1
|
Trabold N, King PR, Crasta D, Iverson KM, Crane CA, Buckheit K, Bosco SC, Funderburk JS. Leveraging Integrated Primary Care to Enhance the Health System Response to IPV: Moving toward Primary Prevention Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5701. [PMID: 37174219 PMCID: PMC10178447 DOI: 10.3390/ijerph20095701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
Intimate partner violence (IPV) is a prominent public health problem in the United States, with significant health impacts that are often severe and persistent. Healthcare systems have been called upon to improve both the systematic identification and treatment of IPV largely by adopting secondary and tertiary prevention efforts. Research to date demonstrates both benefits and challenges with the current strategies employed. In this paper, we summarize current knowledge about the healthcare system's response to IPV and evaluate the strengths, limitations, and opportunities. We offer recommendations to broaden the continuum of healthcare resources to address IPV, which include a population health approach to primary prevention.
Collapse
Affiliation(s)
- Nicole Trabold
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Rochester Institute of Technology, College of Health Science and Technology, Rochester, NY 14623, USA
| | - Paul R King
- Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY 14215, USA
- Department of Counseling, School, and Educational Psychology, University at Buffalo, Buffalo, NY 14260, USA
| | - Dev Crasta
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY 14424, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Cory A Crane
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Rochester Institute of Technology, College of Health Science and Technology, Rochester, NY 14623, USA
| | - Katherine Buckheit
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
| | - Stephen C Bosco
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
| | - Jennifer S Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| |
Collapse
|
2
|
Grekin R, Zivin K, Hall SV, Van T, Mattocks KM. Predictors of Veterans Affairs Health Service Utilization by Women Veterans during Pregnancy. Womens Health Issues 2020; 30:292-298. [PMID: 32417074 DOI: 10.1016/j.whi.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Researchers have examined predictors of Veterans Affairs (VA) service use by women veterans in general, but less is known about predictors of VA service use by pregnant veterans. This study examined characteristics associated with planned and actual VA service use by pregnant veterans. METHODS This study includes data from 510 pregnant veterans enrolled in the Center for Maternal and Infant Outcomes Research in Translation Study. Women veterans completed phone interviews during their first trimester and at 3 months postpartum. The Center for Maternal and Infant Outcomes Research in Translation surveys assessed medical and mental health conditions, VA health care use, trauma history, and pregnancy complications. We conducted bivariate and multivariable logistic regression models assessing planned and actual use of VA services during pregnancy. RESULTS Lifetime post-traumatic stress disorder (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.11-2.69) and history of military sexual trauma (OR, 1.85; 95% CI, 1.19-2.87) were significantly associated with planned VA service use in multivariable models. Lifetime diagnoses of anxiety (OR, 1.78; C.I., 1.15-2.75) were associated with an increased likelihood of actual VA use during pregnancy, whereas Hispanic ethnicity (OR, 0.59; 95% CI, 0.36-0.96), younger age (OR, 0.95; 95% CI, 0.91-0.99), and access to private health insurance (OR, 0.55; 95% CI, 0.37-0.84) were associated with a decreased likelihood of actual VA service use during pregnancy. CONCLUSIONS Results emphasize the association between high-risk mental health characteristics and specific demographic characteristics with VA service use among pregnant veterans. Study findings highlight a continued need for women's health care at the VA, as well as the availability of VA providers knowledgeable about perinatal health issues, and informed community providers regarding women veterans' health.
Collapse
Affiliation(s)
- Rebecca Grekin
- Ann Arbor VA Healthcare System, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan
| | - Stephanie V Hall
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tony Van
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| |
Collapse
|
3
|
Kroll-Desrosiers AR, Crawford SL, Moore Simas TA, Clark MA, Bastian LA, Mattocks KM. Rates and Correlates of Depression Symptoms in a Sample of Pregnant Veterans Receiving Veterans Health Administration Care. Womens Health Issues 2019; 29:333-340. [PMID: 31105035 DOI: 10.1016/j.whi.2019.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Depression is the most commonly diagnosed medical condition among women veterans ages 18 to 44; however, depression symptoms occurring during pregnancy have not been well-studied in this population. METHODS Pregnant veterans were recruited from 15 Veterans Health Administration sites across the United States; our sample included 501 participants. Sociodemographic characteristics, military service, health status, and pregnancy related factors, as well as the Edinburgh Postnatal Depression Scale (EPDS), were collected as part of a telephone survey. Additional data were obtained from electronic health record data. We used multivariable logistic regression models to examine factors associated with an EPDS score suggestive of clinically significant depressive symptoms (≥10). FINDINGS Prenatal EPDS scores of 10 or greater were calculated for 28% of our sample. Our final model indicated that factors associated with decreased odds of an EPDS score of 10 or greater included spousal or partner support during pregnancy (adjusted odds ratio [aOR], 0.35; 95% confidence interval [CI], 0.16-0.77) and employment (aOR, 0.40; 95% CI, 0.24-0.67). A past diagnosis of anxiety (aOR, 2.54; 95% CI, 1.43-4.50), past antidepressant use (aOR, 3.27; 95% CI, 1.71-6.24), and active duty service (aOR, 1.91; 95% CI, 1.08-3.37) were associated with increased odds of having an EPDS score of 10 or greater. CONCLUSIONS This is the first quantitative estimate of depression symptoms in pregnant veterans across multiple Veterans Affairs facilities. The prevalence of depression symptomology was greater than the high end of prevalence estimates in the general pregnant population. Given that the risk of depression increases during the postpartum period, women who can be identified with depressive symptomatology during pregnancy can be offered critical resources and support before giving birth.
Collapse
Affiliation(s)
- Aimee R Kroll-Desrosiers
- Department of Population and Quantitative Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Sybil L Crawford
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tiffany A Moore Simas
- Department of Population and Quantitative Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Obstetrics & Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Melissa A Clark
- Department of Population and Quantitative Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lori A Bastian
- Division of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Pain Research, Informatics, Multimorbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kristin M Mattocks
- Department of Population and Quantitative Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Research and Development, VA Central Western Massachusetts, Leeds, Massachusetts
| |
Collapse
|
4
|
Lithium and valproate serum level fluctuations within the menstrual cycle: a systematic review. Int Clin Psychopharmacol 2019; 34:143-150. [PMID: 30907774 DOI: 10.1097/yic.0000000000000253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Some women affected by mood disorders experience mood instability during the premenstrual phase. Assuming that fluctuations in drug serum levels may contribute to the worsening of mood symptoms, we carried out a systematic review of available studies that investigated changes in lithium and valproate levels in relation to menstrual phases. We selected five studies; four of which assessed menstrual fluctuations in lithium serum levels and one in valproate levels. Study samples included women in their fertile age affected by bipolar disorder, epilepsy as well as healthy ones. Preliminary results showed a close relationship between cyclic premenstrual exacerbation of affective symptoms and a significant decrease in lithium levels during the luteal phase, despite stable oral doses, in bipolar women. In healthy women, lithium levels were influenced by neither menstrual cycle phases nor oral contraceptives use. Valproate serum levels in epileptic women showed a small, nonsignificant decline during the mid-luteal phase. Pharmacokinetic sex differences in adsorption, volume distribution, hepatic metabolism, and renal excretion of mood stabilizers have been supposed to partly explain such menstrual serum level fluctuations. A better understanding in this field could help to counteract the distress related to premenstrual phase, improving therapeutic management of mood disorders in women.
Collapse
|
5
|
Miller LJ, Ghadiali NY. Mental Health Across the Reproductive Cycle in Women Veterans. Mil Med 2019; 183:e140-e146. [PMID: 29415146 DOI: 10.1093/milmed/usx094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/08/2017] [Indexed: 11/12/2022] Open
Abstract
Introduction Premenstrual, perinatal, and/or perimenopausal psychiatric problems require specific screening, assessment, and treatment strategies. The scope of these reproductive-linked psychiatric symptoms among women veterans is unknown. Due to high rates of sexual trauma among women veterans, it is also important to ascertain relationships between sexual trauma experiences and reproductive cycle mood problems. This pilot study investigates the prevalence of self-reported premenstrual, perinatal, and perimenopausal emotional problems and whether these correlate with pre-military sexual abuse, military sexual harassment, and/or military sexual assault, among veterans receiving psychiatric evaluations within a Veterans Administration Women's Health Clinic. Materials and Methods Participants included all women veterans (N = 186) who received psychiatric evaluations within a Veterans Administration Women's Health Clinic over a 13-mo period. Evaluations included a clinical questionnaire, a psychiatric interview, and medical record review. De-identified data were extracted from a clinical data repository for this descriptive study. Results High proportions of study participants reported emotional problems premenstrually (43.3%), during pregnancy (35.1%), postpartum (30.4%), or during perimenopause (31.2%). Unintended pregnancy (73.3% of pregnancies) and pregnancy loss (56.6% of women who had been pregnant) were prominent perinatal stressors. Military sexual harassment was significantly associated with emotional problems during pregnancy and postpartum. Conclusion These pilot data suggest the need for further study of the reproductive mental health needs of women veterans and their relationship with sexual trauma. The findings underscore the need for Veterans Administration facilities and other providers of veterans' health care to be prepared to detect, diagnose, and treat premenstrual, perinatal, and perimenopausal mental health problems.
Collapse
Affiliation(s)
- Laura J Miller
- Professor of Psychiatry; Loyola University Stritch School of Medicine; Medical Director of Women's Mental Health; Edward Hines Jr. VA Hospital; 5000 S. 5th Ave., Bldg. 228, Rm. 1016; Hines IL 60141
| | - Nafisa Y Ghadiali
- Assistant Professor of Psychiatry; Loyola University Stritch School of Medicine; Women's Mental Health Psychiatrist; Edward Hines Jr. VA Hospital; 5000 S. 5th Ave., Bldg. 228, Rm. 1016; Hines IL 60141
| |
Collapse
|
6
|
Katon JG, Zephyrin L, Meoli A, Hulugalle A, Bosch J, Callegari L, Galvan IV, Gray KE, Haeger KO, Hoffmire C, Levis S, Ma EW, Mccabe JE, Nillni YI, Pineles SL, Reddy SM, Savitz DA, Shaw JG, Patton EW. Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017. Semin Reprod Med 2019; 36:315-322. [PMID: 31003246 DOI: 10.1055/s-0039-1678750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The literature on the reproductive health and healthcare of women Veterans has increased dramatically, though there are important gaps. This article aims to synthesize recent literature on reproductive health and healthcare of women Veterans. We updated a literature search to identify manuscripts published between 2008 and July 1, 2017. We excluded studies that were not original research, only included active-duty women, or had few women Veterans in their sample. Manuscripts were reviewed using a standardized abstraction form. We identified 52 manuscripts. Nearly half (48%) of the new manuscripts addressed contraception and preconception care (n = 15) or pregnancy (n = 10). The pregnancy and family planning literature showed that (1) contraceptive use and unintended pregnancy among women Veterans using VA healthcare is similar to that of the general population; (2) demand for VA maternity care is increasing; and (3) women Veterans using VA maternity care are a high-risk population for adverse pregnancy outcomes. A recurrent finding across topics was that history of lifetime sexual assault and mental health conditions were highly prevalent among women Veterans and associated with a wide variety of adverse reproductive health outcomes across the life course. The literature on women Veterans' reproductive health is rapidly expanding, but remains largely observational. Knowledge gaps persist in the areas of sexually transmitted infections, infertility, and menopause.
Collapse
Affiliation(s)
- Jodie G Katon
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Laurie Zephyrin
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia.,Department of Obstetrics and Gynecology, VA Harbor Medical Center, New York City, New York.,Department of Obstetrics and Gynecology, New York School of Medicine, New York, NY
| | - Anne Meoli
- VHA, SimLEARN National Simulation Center, Orlando, Florida
| | - Avanthi Hulugalle
- New York University College of Global Public Health, New York City, New York
| | - Jeane Bosch
- VA San Diego Healthcare System, San Diego, California
| | - Lisa Callegari
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Ileana V Galvan
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia
| | - Kristen E Gray
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Kristin O Haeger
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia
| | - Claire Hoffmire
- Rocky Mountain MIRECC for Suicide Prevention, VA Eastern Colorado Health Care System, Denver, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
| | - Silvina Levis
- Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Medical Center, Miami, Florida
| | - Erica W Ma
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | | | - Yael I Nillni
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Suzanne L Pineles
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Shivani M Reddy
- VA Boston Healthcare System, Boston, Massachusetts.,Center for Advanced Methods Development, RTI International, Waltham, Massachusetts
| | - David A Savitz
- Department of Epidemiology, Brown University, Providence, Rhode Island
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California.,Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
| | - Elizabeth W Patton
- Division of Gynecology, Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
7
|
Conard PL, Armstrong ML. Nursing Care of Women Veterans of the Iraq and Afghanistan Wars. Nurs Womens Health 2018; 22:158-173. [PMID: 29628055 DOI: 10.1016/j.nwh.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/24/2017] [Indexed: 06/08/2023]
Abstract
The Iraq and Afghanistan wars are unlike earlier wars, and the women veterans who have served in them are unlike veterans of earlier wars. Now these veterans are presenting with distinctive general, genitourinary, reproductive, and behavioral health issues. When seeking health care after deployment, they may be accessing multiple health care providers across numerous sites, including the Veterans Health Administration and civilian facilities. Enhanced levels of understanding, respect, and concern for the many combat-related health challenges experienced by these veterans will help civilian nurses and other clinicians provide optimum care. Provision of health care to women veterans should be multidisciplinary and effectively coordinated among various health care providers and facilities to ensure that their post-deployment health and wellness needs are met.
Collapse
|
8
|
Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, Greer N, Wilt TJ. An Evidence Map of the Women Veterans' Health Research Literature (2008-2015). J Gen Intern Med 2017; 32:1359-1376. [PMID: 28913683 PMCID: PMC5698220 DOI: 10.1007/s11606-017-4152-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/08/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning. METHODS The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps. RESULTS We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials. CONCLUSIONS Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.
Collapse
Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Erin E Krebs
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kristine Ensrud
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eva Koeller
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Tina Velasquez
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Nancy Greer
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Timothy J Wilt
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|