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Chen JI, Bui D, Iwashyna TJ, Shahoumian TA, Hickok A, Shepherd-Banigan M, Hawkins EJ, Naylor J, Govier DJ, Osborne TF, Smith VA, Bowling CB, Boyko EJ, Ioannou GN, Maciejewski ML, O'Hare AM, Viglianti EM, Bohnert ASB, Hynes DM. Correction to: Impact of SARS-CoV-2 Infection on Long-Term Depression Symptoms among Veterans. J Gen Intern Med 2024:10.1007/s11606-024-08800-z. [PMID: 38743168 DOI: 10.1007/s11606-024-08800-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Jason I Chen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA.
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| | - David Bui
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Theodore J Iwashyna
- Departments of Medicine and Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
| | | | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Eric J Hawkins
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound HCS, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer Naylor
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Durham VA HCS, Durham, NC, USA
| | - Diana J Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- OHSU-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Thomas F Osborne
- VA Palo Alto HCS, Palo Alto, CA, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - C Barrett Bowling
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Durham VA Geriatric Research Education and Clinical Center, Durham VA HCS, Durham, NC, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research Information Center, VA Puget Sound HCS, Seattle, WA, USA
| | - George N Ioannou
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ann M O'Hare
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Hospital and Specialty Medicine Service, VA Puget Sound HCS, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Elizabeth M Viglianti
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy S-B Bohnert
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Denise M Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- College of Public Health and Human Sciences, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA
- School of Nursing, Oregon Health & Science University (OHSU), Portland, OR, USA
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Govier DJ, Gilbert TA, Jacob RL, Lafferty M, Mulcahy A, Pogoda TK, Zogas A, O’Neil ME, Pugh MJ, Carlson KF. Prevalence and Correlates of VA-Purchased Community Care Use Among Post-9/11-Era Veterans With Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:207-217. [PMID: 38709829 PMCID: PMC11074530 DOI: 10.1097/htr.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Post-9/11-era veterans with traumatic brain injury (TBI) have greater health-related complexity than veterans overall, and may require coordinated care from TBI specialists such as those within the Department of Veterans Affairs (VA) healthcare system. With passage of the Choice and MISSION Acts, more veterans are using VA-purchased care delivered by community providers who may lack TBI training. We explored prevalence and correlates of VA-purchased care use among post-9/11 veterans with TBI. SETTING Nationwide VA-purchased care from 2016 through 2019. PARTICIPANTS Post-9/11-era veterans with clinician-confirmed TBI based on VA's Comprehensive TBI Evaluation (N = 65 144). DESIGN This was a retrospective, observational study. MAIN MEASURES Proportions of veterans who used VA-purchased care and both VA-purchased and VA-delivered outpatient care, overall and by study year. We employed multivariable logistic regression to assess associations between veterans' sociodemographic, military history, and clinical characteristics and their likelihood of using VA-purchased care from 2016 through 2019. RESULTS Overall, 51% of veterans with TBI used VA-purchased care during the study period. Nearly all who used VA-purchased care (99%) also used VA-delivered outpatient care. Veterans' sociodemographic, military, and clinical characteristics were associated with their likelihood of using VA-purchased care. Notably, in adjusted analyses, veterans with moderate/severe TBI (vs mild), those with higher health risk scores, and those diagnosed with posttraumatic stress disorder, depression, anxiety, substance use disorders, or pain-related conditions had increased odds of using VA-purchased care. Additionally, those flagged as high risk for suicide also had higher odds of VA-purchased care use. CONCLUSIONS Veterans with TBI with greater health-related complexity were more likely to use VA-purchased care than their less complex counterparts. The risks of potential care fragmentation across providers versus the benefits of increased access to care are unknown. Research is needed to examine health and functional outcomes among these veterans.
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Affiliation(s)
- Diana J. Govier
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
- Oregon Health & Science University – Portland State University School of Public Health, Portland, OR
| | - Tess A. Gilbert
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
| | - R. Lorie Jacob
- Center of Innovation for Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL
| | - Megan Lafferty
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
| | - Abby Mulcahy
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
- Oregon Health & Science University – Portland State University School of Public Health, Portland, OR
| | - Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
- Boston University School of Public Health, Boston, MA
| | - Anna Zogas
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
- Boston University Chobanian & Avedisian School of Medicine Section of General Internal Medicine, Boston, MA
| | - Maya E. O’Neil
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
- Oregon Health & Science University, Portland, OR
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT
- University of Utah, Salt Lake City, UT
| | - Kathleen F. Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
- Oregon Health & Science University – Portland State University School of Public Health, Portland, OR
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Chen JI, Bui D, Iwashyna TJ, Shahoumian TA, Hickok A, Shepherd-Banigan M, Hawkins EJ, Naylor J, Govier DJ, Osborne TF, Smith VA, Bowling CB, Boyko EJ, Ioannou GN, Maciejewski ML, O'Hare AM, Viglianti EM, Bohnert ASB, Hynes DM. Impact of SARS-CoV-2 Infection on Long-Term Depression Symptoms among Veterans. J Gen Intern Med 2024:10.1007/s11606-024-08630-z. [PMID: 38625482 DOI: 10.1007/s11606-024-08630-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/11/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Prior research demonstrates that SARS-COV-2 infection can be associated with a broad range of mental health outcomes including depression symptoms. Veterans, in particular, may be at elevated risk of increased depression following SARS-COV-2 infection given their high rates of pre-existing mental and physical health comorbidities. However, few studies have tried to isolate SARS-COV-2 infection associations with long term, patient-reported depression symptoms from other factors (e.g., physical health comorbidities, pandemic-related stress). OBJECTIVE To evaluate the association between SARS-COV-2 infection and subsequent depression symptoms among United States Military Veterans. DESIGN Survey-based non-randomized cohort study with matched comparators. PARTICIPANTS A matched-dyadic sample from a larger, stratified random sample of participants with and without known to SARS-COV-2 infection were invited to participate in a survey evaluating mental health and wellness 18-months after their index infection date. Sampled participants were stratified by infection severity of the participant infected with SARS-COV-2 (hospitalized or not) and by month of index date. A total of 186 participants in each group agreed to participate in the survey and had sufficient data for inclusion in analyses. Those in the uninfected group who were later infected were excluded from analyses. MAIN MEASURES Participants were administered the Patient Health Questionnaire-9 as part of a phone interview survey. Demographics, physical and mental health comorbidities were extracted from VHA administrative data. KEY RESULTS Veterans infected with SARS-COV-2 had significantly higher depression symptoms scores compared with those uninfected. In particular, psychological symptoms (e.g., low mood, suicidal ideation) scores were elevated relative to the comparator group (MInfected = 3.16, 95%CI: 2.5, 3.8; MUninfected = 1.96, 95%CI: 1.4, 2.5). Findings were similar regardless of history of depression. CONCLUSION SARS-COV-2 infection was associated with more depression symptoms among Veterans at 18-months post-infection. Routine evaluation of depression symptoms over time following SARS-COV-2 infection is important to facilitate adequate assessment and treatment.
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Affiliation(s)
- Jason I Chen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA.
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| | - David Bui
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Theodore J Iwashyna
- Departments of Medicine and Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
| | | | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Eric J Hawkins
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound HCS, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer Naylor
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Durham VA HCS, Durham, NC, USA
| | - Diana J Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- OHSU-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Thomas F Osborne
- VA Palo Alto HCS, Palo Alto, CA, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - C Barrett Bowling
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Durham VA Geriatric Research Education and Clinical Center, Durham VA HCS, Durham, NC, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research Information Center, VA Puget Sound HCS, Seattle, WA, USA
| | - George N Ioannou
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ann M O'Hare
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Hospital and Specialty Medicine Service, VA Puget Sound HCS, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Elizabeth M Viglianti
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy S-B Bohnert
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Denise M Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- College of Public Health and Human Sciences, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA
- School of Nursing, Oregon Health & Science University (OHSU), Portland, OR, USA
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Govier DJ, Niederhausen M, Takata Y, Hickok A, Rowneki M, McCready H, Smith VA, Osborne TF, Boyko EJ, Ioannou GN, Maciejewski ML, Viglianti EM, Bohnert ASB, O’Hare AM, Iwashyna TJ, Hynes DM. Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection. JAMA Netw Open 2024; 7:e245786. [PMID: 38598237 PMCID: PMC11007577 DOI: 10.1001/jamanetworkopen.2024.5786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/11/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Research demonstrates that SARS-CoV-2 infection is associated with increased risk of all-cause hospitalization. However, no prior studies have assessed the association between SARS-CoV-2 and potentially preventable hospitalizations-that is, hospitalizations for conditions that can usually be effectively managed in ambulatory care settings. Objective To examine whether SARS-CoV-2 is associated with potentially preventable hospitalization in a nationwide cohort of US veterans. Design, Setting, and Participants This cohort study used an emulated target randomized trial design with monthly sequential trials to compare risk of a potentially preventable hospitalization among veterans with SARS-CoV-2 and matched comparators without SARS-CoV-2. A total of 189 136 US veterans enrolled in the Veterans Health Administration (VHA) who were diagnosed with SARS-CoV-2 between March 1, 2020, and April 30, 2021, and 943 084 matched comparators were included in the analysis. Data were analyzed from May 10, 2023, to January 26, 2024. Exposure SARS-CoV-2 infection. Main Outcomes and Measures The primary outcome was a first potentially preventable hospitalization in VHA facilities, VHA-purchased community care, or Medicare fee-for-service care. Extended Cox models were used to examine adjusted hazard ratios (AHRs) of potentially preventable hospitalization among veterans with SARS-CoV-2 and comparators during follow-up periods of 0 to 30, 0 to 90, 0 to 180, and 0 to 365 days. The start of follow-up was defined as the date of each veteran's first positive SARS-CoV-2 diagnosis, with the same index date applied to their matched comparators. Results The 1 132 220 participants were predominantly men (89.06%), with a mean (SD) age of 60.3 (16.4) years. Most veterans were of Black (23.44%) or White (69.37%) race. Veterans with SARS-CoV-2 and comparators were well-balanced (standardized mean differences, all <0.100) on observable baseline clinical and sociodemographic characteristics. Overall, 3.10% of veterans (3.81% of those with SARS-CoV-2 and 2.96% of comparators) had a potentially preventable hospitalization during 1-year follow-up. Risk of a potentially preventable hospitalization was greater among veterans with SARS-CoV-2 than comparators in 4 follow-up periods: 0- to 30-day AHR of 3.26 (95% CI, 3.06-3.46); 0- to 90-day AHR of 2.12 (95% CI, 2.03-2.21); 0- to 180-day AHR of 1.69 (95% CI, 1.63-1.75); and 0- to 365-day AHR of 1.44 (95% CI, 1.40-1.48). Conclusions and Relevance In this cohort study, an increased risk of preventable hospitalization in veterans with SARS-CoV-2, which persisted for at least 1 year after initial infection, highlights the need for research on ways in which SARS-CoV-2 shapes postinfection care needs and engagement with the health system. Solutions are needed to mitigate preventable hospitalization after SARS-CoV-2.
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Affiliation(s)
- Diana J. Govier
- Center to Improve Veteran Involvement in Care, Veterans Affairs (VA) Portland Health Care System, Portland, Oregon
- Oregon Health & Science University–Portland State University School of Public Health, Portland
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care, Veterans Affairs (VA) Portland Health Care System, Portland, Oregon
- Oregon Health & Science University–Portland State University School of Public Health, Portland
| | - Yumie Takata
- College of Health, Oregon State University, Corvallis
| | - Alex Hickok
- Center to Improve Veteran Involvement in Care, Veterans Affairs (VA) Portland Health Care System, Portland, Oregon
| | - Mazhgan Rowneki
- Center to Improve Veteran Involvement in Care, Veterans Affairs (VA) Portland Health Care System, Portland, Oregon
| | - Holly McCready
- Center to Improve Veteran Involvement in Care, Veterans Affairs (VA) Portland Health Care System, Portland, Oregon
| | - Valerie A. Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, VA Durham Health Care System, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Thomas F. Osborne
- VA Palo Alto Health Care System, Palo Alto, California
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Edward J. Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington
| | - George N. Ioannou
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle
| | - Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, VA Durham Health Care System, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Elizabeth M. Viglianti
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Amy S. B. Bohnert
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Ann M. O’Hare
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington
- Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, Washington
- Division of Nephrology, Department of Medicine, University of Washington, Seattle
| | - Theodore J. Iwashyna
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, University of Michigan Medical School, Ann Arbor
- School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Denise M. Hynes
- Center to Improve Veteran Involvement in Care, Veterans Affairs (VA) Portland Health Care System, Portland, Oregon
- College of Health, Oregon State University, Corvallis
- Center for Quantitative Life Sciences, Oregon State University, Corvallis, Oregon
- School of Nursing, Oregon Health & Science University, Portland
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5
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Hynes DM, Niederhausen M, Chen JI, Shahoumian TA, Rowneki M, Hickok A, Shepherd-Banigan M, Hawkins EJ, Naylor J, Teo A, Govier DJ, Berry K, McCready H, Osborne TF, Wong E, Hebert PL, Smith VA, Bowling CB, Boyko EJ, Ioannou GN, Iwashyna TJ, Maciejewski ML, O'Hare AM, Viglianti EM, Bohnert ASB. Risk of Suicide-Related Outcomes After SARS-COV-2 Infection: Results from a Nationwide Observational Matched Cohort of US Veterans. J Gen Intern Med 2024; 39:626-635. [PMID: 37884839 DOI: 10.1007/s11606-023-08440-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Negative mental health-related effects of SARS-COV-2 infection are increasingly evident. However, the impact on suicide-related outcomes is poorly understood, especially among populations at elevated risk. OBJECTIVE To determine risk of suicide attempts and other self-directed violence (SDV) after SARS-COV-2 infection in a high-risk population. DESIGN We employed an observational design supported by comprehensive electronic health records from the Veterans Health Administration (VHA) to examine the association of SARS-COV-2 infection with suicide attempts and other SDV within one year of infection. Veterans with SARS-COV-2 infections were matched 1:5 with non-infected comparators each month. Three periods after index were evaluated: days 1-30, days 31-365, and days 1-365. PARTICIPANTS VHA patients infected with SARS-COV-2 between March 1, 2020 and March 31, 2021 and matched non-infected Veteran comparators. MAIN MEASURES Suicide attempt and other SDV events for the COVID-19 and non-infected comparator groups were analyzed using incidence rates per 100,000 person years and hazard ratios from Cox regressions modeling time from matched index date to first event. Subgroups were also examined. KEY RESULTS 198,938 veterans with SARS-COV-2 (COVID-19 group) and 992,036 comparators were included. Unadjusted one-year incidence per 100,000 for suicide attempt and other SDV was higher among the COVID-19 group: 355 vs 250 and 327 vs 235, respectively. The COVID-19 group had higher risk than comparators for suicide attempts: days 1-30 hazard ratio (HR) = 2.54 (CI:2.05, 3.15), days 31-365 HR = 1.30 (CI:1.19, 1.43) and days 1-365 HR = 1.41 (CI:1.30, 1.54), and for other SDV: days 1-30 HR = 1.94 (CI:1.51, 2.49), days 31-365 HR = 1.32 (CI:1.20, 1.45) and days 1-365 HR = 1.38 (CI:1.26, 1.51). CONCLUSIONS COVID-19 patients had higher risks of both suicide attempts and other forms of SDV compared to uninfected comparators, which persisted for at least one year after infection. Results support suicide risk screening of those infected with SARS-COV-2 to identify opportunities to prevent self-harm.
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Affiliation(s)
- Denise M Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA.
- College of Health, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA.
- School of Nursing, Oregon Health & Science University (OHSU), Portland, OR, USA.
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- OHSU-Portland State University School of Public Health, OHSU, Portland, OR, USA
| | - Jason I Chen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- Department of Psychiatry, OHSU, Portland, OR, USA
| | | | - Mazhgan Rowneki
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Eric J Hawkins
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound HCS, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer Naylor
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Education and Clinical Center, VISN 6 Mental Illness Research, Durham, NC, USA
- Durham VA HCS, Durham, NC, USA
| | - Alan Teo
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- Department of Psychiatry, OHSU, Portland, OR, USA
| | - Diana J Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- OHSU-Portland State University School of Public Health, OHSU, Portland, OR, USA
| | - Kristin Berry
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
| | - Holly McCready
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- Department of Psychiatry, OHSU, Portland, OR, USA
| | - Thomas F Osborne
- VA Palo Alto HCS, Palo Alto, CA, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Edwin Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
| | - Paul L Hebert
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - C Barrett Bowling
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Durham VA Geriatric Research Education and Clinical Center, Durham VA HCS, Durham, NC, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research Information Center, VA Puget Sound HCS, Seattle, WA, USA
| | - George N Ioannou
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Theodore J Iwashyna
- Departments of Medicine and Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ann M O'Hare
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Hospital and Specialty Medicine Service, VA Puget Sound HCS, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Elizabeth M Viglianti
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy S-B Bohnert
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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Hebert PL, Kumbier KE, Smith VA, Hynes DM, Govier DJ, Wong E, Kaufman BG, Shepherd-Banigan M, Rowneki M, Bohnert ASB, Ioannou GN, Boyko EJ, Iwashyna TJ, O’Hare AM, Bowling CB, Viglianti EM, Maciejewski ML. Changes in Outpatient Health Care Use After COVID-19 Infection Among Veterans. JAMA Netw Open 2024; 7:e2355387. [PMID: 38334995 PMCID: PMC10858406 DOI: 10.1001/jamanetworkopen.2023.55387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/18/2023] [Indexed: 02/10/2024] Open
Abstract
Importance The association of COVID-19 infection with outpatient care utilization is unclear. Many studies reported population surveillance studies rather than comparing outpatient health care use between COVID-19-infected and uninfected cohorts. Objective To compare outpatient health care use across 6 categories of care (primary care, specialty care, surgery care, mental health, emergency care, and diagnostic and/or other care) between veterans with or without COVID-19 infection. Design, Setting, and Participants In a retrospective cohort study of Veterans Affairs primary care patients, veterans with COVID-19 infection were matched to a cohort of uninfected veterans. Data were obtained from the Veterans Affairs Corporate Data Warehouse and the Centers for Medicare & Medicaid Services Fee-for-Service Carrier/Physician Supplier file from January 2019 through December 2022. Data analysis was performed from September 2022 to April 2023. Exposure COVID-19 infection. Main Outcomes and Measures The primary outcome was the count of outpatient visits after COVID-19 infection. Negative binomial regression models compared outpatient use over a 1-year preinfection period, and peri-infection (0-30 days), intermediate (31-183 days), and long-term (184-365 days) postinfection periods. Results The infected (202 803 veterans; mean [SD] age, 60.5 [16.2] years; 178 624 men [88.1%]) and uninfected (202 803 veterans; mean [SD] age, 60.4 [16.5] years; 178 624 men [88.1%]) cohorts were well matched across all covariates. Outpatient use in all categories (except surgical care) was significantly elevated during the peri-infection period for veterans with COVID-19 infection compared with the uninfected cohort, with an increase in all visits of 5.12 visits per 30 days (95% CI, 5.09-5.16 visits per 30 days), predominantly owing to primary care visits (increase of 1.86 visits per 30 days; 95% CI, 1.85-1.87 visits per 30 days). Differences in outpatient use attenuated over time but remained statistically significantly higher at 184 to 365 days after infection (increase of 0.25 visit per 30 days; 95% CI, 0.23-0.27 visit per 30 days). One-half of the increased outpatient visits were delivered via telehealth. The utilization increase was greatest for veterans aged 85 years and older (6.1 visits, 95% CI, 5.9-6.3 visits) vs those aged 20 to 44 years (4.8 visits, 95% CI, 4.7-4.8 visits) and unvaccinated veterans (4.5 visits, 95% CI, 4.3-4.6 visits) vs vaccinated veterans (3.2 visits; 95% CI, 3.4-4.8 visits). Conclusions and Relevance This study found that outpatient use increased significantly in the month after infection, then attenuated but remained greater than the uninfected cohorts' use through 12 months, which suggests that there are sustained impacts of COVID-19 infection.
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Affiliation(s)
- Paul L. Hebert
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington School of Medicine, Seattle
| | - Kyle E. Kumbier
- VA Health Services Research & Development, Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Valerie A. Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Denise M. Hynes
- Center of Innovation to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
- Health Management and Policy, Health Data and Informatics Program, Center for Quantitative Life Sciences, College of Health, Oregon State University, Corvallis
| | - Diana J. Govier
- Center of Innovation to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
- School of Nursing, Oregon Health & Science University, Portland
| | - Edwin Wong
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington School of Medicine, Seattle
| | - Brystana G. Kaufman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Durham, North Carolina
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Durham, North Carolina
| | - Mazhgan Rowneki
- Center of Innovation to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Amy S. B. Bohnert
- VA Health Services Research & Development, Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Anesthesiology, University of Michigan, Ann Arbor
| | - George N. Ioannou
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Division of Gastroenterology, University of Washington, Seattle
| | - Edward J. Boyko
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle
| | - Theodore J. Iwashyna
- VA Health Services Research & Development, Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
- School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Ann M. O’Hare
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle
| | - C. Barrett Bowling
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Elizabeth M. Viglianti
- VA Health Services Research & Development, Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
| | - Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- School of Nursing, Oregon Health & Science University, Portland
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Govier DJ, Than CT, Chawla N, Mulcahy AC, Hoggatt KJ, Yano EM, Hynes DM. Veterans Health Administration Healthcare Coverage and Medical Financial Hardship in Low-Income Veterans. Am J Prev Med 2023; 65:406-416. [PMID: 36906192 DOI: 10.1016/j.amepre.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/13/2023]
Abstract
INTRODUCTION The Veterans Health Administration (VA) provides low- to no-cost care to enrolled veterans with low incomes. This study assessed the associations between VA coverage and medical financial hardship among U.S. veterans with low incomes. METHODS Using 2015-2018 National Health Interview Survey data, veterans aged ≥18 years with incomes <200% of the Federal Poverty Level were identified (crude n=2,468, weighted n=3,872,252). Four types of medical financial hardship were assessed: objective, and subjective material, psychologic, and behavioral medical financial hardship. Survey-weighted proportions of veterans with medical financial hardship were calculated, and adjusted probabilities of medical financial hardship that accounted for Veteran characteristics, year-fixed effects, and survey sampling design were estimated. Analyses were conducted from August through December 2022. RESULTS Overall, 34.5% of veterans with low incomes had VA coverage. Among veterans without VA coverage, 38.7% had Medicare insurance, 18.2% had Medicaid insurance, 16.5% had private insurance, 13.5% had other public insurance, and 13.1% were uninsured. In adjusted analyses, veterans with VA coverage had lower probabilities of objective (-8.13 percentage point, p=0.008), subjective material (-6.55 percentage point, p=0.034), subjective psychologic (-10.33 percentage point, p=0.003), and subjective behavioral (-6.72 percentage point, p=0.031) medical financial hardship than veterans with Medicare and no VA coverage. CONCLUSIONS VA coverage was associated with protection against four types of medical financial hardship among veterans with low incomes, yet many are not enrolled. Research is needed to understand reasons these veterans lack VA coverage and to identify strategies to address medical financial hardship.
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Affiliation(s)
- Diana J Govier
- VA Health Services Research & Development (HSR&D) Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon; Department of Health Systems Management & Policy, Oregon Health & Science University - Portland State University School of Public Health, Portland, Oregon.
| | - Claire T Than
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Neetu Chawla
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Abby C Mulcahy
- VA Health Services Research & Development (HSR&D) Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon; Department of Health Systems Management & Policy, Oregon Health & Science University - Portland State University School of Public Health, Portland, Oregon
| | - Katherine J Hoggatt
- San Francisco VA Health Care System, San Francisco, California; Department of Medicine, University of California San Francisco, San Francisco, California
| | - Elizabeth M Yano
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Denise M Hynes
- VA Health Services Research & Development (HSR&D) Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon; School of Social and Behavioral Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon; Center for Quantitative Life Sciences, Oregon State University, Corvallis, Oregon; School of Nursing, Oregon Health & Science University, Portland, Oregon
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Hynes DM, Govier DJ, Niederhausen M, Tuepker A, Laliberte AZ, McCready H, Hickok A, Rowneki M, Waller D, Cordasco KM, Singer SJ, McDonald KM, Slatore CG, Thomas KC, Maciejewski M, Battaglia C, Perla L. Understanding care coordination for Veterans with complex care needs: protocol of a multiple-methods study to build evidence for an effectiveness and implementation study. Front Health Serv 2023; 3:1211577. [PMID: 37654810 PMCID: PMC10465329 DOI: 10.3389/frhs.2023.1211577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023]
Abstract
Background For patients with complex health and social needs, care coordination is crucial for improving their access to care, clinical outcomes, care experiences, and controlling their healthcare costs. However, evidence is inconsistent regarding the core elements of care coordination interventions, and lack of standardized processes for assessing patients' needs has made it challenging for providers to optimize care coordination based on patient needs and preferences. Further, ensuring providers have reliable and timely means of communicating about care plans, patients' full spectrum of needs, and transitions in care is important for overcoming potential care fragmentation. In the Veterans Health Administration (VA), several initiatives are underway to implement care coordination processes and services. In this paper, we describe our study underway in the VA aimed at building evidence for designing and implementing care coordination practices that enhance care integration and improve health and care outcomes for Veterans with complex care needs. Methods In a prospective observational multiple methods study, for Aim 1 we will use existing data to identify Veterans with complex care needs who have and have not received care coordination services. We will examine the relationship between receipt of care coordination services and their health outcomes. In Aim 2, we will adapt the Patient Perceptions of Integrated Veteran Care questionnaire to survey a sample of Veterans about their experiences regarding coordination, integration, and the extent to which their care needs are being met. For Aim 3, we will interview providers and care teams about their perceptions of the innovation attributes of current care coordination needs assessment tools and processes, including their improvement over other approaches (relative advantage), fit with current practices (compatibility and innovation fit), complexity, and ability to visualize how the steps proceed to impact the right care at the right time (observability). The provider interviews will inform design and deployment of a widescale provider survey. Discussion Taken together, our study will inform development of an enhanced care coordination intervention that seeks to improve care and outcomes for Veterans with complex care needs.
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Affiliation(s)
- Denise M. Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Diana J. Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Public Health, Oregon Health & Science University & Portland State University, Portland, OR, United States
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- School of Public Health, Oregon Health & Science University & Portland State University, Portland, OR, United States
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Avery Z. Laliberte
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Holly McCready
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Mazhgan Rowneki
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Dylan Waller
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
| | - Kristina M. Cordasco
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, United States
| | - Sara J. Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Kathryn M. McDonald
- Center for Diagnostic Excellence, Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Nursing, Baltimore, MD, United States
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, United States
- Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, United States
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences & Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, United States
| | - Catherine Battaglia
- Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, United States
- Department of Health Systems, Management & Policy, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa Perla
- Rehabilitation Services, Veterans Affairs Central Office, Washington, DC, United States
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Lafferty M, Govier DJ, Golden SE, Disher NG, Hynes DM, Slatore CG. VA-Delivered or VA-Purchased Care: Important Factors for Veterans Navigating Care Decisions. J Gen Intern Med 2023; 38:1647-1654. [PMID: 36922468 PMCID: PMC10212855 DOI: 10.1007/s11606-023-08128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND/OBJECTIVE The VA MISSION Act aimed to increase Veterans' access to care by allowing eligible Veterans to use VA-paid care from non-VA providers ("VA-purchased care"). We interviewed Veterans who were eligible for both VA-delivered and VA-purchased care to examine factors they consider when making decisions about whether to use VA-delivered or VA-purchased care. METHODS We conducted semi-structured interviews with 28 Veterans across the USA who were eligible for VA-delivered and VA-purchased care, using deductive and inductive analysis to develop themes. Participants were recruited from a survey about healthcare access and decision-making. More than half of participants lived in rural areas, 21 were men, and 25 were > 50 years old. KEY RESULTS Veteran participants identified (1) high-quality relationships with providers based on mutual trust, empathy, authenticity, and continuity of care, and (2) a positive environment or "eco-system of care" characterized by supportive interactions with staff and other Veterans, and exemplary customer service as integral to their decisions about where to receive care. These preferences influenced their engagement with VA and non-VA providers. We discovered corresponding findings related to Veterans' information needs. When making decisions around where to receive care, participants said they would like more information about VA and non-VA providers and services, and about coordination of care and referrals, including understanding processes and implications of utilizing VA-purchased care. DISCUSSION/CONCLUSION Current VA-purchased care eligibility determinations focus on common access metrics (e.g., wait times, distance to care). Yet, Veterans discussed other important factors for navigating care decisions, including patient-provider relationship quality and the larger healthcare environment (e.g., interactions with staff and other Veterans). Our findings point to the need for health systems to collect and provide information on these aspects of care to ensure care decisions reflect what is important to Veterans when navigating where to receive care.
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Affiliation(s)
- Megan Lafferty
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
| | - Diana J Govier
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University - Portland State University School of Public Health, Portland, OR, USA
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Natalie G Disher
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Denise M Hynes
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Health Management and Policy Program, College of Public Health and Human Sciences and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Govier DJ, Hickok A, Edwards ST, Weaver FM, Gordon H, Niederhausen M, Hynes DM. Early Impact of VA MISSION Act Implementation on Primary Care Appointment Wait Time. J Gen Intern Med 2023; 38:889-897. [PMID: 36307640 PMCID: PMC9616400 DOI: 10.1007/s11606-022-07800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Through Community Care Networks (CCNs) implemented with the VA MISSION Act, VA expanded provider contracting and instituted network adequacy standards for Veterans' community care. OBJECTIVE To determine whether early CCN implementation impacted community primary care (PC) appointment wait times overall, and by rural/urban and PC shortage area (HPSA) status. DESIGN Using VA administrative data from February 2019 through February 2020 and a difference-in-differences approach, we compared wait times before and after CCN implementation for appointments scheduled by VA facilities that did (CCN appointments) and did not (comparison appointments) implement CCNs. We ran regression models with all appointments, and stratified by rural/urban and PC HPSA status. All models adjusted for Veteran characteristics and VA facility-level clustering. APPOINTMENTS 13,720 CCN and 40,638 comparison appointments. MAIN MEASURES Wait time, measured as number of days from authorization to use community PC to a Veteran's first corresponding appointment. KEY RESULTS Overall, unadjusted wait times increased by 35.7 days ([34.4, 37.1] 95% CI) after CCN implementation. In adjusted analysis, comparison wait times increased on average 33.7 days ([26.3, 41.2] 95% CI, p < 0.001) after CCN implementation; there was no significant difference for CCN wait times (across-group mean difference: 5.4 days, [-3.8, 14.6] 95% CI, p = 0.25). In stratified analyses, comparison wait time increases ranged from 29.6 days ([20.8, 38.4] 95% CI, p < 0.001) to 42.1 days ([32.9, 51.3] 95% CI, p > 0.001) after CCN implementation, while additional differences for CCN appointments ranged from 13.4 days ([3.5, 23.4] 95% CI, p = 0.008) to -15.1 days ([-30.1, -0.1] 95% CI, p = 0.05) for urban and PC HPSA appointments, respectively. CONCLUSIONS After early CCN implementation, community PC wait times increased sharply at VA facilities that did and did not implement CCNs, regardless of rural/urban or PC HPSA status, suggesting community care demand likely overwhelmed VA resources such that CCNs had limited impact.
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Affiliation(s)
- Diana J Govier
- VA Portland Health Care System (VAPORHCS), Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
- OHSU - PSU School of Public Health, Oregon Health & Sciences University & Portland State University, Portland, OR, USA
| | - Alex Hickok
- VA Portland Health Care System (VAPORHCS), Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
| | - Samuel T Edwards
- VA Portland Health Care System (VAPORHCS), Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
- Oregon Health & Sciences University, Portland, OR, USA
| | - Frances M Weaver
- Edward Hines, Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, IL, USA
- Loyola University Chicago, Chicago, IL, USA
| | - Howard Gordon
- Edward Hines, Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, IL, USA
- Jesse Brown VA Medical Center, Chicago, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | - Meike Niederhausen
- VA Portland Health Care System (VAPORHCS), Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
- OHSU - PSU School of Public Health, Oregon Health & Sciences University & Portland State University, Portland, OR, USA
- Oregon Health & Sciences University, Portland, OR, USA
| | - Denise M Hynes
- VA Portland Health Care System (VAPORHCS), Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA.
- OHSU - PSU School of Public Health, Oregon Health & Sciences University & Portland State University, Portland, OR, USA.
- College of Public Health and Human Sciences and the Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA.
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Braverman MT, Volmar KM, Govier DJ. "The Pain Doesn't Have to Control You." A Qualitative Evaluation of Three Pain Clinics Teaching Nonopioid Pain Management Strategies. Am J Health Promot 2023; 37:210-221. [PMID: 36053192 DOI: 10.1177/08901171221119799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To explore factors related to effectiveness of nonpharmacological treatment for opioid-dependent patients suffering with chronic pain. APPROACH A qualitative study incorporating individual interviews and focus group interviews. SETTING 3 rural Oregon nonopioid pain management clinics. INTERVENTION A 10-week nonpharmacological educational program incorporating cognitive-behavioral therapy, movement therapy, mindfulness, and other skills. PARTICIPANTS AND METHODS Across sites, we conducted 9 individual interviews with clinic staff and 3 focus group interviews with 34 patients who had participated in the course. Thematic analysis was used to identify themes within and across respondent groups. RESULTS Analysis revealed 4 primary themes: program goals; program benefits; characteristics of patients who benefit from the program; coordination of clinic experiences with other care. Several primary findings can be highlighted. The clinics focused on improving patients' quality of life, while opioid use reduction was a potential secondary benefit, driven by patients. Major program benefits included enhanced pain self-management skills, patients' greater assertiveness in communications with healthcare providers, and, in numerous cases, opioid use reduction. Participants were unanimous that predisposition toward active self-management of one's pain was an essential factor for positive outcomes. Patients reported considerable variability in providers' understanding of their clinic participation. CONCLUSION Nonpharmacological approaches for treating chronic pain can be effective for many patients. Clinics teaching these approaches should be more fully integrated into the healthcare system.
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Affiliation(s)
- Marc T Braverman
- School of Social and Behavioral Health Sciences, 2694Oregon State University, Corvallis, OR, USA
| | - Karen M Volmar
- Department of Health Policy and Management, 41474University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diana J Govier
- VA HSR&D Center to Improve Veteran Involvement in Care, Portland, OR, USA
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12
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Weaver FM, Niederhausen M, Hickok A, O’Neill AC, Gordon HS, Edwards ST, Govier DJ, Chen JI, Young R, Whooley M, Hynes DM. Hospital Readmissions Among Veterans Within 90 Days of Discharge Following Initial Hospitalization for COVID-19. Prev Chronic Dis 2022; 19:E80. [PMID: 36455563 PMCID: PMC9717697 DOI: 10.5888/pcd19.220200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Some patients experience ongoing sequelae after discharge, including rehospitalization; therefore, outcomes following COVID-19 hospitalization are of continued interest. We examined readmissions within 90 days of hospital discharge for veterans hospitalized with COVID-19 during the first 10 months of the pandemic in the US. METHODS Veterans hospitalized with COVID-19 at a Veterans Health Administration (VA) hospital from March 1, 2020, through December 31, 2020 were followed for 90 days after discharge to determine readmission rates. RESULTS Of 20,414 veterans hospitalized with COVID-19 during this time period, 13% (n = 2,643) died in the hospital. Among survivors (n = 17,771), 16% (n = 2,764) were readmitted within 90 days of discharge, with a mean time to readmission of 21.6 days (SD = 21.1). Characteristics of the initial COVID-19 hospitalization associated with readmission included length of stay, mechanical ventilator use, higher comorbidity index score, current smoking, urban residence, discharged against medical advice, and hospitalized from September through December 2020 versus March through August 2020 (all P values <.02). Veterans readmitted from September through December 2020 were more often White, lived in a rural or highly rural area, and had shorter initial hospitalizations than veterans hospitalized earlier in the year. CONCLUSION Approximately 1 of 6 veterans discharged alive following a COVID-19 hospitalization from March 1 through December 31, 2020, were readmitted within 90 days. The longer the hospital stay, the greater the likelihood of readmission. Readmissions also were more likely when the initial admission required mechanical ventilation, or when the veteran had multiple comorbidities, smoked, or lived in an urban area. COVID-19 hospitalizations were shorter from September through December 2020, suggesting that hospital over-capacity may have resulted in earlier discharges and increased readmissions. Efforts to monitor and provide support for patients discharged in high bed-capacity situations may help avoid readmissions.
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Affiliation(s)
- Frances M. Weaver
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois,Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, Illinois
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon,Oregon Health and Science University–Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Alex Hickok
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon
| | - Allison C. O’Neill
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon
| | - Howard S. Gordon
- Jesse Brown Veterans Affairs Medical Center and Veterans Affairs Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Samuel T. Edwards
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon,Section of General Internal Medicine, Veterans Affairs Portland Healthcare System, Portland, Oregon
| | - Diana J. Govier
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon
| | - Jason I. Chen
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon,Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
| | - Rebecca Young
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon
| | - Mary Whooley
- San Francisco Veterans Affairs Health Care System, and the University of California, San Francisco, California
| | - Denise M. Hynes
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon,Health Management and Policy, School of Social and Behavioral Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon,School of Nursing, Oregon Health and Science University, Portland, Oregon
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Chen JI, Hickok A, O'Neill AC, Niederhausen M, Laliberte AZ, Govier DJ, Edwards ST, Gordon HS, Slatore CG, Weaver FM, Young R, Hynes DM. Psychiatric disorders newly diagnosed among veterans subsequent to hospitalization for COVID-19. Psychiatry Res 2022; 312:114570. [PMID: 35487047 PMCID: PMC9023376 DOI: 10.1016/j.psychres.2022.114570] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of our study was to evaluate the development of new mental health diagnoses up to 6-months following COVID-19 hospitalization for in a large, national sample. METHOD Data were extracted for all Veterans hospitalized at Veterans Health Administration hospitals for COVID-19 from March through August of 2020 utilizing national administrative data. After identifying the cohort, follow-up data were linked through six months post-hospitalization. Data were analyzed using logistic regression. RESULTS Eight percent of patients developed a new mental health diagnosis following hospitalization. The most common new mental health diagnoses involved depressive, anxiety, and adjustment disorders. Younger and rural patients were more likely to develop new mental health diagnoses. Women and those with more comorbidities were less likely to develop new diagnoses. CONCLUSION A subpopulation of patients hospitalized for COVID-19 developed new mental health diagnoses. Unique demographics predictors indicate the potential need for additional outreach and screening to groups at elevated risk of post-hospitalization, mental health sequelae.
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Affiliation(s)
- Jason I. Chen
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA,Corresponding authors at: 3710 SW U.S. Veterans Hospital Road (R&D 66), Portland, OR 97239, USA
| | - Alex Hickok
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA
| | - Allison C. O'Neill
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA
| | - Meike Niederhausen
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Oregon Health and Science University-Portland State University School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Avery Z. Laliberte
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Diana J. Govier
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA
| | - Samuel T. Edwards
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Howard S. Gordon
- Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA,Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Christopher G. Slatore
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Francis M. Weaver
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA,Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA
| | - Rebecca Young
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA
| | - Denise M. Hynes
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Health Management and Policy, School of Social and Behavioral Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA,School of Nursing, Oregon Health and Science University, Portland, OR, USA,Corresponding authors at: 3710 SW U.S. Veterans Hospital Road (R&D 66), Portland, OR 97239, USA
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Govier DJ, Cohen-Cline H, Marsi K, Roth SE. Differences in access to virtual and in-person primary care by race/ethnicity and community social vulnerability among adults diagnosed with COVID-19 in a large, multi-state health system. BMC Health Serv Res 2022; 22:511. [PMID: 35428257 PMCID: PMC9012053 DOI: 10.1186/s12913-022-07858-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/29/2022] [Indexed: 02/08/2023] Open
Abstract
Background Research exploring telehealth expansion during the COVID-19 pandemic has demonstrated that groups disproportionately impacted by COVID-19 also experience worse access to telehealth. However, this research has been cross-sectional or short in duration; geographically limited; has not accounted for pre-existing access disparities; and has not examined COVID-19 patients. We examined virtual primary care use by race/ethnicity and community social vulnerability among adults diagnosed with COVID-19 in a large, multi-state health system. We also assessed use of in-person primary care to understand whether disparities in virtual access may have been offset by improved in-person access. Methods Using a cohort design, electronic health records, and Centers for Disease Control and Prevention Social Vulnerability Index, we compared changes in virtual and in-person primary care use by race/ethnicity and community social vulnerability in the year before and after COVID-19 diagnosis. Our study population included 11,326 adult patients diagnosed with COVID-19 between March and July 2020. We estimated logistic regression models to examine likelihood of primary care use. In all regression models we computed robust standard errors; in adjusted models we controlled for demographic and health characteristics of patients. Results In a patient population of primarily Hispanic/Latino and non-Hispanic White individuals, and in which over half lived in socially vulnerable areas, likelihood of virtual primary care use increased from the year before to the year after COVID-19 diagnosis (3.6 to 10.3%); while in-person use remained stable (21.0 to 20.7%). In unadjusted and adjusted regression models, compared with White patients, Hispanic/Latino and other race/ethnicity patients were significantly less likely to use virtual care before and after COVID-19 diagnosis; Hispanic/Latino, Native Hawaiian/Pacific Islander, and other race/ethnicity patients, and patients living in socially vulnerable areas were also significantly less likely to use in-person care during these time periods. Conclusions Newly expanded virtual primary care has not equitably benefited individuals from racialized groups diagnosed with COVID-19, and virtual access disparities have not been offset by improved in-person access. Health systems should employ evidence-based strategies to equitably provide care, including representative provider networks; targeted, empowering outreach; co-developed culturally and linguistically appropriate tools and technologies; and provision of enabling resources and services.
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Yoon J, Bui LN, Govier DJ, Cahn MA, Luck J. Determinants of Boarding of Patients with Severe Mental Illness in Hospital Emergency Departments. J Ment Health Policy Econ 2020; 23:61-75. [PMID: 32621726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Boarding of patients in hospital emergency departments (EDs) occurs routinely across the U.S. ED patients with behavioral health conditions are more likely to be boarded than other patients. However, the existing literature on ED boarding of psychiatric patients remains largely descriptive and has not empirically related mental health system capacity to psychiatric boarding. Nor does it show how the mental health system could better address the needs of populations at the highest risk of ED boarding. AIMS OF THE STUDY We examined extent and determinants of "boarding" of patients with severe mental illness (SMI) in hospital emergency departments (ED) and tested whether greater mental health system capacity may mitigate the degree of ED boarding. METHODS We linked Oregon's ED Information Exchange, hospital discharge, and Medicaid data to analyze encounters in Oregon hospital EDs from October 2014 through September 2015 by 7,103 persons aged 15 to 64 with SMI (N = 34,207). We additionally utilized Medicaid claims for years 2010-2015 to identify Medicaid beneficiaries with SMI. Boarding was defined as an ED stay over six hours. We estimated a recursive simultaneous-equation model to test the pathway that mental health system capacity affects ED boarding via psychiatric visits. RESULTS Psychiatric visits were more likely to be boarded than non-psychiatric visits (30.2% vs. 7.4%). Severe psychiatric visits were 1.4 times more likely to be boarded than non-severe psychiatric visits. Thirty-four percent of psychiatric visits by children were boarded compared to 29.6% for adults. Statistical analysis found that psychiatric visit, substance abuse, younger age, black race and urban residence corresponded with an elevated risk of boarding. Discharge destinations such as psychiatric facility and acute care hospitals also corresponded with a higher probability of ED boarding. Greater supply of mental health resources in a county, both inpatient and intensive community-based, corresponded with a reduced risk of ED boarding via fewer psychiatric ED visits. DISCUSSION Psychiatric visit, severity of psychiatric diagnosis, substance abuse, and discharge destinations are among important predictors of psychiatric ED boarding by persons with SMI. A greater capacity of inpatient and intensive community mental health systems may lead to a reduction in psychiatric ED visits by persons with SMI and thereby decrease the extent of psychiatric ED boarding. IMPLICATIONS FOR HEALTH POLICIES Continued investment in mental health system resources may reduce psychiatric ED visits and mitigate the psychiatric ED boarding problem.
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Affiliation(s)
- Jangho Yoon
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 464 Waldo Hall, Corvallis, OR 97331, USA,
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Mendez-Luck CA, Govier DJ, Luck J, Julyan EJ, Mahakalanda S, Herrera-Venson AP. Participation of Latinos in the Diabetes Self-Management Program and Programa de Manejo Personal de la Diabetes. Innov Aging 2020; 4:igaa006. [PMID: 32206733 PMCID: PMC7078852 DOI: 10.1093/geroni/igaa006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Indexed: 01/22/2023] Open
Abstract
Background and Objectives The Diabetes Self-Management Program (DSMP) and Programa de Manejo Personal de la Diabetes (PMPD) have been shown to reduce complications from poorly controlled diabetes. Only a few research studies have examined Latino individuals’ participation in them. This study examines workshop completion among DSMP and PMPD participants and the effects of race/ethnicity, workshop language, workshop type, and workshop site on program completion rates by participants. Research Design and Methods We used data from the National Council on Aging’s data repository of individuals who participated in DSMP or PMPD between January 2010 and March 2019. Using a pooled cross-sectional study design, we examined workshop completion among 8,321 Latino and 23,537 non-Latino white (NLW) participants. We utilized linear probability models to estimate the effects of race/ethnicity and workshop language/type among the full sample; a stratified model estimated the separate effects of workshop language, type, and delivery site among Latinos. Participant characteristics included age, sex, education, number of chronic health conditions, living arrangement, health insurance status, and geographic location of workshop. Results Compared to NLW participants in DSMP English workshops, Latinos enrolled in any workshop had a higher probability of completing at least four workshop sessions, and Latinos enrolled in PMPD Spanish workshops had a higher probability of completing six of six sessions. Among the Latino subsample, participation in PMPD Spanish or English workshops was associated with completing at least four sessions or all six sessions compared with participation in DSMP Spanish or English workshops. Among Latino participants, the effects of workshop site on completion rates were mixed. Discussion and Implications Diabetes self-management education programs tailored for Latino participants had higher completion rates. Further research is warranted to better understand the effect of workshop site and participant characteristics on completion of DSMP and PMPD programs.
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Affiliation(s)
| | - Diana J Govier
- Health Policy and Management, Oregon State University, Corvallis
| | - Jeff Luck
- Health Policy and Management, Oregon State University, Corvallis
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Choun S, Doan L, Govier DJ, Hooker K, Mendez-Luck C, Turner S, Irvin VL. PREDICTORS OF MORTALITY RISK AMONG MEDICARE ADVANTAGE ENROLLEES. Innov Aging 2019. [PMCID: PMC6841292 DOI: 10.1093/geroni/igz038.2654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Overall all-cause mortality rates have declined significantly in past decades among individuals aged 65 and above in every racial and ethnic group. We explored demographic, overall health, and disability development as predictors of mortality in Medicare beneficiaries enrolled in Medicare Advantage plans. We used data from the 2014-2018 Medicare Health Outcomes Survey, a nationally representative panel survey with a two-year follow-up, administered by the Centers for Medicare and Medicaid Services. Our sample consisted of 1,273,494 community-dwelling adults aged 65 and older (Mage = 74.5 years, age range: 65-109 years) enrolled in Medicare Advantage plans. Mortality was assessed over a 2-year follow-up period. We used Cox proportional hazards regression analysis to predict risk of all-cause mortality by demographics, self-rated health, chronic health conditions, smoking status, and activities of daily living (ADLs). Among all participants, the mortality rate was 7.0% (n = 88,058) at 2-year follow-up. Advanced age and being male were significantly associated with greater risk of mortality, while higher levels of education and income were inversely associated with mortality. Controlling for other factors, white adults had higher mortality risk than black or African American, Hispanic, and Asian older adults. Individuals who were unmarried, had lower self-rated health, had more chronic health conditions, smoked, and had more ADL limitations had higher mortality risk. Our findings suggest that sustained health and better functional capacity are important elements in decreasing the risk of mortality in older adults.
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Affiliation(s)
- Soyoung Choun
- Oregon State University, Corvallis, Oregon, United States
| | - Lan Doan
- Oregon State University, Corvallis, Oregon, United States
| | - Diana J Govier
- Oregon State University, Corvallis, Oregon, United States
| | - Karen Hooker
- Oregon State University, Corvallis, Oregon, United States
| | | | - Shelbie Turner
- Oregon State University, Corvallis, Oregon, United States
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