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Khatri UG, Samuels EA, Xiong R, Marshall BDL, Perrone J, Delgado MK. Variation in emergency department visit rates for opioid use disorder: Implications for quality improvement initiatives. Am J Emerg Med 2021; 51:331-337. [PMID: 34800906 DOI: 10.1016/j.ajem.2021.10.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVE Emergency departments (ED) are critical touchpoints for encounters among patients with opioid use disorder (OUD), but implementation of ED initiated treatment and harm reduction programs has lagged. We describe national patient, visit and hospital-level characteristics of ED OUD visits and characterize EDs with high rates of OUD visits in order to inform policies to optimize ED OUD care. METHODS We conducted a descriptive, cross-sectional study with the 2017 Nationwide Emergency Department Sample (NEDS) from the Healthcare Cost and Utilization Project, using diagnostic and mechanism of injury codes from ICD-10 to identify OUD related visits. NEDS weights were applied to generate national estimates. We evaluated ED visit and clinical characteristics of all OUD encounters. We categorized hospitals into quartiles by rate of visits for OUD per 1000 ED visits and described the visit, clinical, and hospital characteristics across the four quartiles. RESULTS In 2017, the weighted national estimate for OUD visits was 1,507,550. Overdoses accounted for 295,954. (19.6%) of visits. OUD visit rates were over 8× times higher among EDs in the highest quartile of OUD visit rate (22.9 per 1000 total ED visits) compared with EDs in the lowest quartile of OUD visit rate (2.7 per 1000 ED visits). Over three fifths (64.2%) of all OUD visits nationwide were seen by the hospitals in the highest quartile of OUD visit rate. These hospitals were predominantly in metropolitan areas (86.2%), over half were teaching hospitals (51.7%), and less than a quarter (23.3%) were Level 1 or Level 2 trauma centers. CONCLUSION Targeting initial efforts of OUD care programs to high OUD visit rate EDs could improve care for a large portion of OUD patients utilizing emergency care.
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Affiliation(s)
- Utsha G Khatri
- National Clinician Scholars Program, Corporal Michael J. Crescenz Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, United States of America; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, United States of America.
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Ruiying Xiong
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Jeanmarie Perrone
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, United States of America; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - M Kit Delgado
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, United States of America; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Perelman School of Medicine, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, United States of America
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2
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Finlay AK, Stimmel M, Blue-Howells J, Rosenthal J, McGuire J, Binswanger I, Smelson D, Harris AHS, Frayne SM, Bowe T, Timko C. Use of Veterans Health Administration Mental Health and Substance Use Disorder Treatment After Exiting Prison: The Health Care for Reentry Veterans Program. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:177-187. [PMID: 26687114 DOI: 10.1007/s10488-015-0708-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Veterans Health Administration (VA) Health Care for Reentry Veterans (HCRV) program links veterans exiting prison with treatment. Among veterans served by HCRV, national VA clinical data were used to describe contact with VA health care, and mental health and substance use disorder diagnoses and treatment use. Of veterans seen for an HCRV outreach visit, 56 % had contact with VA health care. Prevalence of mental health disorders was 57 %; of whom 77 % entered mental health treatment within a month of diagnosis. Prevalence of substance use disorders was 49 %; of whom 37 % entered substance use disorder treatment within a month of diagnosis. For veterans exiting prison, increasing access to VA health care, especially for rural veterans, and for substance use disorder treatment, are important quality improvement targets.
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Affiliation(s)
- Andrea K Finlay
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.
| | - Matthew Stimmel
- Veterans Justice Programs, Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Jessica Blue-Howells
- Veterans Justice Programs, Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Joel Rosenthal
- Veterans Justice Programs, Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Jim McGuire
- Veterans Justice Programs, Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Ingrid Binswanger
- Kaiser Permanente Institute for Health Research, 10065 E. Harvard Avenue, Suite 300, Denver, CO, 80231, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
| | - David Smelson
- National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA, 01730, USA
- Department of Psychiatry, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA, 01655, USA
| | - Alex H S Harris
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Susan M Frayne
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
- Women's Health Service, Medical Service, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
- Division of General Medical Disciplines, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305, USA
| | - Tom Bowe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
| | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305, USA
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3
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Shiner B, Westgate CL, Bernardy NC, Schnurr PP, Watts BV. Trends in Opioid Use Disorder Diagnoses and Medication Treatment Among Veterans With Posttraumatic Stress Disorder. J Dual Diagn 2017; 13:201-212. [PMID: 28481727 PMCID: PMC6190703 DOI: 10.1080/15504263.2017.1325033] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Despite long-standing interest in posttraumatic stress disorder (PTSD) and opioid use disorder comorbidity, there is a paucity of data on the prevalence of opioid use disorder in patients with PTSD. Therefore, there is limited understanding of the use of medications for opioid use disorder in this population. We determined the prevalence of diagnosed opioid use disorder and use of medications for opioid use disorder in a large cohort of patients with PTSD. METHODS We obtained administrative and pharmacy data for veterans who initiated PTSD treatment in the Department of Veterans Affairs (VA) between 2004 and 2013 (N = 731,520). We identified those with a comorbid opioid use disorder diagnosis (2.7%; n = 19,998) and determined whether they received a medication for opioid use disorder in the year following their initial clinical PTSD diagnosis (29.6%; n = 5,913). Using logistic regression, we determined the predictors of receipt of opioid use disorder medications. RESULTS Comorbid opioid use disorder diagnoses increased from 2.5% in 2004 to 3.4% in 2013. Patients with comorbid opioid use disorder used more health services and had more comorbidities than other patients with PTSD. Among patients with PTSD and comorbid opioid use disorder, use of medications for opioid use disorder increased from 22.6% to 35.1% during the same time period. Growth in the use of buprenorphine (2.0% to 22.7%) was accompanied by relative decline in use of methadone (19.3% to 12.7%). Patients who received buprenorphine were younger and more likely to be rural, White, and married. Patients who received methadone were older, urban, unmarried, from racial and ethnic minorities, and more likely to see substance abuse specialists. While use of naltrexone increased (2.8% to 8.6%), most (87%) patients who received naltrexone also had an alcohol use disorder. Controlling for patient factors, there was a substantial increase in the use of buprenorphine, a substantial decrease in the use of methadone, and no change in use of naltrexone across years. CONCLUSIONS Opioid use disorder is an uncommon but increasing comorbidity among patients with PTSD. Patients entering VA treatment for PTSD have their opioid use disorder treated with opioid agonist treatments in large and increasing numbers. There is a need for research both on the epidemiology of opioid use disorder among patients with PTSD and on screening for opioid use disorder.
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Affiliation(s)
- Brian Shiner
- VA Medical Center, 215 North Main St., White River Junction, VT 05009
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd., Hanover, NH 03755
- National Center for PTSD, 215 North Main St., White River Junction, VT 05009
- National Center for Patient Safety, 24 Frank Lloyd Wright Dr., Ann Arbor, MI 48105
| | | | - Nancy C. Bernardy
- National Center for PTSD, 215 North Main St., White River Junction, VT 05009
| | - Paula P. Schnurr
- National Center for PTSD, 215 North Main St., White River Junction, VT 05009
| | - Bradley V. Watts
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd., Hanover, NH 03755
- National Center for Patient Safety, 24 Frank Lloyd Wright Dr., Ann Arbor, MI 48105
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4
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Park BJ, Cho HM, Choi YS, Seo JW. What Is Important in Selecting a Designated Hospital for the Korean Veterans with Hip Fractures? Hip Pelvis 2017; 29:97-103. [PMID: 28611960 PMCID: PMC5465401 DOI: 10.5371/hp.2017.29.2.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose The Korea Veterans Health Service (KVHS) implemented the ‘designated hospital system’ so that veterans can receive prompt medical attention at hospitals near their residences when experience medical emergencies, including hip fractures. We analyzed the hospital-selection process of Korean veterans following a hip fracture. We then evaluated (the validity and considerations) for choosing designated hospitals. Materials and Methods The study population consisted of 183 veteran patients (84 treated at a single veterans hospital and the remaining 99 treated at 39 designated hospitals) who underwent hip fracture between January 2010 and February 2015 in the Honam region of South Korea. The subjects were divided into the ‘nearest group’ (those who chose the hospital closest to their residences) and the ‘non-nearest group’ (those who did not choose the hospital closest to their residences). We compared the age, ambulatory status, combined disease and fracture type, factors that we speculated may impact hospital choice. Results Although the patients had difficulty moving due to hip fractures, 116 (63.4%) patients choose hospitals that were not closest to their residences. Patients with three or more comorbidities (P=0.028) and older ages (P=0.046) were statistically more likely to fall into the non-nearest group. Ambulatory status and fracture type were shown not to significantly impact choice between nearest and non-nearest hospital. Patients in the non-nearest group tended to seek care at larger hospitals. Conclusion Korean veterans with hip fractures tended to seek care at larger hospitals, regardless of distance. We must therefore consider the number of beds and departments when choosing designated hospitals.
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Affiliation(s)
- Bong-Ju Park
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea
| | - Hong-Man Cho
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea
| | - Yong-Suk Choi
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea
| | - Jae-Woong Seo
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea
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5
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West AN, Weeks WB, Charlton ME. Differences Among States in Rural Veterans' Use of VHA and Non-VHA Hospitals. J Rural Health 2017; 33:32-40. [PMID: 26449177 DOI: 10.1111/jrh.12152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE To understand how vouchers for non-VHA care of VHA-enrolled veterans might affect rural enrollees, we determined how much enrollees use VHA and non-VHA inpatient care, and whether this use varies substantially between rural and urban residents depending on state of residence. METHODS For veterans listed in the 2007 VHA enrollment file as living in Arizona, Iowa, Louisiana, Tennessee, Florida, South Carolina, Pennsylvania, or New York, we merged 2004-2007 administrative discharge data for all VHA hospitalizations with all non-VHA hospitalizations listed in state health department or hospital association databases. Within states, rural and urban residents (RUCA-defined) were compared on VHA and non-VHA hospitalization rates, overall and for major diagnostic categories. FINDINGS Non-VHA hospital use was much greater than VHA use, though it also was more variable across states. In states with higher proportions of urban enrollees, use of non-VHA hospitals was lower for small or isolated rural town residents than urban residents; in the more rural states, it was greater. Rural enrollees also used VHA hospitals more than urban enrollees if they lived in the South, but they used VHA hospitals less in other states. Findings were consistent across principal diagnoses, except that in every state, rural veterans were hospitalized less often for mental disorders but more for respiratory diseases. Logistic regressions controlling several covariates consistently showed that very rural enrollees relied on VHA hospitals more than urban enrollees. Vouchers would likely increase non-VHA use more in states with greater rural populations. CONCLUSIONS Vouchers for non-VHA inpatient care might have greater impact in rural states.
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Affiliation(s)
- Alan N West
- Research Service, VA Medical Center, White River Junction, Vermont.,Geisel Medical School, Hanover, New Hampshire.,Veterans Rural Health Resource Center - Eastern Region, White River Junction, Vermont
| | - William B Weeks
- Geisel Medical School, Hanover, New Hampshire.,The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
| | - Mary E Charlton
- Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City, Iowa.,Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa
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6
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Rongey C, Shen H, Hamilton N, Backus LI, Asch SM, Knight S. Impact of rural residence and health system structure on quality of liver care. PLoS One 2013; 8:e84826. [PMID: 24386420 PMCID: PMC3873451 DOI: 10.1371/journal.pone.0084826] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/21/2013] [Indexed: 02/07/2023] Open
Abstract
Background Specialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV) becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We sought to determine the influence of rural residency on access to HCV specialists and quality of liver care. Methods The study used a national cohort of 151,965 Veterans Health Administration (VHA) patients with HCV starting in 2005 and followed to 2009. The VHA’s constant national benefit structure reduces the impact of insurance as an explanation for observed disparities. Multivariate cox proportion regression models for each quality indicator were performed. Results Thirty percent of VHA patients with HCV reside in rural and highly rural areas. Compared to urban residents, highly rural (HR 0.70, CI 0.65-0.75) and rural (HR 0.96, CI 0.94-0.97) residents were significantly less likely to access HCV specialty care. The quality indicators were more mixed. While rural residents were less likely to receive HIV screening, there were no significant differences in hepatitis vaccinations, endoscopic variceal and hepatocellular carcinoma screening between the geographic subgroups. Of note, highly rural (HR 1.31, CI 1.14-1.50) and rural residents (HR 1.06, CI 1.02-1.10) were more likely to receive HCV therapy. Of those treated for HCV, a third received therapy from a non-specialist provider. Conclusion Rural patients have less access to HCV specialists, but this does not necessarily translate to quality deficits. The VHA's efforts to improve specialty care access, rural patient behavior and decentralization of HCV therapy beyond specialty providers may explain this contradiction. Lessons learned within the VHA are critical for US healthcare systems restructuring into accountable care organizations that acquire features of integrated systems.
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Affiliation(s)
- Catherine Rongey
- Department of Medicine, Veterans Affairs Medical Center and University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Hui Shen
- Department of Biostatics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America
| | - Nathan Hamilton
- Department of Biostatics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America
| | - Lisa I. Backus
- Department of Medicine, Veterans Affairs Medical Center, Palo Alto, California, United States of America
- Office of Public Health and Population Health, Department of Veterans Affairs, Washington, District of Columbia, United States of America
| | - Steve M. Asch
- Department of Medicine, Veterans Affairs Medical Center, Palo Alto, California, United States of America
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Sara Knight
- Departments of Psychiatry and Urology, Veterans Affairs Medical Center, San Francisco, California, United States of America
- Office of Research and Development, Department of Veterans Affairs, Washington, District of Columbia, United States of America
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7
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Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation. Transl Behav Med 2013; 1:644-51. [PMID: 24073089 DOI: 10.1007/s13142-011-0098-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The Veterans Health Administration (VHA) is the largest single provider of medical care to people with hepatitis C (HCV) in the USA. Given the advent of promising new HCV therapies, the VHA is now faced with a large number of chronically HCV-infected veterans with concomitant psychiatric or substance use comorbid conditions who will need to either be retreated or newly treated for HCV or will require management for chronic liver disease. There is a critical need in the VHA for behavioral medicine and hepatology specialists, along with infectious disease and primary care providers with an interest in hepatitis C, to provide coordinated care for these complex patients. The VHA Health Services Research and Development Service has advocated for the application of strong implementation science theories and methods to translate new models of healthcare delivery in clinical practice. To inform the delivery and evaluation of integrated behavioral medicine and specialty care for vulnerable patient populations, we sought to develop an enriched framework which incorporates implementation science theory and strong conceptual models for access to care. In this paper, we present a hybrid conceptual framework that accomplishes this goal. To illustrate how this hybrid model could inform the translation of a novel method of healthcare delivery, we provide a case study of a VHA initiative to improve access to integrated behavioral medicine and specialty care among veterans with HCV.
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Richardson KK, Cram P, Vaughan-Sarrazin M, Kaboli PJ. Fee-based care is important for access to prompt treatment of hip fractures among veterans. Clin Orthop Relat Res 2013; 471:1047-53. [PMID: 23322188 PMCID: PMC3563825 DOI: 10.1007/s11999-013-2783-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 01/02/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip fracture is a medical emergency for which delayed treatment increases risk of disability and death. In emergencies, veterans without access to a Veterans Administration (VA) hospital may be admitted to non-VA hospitals under fee-based (NVA-FB) care paid by the VA. The affect of NVA-FB care for treatment and outcomes of hip fractures is unknown. QUESTIONS/PURPOSES This research seeks to answer three questions: (1) What patient characteristics determine use of VA versus NVA-FB hospitals for hip fracture? (2) Does time between admission and surgery differ by hospital (VA versus NVA-FB)? (3) Does mortality differ by hospital? METHODS Veterans admitted for hip fractures to VA (n = 9308) and NVA-FB (n = 1881) hospitals from 2003 to 2008 were identified. Primary outcomes were time to surgery and death. Logistic regression identified patient characteristics associated with NVA-FB hospital admissions; differences in time to surgery and death were evaluated using Cox proportional hazards regression, controlling for patient covariates. RESULTS Patients admitted to NVA-FB hospitals were more likely to be younger, have service-connected disabilities, and live more than 50 miles from a VA hospital. Median days to surgery were less for NVA-FB admissions compared with VA admissions (1 versus 3 days, respectively). NVA-FB admissions were associated with 21% lower relative risk of death within 1 year compared with VA hospital admissions. CONCLUSIONS For veterans with hip fractures, NVA-FB hospital admission was associated with shorter time to surgery and lower 1-year mortality. These findings suggest fee-based care, especially for veterans living greater distances from VA hospitals, may improve access to care and health outcomes. LEVEL OF EVIDENCE Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kelly K. Richardson
- Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USA ,Veterans Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, Iowa City, IA USA
| | - Peter Cram
- Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USA ,Veterans Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, Iowa City, IA USA ,University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Mary Vaughan-Sarrazin
- Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USA ,Veterans Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, Iowa City, IA USA ,University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Peter J. Kaboli
- Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USA ,Veterans Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, Iowa City, IA USA ,University of Iowa Carver College of Medicine, Iowa City, IA USA
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9
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Chambers RA. The Addiction Psychiatrist as Dual Diagnosis Physician: A Profession in Great Need and Greatly Needed. J Dual Diagn 2013; 9:10.1080/15504263.2013.807072. [PMID: 24223531 PMCID: PMC3819106 DOI: 10.1080/15504263.2013.807072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Addiction is the number one cause of premature illness and death in the U.S., especially among people with mental illness. Yet American medicine lacks sufficient workforce capacity, expertise, training, infrastructure, and research to support treatment for people with co-occurring addictions and mental illness. This essay argues that the addiction psychiatrist is essential in dual diagnosis care.
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Affiliation(s)
- R Andrew Chambers
- Lab for Translational Neuroscience of Dual Diagnosis & Development, Department of Psychiatry, Indiana University School of Medicine, Institute of Psychiatric Research, 791 Union Drive, Indianapolis, IN 46202, USA,
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10
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MacKenzie TA, Wallace AE, Weeks WB. Impact of Rural Residence on Survival of Male Veterans Affairs Patients After Age 65. J Rural Health 2010; 26:318-24. [DOI: 10.1111/j.1748-0361.2010.00300.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Wallace AE, Lee R, MacKenzie TA, West AN, Wright S, Booth BM, Hawthorne K, Weeks WB. A Longitudinal Analysis of Rural and Urban Veterans’ Health-Related Quality of Life. J Rural Health 2010; 26:156-63. [DOI: 10.1111/j.1748-0361.2010.00277.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Moore RS, Annechino RM, Lee JP. Unintended consequences of smoke-free bar policies for low-SES women in three California counties. Am J Prev Med 2009; 37:S138-43. [PMID: 19591753 PMCID: PMC2730500 DOI: 10.1016/j.amepre.2009.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 03/03/2009] [Accepted: 05/05/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND To amplify earlier studies of unintended consequences of public policies, this article illustrates both negative and positive unanticipated consequences of smoke-free workplace policies in California bars for women of low SES. METHODS The article relies on thematic analysis in 2008 of qualitative data gathered between 2001 and 2007 from three mixed-method studies of tobacco use in and around bars where indoor smoking is prohibited. RESULTS Unanticipated consequences primarily occurred when bars did comply with the law and smokers went outside the bar to smoke, particularly when smokers stood on the street outside the bar. Key negative consequences for women who smoked outside of bars included threats to their physical safety and their public image. For women living near bars, increased smoking on the street may have increased their exposure to secondhand smoke and disruptive noise. For some women, however, unanticipated negative consequences were identified with noncompliant bars. Smokers were conjectured to congregate in the smaller number of bars where smoking was still allowed, resulting in increased exposure to secondhand smoke for low-SES women working in these bars. A common positive unintended consequence of the tobacco control ordinance was increased social circulation and solidarity, as smokers gathered outside bars to smoke. CONCLUSIONS Smoke-free workplace laws in bars can have both negative and positive consequences for workers and smokers, and low-income women in particular.
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Affiliation(s)
- Roland S Moore
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA.
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13
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Weeks WB, Wallace AE, West AN, Heady HR, Hawthorne K. Research on Rural Veterans: An Analysis of the Literature. J Rural Health 2008; 24:337-44. [DOI: 10.1111/j.1748-0361.2008.00179.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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14
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Comparing the Characteristics, Utilization, Efficiency, and Outcomes of VA and Non-VA Inpatient Care Provided to VA Enrollees. Med Care 2008; 46:863-71. [DOI: 10.1097/mlr.0b013e31817d92e1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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West AN, Weeks WB, Wallace AE. Rural veterans and access to high-quality care for high-risk surgeries. Health Serv Res 2008; 43:1737-51. [PMID: 18665855 DOI: 10.1111/j.1475-6773.2008.00876.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To determine whether older Veterans Health Administration (VA) health care enrollees obtain most high-risk surgeries in non-VA hospitals under Medicare, whether residence in less populous areas increases this reliance on non-VA care or the likelihood of obtaining it in hospitals with higher mortality rates, and whether directing VA enrollees to better hospitals would add a substantial travel burden. DATA SOURCES VA and Medicare hospital discharge data from 2000 and 2001 for VA enrollees 65 years or older who received any of 14 high-risk elective procedures, including heart, vascular, and cancer surgeries. STUDY DESIGN/DATA EXTRACTION: We compared urban, suburban, and rural patients on use of VA versus non-VA hospitals, use of non-VA hospitals of higher versus lower mortality rates, travel times to get to these hospitals, and the additional travel burden if they had gone to lower mortality hospitals. PRINCIPAL FINDINGS Regardless of residence, VA enrollees obtained most high-risk surgeries in non-VA hospitals. Urban veterans were most likely to get heart or cancer surgeries in lower mortality hospitals, but rural veterans were most likely to get vascular surgeries in lower mortality hospitals. Average travel times to lower or higher mortality hospitals did not differ greatly. CONCLUSIONS Accessing better hospitals need not add a great travel burden for rural veterans.
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Affiliation(s)
- Alan N West
- VA Outcomes Group Research Enhancement Award Program, Veterans Affairs Medical Center, White River Junction, VT 05009, USA
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Carey K, Montez-Rath ME, Rosen AK, Christiansen CL, Loveland S, Ettner SL. Use of VA and Medicare services by dually eligible veterans with psychiatric problems. Health Serv Res 2008; 43:1164-83. [PMID: 18355256 DOI: 10.1111/j.1475-6773.2008.00840.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine how service accessibility measured by geographic distance affects service sector choices for veterans who are dually eligible for veterans affairs (VA) and Medicare services and who are diagnosed with mental health and/or substance abuse (MH/SA) disorders. DATA SOURCES Primary VA data sources were the Patient Treatment (acute care), Extended Care (long-term care), and Outpatient Clinic files. VA cost data were obtained from (1) inpatient and outpatient cost files developed by the VA Health Economics and Resource Center and (2) outpatient VA Decision Support System files. Medicare data sources were the denominator, Medicare Provider Analysis Review (MEDPAR), Provider-of-Service, Outpatient Standard Analytic and Physician/Supplier Standard Analytic files. Additional sources included the Area Resource File and Census Bureau data. STUDY DESIGN We identified dually eligible veterans who had either an inpatient or outpatient MH/SA diagnosis in the VA system during fiscal year (FY)'99. We then estimated one- and two-part regression models to explain the effects of geographic distance on both VA and Medicare total and MH/SA costs. PRINCIPAL FINDINGS Results provide evidence for substitution between the VA and Medicare, demonstrating that poorer geographic access to VA inpatient and outpatient clinics decreased VA expenditures but increased Medicare expenditures, while poorer access to Medicare-certified general and psychiatric hospitals decreased Medicare expenditures but increased VA expenditures. CONCLUSIONS As geographic distance to VA medical facility increases, Medicare plays an increasingly important role in providing mental health services to veterans.
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Affiliation(s)
- Kathleen Carey
- VA Center for Health Quality, Outcomes and Economic Research and, Boston University School of Public Health, 200 Springs Road, Bedford, MA 01730, USA.
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