1
|
Pav V, Burns A, Colahan C, Robison B, Kean J, DuVall S. Illustration of Continuous Enrollment and Beneficiary Categorization in DoD and VA Infrastructure for Clinical Intelligence. Mil Med 2024; 189:466-474. [PMID: 36461620 DOI: 10.1093/milmed/usac352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/07/2022] [Accepted: 10/31/2022] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The DoD and VA Infrastructure for Clinical Intelligence (DaVINCI) data-sharing initiative has bridged the gap between DoD and VA data. DaVINCI utilizes the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) to map DoD and VA-specific health care codes to a standardized terminology. Although OMOP CDM provides a standardized longitudinal view of health care concepts, it fails in capturing multiple and changing relationships beneficiaries have with DoD and VA as it has a static (vs. yearly) person characteristic table. Furthermore, DoD and VA utilize different policies and terminology to identify their respective beneficiaries, which makes it difficult to track patients longitudinally. The primary purpose of this report is to provide a methodology for categorizing beneficiaries and creating continuous longitudinal patient records to maximize the use of the joint DoD and VA data in DaVINCI. MATERIALS AND METHODS For calendar year 2000-2020, we combined DoD and VA OMOP CDM and source databases to uniquely categorize beneficiaries into the following hierarchical groups: Active Duty, Guard, and Reserve Service Members (ADSMs); Separatees; Retirees; Veterans; and Deceased. Once the cohorts were identified, we examined calendar year 2020 health care utilization data using the OMOP VISIT_OCCURRENCE, DRUG_EXPOSURE, MEASUREMENT, and PROCEDURE tables. We also used the Defense Enrollment and Eligibility Reporting System source table to derive enrollment periods for DoD beneficiaries. As VA does not have enrollment plans, we utilized the VA's priority groups (1-5) in the SPATIENT source table to crosswalk the DoD's enrollment concept to the VA. We then assessed lengths of continuous enrollments in DoD and VA and the impact of appending the longitudinal records together. RESULTS The majority of the ADSMs utilized the DoD system, but about 60,557 (3%) were seen in the VA for varied types of care. The market share of care provided to ADSMs by the VA varied by specialty and location. For Retirees, the split between DoD (1,625,874 [75%]) and VA (895,992 [41%]) health care utilization was more significant. The value added for utilizing DaVINCI in longitudinal studies was the highest for researchers normally limited to DoD data only. For beneficiaries who had 5 years of continuous enrollment, DaVINCI increased the potential study population by over 202% compared to using DoD data alone and by over 14% compared to VA data alone. Among beneficiaries with 20 years of continuous enrollment, DaVINCI increased the potential study population by over 133% compared to DoD data and by nearly 39% compared to VA data. CONCLUSIONS DaVINCI has successfully combined DoD and VA data and utilized OMOP CDM to standardize health care concepts. However, to fully maximize the potential of DaVINCI's DoD and VA OMOP databases, researchers must uniquely categorize the DaVINCI cohort and build longitudinal patient records across DoD and VA. Because of the low other health insurance rates among DoD enrollees and their choice to enroll to a DoD Primary Care Manager, we believe this population to be the least censored in the DoD. Applying a similar concept through VA's priority groups (1-5) would enable researchers to follow ADSMs as they transition from the military.
Collapse
Affiliation(s)
- Veronika Pav
- Kennell and Associates Inc., Falls Church, VA 22042, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Andrew Burns
- Alqimi Technology Solutions, Inc., Rockville, MD 20850, USA
| | | | - Brian Robison
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Jacob Kean
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Scott DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| |
Collapse
|
2
|
Abstract
RATIONALE Patient-centered outcomes are increasingly sought to evaluate social interactions and healthcare interventions in patients with sleep disorders. Yet, measures to assess quality of life (QoL) are lacking for those who experience nightmares. OBJECTIVE The aim of the study is to describe the development and validation of a new health-related quality of life (HRQoL) instrument for patients with nightmares. METHODS Attributes obtained from a focus group of patients (n = 113) with established nightmares were analyzed using exploratory factor analysis to elicit salient QoL themes for the new instrument. A validation cohort (n = 34) was used to determine the psychometric performance of the 16-item questionnaire including item-scaling, concurrent validity, and test-retest reliability tested four weeks apart. RESULTS Four factors (sleep health, emotional and psychological well-being, social interaction, and motivation) explained 53.9% of the total variance. The Nightmare Quality of Life (NQoL) showed good internal consistency (Cronbach's alpha 0.85) and test-retest reliability (ICC = 0.89). Concurrent validity was evidenced by a strong correlation with the Nightmare Distress Questionnaire (r = 0.87; p < .001) and more modest associations with the Nightmare Frequency Questionnaire (r = , 0.69; p < .001), SF-36 (r = -0.68; p < .001), and PSQI (r = 0.45; p = .007). CONCLUSIONS The NQoL has demonstrable construct validity and reliability and represents a promising multi-dimensional instrument to assess outcome measures for quality of life in patients with nightmares.
Collapse
Affiliation(s)
- Ali A El-Solh
- Department of Research and Development, VA Western New York Healthcare System, Buffalo, New York.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.,Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, Buffalo, NY, USA
| | - Yolanda Lawson
- Department of Research and Development, VA Western New York Healthcare System, Buffalo, New York
| | - Gregory E Wilding
- Department of Biostatistics, School of Public Health and Health Professions, Buffalo, New York
| |
Collapse
|
3
|
Detweiler MB, Lutgens BW, Choudhury D, Kenneth A, Kalafat N, Sherigar RM, Bader G. Association of Renal Clearance with Cerebral White Matter Vascular Disease in Hospitalized Veterans With and Without Delirium. South Med J 2021; 113:401-406. [PMID: 32747970 DOI: 10.14423/smj.0000000000001132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the relation between renal function and delirium and to assess and compare the relation between cerebral white matter lesion (WML) and renal function as estimated by three formulas for the estimated glomerular filtration rate (eGFR) in older adult hospitalized veterans with and without delirium. METHODS Commonly used formulas to assess renal function-the four-variable Modification of Diet in Renal Disease (MDRD), the six-variable MDRD, and the Cockcroft-Gault eGFR equations-were used to assess renal function in 100 older adult hospitalized veterans with delirium (delirium group) and 100 hospitalized veterans without delirium (nondelirium group) that were age, sex, and race matched. WML location and volumes were assessed using brain computed tomography imaging for each of the 200 veterans in the study. One radiologist, blinded to the diagnoses of the veterans, examined head computed tomography scans for WML in the cortex, subcortex (frontal, temporal, parietal, occipital lobes), basal ganglia (globus pallidus, caudate, putamen), and internal capsule. WML were graded as not present, <1 cm, 1 to 2 cm, or >2 cm. Exploratory χ2 analyses were used to determine the association between the stage of chronic kidney disease and WML. Simple logistic regression analyses were then used to estimate the strength of association between the stages of kidney disease and WML for particular regions of the brain. RESULTS The mean age of delirium group and nondelirium group veterans was 66 years. χ2 tests revealed no reliable relation between stages of renal disease and delirium. χ2 exploratory analyses of WML in brain regions by renal disease stages demonstrated significant differences in associations among the MDRD-4, MDRD-6, and Cockcroft-Gault formulas for measuring eGFR. The MDRD-4 formula was least associated with the presence or absence of WML. The Cockcroft-Gault estimation of eGFR was most associated with the presence or absence of WML. Simple logistic regressions showed notable increases in the association between stages of renal failure and WMLs in specific areas of the brain, with the MDRD-4 being the least associative with the fewest specific areas and the Cockcroft-Gault formula being the most associative with the most specific areas. CONCLUSIONS The association between stages 2 through 5 of chronic kidney disease and WLM support the role of kidney function as a potential risk factor for WML in older adult military veterans. The Cockcroft-Gault formula is an important renal index of suspected WML and renal stages 2 through 5, superior to the MDRD-6 and MDRD-4, respectively, in association with WML in older adult military veterans.
Collapse
Affiliation(s)
- Mark B Detweiler
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Brian W Lutgens
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Devasmita Choudhury
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Arline Kenneth
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Naciye Kalafat
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Rathnakara M Sherigar
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| | - Geoffrey Bader
- From the Departments of Psychiatry, Nephrology, and Radiology and Nuclear Medicine, Veterans Affairs Medical Center, Salem, Virginia, Camillus House, Miami, Florida, and the Medical College of Wisconsin-Northeastern Wisconsin Psychiatry Residency Program, Green Bay
| |
Collapse
|
4
|
Abstract
Nightmares are considered the hallmark of posttraumatic stress disorder (PTSD). Although the characteristics of these distressing dreams may vary with the type of traumatic event, the pathophysiology exposes central dysfunction of brain structures at the level of the hippocampus, amygdala, and locus coeruleus, modulated by neurochemical imbalance in nor-adrenergic, dopaminergic, and serotonin pathways. Underlying comorbid conditions, including other sleep disorders, may contribute to worsening symptoms. Addressing sleep disruption can alleviate the severity of these nocturnal events and augment the effectiveness of other PTSD treatments. The expansion of behavioral treatment modalities for PTSD-related nightmares has been encouraging, but the core of these interventions is heavily structured around memory manipulation and imagery rescripting. A lack of a standardized delivery and a high dropout rate continue to pose significant challenges in achieving successful outcomes. The efficacy of existing pharmacological studies, such as α-adrenergic blocking agents, antidepressants, and atypical antipsychotics, has been undermined by methodological limitations and absence of large randomized controlled trials. This review is aimed at reviewing the available treatment strategies for alleviating nightmares in subjects with PTSD. Given the intricate relationship between PTSD and nightmares, future clinical trials have to adopt a more pragmatic approach focused not only on efficacy of novel interventions but also on adjunctive iteration of existing therapies tailored to individual socio-cultural background.
Collapse
Affiliation(s)
- Ali A El-Solh
- Research Department, VA Western New York Healthcare System, Buffalo, NY, USA,
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA,
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA,
- Department of Community and Health Behavior, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA,
| |
Collapse
|
5
|
Detweiler MB, Sherigar RM, Bader G, Sullivan K, Kenneth A, Kalafat N, Reddy P, Lutgens B. Association of White Matter Lesions, Cerebral Atrophy, Intracranial Extravascular Calcifications, and Ventricular-Communicating Hydrocephalus with Delirium Among Veterans. South Med J 2017; 110:432-439. [DOI: 10.14423/smj.0000000000000663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
6
|
Lauckner C, Whitten P. The State and Sustainability of Telepsychiatry Programs. J Behav Health Serv Res 2017; 43:305-18. [PMID: 25794639 DOI: 10.1007/s11414-015-9461-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Telepsychiatry, or the provision of psychiatric care across a distance using communication technologies, has become widespread and has been used successfully for treating a variety of mental illnesses. Little is known, however, about the sustainability of telepsychiatry programs and their long-term success. The goal of this study was to determine current trends in telepsychiatry by completing an extensive literature review and to follow-up with the authors of telepsychiatry research to examine the current status of their programs and success factors or barriers associated with their experiences. Results indicated that modern telepsychiatry programs often target veteran/military or child populations and that many rely on either federal or internal funding. Interestingly, several researchers indicated that they wished to improve current funding mechanisms, while others wished for improvements in the technology used. Implications of these findings for behavioral health researchers are discussed, along with suggestions for improving future telepsychiatry programs.
Collapse
|
7
|
Detweiler MB, Pagadala B, Candelario J, Boyle JS, Detweiler JG, Lutgens BW. Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center. J Clin Med 2016; 5:jcm5120117. [PMID: 27999253 PMCID: PMC5184790 DOI: 10.3390/jcm5120117] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/28/2016] [Accepted: 12/09/2016] [Indexed: 11/17/2022] Open
Abstract
The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0–6.0 mg), clonidine (63%, 0.1–2.0 mg), quetiapine (50%, 12.5–800.0 mg), mirtazapine (50%; 7.5–30.0 mg), and terazosin (64%, 50.0–300.0 mg). Notably, olanzapine (2.5–10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares.
Collapse
Affiliation(s)
- Mark B Detweiler
- Staff Psychiatrist, Veterans Affairs Medical Center, Salem, VA 24153, USA.
- Department Psychiatry, Edward via College of Osteopathic Medicine, Blacksburg, VA 24060, USA.
- Virginia Tech-Carilion Clinic Psychiatry Residency Program, Roanoke, VA 24014, USA.
- Geriatric Research Group, Veterans Affairs Medical Center, Salem, VA 24153, USA.
| | | | - Joseph Candelario
- Geriatric Research Group, Veterans Affairs Medical Center, Salem, VA 24153, USA.
- Emergency Department, Veterans Affairs Medical Center, Salem, VA 24153, USA.
| | - Jennifer S Boyle
- Attending Physician, Veterans Affairs Medical Ce.nter, Syracuse, NY 13210, USA.
| | - Jonna G Detweiler
- Geriatric Research Group, Veterans Affairs Medical Center, Salem, VA 24153, USA.
| | - Brian W Lutgens
- Geriatric Research Group, Veterans Affairs Medical Center, Salem, VA 24153, USA.
| |
Collapse
|
8
|
|