National Healthcare Quality and Disparities Report
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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
76 to 100 of 110 Research Studies DisplayedSchmajuk G, Tonner C, Miao Y
Folic acid supplementation is suboptimal in a national cohort of older veterans receiving low dose oral methotrexate.
The authors aimed to determine the prevalence, predictors of, and persistence of folic acid use in a population-based cohort of methotrexate (MTX) users with rheumatic diseases. They found that patients who did not see a rheumatologist were 23% less likely to receive folic acid compared to patients who did have a rheumatologist visit during the baseline period, and after 20 months, only 50% of patients continued to receive folic acid. The authors recommend improving patient safety for users of MTX by standardizing workflows for folic acid supplementation.
AHRQ-funded; HS024412.
Citation: Schmajuk G, Tonner C, Miao Y .
Folic acid supplementation is suboptimal in a national cohort of older veterans receiving low dose oral methotrexate.
PLoS One 2016 Dec 15;11(12):e0168369. doi: 10.1371/journal.pone.0168369.
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Keywords: Elderly, Healthcare Utilization, Medication, Arthritis
Thomas KS, Allen SM
Interagency partnership to deliver veteran-directed home and community-based services: interviews with Aging and Disability Network agency personnel regarding their experience with partner Department of Veterans Affairs medical centers.
The objective of this article is to describe the Aging and Disability Network agency (ADNA) personnel's perceptions of the implementation of the VD-HCBS program with partner Department of Veterans Affairs medical centers (VAMCs). Results suggest that the majority of ADNA personnel interviewed perceive the collaboration experience to be positive. Interviewees reported several key mechanisms for facilitating a successful partnership.
AHRQ-funded; HS000011.
Citation: Thomas KS, Allen SM .
Interagency partnership to deliver veteran-directed home and community-based services: interviews with Aging and Disability Network agency personnel regarding their experience with partner Department of Veterans Affairs medical centers.
J Rehabil Res Dev 2016;53(5):611-18. doi: 10.1682/jrrd.2015.02.0019.
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Keywords: Community-Based Practice, Provider: Health Personnel, Home Healthcare, Training
Banerjee G, Edelman EJ, Barry DT
Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study.
The researchers estimated the influence of non-medical use of prescription opioids on heroin initiation among US veterans receiving medical care. Using a multivariable Cox regression model, they found that non-medical use of prescription opioids was associated positively and independently with heroin initiation.
AHRQ-funded; HS021112; HS023258.
Citation: Banerjee G, Edelman EJ, Barry DT .
Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study.
Addiction 2016 Nov;111(11):2021-31. doi: 10.1111/add.13491.
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Keywords: Medication, Opioids, Substance Abuse
Carballo NJ, Alessi CA, Martin JL
Perceived effectiveness, self-efficacy, and social support for oral appliance therapy among older veterans with obstructive sleep apnea.
Adherence to oral appliance therapy may be influenced by patients' perceived effectiveness of the therapy, self-efficacy, and availability of social support. The researchers examined these perceptions among older adults with obstructive sleep apnea who were prescribed oral appliance therapy. They concluded that only about one third of older adults perceived it as an effective treatment, were confident about oral appliance use, and/or believed that they would receive needed support.
AHRQ-funded; HS024379.
Citation: Carballo NJ, Alessi CA, Martin JL .
Perceived effectiveness, self-efficacy, and social support for oral appliance therapy among older veterans with obstructive sleep apnea.
Clin Ther 2016 Nov;38(11):2407-15. doi: 10.1016/j.clinthera.2016.09.008.
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Keywords: Elderly, Patient Adherence/Compliance, Sleep Problems, Patient Self-Management
Ramchand R, Ayer L, Kotzias V
Suicide risk among women veterans in distress: perspectives of responders on the veterans crisis line.
The researchers used a qualitative approach to gain insight about the concerns and nature of comments regarding suicidal ideation and intent among women veterans calling the Veterans Crisis Line (VCL). Interviewing 54 VCL call responders, the authors concluded that efforts to prevent and treat the consequences of military sexual trauma; to recognize, prevent, and treat non-suicidal self-harm; and to restrict access to lethal means most commonly reported among women veteran callers may be helpful to mitigate suicide risk in this vulnerable group of veterans.
AHRQ-funded; HS000029.
Citation: Ramchand R, Ayer L, Kotzias V .
Suicide risk among women veterans in distress: perspectives of responders on the veterans crisis line.
Womens Health Issues 2016 Nov - Dec;26(6):667-73. doi: 10.1016/j.whi.2016.07.005.
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Keywords: Behavioral Health, Prevention, Stress, Women
Herrin M, Tate JP, Akgun KM
Weight gain and incident diabetes among HIV-infected veterans initiating antiretroviral therapy compared with uninfected individuals.
The authors used data from the Veterans Aging Cohort Study to determine whether weight gain after antiretroviral therapy has a similar association with incident type 2 diabetes mellitus as weight gained among HIV-uninfected individuals. They found that weight gained during the first year after antiretroviral therapy initiation is associated with greater risk of diabetes mellitus than that among uninfected individuals.
AHRQ-funded; HS018372.
Citation: Herrin M, Tate JP, Akgun KM .
Weight gain and incident diabetes among HIV-infected veterans initiating antiretroviral therapy compared with uninfected individuals.
J Acquir Immune Defic Syndr 2016 Oct 1;73(2):228-36. doi: 10.1097/qai.0000000000001071.
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Keywords: Diabetes, Human Immunodeficiency Virus (HIV), Medication, Obesity: Weight Management
Clark BJ, Rubinsky AD, Ho PM
Alcohol screening scores and the risk of intensive care unit admission and hospital readmission.
This study sought to determine whether alcohol misuse was associated with admission to an intensive care unit (ICU) among patients receiving outpatient care. Among 486,115 veterans receiving outpatient care, the adjusted probability of ICU admission within 1 year was 2.0 percent for abstinent patients, 1.6 percent for patients with lower-risk alcohol use, 1.8 percent for patients with moderate alcohol misuse, and 2.5 percent for patients with severe alcohol misuse.
AHRQ-funded; HS022800.
Citation: Clark BJ, Rubinsky AD, Ho PM .
Alcohol screening scores and the risk of intensive care unit admission and hospital readmission.
Subst Abus 2016 Jul-Sep;37(3):466-73. doi: 10.1080/08897077.2015.1137259.
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Keywords: Alcohol Use, Hospital Readmissions, Intensive Care Unit (ICU), Ambulatory Care and Surgery, Screening, Substance Abuse
Morris AM, Ricci KA, Griffin AR
AHRQ Author: Heslin KC
Personal and professional challenges confronted by hospital staff following hurricane sandy: a qualitative assessment of management perspectives.
This qualitative study assessed the personal and professional challenges that affected staff decisions to report to work following a natural disaster and examined the role of management in addressing staff needs and concerns. Results indicated that staff encountered several barriers in the initial post-Sandy period including transportation problems, personal property damage, and communication issues.
AHRQ-authored.
Citation: Morris AM, Ricci KA, Griffin AR .
Personal and professional challenges confronted by hospital staff following hurricane sandy: a qualitative assessment of management perspectives.
BMC Emerg Med 2016 May 5;16(1):18. doi: 10.1186/s12873-016-0082-5.
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Keywords: Communication, Emergency Preparedness, Workforce
Chavez LJ, Williams EC, Lapham GT
Changes in patient-reported alcohol-related advice following veterans health administration implementation of brief alcohol interventions.
The researchers examined whether an independent measure of brief interventions-patient-reported alcohol-related advice-also increased among VA outpatients who screened positive for alcohol misuse on a mailed survey. They found that among patients with alcohol misuse, the adjusted prevalence of alcohol-related advice increased from 40.4% in 2007 to 55.5% in 2011. Rates of alcohol-related advice increased significantly each year except the last.
AHRQ-funded; HS022800.
Citation: Chavez LJ, Williams EC, Lapham GT .
Changes in patient-reported alcohol-related advice following veterans health administration implementation of brief alcohol interventions.
J Stud Alcohol Drugs 2016 May;77(3):500-8.
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Keywords: Alcohol Use, Behavioral Health, Primary Care, Substance Abuse
Balbale SN, Etingen B, Malhiot A
Perceptions of chronic illness care among veterans with multiple chronic conditions.
The purpose of this study was to use the Patient Assessment of Chronic Illness Care (PACIC) instrument to examine perceptions of chronic care among veterans with multiple chronic conditions (MCC). The authors concluded that quality improvements are needed to strengthen care continuity and coordination.
AHRQ-funded; HS000084.
Citation: Balbale SN, Etingen B, Malhiot A .
Perceptions of chronic illness care among veterans with multiple chronic conditions.
Mil Med 2016 May;181(5):439-44. doi: 10.7205/milmed-d-15-00207..
Keywords: Chronic Conditions, Patient Experience, Quality Improvement
Watkins KE, Smith B, Akincigil A
The quality of medication treatment for mental disorders in the department of Veterans Affairs and in private-sector plans.
The objective of this paper was to compare the quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) with care provided to a comparable population treated in the private sector. The researchers found that VA performance was superior to that of the private sector by more than 30%. They concluded that their findings demonstrate the significant advantages that accrue from an organized, nationwide system of care and suggested that the much higher performance of the VA has important clinical and policy implications.
AHRQ-funded; HS003258; HS021112.
Citation: Watkins KE, Smith B, Akincigil A .
The quality of medication treatment for mental disorders in the department of Veterans Affairs and in private-sector plans.
Psychiatr Serv 2016 Apr;67(4):391-6. doi: 10.1176/appi.ps.201400537.
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Keywords: Quality of Care, Health Insurance, Medication, Behavioral Health
Hernandez SE, Taylor L, Grembowski D
A first look at PCMH implementation for minority veterans: room for improvement.
The researchers sought to determine if the degree of Patient Aligned Care Teams (a patient-centered medical home model), implementation at Veterans Health Administration hospital-based and community-based primary care facilities varied with the percentage of minority veteran patients at each facility. They found that overall implementation of the care teams varied with respect to the racial/ethnic composition of a facility, with medium and high minority facilities having lower implementation scores.
AHRQ-funded; HS013853; HS023376.
Citation: Hernandez SE, Taylor L, Grembowski D .
A first look at PCMH implementation for minority veterans: room for improvement.
Med Care 2016 Mar;54(3):253-61. doi: 10.1097/mlr.0000000000000512.
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Keywords: Patient-Centered Healthcare, Racial and Ethnic Minorities, Community-Based Practice, Primary Care
Rentsch C, Tate JP, Akgun KM
Alcohol-related diagnoses and all-cause hospitalization among HIV-infected and uninfected patients: a longitudinal analysis of United States veterans from 1997 to 2011.
From 1997 to 2011, 46,428 HIV-infected and 93,997 uninfected patients were followed for 1,497,536 person-years. Overall hospitalization rates decreased among HIV-infected and uninfected patients. However, cardiovascular and renal insufficiency admissions increased for all groups while gastrointestinal and liver, endocrine, neurologic, and non-AIDS cancer admissions increased among those with an alcohol-related diagnosis.
AHRQ-funded; HS018372.
Citation: Rentsch C, Tate JP, Akgun KM .
Alcohol-related diagnoses and all-cause hospitalization among HIV-infected and uninfected patients: a longitudinal analysis of United States veterans from 1997 to 2011.
AIDS Behav 2016 Mar;20(3):555-64. doi: 10.1007/s10461-015-1025-y.
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Keywords: Alcohol Use, Hospitalization, Human Immunodeficiency Virus (HIV)
Heath B, Bernhardt J, Michalski TJ
Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults.
The authors described a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. They found that the course addressed an important knowledge gap and recommended engaging nursing staff in advancing antimicrobial stewardship, particularly in the long-term care setting.
AHRQ-funded; HS023866.
Citation: Heath B, Bernhardt J, Michalski TJ .
Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults.
Am J Infect Control 2016 Mar;44(3):349-51. doi: 10.1016/j.ajic.2015.09.026.
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Keywords: Antimicrobial Stewardship, Provider: Health Personnel, Prevention, Training
LaFleur J, Rillamas-Sun E, Colon-Emeric CS
Fracture rates and bone density among postmenopausal veteran and non-veteran women from the Women's Health Initiative.
The authors compared fracture rates and bone mineral density for veterans and non-veterans using Women's Health Initiative data. They found that veterans had higher 10-year probabilities for any major fracture and hip fracture compared with non-veterans, but that risk of fracture at other anatomic sites did not differ by veteran status. They concluded that female veterans had an increased hip fracture rate not explained by differences in well-recognized fracture risk factors.
AHRQ-funded; HS018582.
Citation: LaFleur J, Rillamas-Sun E, Colon-Emeric CS .
Fracture rates and bone density among postmenopausal veteran and non-veteran women from the Women's Health Initiative.
Gerontologist 2016 Feb;56 Suppl 1:S78-90. doi: 10.1093/geront/gnv677.
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Keywords: Elderly, Injuries and Wounds, Osteoporosis, Women
Williams EC, Achtmeyer CE, Young JP
Local implementation of alcohol screening and brief intervention at five Veterans Health Administration primary care clinics: Perspectives of clinical and administrative staff.
The researchers conducted a qualitative key informant study to describe local implementation of alcohol screening and brief intervention from the perspectives of frontline adopters in VA primary care . Findings suggest that the local process of implementing alcohol screening and brief intervention may have inadequately addressed important adopter needs.
AHRQ-funded; HS022800.
Citation: Williams EC, Achtmeyer CE, Young JP .
Local implementation of alcohol screening and brief intervention at five Veterans Health Administration primary care clinics: Perspectives of clinical and administrative staff.
J Subst Abuse Treat 2016 Jan;60:27-35. doi: 10.1016/j.jsat.2015.07.011.
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Keywords: Alcohol Use, Screening, Primary Care
Ahuja V, Sohn MW, Birge JR
Geographic variation in rosiglitazone use surrounding FDA warnings in the Department of Veterans Affairs.
The purpose of this study was to document variation in the use of rosiglitazone and other glucose- lowering drugs across 21 Veterans Integrated Service Networks. It found that aggregate rosiglitazone use increased monotonically from 7.7 percent, in the quarter it was added to the VA formulary, to a peak of 15.3 percent in the quarter when the FDA issued the safety alert.
AHRQ-funded; HS018542.
Citation: Ahuja V, Sohn MW, Birge JR .
Geographic variation in rosiglitazone use surrounding FDA warnings in the Department of Veterans Affairs.
J Manag Care Spec Pharm 2015 Dec;21(12):1214-34. doi: 10.18553/jmcp.2015.21.12.1214.
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Keywords: Adverse Drug Events (ADE), Medication: Safety, Medication, Practice Patterns
LaFleur J, Hoop R, Korner E
Predictors of early discontinuation of pegylated interferon for reasons other than lack of efficacy in United States veterans with chronic hepatitis C.
The researchers determined whether selected patient characteristics predicted discontinued therapy for reasons other than lack of efficcacy (non-LOE) using national databases of U.S. veterans. They found that predictors of greatest magnitude included comorbidities of myocardial infarction/congestive heart failure, renal disease, platelets 100/mm or more, Black race, albumin 3.5 mg/dl or more, sleep aid use, and poor persistence with antidepressants and antihypertensive agents.
AHRQ-funded; HS018582.
Citation: LaFleur J, Hoop R, Korner E .
Predictors of early discontinuation of pegylated interferon for reasons other than lack of efficacy in United States veterans with chronic hepatitis C.
Gastroenterol Nurs 2015 Nov-Dec;38(6):417-28. doi: 10.1097/sga.0000000000000214.
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Keywords: Chronic Conditions, Hepatitis, Medication, Patient Adherence/Compliance
Heslin KC, Gable A, Dobalian A
AHRQ Author: Heslin KC
Special services for women in substance use disorders treatment: how does the Department of Veterans Affairs compare with other providers?
The researchers examined the prevalence of programs and key services for women in VA facilities in a survey of 14,311 substance use disorder treatment facilities. Approximately 31 percent of facilities had special programs exclusively for women. Although the VA had the lowest prevalence of programs for women, at 19.1 percent, it offered a significantly higher average number of key services for women.
AHRQ-authored.
Citation: Heslin KC, Gable A, Dobalian A .
Special services for women in substance use disorders treatment: how does the Department of Veterans Affairs compare with other providers?
Womens Health Issues 2015 Nov-Dec;25(6):666-72. doi: 10.1016/j.whi.2015.07.005.
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Keywords: Substance Abuse, Women, Healthcare Delivery
Price LE, Shea K, Gephart S
The Veterans Affairs's Corporate Data Warehouse: uses and implications for nursing research and practice.
This article described the developments in research associated with the VHA's transition into the world of Big Data analytics through Corporate Data Warehouse (CDW) utilization. The authors found that the most commonly-occurring research topics are pharmacy/medications, systems issues, and weight management/obesity. They concluded that, despite the potential benefit of data mining techniques to improve patient care and services, the CDW and alternative analytical approaches are underutilized by researchers and clinicians.
AHRQ-funded; HS022908.
Citation: Price LE, Shea K, Gephart S .
The Veterans Affairs's Corporate Data Warehouse: uses and implications for nursing research and practice.
Nurs Adm Q 2015 Oct-Dec;39(4):311-8. doi: 10.1097/naq.0000000000000118.
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Keywords: Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Nursing
LaFleur J, DuVall SL, Wilson T
Analysis of osteoporosis treatment patterns with bisphosphonates and outcomes among postmenopausal veterans.
This study evaluated bisphosphonate change behaviors (switching, discontinuing, or reinitiating) over time, as well as fractures and costs, among a large, national cohort of postmenopausal veterans. It found that most bisphosphonate patients discontinue treatment at some point, which did not significantly increase the risk of fracture in this majority non-high risk population. Bisphosphonate change behaviors were associated with significantly lower osteoporosis costs, but significantly higher total costs.
AHRQ-funded; HS018582.
Citation: LaFleur J, DuVall SL, Wilson T .
Analysis of osteoporosis treatment patterns with bisphosphonates and outcomes among postmenopausal veterans.
Bone 2015 Sep;78:174-85. doi: 10.1016/j.bone.2015.04.022..
Keywords: Osteoporosis, Medication, Elderly, Injuries and Wounds
Ricci KA, Griffin AR, Heslin KC
AHRQ Author: Heslin KC
Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making.
This study was conducted to identify factors that most heavily influenced the decisions to evacuate the Manhattan Veterans Administration Medical Center before Hurricane Irene in 2011 and Hurricane Sandy in 2012. The researchers conducted semi-structured interviews with 11 senior leaders on the processes and factors that influenced their evacuation decisions.
AHRQ-authored
Citation: Ricci KA, Griffin AR, Heslin KC .
Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making.
Prehosp Disaster Med. 2015 Jun;30(3):233-8. doi: 10.1017/s1049023x15000229..
Keywords: Emergency Preparedness, Decision Making, Hospitals
Ripley DC, Kwong PL, Vogel WB
How does geographic access affect in-hospital mortality for veterans with acute ischemic stroke?
This study examined the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemic stroke. It found that even after adjusting for the confounding effects of patient, treatment, and facility characteristics, travel time from home to admitting VAMC was significantly associated with inhospital mortality.
AHRQ-funded; HS018540.
Citation: Ripley DC, Kwong PL, Vogel WB .
How does geographic access affect in-hospital mortality for veterans with acute ischemic stroke?
Med Care 2015 Jun;53(6):501-9. doi: 10.1097/mlr.0000000000000366..
Keywords: Stroke, Mortality, Access to Care
Storzbach D, O'Neil ME, Roost SM
Comparing the neuropsychological test performance of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress symptoms.
The purpose of this paper was to compare neuropsychological test performance of veterans with and without mild traumatic brain injury (MTBI), blast exposure, and posttraumatic stress disorder (PTSD) symptoms. The authors found that, although some mild neurocognitive effects were associated with blast exposure, these neurocognitive effects might be better explained by PTSD symptom severity rather than blast exposure or MTBI history alone.
AHRQ-funded; HS022981; HS019456.
Citation: Storzbach D, O'Neil ME, Roost SM .
Comparing the neuropsychological test performance of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress symptoms.
J Int Neuropsychol Soc 2015 May;21(5):353-63. doi: 10.1017/s1355617715000326.
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Keywords: Brain Injury, Behavioral Health, Neurological Disorders
Jump RL, Heath B, Crnich CJ
Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults.
The reseasrchers conducted an anonymous survey of providers who care for older adults from 10 Veterans Affairs long-term-care facilities to assess their knowledge, beliefs, and confidence toward treating infections and antimicrobial stewardship. They found that the average score on 5 questions assessing knowledge was 3.6 out of 5.0, thus supporting a need for education regarding the care of older adults with infections.
AHRQ-funded; HS023866.
Citation: Jump RL, Heath B, Crnich CJ .
Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults.
Am J Infect Control 2015 Mar;43(3):298-300. doi: 10.1016/j.ajic.2014.11.017.
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Keywords: Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Long-Term Care, Medication