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Semeah LM, Orozco T, Wang X, Ahonle ZJ, Cowper-Ripley D, Ganesh SP, Wilson LK, Litt ER, Ahern JK, Santos Roman LM, Varma DS, Lee MJ, Novak JR, Jia H. Rural and Urban Home Modification Program Users: A Comparative Study. HERD 2023; 16:223-235. [PMID: 36727246 DOI: 10.1177/19375867221142627] [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: 02/03/2023]
Abstract
OBJECTIVE To understand the sociodemographic, geographical, and clinical characteristics of rural veterans utilizing home modification (HM) healthcare services under the Home Improvement Structural Alterations (HISA) program, to compare these characteristics between rural and urban veteran users, to estimate the costs of HMs performed, and to present distance that users traveled to HISA-prescribing medical facilities within the Veterans Health Administration (VHA). BACKGROUND Accessible housing is in short supply. HMs allow veterans with disabilities (VWDs) to remain living at home rather than enter institutional-type settings. HISA is associated with decreased inpatient hospitalization rates and increased use of preventative healthcare via outpatient clinic visits. Home accessibility provides psychological benefits improving social interactions and interaction with the physical environment. METHODS This retrospective database study analyzes data from the National Prosthetics Patient Database and other medical datasets within the VHA. RESULTS Results provide a profile of and comparison between rural and urban veteran users. HISA users are substantially older compared to younger VWDs. The frequency of bathroom, railing, and wooden ramp HMs differed significantly between rural and urban users (p values < .001). Rural users traveled more miles than urban users to reach a prescribing facility. CONCLUSIONS Older adults and individuals with disabilities have unmet housing needs since accessible housing is in short supply. This HM healthcare service is helping to meet the housing accessibility needs of older veterans, VWDs, older adults, and people with disabilities, in general.
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Affiliation(s)
- Luz M Semeah
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Tatiana Orozco
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Xinping Wang
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | | | | | | | - Eric R Litt
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Justin K Ahern
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Deepthi Satheesa Varma
- University of Florida Department of Epidemiology and Health Policy Research, Gainesville, FL, USA
| | - Mi Jung Lee
- The University of Texas Medical Branch, Galveston, TX, USA
| | | | - Huanguang Jia
- U.S. Department of Veterans Affairs, Washington, DC, USA
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Lind JD, Fickel J, Cotner BA, Katzburg JR, Cowper-Ripley D, Fleming M, Ong MK, Bergman AA, Bradley SE, Tubbesing SA. Implementing Geographic Information Systems (GIS) into VHA Home Based Primary Care. Geriatr Nurs 2019; 41:282-289. [PMID: 31757414 DOI: 10.1016/j.gerinurse.2019.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 11/18/2022]
Abstract
The Veteran's Health Administration (VHA) Home Based Primary Care (HBPC) program provides comprehensive in-home primary care services to elderly Veterans with complex chronic medical conditions. Nurses have prominent roles in HBPC including as program leaders, primary care providers and nurses who make home visits. Delivery of primary care services to patients in their homes can be challenging due to travel distances, difficult terrain, traffic, and adverse weather. Mapmaking with geographic information systems (GIS) can support optimization of resource utilization, travel efficiency, program capacity, and management during normal operations, and patient safety during disasters. This paper reports on the feasibility, acceptability and outcomes of an initiative to implement GIS mapmaking in VHA HBPC programs. A mixed method evaluation assessed extent of adoption and identified facilitators and barriers to uptake. Results indicate that GIS mapping in VHA HBPC is feasible and can increase effectiveness and efficiency of VHA HBPC nurses.
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Affiliation(s)
- Jason D Lind
- James A. Haley Veterans' Hospital and Clinics, Research and Development Service, 8900 Grand Oak Circle (151R), Tampa, FL 33637-1022, United States.
| | - Jacqueline Fickel
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Bridget A Cotner
- James A. Haley Veterans' Hospital and Clinics, Research and Development Service, 8900 Grand Oak Circle (151R), Tampa, FL 33637-1022, United States
| | - Judith R Katzburg
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Diane Cowper-Ripley
- North Florida/South Georgia Veterans Health System, Center of Innovation, Gainesville, FL, United States; VA Office of Rural Health, GeoSpatial Outcomes Division, Gainesville, FL, United States
| | - Marguerite Fleming
- VA Office of Reporting, Analytics, Performance, Improvement, and Deployment, Center for Innovation and Analytics, Washington, D.C., United States
| | - Michael K Ong
- University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States; Division of Hospital Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Alicia A Bergman
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Sarah E Bradley
- James A. Haley Veterans' Hospital and Clinics, Research and Development Service, 8900 Grand Oak Circle (151R), Tampa, FL 33637-1022, United States
| | - Sarah A Tubbesing
- Home Based Primary Care Program, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
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Katzburg J, Wilson D, Fickel J, Lind JD, Cowper-Ripley D, Fleming M, Ong MK, Bergman AA, Bradley SE, Tubbesing SA. Ensuring the Safety of Chronically Ill Veterans Enrolled in Home-Based Primary Care. Prev Chronic Dis 2019; 16:E122. [PMID: 31489835 PMCID: PMC6745894 DOI: 10.5888/pcd16.180501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Judith Katzburg
- VA Health Services Research and Development, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Health Services Researcher, VA Greater Los Angeles Healthcare System, 16111 Plummer St, Mail code 152, North Hills, CA 91343. or
| | - Debra Wilson
- Orlando VA Medical Center Home Based Primary Care Program, Orlando, Florida
| | - Jacqueline Fickel
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jason D Lind
- James A. Haley Veterans' Hospital and Clinics, Research Section, Tampa, Florida
| | - Diane Cowper-Ripley
- VA North Florida/South Georgia Veterans Health System, Health Services Research and Development; VA Office of Rural Health, GeoSpatial Outcomes Division, Gainesville, Florida
| | - Marguerite Fleming
- Veterans Health Administration, VA Office of Reporting, Analytics, Performance, Improvement, and Deployment, Washington, District of Columbia
| | - Michael K Ong
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Alicia A Bergman
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Sarah E Bradley
- James A. Haley Veterans' Hospital and Clinics, Research Section, Tampa, Florida
| | - Sarah A Tubbesing
- David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California.,VA Greater Los Angeles Healthcare System, Geriatrics and Extended Care, Los Angeles, California
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Semeah L, Cowper-Ripley D, Freytes M, Jia H, Uphold C, Hart D, Campbell C. Occupational Hazard: Disruptive Behavior in Patients. Fed Pract 2019; 36:158-163. [PMID: 31138967 PMCID: PMC6503907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Accurate reporting of disruptive behavior enables the development of strategies that provide for the safe delivery of health care to patients.
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Affiliation(s)
- Luz Semeah
- is a Health Science Specialist, is Director, and are Research Health Scientists, all at the Center of Innovation on Disability and Rehabilitation Research (CINDRR) at the North Florida/South Georgia Veterans Health System (NF/SGVHS) in Gainesville, Florida. is a Licensed Clinical Social Worker, and is a Health Scientist at CINDRR and the Associate Director of Implementation and Outcomes Research at the Geriatric Research Education and Clinical Center at NF/SGVHS. When this article was written, was a Research Assistant at CINDRR and is currently a Student at the University of Florida in Gainesville. Diane Cowper-Ripley is an Affiliated Associate Professor in the Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida. Colleen Campbell is an Instructor at the University of Central Florida School of Social Work. Huanguang Jia is a Professor at the College of Public Health and Health Professions and Connie Uphold is an Associate Professor in the Department of Aging and Geriatrics Research, College of Medicine; both at the University of Florida
| | - Diane Cowper-Ripley
- is a Health Science Specialist, is Director, and are Research Health Scientists, all at the Center of Innovation on Disability and Rehabilitation Research (CINDRR) at the North Florida/South Georgia Veterans Health System (NF/SGVHS) in Gainesville, Florida. is a Licensed Clinical Social Worker, and is a Health Scientist at CINDRR and the Associate Director of Implementation and Outcomes Research at the Geriatric Research Education and Clinical Center at NF/SGVHS. When this article was written, was a Research Assistant at CINDRR and is currently a Student at the University of Florida in Gainesville. Diane Cowper-Ripley is an Affiliated Associate Professor in the Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida. Colleen Campbell is an Instructor at the University of Central Florida School of Social Work. Huanguang Jia is a Professor at the College of Public Health and Health Professions and Connie Uphold is an Associate Professor in the Department of Aging and Geriatrics Research, College of Medicine; both at the University of Florida
| | - Magaly Freytes
- is a Health Science Specialist, is Director, and are Research Health Scientists, all at the Center of Innovation on Disability and Rehabilitation Research (CINDRR) at the North Florida/South Georgia Veterans Health System (NF/SGVHS) in Gainesville, Florida. is a Licensed Clinical Social Worker, and is a Health Scientist at CINDRR and the Associate Director of Implementation and Outcomes Research at the Geriatric Research Education and Clinical Center at NF/SGVHS. When this article was written, was a Research Assistant at CINDRR and is currently a Student at the University of Florida in Gainesville. Diane Cowper-Ripley is an Affiliated Associate Professor in the Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida. Colleen Campbell is an Instructor at the University of Central Florida School of Social Work. Huanguang Jia is a Professor at the College of Public Health and Health Professions and Connie Uphold is an Associate Professor in the Department of Aging and Geriatrics Research, College of Medicine; both at the University of Florida
| | - Huanguang Jia
- is a Health Science Specialist, is Director, and are Research Health Scientists, all at the Center of Innovation on Disability and Rehabilitation Research (CINDRR) at the North Florida/South Georgia Veterans Health System (NF/SGVHS) in Gainesville, Florida. is a Licensed Clinical Social Worker, and is a Health Scientist at CINDRR and the Associate Director of Implementation and Outcomes Research at the Geriatric Research Education and Clinical Center at NF/SGVHS. When this article was written, was a Research Assistant at CINDRR and is currently a Student at the University of Florida in Gainesville. Diane Cowper-Ripley is an Affiliated Associate Professor in the Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida. Colleen Campbell is an Instructor at the University of Central Florida School of Social Work. Huanguang Jia is a Professor at the College of Public Health and Health Professions and Connie Uphold is an Associate Professor in the Department of Aging and Geriatrics Research, College of Medicine; both at the University of Florida
| | - Connie Uphold
- is a Health Science Specialist, is Director, and are Research Health Scientists, all at the Center of Innovation on Disability and Rehabilitation Research (CINDRR) at the North Florida/South Georgia Veterans Health System (NF/SGVHS) in Gainesville, Florida. is a Licensed Clinical Social Worker, and is a Health Scientist at CINDRR and the Associate Director of Implementation and Outcomes Research at the Geriatric Research Education and Clinical Center at NF/SGVHS. When this article was written, was a Research Assistant at CINDRR and is currently a Student at the University of Florida in Gainesville. Diane Cowper-Ripley is an Affiliated Associate Professor in the Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida. Colleen Campbell is an Instructor at the University of Central Florida School of Social Work. Huanguang Jia is a Professor at the College of Public Health and Health Professions and Connie Uphold is an Associate Professor in the Department of Aging and Geriatrics Research, College of Medicine; both at the University of Florida
| | - Destiny Hart
- is a Health Science Specialist, is Director, and are Research Health Scientists, all at the Center of Innovation on Disability and Rehabilitation Research (CINDRR) at the North Florida/South Georgia Veterans Health System (NF/SGVHS) in Gainesville, Florida. is a Licensed Clinical Social Worker, and is a Health Scientist at CINDRR and the Associate Director of Implementation and Outcomes Research at the Geriatric Research Education and Clinical Center at NF/SGVHS. When this article was written, was a Research Assistant at CINDRR and is currently a Student at the University of Florida in Gainesville. Diane Cowper-Ripley is an Affiliated Associate Professor in the Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida. Colleen Campbell is an Instructor at the University of Central Florida School of Social Work. Huanguang Jia is a Professor at the College of Public Health and Health Professions and Connie Uphold is an Associate Professor in the Department of Aging and Geriatrics Research, College of Medicine; both at the University of Florida
| | - Colleen Campbell
- is a Health Science Specialist, is Director, and are Research Health Scientists, all at the Center of Innovation on Disability and Rehabilitation Research (CINDRR) at the North Florida/South Georgia Veterans Health System (NF/SGVHS) in Gainesville, Florida. is a Licensed Clinical Social Worker, and is a Health Scientist at CINDRR and the Associate Director of Implementation and Outcomes Research at the Geriatric Research Education and Clinical Center at NF/SGVHS. When this article was written, was a Research Assistant at CINDRR and is currently a Student at the University of Florida in Gainesville. Diane Cowper-Ripley is an Affiliated Associate Professor in the Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida. Colleen Campbell is an Instructor at the University of Central Florida School of Social Work. Huanguang Jia is a Professor at the College of Public Health and Health Professions and Connie Uphold is an Associate Professor in the Department of Aging and Geriatrics Research, College of Medicine; both at the University of Florida
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Hutt E, Radcliff TA, Henderson W, Maciejewski M, Cowper-Ripley D, Whitfield E. Comparing Survival Following Hip Fracture Repair in VHA and Non-VHA Facilities. Geriatr Orthop Surg Rehabil 2015; 6:22-7. [PMID: 26246949 DOI: 10.1177/2151458514561787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Although postsurgical outcomes are similar between Veterans Health Administration (VHA) and non-VHA hospitals for many procedures, no studies have compared 30-day and 1-year survival following hip fracture repair. Therefore, this study compared survival of veterans aged 65 years and older treated in VHA hospitals with a propensity-matched cohort of Medicare beneficiaries in non-VHA hospitals. MATERIALS AND METHODS Retrospective cohort study of 1894 hip fracture repair patients in VHA or non-VHA hospitals between 2003 and 2005. Current Procedural Terminology codes identified 3542 male patients aged >65 years who had hip fracture repair between 2003 and 2005 in the Veterans Affairs' National Surgical Quality Improvement Program database. The Medicare comparison sample was drawn from 2003 to 2005 Medicare Part A inpatient hospital claims files. To create comparable VHA and Medicare cohorts, patients were propensity score matched on age, admission source (community vs. nursing home), repair type, comorbidity index, race, year, and region. Thirty-day and 1-year survival after surgery were compared between cohorts after further adjustment for selected comorbidities, year of surgery, and pre- and postsurgical length of hospital stay using logistic regression. RESULTS Odds of survival were significantly better in the Medicare than the VHA cohort at 30 days (1.68, 95% CI 1.15-2.44) and 1 year (1.35, 95% CI 1.08-1.69). CONCLUSION Medicare beneficiaries with hip fracture repair in non-VHA hospitals had better survival than veterans in VHA hospitals. Whether this is driven by unobserved patient characteristics or systematic care differences is unknown.
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Affiliation(s)
- Evelyn Hutt
- Denver-Seattle Center of Innovation VA Eastern Colorado Health Care System Denver, CO, USA ; Department of Medicine and School of Public Health University of Colorado Anschutz Medical Campus Aurora, CO, USA
| | - Tiffany A Radcliff
- Department of Health Policy & Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - William Henderson
- Department of Medicine and School of Public Health University of Colorado Anschutz Medical Campus Aurora, CO, USA
| | - Matthew Maciejewski
- Department of Medicine, Duke University Medical Center, Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA
| | - Diane Cowper-Ripley
- Department of Health Outcomes and Policy Malcolm G. Randall VA Medical Center, Gainesville, FL, USA
| | - Emily Whitfield
- Denver-Seattle Center of Innovation VA Eastern Colorado Health Care System Denver, CO, USA
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Stroupe K, Manheim L, Evans C, Guihan M, Ho C, Li K, Cowper-Ripley D, Hogan T, St. Andre J, Huo Z, Smith B. Cost of Treating Pressure Ulcers for Veterans with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1604-62] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Culpepper WJ, Cowper-Ripley D, Litt ER, McDowell TY, Hoffman PM. Using geographic information system tools to improve access to MS specialty care in Veterans Health Administration. ACTA ACUST UNITED AC 2011; 47:583-91. [PMID: 20848371 DOI: 10.1682/jrrd.2009.10.0173] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Access to appropriate and timely healthcare is critical to the overall health and well-being of patients with chronic diseases. In this study, we used geographic information system (GIS) tools to map Veterans Health Administration (VHA) patients with multiple sclerosis (MS) and their access to MS specialty care. We created six travel-time bands around VHA facilities with MS specialty care and calculated the number of VHA patients with MS who resided in each time band and the number of patients who lived more than 2 hours from the nearest specialty clinic in fiscal year 2007. We demonstrate the utility of using GIS tools in decision-making by providing three examples of how patients' access to care is affected when additional specialty clinics are added. The mapping technique used in this study provides a powerful and valuable tool for policy and planning personnel who are evaluating how to address underserved populations and areas within the VHA healthcare system.
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Affiliation(s)
- William J Culpepper
- Multiple Sclerosis Center of Excellence, Department of Veterans Affairs Maryland Healthcare System, Baltimore, MD 21210, USA.
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