
| | - Ling Ge
- Center of Innovation for Complex Chronic Healthcare, VA Medical Center, Hines, Illinois
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Richardson LM, Hill JN, Smith BM, Bauer E, Weaver FM, Gordon HS, Stroupe KT, Hogan TP. Patient prioritization of comorbid chronic conditions in the Veteran population: Implications for patient-centered care. SAGE Open Med 2016; 4:2050312116680945. [PMID: 27928501 PMCID: PMC5131809 DOI: 10.1177/2050312116680945] [Citation(s) in RCA: 8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/17/2016] [Indexed: 12/14/2022] Open
Abstract
Objective: Patients with comorbid chronic conditions may prioritize some conditions over others; however, our understanding of factors influencing those prioritizations is limited. In this study, we sought to identify and elaborate a range of factors that influence how and why patients with comorbid chronic conditions prioritize their conditions. Methods: We conducted semi-structured, one-on-one interviews with 33 patients with comorbidities recruited from a single Veterans Health Administration Medical Center. Findings: The diverse factors influencing condition prioritization reflected three overarching themes: (1) the perceived role of a condition in the body, (2) self-management tasks, and (3) pain. In addition to these themes, participants described the rankings that they believed their healthcare providers would assign to their conditions as an influencing factor, although few reported having shared their priorities or explicitly talking with providers about the importance of their conditions. Conclusion: Studies that advance understanding of how and why patients prioritize their various conditions are essential to providing care that is patient-centered, reflecting what matters most to the individual while improving their health. This analysis informs guideline development efforts for the care of patients with comorbid chronic conditions as well as the creation of tools to promote patient–provider communication regarding the importance placed on different conditions.
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Affiliation(s)
- Lorilei M Richardson
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Veterans Health Administration, Bedford, MA, USA
| | - Jennifer N Hill
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA; Department of Pediatrics, Northwestern University, Evanston, IL, USA
| | - Erica Bauer
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Howard S Gordon
- Center of Innovation for Complex Chronic Health Care, Jesse Brown VHA Medical Center, Veterans Health Administration, Chicago, IL, USA; Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago at College of Medicine, Chicago, IL, USA
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Veterans Health Administration, Bedford, MA, USA; Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Fischer MJ, Stroupe KT, Kaufman JS, O'Hare AM, Browning MM, Sohn MW, Huo Z, Hynes DM. Predialysis nephrology care and dialysis-related health outcomes among older adults initiating dialysis. BMC Nephrol 2016; 17:103. [PMID: 27473684 PMCID: PMC4966864 DOI: 10.1186/s12882-016-0324-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 02/23/2016] [Accepted: 07/22/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Predialysis nephrology care is associated with lower mortality and rates of hospitalization following chronic dialysis initiation. Whether more frequent predialysis nephrology care is associated with other favorable outcomes for older adults is not known. METHODS Retrospective cohort study of patients ≥66 years who initiated chronic dialysis in 2000-2001 and were eligible for VA and/or Medicare-covered services. Nephrology visits in VA and/or Medicare during the 12-month predialysis period were identified and classified by low intensity (<3 visits), moderate intensity (3-6 visits), and high intensity (>6 visits). Outcome measures included very low estimated glomerular filtration rate, severe anemia, use of peritoneal dialysis, and receipt of permanent vascular access at dialysis initiation and death and kidney transplantation within two years of initiation. Generalized linear models with propensity score weighting were used to examine the association between nephrology care and outcomes. RESULTS Among 58,014 patients, 46 % had none, 22 % had low, 13 % had moderate, and 19 % had high intensity predialysis nephrology care. Patients with a greater intensity of predialysis nephrology care had more favorable outcomes (all p < 0.001). In adjusted models, patients with high intensity predialysis nephrology care were less likely to have severe anemia (RR = 0.70, 99 % CI: 0.65-0.74) and more likely to have permanent vascular access (RR = 3.60, 99 % CI: 3.42-3.79) at dialysis initiation, and less likely to die within two years of dialysis initiation (RR = 0.80, 99 % CI: 0.77-0.82). CONCLUSION In a large cohort of older adults treated with chronic dialysis, greater intensity of predialysis nephrology care was associated with more favorable outcomes.
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Affiliation(s)
- Michael J Fischer
- Medicine/Nephrology, Jesse Brown VA Medical Center, University of Illinois Medical Center, Chicago, IL, USA. .,Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA.
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA.,Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, USA
| | - James S Kaufman
- Medicine/Nephrology, VA New York Harbor Healthcare System, New York, NY, USA.,New York University School of Medicine, New York, NY, USA
| | - Ann M O'Hare
- Medicine/Nephrology, VA Puget Sound Healthcare System, Seattle, WA, USA.,Medicine/Nephrology, Group Health Research Institute, University of Washington, Seattle, WA, USA
| | - Margaret M Browning
- Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA.,VA Information Resource Center, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Min-Woong Sohn
- Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA.,Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Zhiping Huo
- Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Denise M Hynes
- Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA.,VA Information Resource Center, Edward Hines, Jr. VA Hospital, Hines, IL, USA.,Medicine/Health Promotion Research, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
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Stroupe KT, Bailey L, Gellad WF, Suda K, Huo Z, Martinez R, Burk M, Cunningham F, Smith BM. Veterans’ Pharmacy and Health Care Utilization Following Implementation of the Medicare Part D Pharmacy Benefit. Med Care Res Rev 2016; 74:328-344. [DOI: 10.1177/1077558716643887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We examined associations between enrollment in Medicare Part D pharmacy benefits and changes in medication acquisition from Department of Veterans Affairs (VA) pharmacies. We included all women and a random 10% sample of men who were VA enrollees, ≥65 years old as of January 1, 2004, and alive through December 2007. We used difference-in-differences models with propensity score weighting to examine changes in medication acquisition between 2005 (before Part D was implemented) and 2007 (after Part D implementation) for veterans who were or were not Part D enrolled. Of 231,716 veterans meeting inclusion criteria, 49,881 (21.5%) were enrolled. While 30-day medication supplies decreased from 26.2 to 23.4 for enrolled veterans, they increased from 36.6 to 37.4 for nonenrolled veterans (difference-in-differences: −4.0, p < .001). Reductions in 30-day supplies were greater among veterans who were required to pay VA copayments for some or all medications and who used VA and Medicare outpatient services.
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Affiliation(s)
- Kevin T. Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA
- Loyola University Chicago Department of Public Health Sciences, Maywood, IL, USA
| | - Lauren Bailey
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | - Walid F. Gellad
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katie Suda
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | - Zhiping Huo
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA
| | - Rachael Martinez
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA
| | - Muriel Burk
- Veterans Affairs Pharmacy Benefit Management Services, Edward Hines Jr. VA Hospital, Hines IL
| | - Francesca Cunningham
- Veterans Affairs Pharmacy Benefit Management Services, Edward Hines Jr. VA Hospital, Hines IL
| | - Bridget M. Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Northwestern University, Chicago IL, USA
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Westbay LC, Cao L, Burnett-Zeigler I, Reizine N, Barton B, Ippolito D, Weaver FM, Stroupe KT. Mental Health-Related Healthcare Use Following Bilateral Deep Brain Stimulation For Parkinson’s Disease. JPD 2015; 5:497-504. [DOI: 10.3233/jpd-140512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Lishan Cao
- Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, IL, USA
| | - Inger Burnett-Zeigler
- Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, IL, USA
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Natalie Reizine
- Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Brandon Barton
- Rush University Medical Center, Department of Neurological Sciences, Chicago, IL, USA
- Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Dolores Ippolito
- Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, IL, USA
| | - Frances M. Weaver
- Loyola University Stritch School of Medicine, Maywood, IL, USA
- Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, IL, USA
| | - Kevin T. Stroupe
- Loyola University Stritch School of Medicine, Maywood, IL, USA
- Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, IL, USA
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Matsumura JS, Stroupe KT, Lederle FA, Kyriakides TC, Ge L, Freischlag JA, Ketteler ER, Kingsley DD, Marek JM, Massen RJ, Matteson BD, Pitcher JD, Langsfeld M, Corson JD, Goff JM, Kasirajan K, Paap C, Robertson DC, Salam A, Veeraswamy R, Milner R, Kasirajan K, Guidot J, Lal BK, Busuttil SJ, Lilly MP, Braganza M, Ellis K, Patterson MA, Jordan WD, Whitley D, Taylor S, Passman M, Kerns D, Inman C, Poirier J, Ebaugh J, Raffetto J, Chew D, Lathi S, Owens C, Hickson K, Dosluoglu HH, Eschberger K, Kibbe MR, Baraniewski HM, Matsumura J, Endo M, Busman A, Meadows W, Evans M, Giglia JS, El Sayed H, Reed AB, Ruf M, Ross S, Jean-Claude JM, Pinault G, Kang P, White N, Eiseman M, Jones R, Timaran CH, Modrall JG, Welborn MB, Lopez J, Nguyen T, Chacko JK, Granke K, Vouyouka AG, Olgren E, Chand P, Allende B, Ranella M, Yales C, Whitehill TA, Krupski WC, Nehler MR, Johnson SP, Jones DN, Strecker P, Bhola MA, Shortell CK, Gray JL, Lawson JH, McCann R, Sebastian MW, Tetterton JK, Blackwell C, Prinzo PA, Lee N, Padberg FT, Cerveira JJ, Lal BK, Zickler RW, Hauck KA, Berceli SA, Lee WA, Ozaki CK, Nelson PR, Irwin AS, Baum R, Aulivola B, Rodriguez H, Littooy FN, Greisler H, O'Sullivan MT, Kougias P, Lin PH, Bush RL, Guinn G, Cagiannos C, Pillack S, Guillory B, Cikrit D, Lalka SG, Lemmon G, Nachreiner R, Rusomaroff M, O'Brien E, Cullen JJ, Hoballah J, Sharp WJ, McCandless JL, Beach V, Minion D, Schwarcz TH, Kimbrough J, Ashe L, Rockich A, Warner-Carpenter J, Moursi M, Eidt JF, Brock S, Bianchi C, Bishop V, Gordon IL, Fujitani R, Kubaska SM, Behdad M, Azadegan R, Agas CM, Zalecki K, Hoch JR, Carr SC, Acher C, Schwarze M, Tefera G, Mell M, Dunlap B, Rieder J, Stuart JM, Weiman DS, Abul-Khoudoud O, Garrett HE, Walsh SM, Wilson KL, Seabrook GR, Cambria RA, Brown KR, Lewis BD, Framberg S, Kallio C, Barke RA, Santilli SM, d'Audiffret AC, Oberle N, Proebstle C, Lee Johnson L, Jacobowitz GR, Cayne N, Rockman C, Adelman M, Gagne P, Nalbandian M, Caropolo LJ, Pipinos II, Johanning J, Lynch T, DeSpiegelaere H, Purviance G, Zhou W, Dalman R, Lee JT, Safadi B, Coogan SM, Wren SM, Bahmani DD, Maples D, Thunen S, Golden MA, Mitchell ME, Fairman R, Reinhardt S, Wilson MA, Tzeng E, Muluk S, Peterson NM, Foster M, Edwards J, Moneta GL, Landry G, Taylor L, Yeager R, Cannady E, Treiman G, Hatton-Ward S, Salabsky B, Kansal N, Owens E, Estes M, Forbes BA, Sobotta C, Rapp JH, Reilly LM, Perez SL, Yan K, Sarkar R, Dwyer SS, Kohler TR, Hatsukami TS, Glickerman DG, Sobel M, Burdick TS, Pedersen K, Cleary P, Kansal N, Owens E, Estes M, Forbes BA, Sobotta C, Back M, Bandyk D, Johnson B, Shames M, Reinhard RL, Thomas SC, Hunter GC, Leon LR, Westerband A, Guerra RJ, Riveros M, Mills JL, Hughes JD, Escalante AM, Psalms SB, Day NN, Macsata R, Sidawy A, Weiswasser J, Arora S, Jasper BJ, Dardik A, Gahtan V, Muhs BE, Sumpio BE, Gusberg RJ, Spector M, Pollak J, Aruny J, Kelly EL, Wong J, Vasilas P, Joncas C, Gelabert HA, DeVirgillio C, Rigberg DA, Cole L. Costs of repair of abdominal aortic aneurysm with different devices in a multicenter randomized trial. J Vasc Surg 2015; 61:59-65. [DOI: 10.1016/j.jvs.2014.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
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Stroupe KT, Weaver FM, Cao L, Ippolito D, Barton BR, Burnett-Zeigler IE, Holloway RG, Vickrey BG, Simuni T, Follett KA. Cost of deep brain stimulation for the treatment of Parkinson's disease by surgical stimulation sites. Mov Disord 2014; 29:1666-74. [DOI: 10.1002/mds.26029] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 08/05/2014] [Accepted: 08/25/2014] [Indexed: 02/04/2023] Open
Affiliation(s)
- Kevin T. Stroupe
- Hines VA Hospital, Center for Management of Complex Chronic Healthcare; Hines Illinois USA
- Loyola University Stritch School of Medicine; Maywood Illinois USA
| | - Frances M. Weaver
- Hines VA Hospital, Center for Management of Complex Chronic Healthcare; Hines Illinois USA
- Loyola University Stritch School of Medicine; Maywood Illinois USA
| | - Lishan Cao
- Hines VA Hospital, Center for Management of Complex Chronic Healthcare; Hines Illinois USA
| | - Dolores Ippolito
- Hines VA Hospital, Center for Management of Complex Chronic Healthcare; Hines Illinois USA
| | - Brandon R. Barton
- Rush University Medical Center; Chicago Illinois USA
- Jesse Brown VA Medical Center; Chicago Illinois USA
| | | | | | - Barbara G. Vickrey
- VA Greater Los Angeles Healthcare System, VA Southwest PADRECC; Los Angeles California USA
- UCLA Department of Neurology; Los Angeles California USA
| | - Tanya Simuni
- Northwestern University, Parkinson's Disease and Movement Disorders Center; Chicago Illinois USA
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Rogers TJ, Smith BM, Weaver FM, Ganesh S, Saban KL, Stroupe KT, Martinez RN, Evans CT, Pape TLB. Healthcare utilization following mild traumatic brain injury in female veterans. Brain Inj 2014; 28:1406-12. [DOI: 10.3109/02699052.2014.919537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stroupe KT, Smith BM, Hogan TP, St. Andre JR, Gellad WF, Weiner S, Lee TA, Burk M, Cunningham F, Piette JD, Rogers TJ, Huo Z, Weaver FM. Medication acquisition across systems of care and patient–provider communication among older veterans. Am J Health Syst Pharm 2013; 70:804-13. [DOI: 10.2146/ajhp120222] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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)
| | - Bridget M. Smith
- Center for Management of Complex Chronic Care (CMC3), Edward Hines, Jr. VA (Veterans Affairs) Hospital, Hines, IL
| | - Timothy P. Hogan
- Center for Health Quality, Outcomes and Economic Research and eHealth Quality Enhancement Research Initiative (QUERI), National eHealth QUERI Coordinating Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
| | | | - Walid F. Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and Assistant Professor, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Muriel Burk
- VA Pharmacy Benefit Management/Strategic Healthcare Group
| | - Francesca Cunningham
- VA Pharmacy Benefit Management/Strategic Healthcare Group, Edward Hines, Jr. VA Hospital
| | - John D. Piette
- Center for Clinical Management Research, University of Michigan, Ann Arbor
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Humensky JL, Jordan N, Stroupe KT, Hynes D. Employment status of veterans receiving substance abuse treatment from the U.S. Department of Veterans Affairs. Psychiatr Serv 2013; 64:177-80. [PMID: 23370624 DOI: 10.1176/appi.ps.201200024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined employment outcomes of veterans with substance use disorders and comorbid general medical and psychiatric disorders following substance abuse treatment. METHODS The authors obtained employment and other information reported by 5,729 veterans at intake and at follow-up three to nine months after receiving substance abuse treatment from the U.S. Department of Veterans Affairs during 2001-2010. Random-effects logistic regression models examined the probability of having employment earnings and days of paid work during the past 30 days among veterans with comorbid conditions. RESULTS The percentage of veterans with any days of paid work rose from 28% at intake to 35% at follow-up. Veterans with comorbid anxiety and general medical conditions had lower odds of having earnings from employment or days of paid work at follow-up. CONCLUSIONS Veterans with substance use disorders, particularly those with comorbid general medical and anxiety disorders, may be at risk of employment problems.
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Affiliation(s)
- Jennifer L Humensky
- Health Services Research and Development Service, Edward Hines, Jr. Veterans Affairs VA Hospital, Hines, Illinois, USA.
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Evans CT, St Andre JR, Pape TLB, Steiner ML, Stroupe KT, Hogan TP, Weaver FM, Smith BM. An evaluation of the Veterans Affairs traumatic brain injury screening process among Operation Enduring Freedom and/or Operation Iraqi Freedom veterans. PM R 2013; 5:210-20; quiz 220. [PMID: 23375630 DOI: 10.1016/j.pmrj.2012.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 11/26/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the early results of the U.S. Department of Veterans Affairs (VA) screening program for traumatic brain injury (TBI) and to identify patient and facility characteristics associated with receiving a TBI screen and results of the screening. DESIGN National retrospective cohort study. SETTING VA Medical facilities. PATIENTS A total of 170,681 Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF) Veterans who sought care at VA medical facilities from April 2007 to September 30, 2008. METHODS Data were abstracted from VA administrative and operational databases, including patient demographics, facility characteristics, and outcomes. MAIN OUTCOME MEASUREMENTS The main outcomes were receipt of and results of the TBI screen. RESULTS The majority of veterans eligible received the TBI screen (91.6%). Screening rates varied by patient and facility characteristics. In all, 25% of screened veterans had probable TBI exposure, in which the majority of the exposures were blasts (85.0%). The rate of a positive TBI screen was 20.5% for the screened cohort. Male gender, service in the army, multiple deployments, and mental health diagnoses in the previous year were associated with a positive screen. CONCLUSIONS TBI screening rates are high in VA; concomitant mental health diagnoses were highly prevalent in individuals with positive TBI screens. These data indicate that there will be a significant need for long-term health care services for veterans with TBI symptomatology.
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Affiliation(s)
- Charlesnika T Evans
- Center for Management of Complex Chronic Care, Edward Hines Jr. Veterans Affairs (VA) Hospital, Department of VA, Hines, IL 60141, USA.
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Stroupe KT, Smith BM, Hogan TP, St. Andre JR, Pape T, Steiner ML, Proescher E, Huo Z, Evans CT. Healthcare utilization and costs of Veterans screened and assessed for traumatic brain injury. ACTA ACUST UNITED AC 2013; 50:1047-68. [DOI: 10.1682/jrrd.2012.06.0107] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 01/31/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Kevin T. Stroupe
- Center for Management of Complex Chronic Care, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL
| | - Bridget M. Smith
- Center for Management of Complex Chronic Care, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL
| | - Timothy P. Hogan
- Center for Health Quality, Outcomes and Economic Research & eHealth QUERI, National eHealth QUERI Coordinating Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; and Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA
| | | | - Theresa Pape
- Center for Management of Complex Chronic Care, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL;Physical Medicine and Rehabilitation, Edward Hines Jr. VA Hospital, Hines, IL
| | - Monica L. Steiner
- Physical Medicine and Rehabilitation, Edward Hines Jr. VA Hospital, Hines, IL
| | | | - Zhiping Huo
- Center for Management of Complex Chronic Care, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL
| | - Charlesnika T. Evans
- Center for Management of Complex Chronic Care, Edward Hines Jr. Department of Veterans Affairs (VA) Hospital, Hines, IL;Spinal Cord Injury Quality Enhancement Research Initiative (QUERI), Edward Hines Jr. VA Hospital, Hines, IL;Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Fischer MJ, Krishnamoorthi VR, Smith BM, Evans CT, St Andre JR, Ganesh S, Huo Z, Stroupe KT. Prevalence of chronic kidney disease in patients with spinal cord injuries/disorders. Am J Nephrol 2012; 36:542-8. [PMID: 23221005 DOI: 10.1159/000345460] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) and spinal cord injury and disorders (SCI/D) are common and costly conditions among Veterans. However, little is known about CKD among adults with SCI/D. METHODS We conducted cross-sectional analyses of Veterans with SCI/D across all VA facilities in 2006. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) and categorized by standard eGFR strata. eGFR was calculated in two ways: (a) the Modification of Diet in Renal Disease (MDRD) equation and (b) the MDRD equation + an empirically derived correction factor for SCI/D (MDRD-SCI/D). Logistic regression models were used to examine the relationship between patient characteristics and CKD. RESULTS Among 9,333 SCI/D Veterans with an available eGFR, the proportion with CKD was substantially higher based on the MDRD-SCI/D equation (35.2%) than based on the MDRD equation (10.2%). In adjusted analyses, while older age (OR for >65 years = 2.53; 95% CI: 2.21-2.89), female sex (OR 2.18; 95% CI: 1.62-2.92), and a non-traumatic cause for injury (OR 1.39; 95% CI: 1.23-1.57) were associated with an increased odds of CKD, black race (OR 0.64; 95% CI: 0.56-0.72) and a duration of injury of ≥10 years (OR 0.76; 95% CI: 0.67-0.86) were associated with a decreased odds of CKD. Diagnostic codes for CKD and nephrology visits were infrequent for SCI/D Veterans with CKD (27.51 and 6.58%, respectively). CONCLUSION Using a recently validated version of the MDRD equation with a correction factor for SCI/D, over 1 in 3 Veterans with SCI/D had CKD, which is more than 3-fold higher than when traditional MDRD estimation is used.
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Affiliation(s)
- Michael J Fischer
- Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA.
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Stroupe KT, Tarlov E, Lee TA, Weichle TW, Zhang QL, Michaelis LC, Ozer H, Durazo-Arvizu R, Browning MM, Hynes DM. Hemoglobin Levels Triggering Erythropoiesis-Stimulating Agent Therapy in Patients with Cancer: the Shift After United States Food and Drug Administration Policy Changes. Pharmacotherapy 2012; 32:988-97. [DOI: 10.1002/phar.1134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kevin T. Stroupe
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
- Veterans Affairs Information Resource Center (K.T. Stroupe, E. Tarlov, M.M. Browning, and D.M. Hynes); Hines Veterans Affairs Hospital; Hines Illinois
- Stritch School of Medicine; Loyola University Chicago; Maywood Illinois
| | - Elizabeth Tarlov
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
- Veterans Affairs Information Resource Center (K.T. Stroupe, E. Tarlov, M.M. Browning, and D.M. Hynes); Hines Veterans Affairs Hospital; Hines Illinois
| | - Todd A. Lee
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
- College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Thomas W. Weichle
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
| | - Qiuying L. Zhang
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
| | | | - Howard Ozer
- College of Medicine; University of Illinois at Chicago; Chicago Illinois
| | | | - Margaret M. Browning
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
- Veterans Affairs Information Resource Center (K.T. Stroupe, E. Tarlov, M.M. Browning, and D.M. Hynes); Hines Veterans Affairs Hospital; Hines Illinois
| | - Denise M. Hynes
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
- Veterans Affairs Information Resource Center (K.T. Stroupe, E. Tarlov, M.M. Browning, and D.M. Hynes); Hines Veterans Affairs Hospital; Hines Illinois
- College of Medicine; University of Illinois at Chicago; Chicago Illinois
- Institute for Health Research and Policy (D.M. Hynes); University of Illinois at Chicago; Chicago Illinois
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Stroupe KT, Lederle FA, Matsumura JS, Kyriakides TC, Jonk YC, Ge L, Freischlag JA. Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysm in the OVER trial. J Vasc Surg 2012; 56:901-9.e2. [DOI: 10.1016/j.jvs.2012.01.086] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/19/2012] [Accepted: 01/26/2012] [Indexed: 11/26/2022]
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Stelmack JA, Tang XC, Reda DJ, Stroupe KT, Rinne S, Massof RW. VA LOVIT II: a protocol to compare low vision rehabilitation and basic low vision. Ophthalmic Physiol Opt 2012; 32:461-71. [PMID: 22958237 DOI: 10.1111/j.1475-1313.2012.00933.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the effectiveness of low vision rehabilitation (LVR) and basic low vision (LV) in a single masked multicentre randomised controlled trial (RCT). METHODS Three hundred and thirty patients eligible for US. Veterans Affairs (VA) healthcare services with primary eye diagnosis (better-seeing eye) of macular disease and best-corrected distance visual acuity of 0.40-1.00 logMAR (6/15 to 6/60 or 20/50 to 20/200 Snellen) are being enrolled at seven VA facilities. All participants receive an optometric LV examination; and they are eligible to receive the same LV devices that are provided without charge. In LVR, a LV therapist dispenses devices and provides 2 or 3 (1½ to 2½ h) therapy sessions with assigned homework to teach effective use of remaining vision and LV devices. Contact time with the therapist depends upon the devices prescribed and the patient's progress in learning the skills that are taught. In basic LV, devices are dispensed by the optometrist without LV therapy. Contact time for dispensing is one hour or less depending on LV devices prescribed. The primary outcome measure is a comparison of the changes in visual reading ability (estimated from patients' difficulty ratings of reading items on the VA LV VFQ-48 questionnaire) between the treatment and control arms from pre-intervention baseline to 4 months (2 months after completion of treatment). Secondary outcome measures are changes in overall visual ability, visual ability domain scores calculated from subsets of items (mobility, visual information processing and visual motor skills), Short Form-36, and Minnesota Low Vision Reading Test scores. Cost-effectiveness analysis will be conducted using VA LV VFQ-48 scores and QALYS computed from EuroQol scores. RESULTS A total of 137 patients representing 41.5% of the study target of 330 patients were randomised from October 2010 to March 2012. Among those 137 patients, mean age was 80.2 (S.D. ± 9.9) years at enrollment; 97.1% of the patients were males; 94.2% were white. Mean best corrected VA was 0.65 (S.D. ± 0.3) logMAR (approximately Snellen 6/27 or 20/90) at baseline. CONCLUSIONS LOVIT II is the first multicentre RCT comparing the effectiveness and cost-effectiveness of LVR and basic LV for patients with macular diseases and near normal or moderate levels of visual impairment.
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Affiliation(s)
- Joan A Stelmack
- Edward Hines, Jr. Veterans Affairs Hospital, Hines, IL, USA.
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Ullrich PM, Smith BM, Poggensee L, Evans CT, Stroupe KT, Weaver FM, Burns SP. Pain and post-traumatic stress disorder symptoms during inpatient rehabilitation among operation enduring freedom/operation iraqi freedom veterans with spinal cord injury. Arch Phys Med Rehabil 2012; 94:80-5. [PMID: 22864017 DOI: 10.1016/j.apmr.2012.07.018] [Citation(s) in RCA: 27] [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] [Received: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the frequency of post-traumatic stress disorder (PTSD) symptoms and pain, and how PTSD symptoms were associated with pain severity ratings and the longitudinal course of pain during inpatient rehabilitation for spinal cord injury (SCI) among veterans of the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) conflicts. DESIGN Longitudinal analysis of data gathered from electronic medical records. SETTING SCI specialty care centers within the Department of Veterans Affairs. PARTICIPANTS Veterans of the OEF/OIF conflicts (N=87) who received inpatient rehabilitation for SCI and disorders at Department of Veterans Affairs SCI centers between May 2003 and October 2009. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) PTSD screening at start of rehabilitation and pain numeric rating scale measurements completed throughout rehabilitation. Cut-scores were used to categorize participants into 1 of 4 groups on the basis of scores at the start of rehabilitation: Pain and PTSD, Pain Alone, PTSD Alone, Neither Condition. RESULTS Comorbid pain and PTSD symptoms were more common than either condition alone, and nearly as common as not having either condition. Participants with pain at the start of rehabilitation (Pain and PTSD, Pain-Alone groups) showed declines in pain ratings over the course of rehabilitation. In contrast, participants in the PTSD-Alone group showed increasing pain over the course of rehabilitation. CONCLUSIONS Pain and PTSD symptoms may be more likely to manifest as comorbidities than as isolated conditions during inpatient rehabilitation. Assessment routines and care plans should be prepared with comorbidities as a foremost concern. It is advisable to screen for pain and PTSD at multiple time points during inpatient rehabilitation to detect new or emerging concerns.
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Affiliation(s)
- Philip M Ullrich
- Department of Veterans Affairs, Spinal Cord Injury and Disorders Services, VA Puget Sound Healthcare System, Seattle, WA, USA.
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Tarlov E, Stroupe KT. Advancing veterans' healthcare using electronic data: Lessons learned from researchers in the field. ACTA ACUST UNITED AC 2011; 47:vii-xi. [PMID: 21110241 DOI: 10.1682/jrrd.2010.08.0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
We evaluated the improvement in Department of Veterans Affairs (VA) race data completeness that could be achieved by linking VA data with data from Medicare and the Department of Defense (DOD) and examined agreement in values across the data sources. After linking VA with Medicare and DOD records for a 10% sample of VA patients, we calculated the percentage for which race could be identified in those sources. To evaluate race agreement, we calculated sensitivities, specificities, positive predictive values (PPVs), negative predictive values, and kappa statistics. Adding Medicare (and DOD) data improved race data completeness from 48% to 76%. Among older patients (≥65 years), adding Medicare data improved data completeness to nearly 100%. Among younger patients (<65 years), combining Medicare and DOD data improved completeness to 75%, 18 percentage points beyond that achieved with Medicare data alone. PPVs for white and African-American categories were 98.6 and 94.7, respectively, in Medicare and 97.0 and 96.5, respectively, in DOD data using VA self-reported race as the gold standard. PPVs for the non-African-American minority groups were lower, ranging from 30.5 to 48.2. Kappa statistics reflected these patterns. Supplementing VA with Medicare and DOD data improves VA race data completeness substantially. More study is needed to understand poor rates of agreement between VA and external sources in identifying non-African-American minority individuals.
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Affiliation(s)
- Kevin T Stroupe
- Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital (151H), 5000 South 5th Ave, Bldg 1B260, Hines, IL 60141-5151, USA.
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