The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Susan M Frayne - One of the best experts on this subject based on the ideXlab platform.
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receipt of pharmacotherapy for opioid use disorder by justice involved u s veterans Health Administration patients
Drug and Alcohol Dependence, 2016Co-Authors: Andrea K Finlay, Susan M Frayne, Christine Timko, Joel Rosenthal, Sean Clark, Jessica Bluehowells, Jim Mcguire, Alex H S HarrisAbstract:Abstract Background Pharmacotherapy – methadone, buprenorphine, or naltrexone – is an evidence-based treatment for opioid use disorder, but little is known about receipt of these medications among veterans involved in the justice system. The current study examines receipt of pharmacotherapy for opioid use disorder among veterans with a history of justice involvement at U.S. Veterans Health Administration (VHA) facilities compared to veterans with no justice involvement. Methods Using national VHA clinical and pharmacy records, we conducted a retrospective cohort study of veterans with an opioid use disorder diagnosis in fiscal year 2012. Using a mixed-effects logistic regression model, we examined receipt of pharmacotherapy in the 1-year period following diagnosis as a function of justice involvement, adjusting for patient and facility characteristics. Results The 1-year rate of receipt for pharmacotherapy for opioid use disorder was 27% for prison-involved veterans, 34% for jail/court-involved veterans, and 33% for veterans not justice-involved. Compared to veterans not justice-involved, those prison-involved had 0.75 lower adjusted odds (95% confidence interval [CI]: 0.65–0.87) of receiving pharmacotherapy whereas jail/court-involved veterans did not have significantly different adjusted odds. Conclusions Targeted efforts to improve receipt of pharmacotherapy for opioid use disorder among veterans exiting prison is needed as they have lower odds of receiving these medications.
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military related sexual trauma among veterans Health Administration patients returning from afghanistan and iraq
American Journal of Public Health, 2010Co-Authors: Rachel Kimerling, Amy E Street, Joanne Pavao, Mark W Smith, Ruth C Cronkite, Tyson H Holmes, Susan M FrayneAbstract:We examined military-related sexual trauma among deployed Operation Enduring Freedom and Operation Iraqi Freedom veterans. Of 125 729 veterans who received Veterans Health Administration primary care or mental Health services, 15.1% of the women and 0.7% of the men reported military sexual trauma when screened. Military sexual trauma was associated with increased odds of a mental disorder diagnosis, including posttraumatic stress disorder, other anxiety disorders, depression, and substance use disorders. Sexual trauma is an important postdeployment mental Health issue in this population.
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the veterans Health Administration and military sexual trauma
American Journal of Public Health, 2007Co-Authors: Rachel Kimerling, Amy E Street, Mark W Smith, Kristian S Gima, Susan M FrayneAbstract:Objectives. We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence.Methods. We analyzed VHA administrative data for 185 880 women and 4139888 men who were veteran outpatients and were treated in VHA Health care settings nationwide during 2003.Results. Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental Health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR]=8.83; 99% confidence interval [CI] = 8.34, 9.35 for women; AOR = 3.00; 99% CI = 2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged.Conclusions. The VHA policies regarding military sexual trauma represent a uniquely comprehensive Health care response to sexual trauma. Results attest to the feasibility of universal screenin...
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the veterans Health Administration and military sexual trauma
American Journal of Public Health, 2007Co-Authors: Rachel Kimerling, Amy E Street, Mark W Smith, Kristian S Gima, Susan M FrayneAbstract:Objectives. We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence. Methods. We analyzed VHA administrative data for 185 880 women and 4139888 men who were veteran outpatients and were treated in VHA Health care settings nationwide during 2003. Results. Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental Health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR]=8.83; 99% confidence interval [CI]=8.34, 9.35 for women; AOR=3.00; 99% CI=2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged. Conclusions. The VHA policies regarding military sexual trauma represent a uniquely comprehensive Health care response to sexual trauma. Results attest to the feasibility of universal screening, which yields clinically significant information with particular relevance to mental Health and behavioral Health treatment. Women's Health literature regarding sexual trauma will be particularly important to inform Health care services for both male and female veterans.
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gender and use of care planning for tomorrow s veterans Health Administration
Journal of Womens Health, 2007Co-Authors: Susan M Frayne, Elizabeth M Yano, Lakshmi Ananth, Samina Iqbal, Ann Thrailkill, Ciaran S PhibbsAbstract:Background: Historically, men have been the predominant users of Veterans Health Administration (VHA) care. With more women entering the system, a systematic assessment of their Healthcare use and costs of care is needed. We examined how utilization and costs of VHA care differ in women veterans compared with men veterans. Methods: In this cross-sectional study using centralized VHA administrative databases, main analyses examined annual outpatient and inpatient utilization and costs of care (outpatient, inpatient, and pharmacy) for all female (n = 178,849) and male (n = 3,943,532) veterans using VHA in 2002, accounting for age and medical/mental Health conditions. Results: Women had 11.8% more outpatient encounters, 25.9% fewer inpatient days, and 11.4% lower total cost than men; after adjusting for age and medical comorbidity, differences were less pronounced (1.3%, 10.9%, and 2.8%, respectively). Among the 30.8% of women and 24.4% of men with both medical and mental Health conditions, women used outpat...
Amy K Rosen - One of the best experts on this subject based on the ideXlab platform.
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factors associated with hospital admission after outpatient surgery in the veterans Health Administration
Health Services Research, 2018Co-Authors: Amy K Rosen, Kamal M F Itani, Mary T Hawn, Hillary J Mull, William Obrien, Nathalie Mcintosh, Aaron LeglerAbstract:OBJECTIVE: To examine factors associated with 0- to 7-day admission after outpatient surgery in high-volume specialties: general surgery, orthopedics, urology, ear/nose/throat, and podiatry. STUDY DESIGN: We calculated rates and assessed diagnosis codes for 0- to 7-day admission after outpatient surgery for Centers for Medicare and Medicaid Services (CMS) and Veterans Health Administration (VA) dually enrolled patients age 65 and older. We also estimated separate multilevel logistic regression models to compare patient, procedure, and facility characteristics associated with postoperative admission. DATA COLLECTION: 2011-2013 surgical encounter data from the VA Corporate Data Warehouse; geographic data from the Area Health Resources File; CMS enrollment and hospital admission data. PRINCIPAL FINDINGS: Among 63,585 outpatient surgeries in 124 facilities, 0- to 7-day admission rates ranged from 5 percent (podiatry) to 28 percent (urology); nearly 66 percent of the admissions occurred on the day of surgery. Only 97 admissions were detected in the CMS data (1 percent). Surgical complications were diagnosed in 4 percent of admissions. Procedure complexity, measured by relative value units or anesthesia risk score, was associated with admission across all specialties. CONCLUSION: As many as 20 percent of VA outpatient surgeries result in an admission. Complex procedures are more likely to be followed by admission, but more evidence is required to determine how many of these reflect potential safety or quality problems.
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gender differences in veterans Health Administration mental Health service use effects of age and psychiatric diagnosis
Womens Health Issues, 2009Co-Authors: Sharmila Chatterjee, Maria E Rath, Avron Spiro, Susan V Eisen, Kevin L Sloan, Amy K RosenAbstract:Purpose The objective of this study was to compare gender differences in mental Health disease burden and outpatient mental Health utilization among veterans utilizing Veterans Health Administration (VHA) mental Health services in fiscal year 1999 (FY99), after the first Gulf War and significant restructuring of VHA services. Methods We used logistic regression to examine the relationships among gender, age, diagnostic groups, and utilization of mental Health and specialty mental Health services in a national sample of veterans. The sample included 782,789 veterans with at least 1 outpatient visit in the VHA in FY99 associated with a mental Health or substance abuse (SA) diagnosis. Subgroup analyses were performed for 4 diagnostic categories: 1) posttraumatic stress disorder (PTSD), 2) SA disorders, 3) bipolar and psychotic disorders, and 4) mood and anxiety disorders. Main Findings Younger women veterans ( Conclusion Women veterans underutilized specialty mental Health services in relation to men but receipt of mental Health care overall in FY99 varied by age and diagnosis. Examining gender differences alone, without taking other factors into account, may not provide an adequate picture of women veterans' current mental Health service needs.
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Relationship of hospital organizational culture to patient safety climate in the Veterans Health Administration.
Medical Care Research and Review, 2009Co-Authors: Christine W. Hartmann, Amy K Rosen, Shibei Zhao, Mark Meterko, Priti Shokeen, Sara J. Singer, David M. GabaAbstract:Improving safety climate could enhance patient safety, yet little evidence exists regarding the relationship between hospital characteristics and safety climate. This study assessed the relationship between hospitals' organizational culture and safety climate in Veterans Health Administration (VA) hospitals nationally. Data were collected from a sample of employees in a stratified random sample of 30 VA hospitals over a 6-month period (response rate = 50%; n = 4,625). The Patient Safety Climate in Healthcare Organizations (PSCHO) and the Zammuto and Krakower surveys were used to measure safety climate and organizational culture, respectively. Higher levels of safety climate were significantly associated with higher levels of group and entrepreneurial cultures, while lower levels of safety climate were associated with higher levels of hierarchical culture. Hospitals could use these results to design specific interventions aimed at improving safety climate.
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evaluating the patient safety indicators how well do they perform on veterans Health Administration data
Medical Care, 2005Co-Authors: Amy K Rosen, Peter E Rivard, Shibei Zhao, Susan Loveland, Dennis Tsilimingras, Cindy L Christiansen, Anne ElixhauserAbstract:Background:The Patient Safety Indicators (PSIs), an administrative data-based tool developed by the Agency for Healthcare Research and Quality, are increasingly being used to screen for potential in-hospital patient safety problems. Although the Veterans Health Administration (VA) is a national lead
Katherine M Iverson - One of the best experts on this subject based on the ideXlab platform.
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intimate partner violence screening in the veterans Health Administration demographic and military service characteristics
American Journal of Preventive Medicine, 2017Co-Authors: Melissa E Dichter, Terri N Haywood, Anneliese E Butler, Scarlett L Bellamy, Katherine M IversonAbstract:Introduction Intimate partner violence (IPV) includes psychological, physical, or sexual aggression by a current or former intimate partner and is associated with a wide range of Health and social impacts, especially for women. Women veterans may be at increased risk for experiencing IPV, and some Veterans Health Administration (VHA) facilities have initiated routine screening of female patients for past-year IPV. This study presents the first examination of clinical IPV screening responses recorded from female VHA patients across 13 facilities nationwide, and identifies associations with patient demographic and military service characteristics. Methods Electronic medical record data were extracted for a cohort of 8,885 female VHA patients who completed screening for experience of past-year IPV during a clinic visit between April 2014 and April 2016. Analyses, conducted in 2016, examined the overall proportion of patients screening positive for IPV, as well as associations by demographic and military service characteristics. Results Overall, 8.7% of patients screened positive for past-year IPV. Odds of screening positive for IPV were higher among women who were younger (aged Conclusions Study findings indicate a significant proportion of female VHA patients disclosing past-year IPV during clinical screening, and identify characteristics associated with increased vulnerability. Implications for future research and program implementation include addressing high-risk subpopulations and further investigating the impact of screening and follow-up care.
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intimate partner violence detection and care in the veterans Health Administration patient and provider perspectives
Womens Health Issues, 2015Co-Authors: Melissa E Dichter, Katherine M Iverson, Clara Wagner, Erica B GoldbergAbstract:Abstract Background Women veterans experience high rates of intimate partner violence (IPV), with associated negative Health impacts. The Veterans Health Administration (VHA) has recently developed plans to implement routine IPV screening and provide IPV-related follow-up services for VHA patients. Previous research has examined barriers and facilitators to Health care provider screening for IPV. The next step is to examine patients' disclosure of IPV experiences to Health care providers and effective response to such disclosures. We sought to identify VHA patients' and providers' perspectives on how to facilitate effective IPV detection and care in VHA. Methods We conducted semistructured, qualitative interviews with 25 female veteran patients and 15 VHA Health care providers. We used an inductive approach to analyzing interview transcripts and identifying themes that constituted study findings. Results Themes fell in to two broad categories: 1) barriers to disclosure and 2) barriers to an adequate response to disclosure and providing follow-up care. Barriers to disclosure of IPV to Health care providers included lack of provider inquiry, lack of comfort, and concerns about the consequences of disclosure and lack of privacy. Patients and providers both indicated a need for expanded resources to respond to IPV in VHA. Conclusions Findings support current plans for IPV program implementation in VHA and point to recommendations for practice and implications for further research.
Anthony P Morreale - One of the best experts on this subject based on the ideXlab platform.
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a report of the efforts of the veterans Health Administration national antimicrobial stewardship initiative
Infection Control and Hospital Epidemiology, 2017Co-Authors: Allison Kelly, Makoto Jones, Kelly Echevarria, Stephen M Kralovic, Matthew H Samore, Matthew Bidwell Goetz, Karl Madaraskelly, Loretta A Simbartl, Anthony P MorrealeAbstract:OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated Healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large Healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513-520.
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a report of the efforts of the veterans Health Administration national antimicrobial stewardship initiative
Infection Control and Hospital Epidemiology, 2017Co-Authors: Allison Kelly, Makoto Jones, Kelly Echevarria, Stephen M Kralovic, Matthew H Samore, Matthew Bidwell Goetz, Karl Madaraskelly, Loretta A Simbartl, Anthony P MorrealeAbstract:OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated Healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 ( P P Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large Healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513–520
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clinical pharmacist prescribing activities in the veterans Health Administration
American Journal of Health-system Pharmacy, 2016Co-Authors: Heather Ourth, Julie A Groppi, Anthony P Morreale, Kimberly QuiccirobertsAbstract:Purpose A comprehensive overview of clinical pharmacist prescribing authority and collaborative drug therapy management activities within the Veterans Health Administration (VHA) is presented. Summary In VHA terminology, “scope of practice” (SOP) denotes authorization to perform as an advanced practice provider, autonomously or collaboratively managing all facets of a patient’s disease or condition; VHA clinical pharmacists with an SOP have prescribing authority. National policies outline the broad requirements for conferral of an SOP to VHA clinical pharmacists and processes for SOP development and oversight, as well as the responsibilities of facility and clinical pharmacy leaders to support the role of the clinical pharmacist within the VHA Healthcare system. The limits of each pharmacist’s SOP are determined at the facility level, with prescribing and other patient care authorities granted according to demonstrated competence. There are approximately 7700 VHA clinical pharmacists, of whom about 3200 (41%) have an active SOP. During fiscal year 2015, VHA clinical pharmacists accounted for more than 5 million patient encounters and 1.9 million prescriptions for chronic disease–targeted medications, generating at least 20% of prescriptions for hepatitis C therapies, hypoglycemic agents, and erythropoiesis-stimulating agents and 69% of prescriptions for anticoagulants systemwide. Conclusion Clinical pharmacists with an SOP constitute a rapidly expanding workforce within the VHA system, as illustrated by tremendous growth in their numbers since 2010. These individuals play a key role as advanced practice providers, helping to improve access to high-quality chronic disease and medication management for the nation’s veterans.
Kelly Echevarria - One of the best experts on this subject based on the ideXlab platform.
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a report of the efforts of the veterans Health Administration national antimicrobial stewardship initiative
Infection Control and Hospital Epidemiology, 2017Co-Authors: Allison Kelly, Makoto Jones, Kelly Echevarria, Stephen M Kralovic, Matthew H Samore, Matthew Bidwell Goetz, Karl Madaraskelly, Loretta A Simbartl, Anthony P MorrealeAbstract:OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated Healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 ( P P Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large Healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513–520
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a report of the efforts of the veterans Health Administration national antimicrobial stewardship initiative
Infection Control and Hospital Epidemiology, 2017Co-Authors: Allison Kelly, Makoto Jones, Kelly Echevarria, Stephen M Kralovic, Matthew H Samore, Matthew Bidwell Goetz, Karl Madaraskelly, Loretta A Simbartl, Anthony P MorrealeAbstract:OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated Healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large Healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513-520.
