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- Access to Care (2)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 10 of 10 Research Studies DisplayedMeyer AND, Singh H, Zimolzak AJ
Cancer evaluations during the COVID-19 pandemic: an observational study using National Veterans Affairs data.
This observational study examined the reasons why fewer cancer diagnoses have been made during the COVID-19 pandemic using electronic health record data from the Department of Veterans Affairs before (March 10, 2019-March 7, 2020) and during (March 8, 2020-March 6, 2021) the pandemic. Electronic triggers were applied to 8,021,406 veterans' electronic health records to identify follow-up delays for abnormal results warranting evaluation for 5 cancers: bladder, breast, colorectal, liver, and lung cancers. Between the prepandemic and pandemic periods, test quantities decreased by 12.6%-27.8%, and proportions of abnormal results lacking follow-up decreased for urinalyses by 0.8%, increased by 2.3% for fecal occult blood tests/fecal immunochemical test and 1.8% for chest imaging, and remained constant for the other diagnostic tests (mammograms for breast cancer and elevated alpha-fetoprotein for liver cancer). This significant decrease in diagnostic testing may have led to reduced cancer rates.
AHRQ-funded; HS027363.
Citation: Meyer AND, Singh H, Zimolzak AJ .
Cancer evaluations during the COVID-19 pandemic: an observational study using National Veterans Affairs data.
Am J Prev Med 2022 Dec;63(6):1026-30. doi: 10.1016/j.amepre.2022.07.004..
Keywords: COVID-19, Cancer, Public Health
Fletcher EH, Kalofonos I
Adaptation of a Hearing Voices group facilitation training for VA stakeholders.
The purpose of this study was to describe an adaptation of a Hearing Voices (HV) group facilitation training at the Veterans Administration hospital of Greater Los Angeles (VAGLA) and to explore training modifications, trainee perceptions and application and intervention outcomes. Researchers conducted surveys of trainees (n = 18) and collected field notes throughout the 24-hour online training. The study found that the training had high acceptability and appropriateness and high feasibility in implementation.
AHRQ-funded; HS026407.
Citation: Fletcher EH, Kalofonos I .
Adaptation of a Hearing Voices group facilitation training for VA stakeholders.
Community Ment Health J 2022 Nov;58(8):1592-604. doi: 10.1007/s10597-022-00975-1..
Keywords: Behavioral Health, Training
Williams PH, Gilmartin HM, Leonard C
The influence of the Rural Transitions Nurse Program for veterans on healthcare utilization costs.
This study’s objective was to examine changes from pre- to post-hospitalization in total, inpatient, and outpatient 30-day healthcare utilization costs for Veterans Affairs Healthcare System Rural Transitions Nurse Program (TNP) enrollees compared to controls. Although findings showed no difference in change in total costs between veterans enrolled in TNP and controls, TNP was associated with a smaller increase in direct inpatient medical costs and a larger increase in direct outpatient medical costs, suggesting a shifting of costs from the inpatient to outpatient setting.
AHRQ-funded; HS024569.
Citation: Williams PH, Gilmartin HM, Leonard C .
The influence of the Rural Transitions Nurse Program for veterans on healthcare utilization costs.
J Gen Intern Med 2022 Nov;37(14):3529-34. doi: 10.1007/s11606-022-07401-y..
Keywords: Rural Health, Nursing, Transitions of Care, Healthcare Utilization, Healthcare Costs
Griffith KN, Asfaw DA, Childers RG
Changes in US veterans' access to specialty care during the COVID-19 pandemic.
This research letter examined changes in US veterans’ access to specialty care during the COVID-19 pandemic through October 2021. The Veterans Health Administration (VHA) completed 14,516,937 internal referrals and purchased an additional 9,904,132 referrals to community-based specialists during the study period. Before the pandemic VHA specialists completed a mean 452,148 referrals each month. Volume dropped starting in March 2020 and did not fully until recover until March 2021. Peak decline was in April 2020 by 70.7% to 132,481 referrals. Community care referrals declined by 32.9% in June 2020, but rebounded thereafter and exceeded the prepandemic baseline by March 2021. Waits for VHA specialists began rising in June 2020, peaked in July 2020 and returned to prepandemic levels by spring 2021. Mean waits for community specialists peaked in June 2020 and returned to prepandemic baseline levels by August 2020.
AHRQ-funded; HS026395.
Citation: Griffith KN, Asfaw DA, Childers RG .
Changes in US veterans' access to specialty care during the COVID-19 pandemic.
JAMA Netw Open 2022 Sep;5(9):e2232515. doi: 10.1001/jamanetworkopen.2022.32515..
Keywords: COVID-19, Access to Care
McGinnis KA, Justice AC, Moore RD
Discrimination and calibration of the veterans aging cohort study index 2.0 for predicting mortality among people with human immunodeficiency virus in North America.
Using data from the North American AIDS Cohort Collaboration (NA-ACCORD), the authors translated Veterans Aging Cohort Study (VACS) Index 2.0 scores into validated probability estimates of mortality among people with HIV (PWH). They found that predicted and observed mortality largely overlapped in VACS and the NA-ACCORD subset, overall and within subgroups. Based on this validation, they concluded that VACS Index 2.0 can reliably estimate probability of all-cause mortality, at various follow-up times, among PWH in North America.
AHRQ-funded; 90047713.
Citation: McGinnis KA, Justice AC, Moore RD .
Discrimination and calibration of the veterans aging cohort study index 2.0 for predicting mortality among people with human immunodeficiency virus in North America.
Clin Infect Dis 2022 Aug 25;75(2):297-304. doi: 10.1093/cid/ciab883..
Keywords: Human Immunodeficiency Virus (HIV), Chronic Conditions
Feyman Y, Asfaw DA, Griffith KN
Geographic variation in appointment wait times for US military veterans.
The purpose of this cross-sectional study was to examine geographic variation in wait times experienced by veterans for primary care, mental health, and other specialties since the passage of the Veterans Access, Choice, and Accountability Act in 2014 and the VA MISSION (Maintaining Systems and Strengthening Integrated Outside Networks) Act in 2018. These acts allowed veterans to have access to community-based care centers. Data analysis was performed using data from the Veterans Health Administration (VHA) Corporate Data Warehouse. Participants include a final sample of 22,632,918 million appointments for 4,846,892 unique veterans who sought medical care from January 1, 2018, to June 30, 2021. The main outcomes were total appointment wait times in days for the categories of primary care, mental health, and all other specialties. VHA medical centers are organized into regions called Veterans Integrated Services Networks (VISNs); wait times were aggregated to the VISN level. The study found that Among non-VHA appointments, mean VISN-level appointment wait times were 38.9 days for primary care, 43.9 days for mental health, and 41.9 days for all other specialties. Among VHA appointments, mean VISN-level appointment wait times were 29.0 days for primary care, 33.6 days for mental health, and 35.4 days for all other specialties. There was substantial geographic variation in appointment wait times. The researchers concluded that VHA wait times in a majority of VISNs were lower than those for community-based clinicians.
AHRQ-funded; HS026395.
Citation: Feyman Y, Asfaw DA, Griffith KN .
Geographic variation in appointment wait times for US military veterans.
JAMA Netw Open 2022 Aug;5(8):e2228783. doi: 10.1001/jamanetworkopen.2022.28783..
Keywords: Access to Care
Ward MJ, Shuster JL, Mohr NM
Implementation of telehealth for psychiatric care in VA emergency departments and urgent care clinics.
The purpose of this AHRQ-funded, mixed-methods study was to evaluate an emergency telehealth intervention in emergency department (ED) and urgent care clinic (UCC) settings within the Veterans Health Administration (VHA) in March 2020. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was utilized to compare the 3 months preimplementation of the telehealth intervention (December 1, 2019 through February 29, 2020) with the 3 months postimplementation of the telehealth intervention (April 1, 2020 through June 30, 2020), and then assess sustainability through January 31, 2021. Qualitative data from surveys and semistructured interviews were conducted and analyze. The telemental health intervention was used in 83% (319) of unscheduled mental health consultations in the postimplementation phase, with no adverse trends in length of stay, 7-day revisits, or 30-day mortality. In the sustainability phase, use of the intervention was high with 82% (n = 1,010) of all unscheduled mental health consultations performed by telemental health. The study concluded that the use of unscheduled telemental health intervention was highly acceptable and sustainable in ED and UCC settings and did not impact the safety and efficacy of mental health consultations.
AHRQ-funded; HS025753.
Citation: Ward MJ, Shuster JL, Mohr NM .
Implementation of telehealth for psychiatric care in VA emergency departments and urgent care clinics.
Telemed J E Health 2022 Jul;28(7):985-93. doi: 10.1089/tmj.2021.0263..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Behavioral Health, Emergency Department
Danan ER, Brunner J, Bergman A
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
The purpose of this study was to determine whether a history of sexual assault in women Veterans is associated with decreased cervical cancer screening completion. The researchers analyzed data from a 2015 survey of 1049 women Veterans who accessed primary care services at 12 Veterans health administration facilities (VA’s) in nine states, and linked responses with electronic health data from the VA system. Fifty-seven percent (616) of women Veterans reported lifetime sexual assault, and those who did so had a greater likelihood of reporting a high level of distress associated with pelvic examinations and delaying a gynecologic exam due to distress. However, in the final adjusted model, there was not a significant association between lifetime sexual assault and reduced odds of cervical cancer screening completion. The study concluded that there was no significant association between sexual assault and gaps in cervical cancer screening completion.
AHRQ-funded; HS026379.
Citation: Danan ER, Brunner J, Bergman A .
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
J Womens Health 2022 Jul;31(7):1040-47. doi: 10.1089/jwh.2021.0237.AHRQ-funded; HS026379..
Keywords: Women, Cancer: Cervical Cancer, Cancer, Screening, Trauma
Gilmartin HM, Warsavage T, Hines A
Effectiveness of the rural transitions nurse program for veterans: a multicenter implementation study.
This study evaluated the effectiveness of the rural Transitions Nurse Program (TNP), a program to help veterans transferred from rural areas to urban VA Medical Centers for care. A case-control study was conducted from April 2017 to September 2019 with 3001 veterans enrolled in TNP and 6002 matched controls. Interventions were led by a transition nurse who assessed discharge readiness, provided postdischarge communication with primary care providers (PCPs), and called the Veteran within 72 h of discharge home to assess needs, and encouraged follow-up appointment attendance. Controls had no change to their care. Primary outcomes evaluated were PCP visits within 14 days of discharge and all-cause 30-day readmissions, with secondary outcomes 30-day emergency department (ED) visits and 30-day mortality. Patients were matched by their length of stay, prior hospitalizations and PCP visits, urban/rural status, and 32 Elixhauser comorbidities. The veterans enrolled in TNP were more likely to see their PCP within 14 days of discharge than their matched controls. TNP enrollment was not associated with reduced 30-day ED visits or readmissions but was associated with reduced 30-day mortality.
AHRQ-funded; HS024569.
Citation: Gilmartin HM, Warsavage T, Hines A .
Effectiveness of the rural transitions nurse program for veterans: a multicenter implementation study.
J Hosp Med 2022 Mar;17(3):149-57. doi: 10.1002/jhm.12802..
Keywords: Rural Health, Transitions of Care, Nursing, Healthcare Delivery
Feyman Y, Auty SG, Tenso K
County-level impact of the COVID-19 pandemic on excess mortality among U.S. veterans: a population-based study.
This study investigated the county-level impact of the COVID-19 pandemic on excess mortality among U.S. veterans. The authors queried Veterans Health Administration (VHA) administrative data on demographics and comorbidities for 11.4 million enrollees during 2016-2020. Eight mortality prediction models at the county-level were used including Poisson, Poisson quasi-likelihood, negative binomial, and generalized estimating equations. All models demonstrated excellent agreement between observed and predicted mortality. An excess mortality rate of 13% in 2020 was found, which corresponds to 50,299 excess deaths. Despite mortality risk factors of veterans, their excess mortality rate was slightly lower than the general population.
AHRQ-funded; HS026395.
Citation: Feyman Y, Auty SG, Tenso K .
County-level impact of the COVID-19 pandemic on excess mortality among U.S. veterans: a population-based study.
Lancet Reg Health Am 2022 Jan;5:100093. doi: 10.1016/j.lana.2021.100093.
AHRQ-funded; HS026395..
AHRQ-funded; HS026395..
Keywords: COVID-19, Mortality