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Elam R, Doan J, Weaver F, Ray C, Miskevics S, Gonzalez B, Obremskey W, Carbone L. "Pathological" fractures in spinal cord injuries and disorders: Insight into International classification of diseases, ninth revision coding. J Spinal Cord Med 2023; 46:317-325. [PMID: 35254231 PMCID: PMC9987728 DOI: 10.1080/10790268.2022.2042658] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Analyses of osteoporosis-related fractures in persons with Spinal Cord Injury or Disorder (SCID) using administrative data often exclude pathological fractures (International Classification of Diseases, Ninth Revision (ICD-9) codes 733.1x). We examined how often lower extremity "pathological" fractures were secondary to osteoporosis. DESIGN Retrospective case-control study, fiscal years 2005-2015. SETTING Veterans Health Administration. PARTICIPANTS Veterans with SCID and an ICD-9 code for lower extremity fracture. OUTCOME MEASURES Clinical and SCID-related characteristics were compared in pathological and non-pathological fractures. A subset of Veterans with lower extremity fracture had data on fracture etiology from prior electronic health record (eHR) review. Of these, all with eHR-confirmed pathological fractures were considered cases. For each case, four unmatched controls with non-pathological fractures from this subset were randomly selected. Fracture etiology was compared between subsample cases and controls. We sought expert opinion from specialists who care for these fractures to understand their perspectives on what constitutes a pathological fracture and narrate our findings. RESULTS 6,397 Veterans sustained 16,279 lower extremity fractures, including 314 (1.93%) pathological fractures in 264 Veterans. Ten of 13 (76.9%) cases of pathological fracture (76.9%) and 82.4% of non-pathological fractures were secondary to osteoporosis. Of the 19 experts surveyed, only two coded osteoporotic fractures as pathological. CONCLUSION Most pathological lower extremity fractures by ICD-9 codes in SCID are secondary to osteoporosis. Pathological fractures can be considered for inclusion in epidemiologic studies of osteoporosis in SCID when the risk-benefit profile for the study favors capturing all osteoporotic fractures at the expense of some misclassification.
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Affiliation(s)
- Rachel Elam
- Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA.,Department of Medicine, Division of Rheumatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - James Doan
- Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Physical Medicine and Rehabilitation, Charlestown, Massachusetts, USA.,VA Boston Healthcare system, West Roxbury, Boston, Massachusetts, USA
| | - Frances Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biostatistics, University of Illinois, Chicago, Illinois, USA.,Department of Mathematics, Northeastern Illinois University, Chicago, Illinois, USA
| | - William Obremskey
- Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA.,Department of Medicine, J. Harold Harrison M.D. Distinguished Chair in Rheumatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Sinnott B, Ray C, Weaver F, Gonzalez B, Chu E, Premji S, Raiford M, Elam R, Miskevics S, Parada S, Carbone L. Risk Factors and Consequences of Lower Extremity Fracture Nonunions in Veterans With Spinal Cord Injury. JBMR Plus 2022; 6:e10595. [PMID: 35309860 PMCID: PMC8914149 DOI: 10.1002/jbm4.10595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/16/2021] [Indexed: 12/11/2022] Open
Abstract
We used Veterans Health Administration (VHA) national administrative data files to identify a cohort (fiscal years 2005–2014) of veterans with spinal cord injuries and disorders (SCID) to determine risk factors for and consequences of lower extremity fracture nonunions. Odds ratios (OR) for fracture nonunion were computed using multivariable‐adjusted logistic regression models. We identified three risk factors for nonunion: (i) older age (OR = 2.29; 95% confidence interval [CI] 1.21–4.33), (ii) longer duration of SCID (OR = 1.02; 95% CI 1.00–1.04), and (iii) fracture site (distal femur), with OR (comparison distal femur) including distal tibia/fibula (OR = 0.14; 95% CI 0.09–0.24), proximal tibia/fibula (OR = 0.19; 95% CI 0.09–0.38), proximal femur (OR = 0.10; 95% CI 0.04–0.21), and hip (OR = 0.13; 95% CI 0.07–0.26). Nonunions resulted in multiple complications, with upwards of 1/3 developing a pressure injury, 13% osteomyelitis, and almost 25% requiring a subsequent amputation. Our data have identified a high‐risk population for fracture nonunion of older veterans with a long duration of SCID who sustain a distal femur fracture. In view of the serious complications of these nonunions, targeted interventions in these high‐risk individuals who have any signs of delayed union should be considered. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
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Affiliation(s)
- Bridget Sinnott
- Charlie Norwood Veterans Affairs Medical Center Augusta GA USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs Hines VA Hospital Hines IL USA
| | - Frances Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs Hines VA Hospital Hines IL USA
- Parkinson School of Health Sciences and Public Health Loyola University Maywood IL USA
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs Hines VA Hospital Hines IL USA
- Feinberg School of Medicine Northwestern University Chicago IL USA
- Department of Biostatistics University of Illinois Chicago IL USA
- Department of Mathematics Northeastern Illinois University Chicago IL USA
| | - Elizabeth Chu
- Division of Rheumatology, Medical College of Georgia Augusta University Augusta GA USA
| | - Sarah Premji
- Division of Rheumatology, Medical College of Georgia Augusta University Augusta GA USA
| | - Mattie Raiford
- Division of Rheumatology, Medical College of Georgia Augusta University Augusta GA USA
| | - Rachel Elam
- Charlie Norwood Veterans Affairs Medical Center Augusta GA USA
- Division of Rheumatology, Medical College of Georgia Augusta University Augusta GA USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs Hines VA Hospital Hines IL USA
| | - Stephen Parada
- Department of Orthopaedic Surgery, Medical College of Georgia Augusta University Augusta GA USA
| | - Laura Carbone
- Charlie Norwood Veterans Affairs Medical Center Augusta GA USA
- Division of Rheumatology, Medical College of Georgia Augusta University Augusta GA USA
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Le B, Ray C, Gonzalez B, Miskevics S, Weaver FM, Priebe M, Carbone LD. Reasons for Initiation and Discontinuation of Pharmacological Therapies for Osteoporosis in Veterans with Spinal Cord Injury and Disorders. J Clin Densitom 2021; 24:67-77. [PMID: 31262561 DOI: 10.1016/j.jocd.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Medications for osteoporosis have not been reported to reduce fracture rates in patients with spinal cord injury and disorders (SCI/D), yet these medications are still prescribed. Clinical decision-making underscoring the initiation and discontinuation of osteoporosis medications in SCI/D remains poorly understood. METHODOLOGY Veterans with a SCI/D with at least one prescription for an osteoporosis medication (bisphosphonate, calcitonin, denosumab, raloxifene, and teriparatide) who received healthcare within Veterans Affairs (VA) from 2005 to 2015 were identified using VA administrative databases. A 10% subsample of Veterans was selected for electronic health record review. RESULTS Two hundred and sixty-seven Veterans with 330 prescriptions underwent electronic health record review. Bisphosphonates were the most frequently prescribed medication for osteoporosis (n = 223, 67.6%). Of the 187 Veterans with prescriptions for prevention or treatment of osteoporosis, the primary reason for initiation was Dual Energy X-ray Absorptiometry (DXA) scan with osteopenia or osteoporosis (n = 119, 63.6% of Veterans), primarily at the hip (81.0% of DXAs). The majority (79.0%) of DXAs were "screening tests," with SCI/D being the sole reason for the scan. Fractures (n = 51, 27.3%) and fall risk concerns (n = 29, 15.5%) were other major reasons for initiation. On average, oral bisphosphonates were filled for <3 yr, with medication-related side effects (n = 23, 15.8% of bisphosphonates discontinued), predominately gastrointestinal (n = 17, 73.9% of reported side effects), the most common reason for discontinuation. Drug holidays occurred in 14.3% of 35 oral bisphosphonates used for ≥5 yr. No cases of osteonecrosis of the jaw were found. There was one case of an atypical femoral fracture which could not be confirmed. CONCLUSIONS The decision to initiate pharmacological therapies in SCI/D is primarily based on osteopenia or osteoporosis at the hip by screening DXAs. Gastrointestinal side effects are the major reason for discontinuation of oral bisphosphonates. New therapies for osteoporosis in SCI/D are needed.
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Affiliation(s)
- Brian Le
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA; Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biostatistics, University of Illinois, Chicago, IL, USA; Department of Mathematics, Northeastern Illinois University, Chicago, IL, USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA; Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - Michael Priebe
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Laura D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA; Department of Medicine, Division of Rheumatology, J. Harold Harrison, MD, Distinguished University Chair in Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA.
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Le B, Ray C, Gonzalez B, Miskevics S, Weaver FM, Priebe M, Carbone LD. Laboratory evaluation of secondary causes of bone loss in Veterans with spinal cord injury and disorders. Osteoporos Int 2019; 30:2241-2248. [PMID: 31410501 DOI: 10.1007/s00198-019-05089-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED An electronic health record (eHR) review of Veterans with a spinal cord injury and disorder (SCI/D) was conducted to understand the extent to which Veterans Affairs (VA) providers pursue workups for secondary causes of osteoporosis in this population. Laboratory tests for secondary causes were ordered in only one-third of Veterans, with secondary causes identified in two-thirds of those tested, most frequently, hypogonadism and hypovitaminosis D. PURPOSE To identify workups for secondary causes of osteoporosis in SCI/D and the extent to which subspecialty consultations are sought. METHODS A total of 3018 prescriptions for an osteoporosis medication (bisphosphonate, calcitonin, denosumab, raloxifene, teriparatide) among 2675 Veterans were identified in fiscal years 2005-2015 from VA administrative databases. Approximately 10% of these prescriptions were selected for eHR review. RESULTS eHR records of 187 Veterans with a SCI/D who had received pharmacological treatment for osteoporosis were reviewed. Workups for secondary causes of osteoporosis were performed in 31.5% of Veterans (n = 59) with approximately 64.4% of those tested (n = 38) having at least one abnormality. Hypogonadism (52.0% of those tested) and hypovitaminosis D (50.0% of those tested) were the most common secondary causes of osteoporosis identified in this population. Approximately 10% of primary care and SCI providers consulted subspecialists for further evaluation and treatment of osteoporosis. Endocrinologists more frequently performed a workup for secondary causes of osteoporosis compared to other provider specialties. CONCLUSIONS Screening for secondary causes of osteoporosis, particularly for hypogonadism and hypovitaminosis D, should be considered in patients with a SCI/D.
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Affiliation(s)
- B Le
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - C Ray
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - B Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Biostatistics, University of Illinois, Chicago, IL, USA
| | - S Miskevics
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - F M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Mathematics, Northeastern Illinois University, Chicago, IL, USA
| | - M Priebe
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
- Department of Medicine, Division of Rheumatology, J. Harold Harrison, MD, Distinguished University Chair in Rheumatology, Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 309012, USA.
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Weaver FM, Le B, Ray C, Miskevics S, Gonzalez B, Carbone LD. Predicting osteoporosis medication receipt in Veterans with a spinal cord injury: A retrospective cohort study. J Spinal Cord Med 2019; 42:760-767. [PMID: 30888309 PMCID: PMC6830189 DOI: 10.1080/10790268.2019.1584259] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective: To describe frequency and predictors of use of pharmacological therapies for osteoporosis in persons with a spinal cord injury (SCI).Design: Retrospective cohort study.Setting: United States Veterans Health Administration (VA) national databases.Participants: 11,048 persons with a traumatic SCI who received VA health care between Fiscal Years (FY) 2005-2015. Pharmacy data from VA's Corporate Data Warehouse were used to identify prescriptions for Food and Drug Administration-approved pharmacological treatments for osteoporosis including bisphosphonates, calcitonin, denosumab, raloxifene and teriparatide.Outcome Measures: Demographics, clinical and SCI-related characteristics, receipt of a dual energy x-ray absorptiometry (DXA), and prevalent lower extremity fractures were examined to determine factors related to receiving a pharmacological agent for osteoporosis.Results: 1,041 persons (9.4%) had a prescription for a pharmacological agent for osteoporosis; the majority (n = 964, 93.0%) were bisphosphonates. There was a significant decline in the number of these prescriptions from FY 2005 (13.0%) to FY 2015 (2.2%). In multivariable analysis, age (>50 years) (OR = 1.60, 95% CI 1.31-1.94); female sex (OR = 4.09, 95% CI 2.74-6.09); opioid (OR = 1.24, 95% CI 1.01-1.51) or corticosteroid (OR = 1.92, 95% CI 1.01-1.51) prescriptions; complete injury (OR = 1.26, 95% CI 1.04-1.53); receipt of a DXA scan (OR = 84.03, 95% CI 59.80-118.07) and prevalent fracture (OR = 5.43, 95% CI 4.13-7.15) were positive predictors. Black race (OR = 0.43, 95% CI 0.33-0.57) and obese BMI (OR = 0.59, 95% CI 0.45-0.76) were negative predictors.Conclusions: Prescriptions for osteoporosis medications for persons with a SCI declined in recent years. The strongest predictors for having filled these prescriptions were having had a DXA or a prevalent fracture.
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Affiliation(s)
- Frances M. Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA,Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA,Correspondence to: Frances M. Weaver, PhD, CINCCH (151H), Hines VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA.
| | - Brian Le
- Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA,Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,Department of Biostatistics, University of Illinois, Chicago, Illinois, USA,Department of Mathematics, Northeastern Illinois University, Chicago, Illinois, USA
| | - Laura D. Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA,Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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LaVela SL, Etingen B, Miskevics S, Cella D. Use of PROMIS-29® in US Veterans: Diagnostic Concordance and Domain Comparisons with the General Population. J Gen Intern Med 2019; 34:1452-1458. [PMID: 31144276 PMCID: PMC6667584 DOI: 10.1007/s11606-019-05011-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 12/21/2018] [Accepted: 02/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND PROMIS® items have not been widely or systematically used within the Veterans Health Administration (VA). OBJECTIVE To examine the concordance of PROMIS-29® scores and medical record diagnosis in US Veterans and to compare Veteran scores relative to US population norms. DESIGN/PARTICIPANTS Cross-sectional multi-site survey of Veterans (n = 3221) provided sociodemographic and PROMIS-29® domain data. Electronic medical records provided health condition (depression, anxiety, sleep disorders, pain disorders) diagnosis data. MAIN MEASURES For each domain, we calculated PROMIS® standardized T scores and used t tests to compare PROMIS® scores for Veterans diagnosed with each targeted health condition vs. those without that documented clinical diagnosis and compare mean Veterans' PROMIS-29® with US adult population norms. KEY RESULTS Veterans with (vs. without) a depression diagnosis reported significantly higher PROMIS® depression scores (60.3 vs. 49.6, p < .0001); those with an anxiety diagnosis (vs. without) reported higher average PROMIS® anxiety scores (62.7 vs. 50.9, p < .0001). Veterans with (vs. without) a pain disorder reported higher pain interference (65.3 vs. 57.7, p < .0001) and pain intensity (6.4 vs. 4.4, p < .0001). Veterans with (vs. without) a sleep disorder reported higher sleep disturbance (55.8 vs. 51.2, p < .0001) and fatigue (57.5 vs. 51.8, p < .0001) PROMIS® scores. Compared with the general population norms, Veterans scored worse across all PROMIS-29® domains. CONCLUSIONS We found that PROMIS-29® domains are selectively sensitive to expected differences between clinically-defined groups, suggesting their appropriateness as indicators of condition symptomology among Veterans. Notably, Veterans scored worse across all PROMIS-29(R) domains compared with population norms. Taken collectively, our findings suggest that PROMIS-29® may be a useful tool for VA providers to assess patient's physical and mental health, and because PROMIS® items are normed to the general population, this offers a way to compare the health of Veterans with the adult population at large and identify disparate areas for intervention.
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Affiliation(s)
- Sherri L LaVela
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Edward Hines Jr. VA Hospital, Hines, IL, USA.
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Bella Etingen
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Scott Miskevics
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Weaver FM, Binns-Calvey A, Gonzalez B, Kostovich C, LaVela S, Stroupe KT, Kelly B, Ashley N, Miskevics S, Gerber B, Burkhart L, Schwartz A, Weiner SJ. Alerting Doctors About Patient Life Challenges: A Randomized Control Trial of a Previsit Inventory of Contextual Factors. MDM Policy Pract 2019; 4:2381468319852334. [PMID: 31192310 PMCID: PMC6540506 DOI: 10.1177/2381468319852334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/02/2018] [Accepted: 04/13/2019] [Indexed: 11/15/2022] Open
Abstract
Objective. Effective care attends to relevant patient life context. We tested whether a patient-completed inventory helps providers contextualize care and increases patients’ perception of patient-centered care (PCC). Method. The inventory listed six red flags (e.g., emergency room visits) and if the patient checked any, prompted for related contextual factors (e.g., transportation difficulties). Patients were randomized to complete the inventory or watch health videos prior to their visit. Patients presented their inventory results to providers during audio-recorded encounters. Audios were coded for physician probing and incorporating context in care plans. Patients completed the Consultation and Relational Empathy (CARE) instrument after the encounter. Results. A total of 272 Veterans were randomized. Adjusting for covariates and clustering within providers, inventory patients rated visits as more patient-centered (44.5; standard error = 1.1) than controls (42.7, standard error = 1.1, P = 0.04, CARE range = 10–50). Providers were more likely to probe red flags (odds ratio = 1.54; confidence interval = 1.07–2.22; P = 0.02) when receiving the inventory, but not incorporating context into care planning. Conclusion. A previsit inventory of life context increased perceptions of PCC and providers’ likelihood of exploring context but not contextualizing care. Information about patients’ life challenges is not sufficient to assure that context informs provider decision making even when provided at the point of care by patients themselves.
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Affiliation(s)
- Frances M Weaver
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Amy Binns-Calvey
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Beverly Gonzalez
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Carol Kostovich
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Sherri LaVela
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Kevin T Stroupe
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Brendan Kelly
- Jesse Brown VA Medical Center, Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois
| | - Naomi Ashley
- Jesse Brown VA Medical Center, Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois
| | - Scott Miskevics
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Ben Gerber
- Department of Medicine, College of Medicine
| | - Lisa Burkhart
- Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois
| | - Alan Schwartz
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Saul J Weiner
- Jesse Brown VA Medical Center, Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois
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Abstract
OBJECTIVE To examine variables associated with satisfaction with life (SWL) in individuals with a spinal cord injury (SCI). DESIGN Cross-sectional, national survey to assess SWL, demographic and injury characteristics, health care utilization, chronic conditions (obesity, diabetes, heart problems, lung problems, hypertension, high cholesterol), symptoms (poor sleep, pain, depression), social support, grief/loss, and independence. SETTING/PARTICIPANTS Community-dwelling Veterans with SCI. Outcome Measures/Analyses: Bivariate analyses were conducted to assess differences in demographics, injury characteristics, chronic conditions, symptoms, social support, grief/loss, and independence in individuals who reported low SWL (≤20) vs. average/high SWL (21-35). Multivariate logistic regression assessed factors independently associated with low SWL. RESULTS 896 Veterans with SCI (62%) responded. Average age was 62 years, the majority were male (94%), Caucasian (77%), and had paraplegia (61%). Odds of low SWL were 2.4 times greater for individuals experiencing pain (OR = 2.43, CI95: 1.47-4.02, P = 0.0005). Odds of low SWL were increased for individuals reporting greater grief/loss due to their SCI (OR = 1.14, CI95: 1.10-1.18, P < 0.0001). Lesser odds of low SWL were seen for individuals reporting greater emotional social support (OR = 0.97, CI95: 0.96-0.99, P < 0.0001) and independence (OR = 0.94, CI95: 0.90-0.97, P < 0.0001). CONCLUSIONS Pain and feelings of grief/loss due to injury were associated with low SWL. Self-perceived independence and good social support were associated with better SWL. Along with addressing pain and facilitating independence and social support, these findings suggest that interventions to improve SWL should focus on helping individuals deal with grief/loss due to injury.
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,Correspondence to: Sherri L. LaVela, PhD, MPH, MBA, Department of Veterans Affairs, Edward Hines, Jr. VA Hospital (151-H, Building 1, Office D-312), 5th Avenue & Roosevelt Road, Hines, IL60141, USA; Ph: (708) 202-5895, (708) 202-2499.
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Allen W. Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Illinois, USA
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Etingen B, Locatelli SM, Miskevics S, LaVela SL. Examining the relationship between post-traumatic stress disorder and social participation among Veterans with spinal cord injuries and disorders. Disabil Rehabil 2017; 40:2637-2643. [PMID: 28743195 DOI: 10.1080/09638288.2017.1355938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/19/2022]
Abstract
PURPOSE The objectives of this study were to examine differences in social participation among Veterans with spinal cord injuries/disorders with and without post-traumatic stress disorder, and determine if lower social participation was independently associated with having post-traumatic stress disorder. METHODS A cross-sectional mailed national survey was sent to a national sample of Veterans with spinal cord injuries/disorders who received prior-year Veterans Affairs healthcare. Surveys provided data on: demographics, health conditions, injury characteristics, and social participation. Analyses included bivariate comparisons, and multivariate logistic regression to determine if lower social participation was independently associated with post-traumatic stress disorder. RESULTS Veterans with (vs. without) post-traumatic stress disorder (n = 896) reported lower social participation (40.2 vs. 43.9, p < 0.0001). Multivariate analyses showed that longer duration of injury (OR = 0.98, 95% CI: 0.97-1.00, p = 0.04) and white race (OR = 0.62, 95% CI: 0.38-1.01, p = 0.05) were associated with lower odds of post-traumatic stress disorder, while a greater number of health conditions (OR = 1.43, 95% CI: 1.25-1.64, p < 0.0001) was associated with greater odds. When controlling for covariates, lower social participation was independently associated with post-traumatic stress disorder (OR = 0.94, 95% CI: 0.90-0.98, p = 0.003). CONCLUSIONS Results indicate post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. Efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation. Implications for Rehabilitation Individuals with spinal cord injuries/disorders often have post-traumatic stress disorder; in Veterans with spinal cord injuries/disorders this may be compounded by trauma incurred through military experiences. Social participation, an important aspect of rehabilitation and community integration following spinal cord injury or disorder, may be hindered by symptoms of post-traumatic stress disorder. Our data show that post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. These results indicate that efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation in this patient population.
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Affiliation(s)
- Bella Etingen
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Sara M Locatelli
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Scott Miskevics
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Sherri L LaVela
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA.,b Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
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Abderhalden L, Weaver FM, Bethel M, Demirtas H, Burns S, Svircev J, Hoenig H, Lyles K, Miskevics S, Carbone LD. Response to Sabour: Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders: methodological issues. Osteoporos Int 2017; 28:2261-2262. [PMID: 28508089 DOI: 10.1007/s00198-017-4056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Affiliation(s)
- L Abderhalden
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - F M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - M Bethel
- Charlie Norwood Veterans Affairs Medical Center, 950 15th St., 6D-155, Augusta, GA, 30912, USA
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - H Demirtas
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - S Burns
- VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - J Svircev
- VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - H Hoenig
- Durham VA Medical Center, 508 Fulton St, Durham, NC, USA
| | - K Lyles
- VA Medical Centers, Duke University, Durham, NC, USA
- The Carolinas Center for Medical Excellence, Cary, NC, USA
| | - S Miskevics
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, 950 15th St., 6D-155, Augusta, GA, 30912, USA.
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Locatelli SM, Etingen B, Miskevics S, LaVela SL. Effect of the environment on participation in spinal cord injuries/disorders: The mediating impact of resilience, grief, and self-efficacy. Rehabil Psychol 2017; 62:334-344. [PMID: 28581319 DOI: 10.1037/rep0000153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of the study was to test the hypothesis that the influence of environmental barriers on participation will be fully mediated by psychosocial factors (resilience, grief or loss, and self-efficacy) among individuals with spinal cord injuries and disorders. METHOD This was a cross-sectional mailed survey with a national sample of veterans with spinal cord injuries and disorders (n = 565), which included measures of demographics, perceived environmental barriers, participation, resilience, grief or loss, and self-efficacy. Data were analyzed using a latent variable path analysis; the model fit was assessed using χ2, normed χ2, root mean square error of approximation (RMSEA; <0.07), Comparative Fit Index (CFI; ≥0.95), and Tucker-Lewis Index (TLI; ≥0.95). RESULTS Participants were mostly male (93.9%), Caucasian or White (74.2%), and, on average, 62.4 years of age (SD = 10.48). Almost 62% had paraplegia, and 38.3% had a motor or sensory complete injury. The hypothesized model showed excellent fit, χ2(42) = 153.40, normed χ2 = 3.65, RMSEA = 0.07, CFI = 0.96, TLI = 0.95. To assess for full mediation, a direct path was added from environment to participation. This model showed nearly identical fit, χ2(41) = 153.39, normed χ2 = 3.74, RMSEA = 0.07, CFI = 0.96, TLI = 0.95; the path from environment to participation was not significant, unstandardized coefficient = -0.04, p = .92. Examination of indirect effects of the hypothesized model demonstrated that environment significantly influences participation through psychosocial factors, unstandardized coefficient = -4.85, p < .001. Together these results support full mediation. CONCLUSIONS In conclusion the present study expands upon past research by suggesting that perceived environmental barriers play a role in internal factors, such as resilience and self-efficacy, which in turn influence participation. Interventions to improve environmental barriers may be warranted, but attention must also be paid to resilience, grief or loss, and self-efficacy to increase participation. (PsycINFO Database Record
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Etingen B, Martinez RN, Vallette MA, Dendinger R, Bidassie B, Miskevics S, Khan HT, Cozart HT, Locatelli SM, Weaver FM. Patient perceptions of environmental control units: experiences of Veterans with spinal cord injuries and disorders receiving inpatient VA healthcare. Disabil Rehabil Assist Technol 2017; 13:325-332. [DOI: 10.1080/17483107.2017.1312574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Rachael N. Martinez
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Marissa A. Vallette
- VA-Center for Applied Systems Engineering (VA-CASE), Clinical Partnerships in Healthcare Transformation (CPHT), Veterans Engineering Resource Center (VERC), Indianapolis, IN, USA
| | - Ryan Dendinger
- VA-Center for Applied Systems Engineering (VA-CASE), Clinical Partnerships in Healthcare Transformation (CPHT), Veterans Engineering Resource Center (VERC), Indianapolis, IN, USA
| | - Balmatee Bidassie
- VA-Center for Applied Systems Engineering (VA-CASE), Clinical Partnerships in Healthcare Transformation (CPHT), Veterans Engineering Resource Center (VERC), Indianapolis, IN, USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Hira T. Khan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Huberta T. Cozart
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Sara M. Locatelli
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Frances M. Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
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Abderhalden L, Weaver FM, Bethel M, Demirtas H, Burns S, Svircev J, Hoenig H, Lyles K, Miskevics S, Carbone LD. Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders. Osteoporos Int 2017; 28:925-934. [PMID: 27924381 DOI: 10.1007/s00198-016-3841-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 05/05/2016] [Accepted: 11/11/2016] [Indexed: 01/09/2023]
Abstract
UNLABELLED Low T-scores at the hip predict incident fractures in persons with a SCI. INTRODUCTION Persons with a spinal cord injury (SCI) have substantial morbidity and mortality following osteoporotic fractures. The objective of this study was to determine whether dual-energy X-ray absorptiometry (DXA) measurements predict osteoporotic fractures in this population. METHODS A retrospective historical analysis that includes patients (n = 552) with a SCI of at least 2 years duration who had a DXA performed and were in the VA Spinal Cord Disorders Registry from fiscal year (FY) 2002-2012 was performed. RESULTS The majority of persons (n = 455, 82%) had a diagnosis of osteoporosis or osteopenia, with almost half having osteoporosis. BMD and T-scores at the lumbar spine were not significantly associated with osteoporotic fractures (p > 0.48) for both. In multivariable analyses, osteopenia (OR = 4.75 95% CI 1.23-17.64) or osteoporosis (OR = 4.31, 95% CI 1.15-16.23) compared with normal BMD was significantly associated with fractures and higher T-scores at the hip were inversely associated with fractures (OR 0.73 (95% CI 0.57-0.92)). There was no significant association of T-scores or World Health Organization (WHO) classification with incident fractures in those with complete SCI (p > 0.15 for both). CONCLUSION The majority (over 80%) of individuals with a SCI have osteopenia or osteoporosis. DXA-derived measurements at the hip, but not the lumbar spine, predict fracture risk in persons with a SCI. WHO-derived bone density categories may be useful in classifying fracture risk in persons with a SCI.
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Affiliation(s)
- L Abderhalden
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - F M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - M Bethel
- Charlie Norwood Veterans Affairs Medical Center, 950 15th St, 6D-155, Augusta, GA, 30912, USA
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - H Demirtas
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - S Burns
- VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - J Svircev
- VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - H Hoenig
- Durham VA Medical Center, 508 Fulton St, Durham, NC, USA
| | - K Lyles
- Duke University and VA Medical Centers, Durham, NC, USA
- The Carolinas Center for Medical Excellence, Cary, NC, USA
| | - S Miskevics
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, 950 15th St, 6D-155, Augusta, GA, 30912, USA.
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Bethel M, Weaver FM, Bailey L, Miskevics S, Svircev JN, Burns SP, Hoenig H, Lyles K, Carbone LD. Risk factors for osteoporotic fractures in persons with spinal cord injuries and disorders. Osteoporos Int 2016; 27:3011-21. [PMID: 27230522 DOI: 10.1007/s00198-016-3627-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/02/2016] [Indexed: 01/15/2023]
Abstract
UNLABELLED Clinical risk factors for fracture were explored among Veterans with a spinal cord injury. At the end of 11 years of follow-up, the absolute risk of fracture was approximately 20 %. Among the clinical and SCI-related factors explored, a prior history of fracture was strongly associated with incident fracture. INTRODUCTION Few studies to date have comprehensively addressed clinical risk factors for fracture in persons with spinal cord injury (SCI). The purpose of this study was to identify risk factors for incident osteoporotic fractures in persons with a SCI that can be easily determined at the point of care. METHODS The Veteran's Affairs Spinal Cord Dysfunction Registry, a national database of persons with a SCI, was used to examine clinical and SCI-related risk factors for fracture. Incident fractures were identified in a cohort of persons with chronic SCI, defined as SCI present for at least 2 years. Cox regression models were used to estimate the risk of incident fractures. RESULTS There were 22,516 persons with chronic SCI included in the cohort with 3365 incident fractures. The mean observational follow-up time for the overall sample was 6.2 years (median 6.0, IQR 2.9-11.0). The mean observational follow-up time for the fracture group was 3.9 years (median 3.3, IQR 1.4-6.1) and 6.7 years (median 6.7, IQR 3.1-11.0) for the nonfracture group. By the end of the study, which included predominantly older Veterans with a SCI observed for a relatively short period of time, the absolute (i.e., cumulative hazard) for incident fractures was 0.17 (95%CI 0.14-0.21). In multivariable analysis, factors associated with an increased risk of fracture included White race, traumatic etiology of SCI, paraplegia, complete extent of SCI, longer duration of SCI, use of anticonvulsants and opioids, prevalent fractures, and higher Charlson Comorbidity Indices. Women aged 50 and older were also at higher risk of sustaining an incident fracture at any time during the 11-year follow-up period. CONCLUSIONS There are multiple clinical and SCI-related risk factors which can be used to predict fracture in persons with a SCI. Clinicians should be particularly concerned about incident fracture risk in persons with a SCI who have had a previous fracture.
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Affiliation(s)
- M Bethel
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
- Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA, USA.
| | - F M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - L Bailey
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - S Miskevics
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - J N Svircev
- VA Puget Sound Health Care System-Seattle Division, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - S P Burns
- VA Puget Sound Health Care System-Seattle Division, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - H Hoenig
- Durham VA Medical Center, Durham, NC, USA
| | - K Lyles
- Department of Medicine, Duke University, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, VAMC, Durham, NC, USA
| | - L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA, USA
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LaVela SL, Turcios S, Malhiot A, Etingen B, Hill JN, Miskevics S. Do perceptions of family-centered care differ in older and younger family/caregivers of U.S. veterans? Fam Syst Health 2016; 34:136-149. [PMID: 26986623 DOI: 10.1037/fsh0000173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Family-centered care (FCC) involves partnering with patients and family/caregivers ("caregivers"), engaging them in decisions, and providing support. FCC may be measured across 3 dimensions: respect, collaboration, and support and needs likely vary by caregiver age. The objective was to examine and compare caregiver perceptions of FCC by age. METHOD We mailed surveys to family/caregivers of Veterans. We collected demographics and measured respect, collaboration, and support using the Family-Centered Care Survey (FCCS). We calculated mean values and conducted bivariate comparisons, dichotomized by caregiver age (≥60 vs. <60), of demographics and FCC constructs. We completed thematic analysis on open-ended text. RESULTS Caregivers (n = 2,111) aged ≥60 versus <60 were more likely to be spouses (81% vs. 62%, p < .0001) and White (74% vs. 50%, p < .0001). Overall FCC subscales values were high: respect (3.30), collaboration (3.07), and support (2.99). Older caregivers reported higher respect (3.36 vs. 3.22, p < .001), collaboration (3.12 vs. 2.98, p < .0001), and support (3.06 vs. 2.88, p < .0001). Qualitative analysis revealed collaboration, communication, hospital climate, and physical environment as important to FCC and supplemented quantitative findings on age. Examples highlighted both positive perceptions of FCC and areas of concern, such as feeling "unheard" and "like I am bothering providers," and needing "more comfortable seating" and "better parking." DISCUSSION Caregivers perceived high FCC levels at VA facilities, reporting highest on respect and lowest on support. Older caregivers perceived better FCC compared with younger caregivers. Several concerns identified can be used to target improvements to FCC including: improved support, collaboration between patient/family/provider, and climate/environmental enhancements. (PsycINFO Database Record
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Affiliation(s)
- Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital
| | - Stephanie Turcios
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital
| | - Alex Malhiot
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital
| | - Jennifer N Hill
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital
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Abstract
OBJECTIVES Given the burden of multiple chronic conditions (MCCs) in the Veterans Affairs (VA) Health Care System, understanding perspectives of Veterans with MCC is essential to evaluate chronic care and ensure that care and quality improvement efforts align with patient needs. The purpose of this study was to use the Patient Assessment of Chronic Illness Care (PACIC) instrument to examine perceptions of chronic care among Veterans with MCC. METHODS We conducted a nation-wide, cross-sectional mailed survey. Study inclusion criteria were Veteran patients with MCC who receive care from eight VA facilities. The survey included questions on patient demographics, recent hospital or doctor visits, and the PACIC instrument. Chronic condition and health care utilization data were extracted from VA administrative databases. RESULTS The sample (n = 3,519) was mostly male; average age was 68.1 years. Mean PACIC summary score was 3.05 (standard deviation [SD] = 1.12). Respondents achieved higher scores (favorable perceptions) in the Delivery System Design and Patient Activation subscales, and lowest scores (unfavorable perceptions) in the Follow-up/Coordination subscale. Characteristics associated with higher scores included non-white race, recent VA doctor visit, and high school or less education. CONCLUSIONS Perceptions of chronic care were high; however, quality improvements are needed to enhance care continuity and coordination.
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Affiliation(s)
- Salva N Balbale
- Center for Evaluation of Practices and Experiences of Patient-Centered Care, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
| | - Bella Etingen
- Center for Evaluation of Practices and Experiences of Patient-Centered Care, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
| | - Alex Malhiot
- Center for Evaluation of Practices and Experiences of Patient-Centered Care, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
| | - Scott Miskevics
- Center for Evaluation of Practices and Experiences of Patient-Centered Care, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
| | - Sherri L LaVela
- Center for Evaluation of Practices and Experiences of Patient-Centered Care, Department of Veterans Affairs, 5000 South 5th Avenue (151H), Hines, IL 60141
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Etingen B, Miskevics S, LaVela SL. Assessing the Associations of Patient-Reported Perceptions of Patient-Centered Care as Supplemental Measures of Health Care Quality in VA. J Gen Intern Med 2016; 31 Suppl 1:10-20. [PMID: 26951271 PMCID: PMC4803677 DOI: 10.1007/s11606-015-3557-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patient-reported experience measures (PREMs) are useful for assessing health care quality and safety and patients' perceptions of health care. OBJECTIVE We aimed to assess the relationship between PREMS [e.g., measures of patient-centered care (PCC)] and health care quality metrics. DESIGN We conducted a national survey via mail. Survey data were supplemented with US Department of Veteran Affairs (VA) administrative data. PARTICIPANTS Veteran (n = 5512) VA health care users participated in the study. MAIN MEASURES PCC measures included: patient activation; shared decision-making (SDM); empathy and holistic care; chronic illness care; perceptions of participation, respect for choices, and support; and overall health care experience. Health care quality measures included: preventive care screening receipt; chronic condition management (diabetes, hypertension); and health care utilization (hospitalizations, emergency room (ER) visits). Analyses included: bivariate comparisons of PCC measures by health care quality measures; and multivariate linear regression to identify variables associated with attaining multiple positive health care quality indicators (when controlling for potential confounders). KEY RESULTS PREMs assessing factors relating to patient-provider communication (e.g., empathic provider care, shared decision-making) are mainly related to clinical indicators representing good chronic condition management, while those relating more broadly to health care in general (e.g., patient activation, chronic illness care) are mainly related to measures of appropriate health care use (e.g., preventive care screening receipt; potentially avoidable hospitalizations; unscheduled care, such as ER visits). When controlling for potential confounders, higher perceptions of the decision-making effectiveness component of SDM (β = 0.004, p = 0.03) and empathy and holistic care (β = 0.01, p = 0.02) showed a weak but positive relationship with attaining a greater number of positive health care quality indicators, while a weak but negative relationship emerged for perceptions of participation, respect for choices, and support (β = -0.003, p = 0.03) and overall VA experiences (β = -0.10, p = 0.04). CONCLUSIONS PREMs that measure PCC offer rich data about health care quality while engaging patients, and considering patient experiences and preferences, in performance assessment. PREMs may be used to supplement existing performance metrics.
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Affiliation(s)
- Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA.
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA.
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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LaVela SL, Etingen B, Miskevics S. Factors Influencing Self-Care Behaviors in Persons with Spinal Cord Injuries and Disorders. Top Spinal Cord Inj Rehabil 2016; 22:27-38. [PMID: 29398891 DOI: 10.1310/sci2201-27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/11/2022]
Abstract
Background: Individuals with spinal cord injury/disorder (SCI/D) must learn to adjust to and manage functional challenges after SCI/D onset. For these individuals, resilience (ie, the adaptive response to stressful events) may be related to their willingness and ability to conduct self-care behaviors. Objective: The study objectives were to examine the relationship between patient-reported perceptions of independence in performing self-care behaviors and resilience among Veterans with SCI/D and to examine variables (including resilience) associated with high self-care scores (controlling for confounders). Methods: In this cross-sectional survey, we conducted bivariate analyses to examine differences in demographic, injury, and health characteristics and resilience scores for individuals with SCI/D. We conducted a multivariate block-design linear regression to examine factors associated with ability to perform self-care. Results: Level of injury (β = 7.74, P < .0001), resilience (β = 0.08, P = .0216), marital status (β = 1.75, P = .0445), and living arrangement (β = 4.37, P < .0001) were positively related to higher self-care behaviors. Completeness of injury (β = -2.79, P < .0001), age (β = -0.09, P = .0052), age at injury (β = -0.05, P = .0129), and number of comorbid health conditions (β = -0.72, P < .0001) showed negative relationships with higher self-care. Conclusions: Self-care ability is related to multiple factors, including resilience. The positive relationship between resilience and self-care suggests that greater resilience, independent of injury level/severity, may contribute to improved self-care behaviors in individuals with SCI/D. Other factors that showed a positive relationship with self-care included younger age, living alone, paraplegic level injury, and fewer health conditions. Understanding the profile of persons with SCI/D with regard to self-care behaviors is important to the development of tailored interventions to improve self-care.
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Affiliation(s)
- Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois.,Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois
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Abstract
Objective: To measure patients’ perceptions of the environment of care (EOC), with a focus on the physical environment, in which healthcare is delivered. Background: The EOC may impact patient experiences, care perceptions, and health outcomes. EOC may be improved through redesign of existing physical structures or spaces or by adding nurturing amenities. Methods: Demographics, health status, hospital use, and data on the environment (physical, comfort, orientation, and privacy) were collected via a mailed cross-sectional survey sent to patients seen at four hospital Centers of Innovation (COIs; that implemented many modifications to the healthcare environment to address physical, comfort, orientation, and privacy factors) and four matched controls, supplemented with checklist and VA administrative data. A modified Perceived Hospital Environment Quality Indicators instrument was used to measure patients’ EOC perceptions. Results: Respondents (3,321/5,117; 65% response) rated, [mean ( SD)], exterior space highest, 3.09 (0.73), followed by interior space, 2.96 (0.74), and privacy, 2.44 (1.01). COIs had significantly higher ratings than controls on interior space (2.99 vs. 2.96, p = .02) and privacy (2.48 vs. 2.38, p = .005) but no differences for exterior space. Subscales with significantly higher ratings in COIs (vs. controls) in interior space were “spatial–physical comfort” and “orientation,” for example, clean, good signage, spacious rooms, and for privacy included “not too crowded” and “able to talk without being overheard.” Checklist findings confirmed the presence of EOC innovations rated highly by patients. Conclusions: Patients identified cleanliness, good signs/information points, adequate seating, nonovercrowding, and privacy for conversations as important. Hospital design modifications, with particular attention to the physical environment, can improve patient EOC perceptions.
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University Chicago, Chicago, IL, USA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Jennifer N. Hill
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
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LaVela SL, Landers K, Etingen B, Karalius VP, Miskevics S. Factors related to caregiving for individuals with spinal cord injury compared to caregiving for individuals with other neurologic conditions. J Spinal Cord Med 2015; 38:505-14. [PMID: 24993244 PMCID: PMC4612206 DOI: 10.1179/2045772314y.0000000240] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 10/31/2022] Open
Abstract
CONTEXT/OBJECTIVE To compare outcomes among caregivers of adults with spinal cord injuries (SCIs) to caregivers of adults with other neurological conditions, and determine if caregiving for SCI is associated with poor health status and chronic conditions. DESIGN Secondary data analysis of 2009/2010 Behavioral Risk Factor Surveillance System survey. PARTICIPANTS Informal caregivers of adults with neurological conditions. OUTCOME MEASURES Sociodemographics, caregiving factors (e.g. role, emotional support, life satisfaction), lifestyle behaviors, chronic conditions, and health status. RESULTS Demographics and lifestyle behaviors did not differ in caregivers of adults with SCI vs. caregivers of adults with other neurological conditions (except younger age of SCI caregivers). Greater proportions of caregivers of adults with SCI had coronary heart disease (CHD) (12% vs. 6%, P = 0.06) and were obese (43% vs. 28%, P = 0.03). Frequent physical distress was reported by 20% of caregivers of persons with SCI (vs. 12% of other caregivers, P = 0.09), but mental health did not differ between caregiver groups. A greater proportion of caregivers of adults with SCI experienced insufficient sleep (47% vs. 30%, P = 0.008) and more days without enough sleep (13 vs. 9 days, P = 0.008). Odds of being younger, caregiver of a spouse, having CHD, and being obese were associated with being a caregiver of an adult with SCI. CONCLUSION Caregivers of adults with SCI report similar mental health status, but more poor sleep, and have increased odds of CHD and obesity. Interventions to address physical distress, improve sleep, and address CHD and obesity are needed in this cohort.
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Affiliation(s)
| | | | - Bella Etingen
- Correspondence to: Bella Etingen, Health Services Research & Development, Department of Veterans Affairs, Edward Hines, Jr. VA Hospital (151-H, Building 1, Office D-322), 5th Avenue & Roosevelt Road, Hines, IL 60141, USA.
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Evans CT, LaVela SL, Weaver FM, Priebe M, Sandford P, Niemiec P, Miskevics S, Parada JP. Epidemiology of Hospital-Acquired Infections in Veterans With Spinal Cord Injury and Disorder. Infect Control Hosp Epidemiol 2015; 29:234-42. [DOI: 10.1086/527509] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To describe the epidemiology of hospital-acquired infections (HAIs) in veterans with spinal cord injury and disorder (SCI&D).Design.Retrospective medical record review.Setting.Midwestern Department of Veterans Affairs spinal cord injury center.Participants.A total of 226 patients with SCI&D hospitalized at least once during a 2-year period (October 1, 2001, through September 30, 2003).Results.A total of 549 hospitalizations were included in the analysis (mean duration of hospitalization, 33.7 days); an HAI occurred during 182 (33.2%) of these hospitalizations. A total of 657 HAIs occurred during 18,517 patient-days in the hospital (incidence rate, 35.5 HAIs per 1,000 patient-days). Almost half of the 226 patients had at least 1 HAI; the mean number of HAIs among these patients was 6.0 HAIs per patient. The most common HAIs were urinary tract infection (164 [25.0%] of the 657 HAIs; incidence rate, 8.9 cases per 1,000 patient-days), bloodstream infection (111 [16.9%]; incidence rate, 6.0 cases per 1,000 patient-days), and bone and joint infection (103 [15.7%]; incidence rate, 5.6 cases per 1,000 patient-days). The most common culture isolates were gram-positive bacteria (1,082 [45.6%] of 2,307 isolates), including Staphylococcus aureus, and gram-negative bacteria (1,033 [43.6%] of isolates), including Pseudomonas aeruginosa. Multivariate regression demonstrated that predictors of HAI were longer length of hospital stay (P = .002), community-acquired infection (P = .007), and use of a urinary invasive device (P = .01) or respiratory invasive device (P = .04).Conclusions.The overall incidence of HAIs in persons with SCI&D was higher than that reported for other populations, confirming the increased risk of HAI in persons with spinal cord injury. The increased risk associated with longer length of stay and with community-acquired infection suggests that strategies are needed to reduce the duration of hospitalization and to effectively treat community-acquired infection, to decrease infection rates. There is significant room for improvement in reducing the incidence of HAIs in this population.
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Gawron AJ, Pandolfino J, Miskevics S, LaVela SL. Initial proton pump inhibitor characteristics associated with long-term prescriptions in US veterans diagnosed with gastro-oesophageal reflux disease. Journal of Pharmaceutical Health Services Research 2014. [DOI: 10.1111/jphs.12057] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Andrew J. Gawron
- Division of Gastroenterology and Hepatology; Feinberg School of Medicine; Northwestern University; Chicago USA
- Center for Healthcare Studies; Feinberg School of Medicine; Northwestern University; Chicago IL USA
- Health Services Research and Development; Department of Veterans Affairs; Edward Hines Jr. VA Hospital; Hines IL USA
| | - John Pandolfino
- Division of Gastroenterology and Hepatology; Feinberg School of Medicine; Northwestern University; Chicago USA
| | - Scott Miskevics
- Health Services Research and Development; Department of Veterans Affairs; Edward Hines Jr. VA Hospital; Hines IL USA
| | - Sherri L. LaVela
- Center for Healthcare Studies; Feinberg School of Medicine; Northwestern University; Chicago IL USA
- Health Services Research and Development; Department of Veterans Affairs; Edward Hines Jr. VA Hospital; Hines IL USA
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Hill JN, Miskevics S, LaVela SL. Electronic Medical Record Documentation of Practices, Patient Experiences, and Impacts of Integrative Medicine. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5301.abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Jennifer N. Hill
- (1) Department of Veterans Affairs/Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Hines, IL, USA
| | - Scott Miskevics
- (1) Department of Veterans Affairs/Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Hines, IL, USA
| | - Sherri L. LaVela
- (1) Department of Veterans Affairs/Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Hines, IL, USA
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Ullrich PM, Lavela SL, Evans CT, Miskevics S, Weaver FM, Goldstein B. Associations between perceptions of evidence and adoption of H1N1 influenza infection prevention strategies among healthcare workers providing care to persons with spinal cord injury. J Adv Nurs 2013; 70:1793-800. [PMID: 24341504 DOI: 10.1111/jan.12336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2013] [Indexed: 11/30/2022]
Abstract
AIM To examine associations between perceptions of evidence (research evidence, clinical expertise, patient preferences) and outcomes of a nationwide programme to implement H1N1 influenza prevention guidelines. BACKGROUND Healthcare workers do not consistently adhere to recommended infection control practices and this may be associated with their perceptions of evidence sources. DESIGN Cross-sectional mailed survey. METHOD A survey of healthcare workers was administered in August 2010 after implementation of H1N1 prevention guidelines. Outcomes of interest were ratings of adherence to H1N1 prevention guidelines. FINDINGS Respondents with complete data (N = 283) were included in analyses. Facility-level adherence to guidelines was associated with opinions of clinical experts. Healthcare workers who rated clinical expertise as aligning with recommendations also rated their facilities as being more adherent to guidelines. Perceptions of research evidence and patient preferences were not associated with facility adherence. Personal adherence was not associated with perceptions of evidence, except among those healthcare workers who rated both clinical experts and patients as unsupportive of guidelines; these practitioners were less likely to adhere to recommended personal hygiene practices. CONCLUSION Efforts to implement guidelines might be most effective when capitalizing on the influence of clinical experts. To better explain variability in guideline adherence, inclusion of a broader array of variables is recommended for future studies.
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Affiliation(s)
- Philip M Ullrich
- Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI) and VA Puget Sound Healthcare System, Seattle, Washington, USA
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Lavela SL, Goldstein B, Etingen B, Miskevics S, Weaver FM. Factors Associated With H1N1 Influenza Vaccine Receipt in a High-Risk Population During the 2009-2010 H1N1 Influenza Pandemic. Top Spinal Cord Inj Rehabil 2013; 18:306-14. [PMID: 23459437 DOI: 10.1310/sci1804-306] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 11/11/2022]
Abstract
BACKGROUND Persons with spinal cord injuries and disorders (SCI/D) are at high risk for respiratory complications from influenza. During pandemic situations, where resources may be scarce, uncertainties may arise in veterans with SCI/D. OBJECTIVE To describe concerns, knowledge, and perceptions of information received during the 2009-2010 H1N1 influenza pandemic and to examine variables associated with H1N1 vaccine receipt. METHODS In August 2010, a cross-sectional survey was mailed to a national sample of veterans with traumatic and nontraumatic SCI/D. RESULTS During the pandemic, 58% of veterans with SCI/D received the H1N1 vaccine. Less than two-thirds of non-H1N1 vaccine recipients indicated intentions to get the next season's influenza vaccine. Being ≥50 years of age and depressed were significantly associated with higher odds of H1N1 vaccination. Being worried about vaccine side effects was associated with lower odds of H1N1 receipt. Compared to individuals who reported receiving an adequate amount of information about the pandemic, those who received too little information had significantly lower odds of receiving the H1N1 vaccine. Those who received accurate/clear information (vs confusing/conflicting) had 2 times greater odds of H1N1 vaccine receipt. CONCLUSIONS H1N1 influenza vaccination was low in veterans with SCI/D. Of H1N1 vaccine nonrecipients, only 63% intend to get a seasonal vaccine next season. Providing an adequate amount of accurate and clear information is vital during uncertain times, as was demonstrated by the positive associations with H1N1 vaccination. Information-sharing efforts are needed, so that carry-over effects from the pandemic do not avert future healthy infection prevention behaviors.
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Affiliation(s)
- Sherri L Lavela
- Center for Management of Complex Chronic Care, Hines VA Hospital, Hines, Illinois ; Spinal Cord Injury Quality Enhancement Research Initiative, Department of Veterans Affairs , Hines, Illinois ; Institute for Healthcare Studies , Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Ullrich PM, Lincoln RK, Tackett MJ, Miskevics S, Smith BM, Weaver FM. Pain, depression, and health care utilization over time after spinal cord injury. Rehabil Psychol 2013; 58:158-65. [DOI: 10.1037/a0032047] [Citation(s) in RCA: 39] [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: 11/08/2022]
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Barry W, St Andre JR, Evans CT, Sabharwal S, Miskevics S, Weaver FM, Smith BM. Hypertension and antihypertensive treatment in veterans with spinal cord injury and disorders. Spinal Cord 2012; 51:109-15. [DOI: 10.1038/sc.2012.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Evans CT, Weaver FM, Rogers TJ, Rapacki L, Miskevics S, Hahm B, Smith B, Lavela SL, Goldstein B, Burns SP. Guideline-recommended management of community-acquired pneumonia in veterans with spinal cord injury. Top Spinal Cord Inj Rehabil 2012; 18:300-5. [PMID: 23459590 PMCID: PMC3584786 DOI: 10.1310/sci1804-300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 11/11/2022]
Abstract
BACKGROUND Pneumonia is a leading cause of death in persons with spinal cord injuries and disorders (SCI/D), but little is known about guideline-based management for this disease in persons with SCI/D. OBJECTIVES The goal of this study was to describe guideline-based medical care for community-acquired pneumonia (CAP) in veterans with SCI/D. METHODS A retrospective medical record review was conducted at 7 Department of Veterans Affairs (VA) medical centers where veterans with SCI/D and CAP between 2005 and 2008 were included. Outcomes assessed were receipt of blood or sputum culture, antibiotic timeliness, appropriateness of empiric antibiotic treatment, and vaccination. RESULTS In 70 patients, 77 CAP episodes occurred and 83.1% were treated in the inpatient setting. The average age was 70.0 years and 64.9% had tetraplegia. Sputum culture was completed in 24.7% and blood culture in 59.7% of cases. Of inpatients, 79.7% had antibiotic treatment within 8 hours and 45.1% received guideline-recommended empirical antibiotics. More than 90% of inpatients received antibiotic treatment within 3 days of presentation and 78.1% received recommended treatment. The rates of pneumococcal pneumonia (89.9%) and influenza (79.7%) vaccinations were high in CAP cases. CONCLUSIONS Diagnostic testing and early guideline-recommended treatment is variable in veterans with SCI/D and CAP. However vaccination against influenza and pneumococcal pneumonia is high. Specific guidelines for management of CAP in SCI/D patients may be needed, which reflect the unique risk factors and needs of this population. These data can be used as a benchmark for improvements in care processes for treating and managing CAP in persons with SCI/D.
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Affiliation(s)
- Charlesnika T Evans
- Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, Illinois ; Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI) , Hines, Illinois ; Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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LaVela SL, Evans CT, Prohaska TR, Miskevics S, Ganesh SP, Weaver FM. Males Aging With a Spinal Cord Injury: Prevalence of Cardiovascular and Metabolic Conditions. Arch Phys Med Rehabil 2012; 93:90-5. [DOI: 10.1016/j.apmr.2011.07.201] [Citation(s) in RCA: 42] [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] [Received: 03/23/2011] [Revised: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 10/14/2022]
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LaVela SL, Johnson BW, Miskevics S, Weaver FM. Impact of a multicomponent support services program on informal caregivers of adults aging with disabilities. J Gerontol Soc Work 2012; 55:160-174. [PMID: 22324332 DOI: 10.1080/01634372.2011.642472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A multicomponent support services program was implemented for veterans aging with disabilities and their informal caregivers (n = 42 dyads). Caregiver outcomes (satisfaction, physical and mental health status, burden, and benefits) were evaluated before and after program use. Caregivers reported significant improvements in mental health post-program. Caregivers who provided care to individuals with impaired physical health experienced meaningful improvements in burden after the support services were rendered. Supporting caregiver health status through such programs is vital to preserve noninstitutional long-term care for persons aging with disabilities, particularly when care is provided over many years to an individual with physical impairments.
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Affiliation(s)
- Sherri L LaVela
- Center for Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Illinois 60141, USA.
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Simuni T, Borushko E, Avram MJ, Miskevics S, Martel A, Zadikoff C, Videnovic A, Weaver FM, Williams K, Surmeier DJ. Tolerability of isradipine in early Parkinson's disease: a pilot dose escalation study. Mov Disord 2011; 25:2863-6. [PMID: 20818667 DOI: 10.1002/mds.23308] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Recent data suggests that isradipine, a dihydropyridine calcium channel blocker, is neuroprotective in preclinical models of parkinsonism. Isradipine has not been systematically studied in patients with Parkinson's disease (PD). The aim of this study was to evaluate safety and tolerability of isradipine controlled release (CR) in patients with early PD. Qualified subjects (n = 31) received isradipine CR, titrated from 5 to 20 mg daily dose over 8 weeks as tolerated. Eighty-one percent of subjects completed the study. Tolerability of isradipine CR was dose dependent: 94% for 5 mg dose; 87% for 10 mg; 68% for 15 mg; and 52% for 20 mg. Isradipine had no significant effect on blood pressure or PD motor disability. The two most common reasons for dose reduction were leg edema (7) and dizziness (3). There was no difference in isradipine tolerability between subjects with and without dopaminergic treatment, or with and without hypertension.
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Affiliation(s)
- Tanya Simuni
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
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Weaver FM, Smith B, LaVela SL, Evans CT, Ullrich P, Miskevics S, Goldstein B, Strayer J, Burns SP. Smoking behavior and delivery of evidence-based care for veterans with spinal cord injuries and disorders. J Spinal Cord Med 2011; 34:35-45. [PMID: 21528625 PMCID: PMC3066496 DOI: 10.1179/107902610x12911165975061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [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: 10/31/2022] Open
Abstract
OBJECTIVE Little is known about those veterans with spinal cord injuries and disorders (SCI/D) who smoke cigarettes. This study identified the factors associated with smoking in this population, motivations for smoking, and the readiness for smoking cessation. Current practices for the delivery of evidence-based tobacco cessation were also examined. DESIGN Methods included surveys of veterans with SCI/D, medical record reviews of current smokers, and telephone interviews with SCI/D providers. SETTING Six Veterans Health Administration facilities with SCI centers and one SCI clinic. PARTICIPANTS Survey data were analyzed for 1210 veterans, 256 medical records were reviewed, and 15 providers served as key informants. INTERVENTIONS Observational study. OUTCOME MEASURES Veterans self-reported smoking status, quit attempts, methods and care received, motivation for smoking, and health care conditions. Medical record review and informant interviews examined the tobacco cessation care provided. RESULTS Whereas 22% of the respondents were current smokers; 51% were past smokers. Current smokers more often reported respiratory illnesses and/or symptoms, alcohol use, pain, and depression than past or never smokers, and approximately half made quit attempts in the past year. Smokers received referral to counseling (57%) and/or prescription for medication/nicotine replacement (23%). Key informants identified difficulty of providing follow-up and patients' unwillingness to consider quitting as barriers. CONCLUSION Veterans with SCi/D who smoke also had other health problems. Providers offer counseling and medication, but often have difficulty following patients to arrange/provide support. Identifying other support methods such as telehealth, considering the use of combination cessation therapies, and addressing other health concerns (e.g., depression) may affect tobacco cessation in this population.
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Affiliation(s)
- Frances M. Weaver
- Center for Management of Complex Chronic Care and the Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines, IL,Program in Health Services Research, Department of Medicine, Loyola University, Maywood, IL,Correspondence to: Frances M. Weaver, Center for Management of Complex Chronic Care and the Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines, IL 60141, USA. E-mail:
| | - Bridget Smith
- Center for Management of Complex Chronic Care and the Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines, IL,Program in Health Services Research, Department of Medicine, Loyola University, Maywood, IL
| | - Sherri L. LaVela
- Center for Management of Complex Chronic Care and the Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines, IL,Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Charlesnika T. Evans
- Center for Management of Complex Chronic Care and the Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines, IL,Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Philip Ullrich
- Spinal Cord Injury Quality Enhancement Research Initiative, VA Puget Sound Healthcare System, Seattle, WA
| | - Scott Miskevics
- Center for Management of Complex Chronic Care and the Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines, IL
| | - Barry Goldstein
- Spinal Cord Injury Quality Enhancement Research Initiative, VA Puget Sound Healthcare System, Seattle, WA,Harborview Injury Prevention and Research Center and Department of Rehabilitation Medicine, University of Washington
| | | | - Stephen P. Burns
- Spinal Cord Injury Quality Enhancement Research Initiative, VA Puget Sound Healthcare System, Seattle, WA,Harborview Injury Prevention and Research Center and Department of Rehabilitation Medicine, University of Washington
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Smith BM, Evans CT, Ullrich P, Burns S, Guihan M, Miskevics S, LaVela SL, Rajan S, Weaver FM. Using VA data for research in persons with spinal cord injuries and disorders: Lessons from SCI QUERI. ACTA ACUST UNITED AC 2010; 47:679-88. [DOI: 10.1682/jrrd.2009.08.0117] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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LaVela SL, Evans CT, Miskevics S, Parada JP, Priebe M, Weaver FM. Long-term outcomes from nosocomial infections in persons with spinal cord injuries and disorders. Am J Infect Control 2007; 35:393-400. [PMID: 17660010 DOI: 10.1016/j.ajic.2006.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 08/21/2006] [Accepted: 08/22/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nosocomial infection may contribute to poor long-term consequences in persons who have spinal cord injuries and disorders (SCI&D). METHODS This is a cohort study of individuals who had SCI&D and were hospitalized at least once during 2002. They were followed for 3 years to assess inpatient (IP) admissions, total IP length of stay (LOS), outpatient (OP) visits, and mortality. Count data models and a Cox proportional hazards model were used to assess the relationship between previous infection and subsequent IP and OP use and long-term mortality, respectively. RESULTS Of persons who had SCI&D, 59% had at least one nosocomial infection. Multivariable regression indicated that veterans who had SCI&D had more IP admissions (b = 0.405; P < .0001) and longer IP LOS (b = 0.843; P < .0001) if they had a previous infection; however, infection status was not a predictor of future OP visits. Survival time was lower (913.93 versus 1034.75 days, P = .004) in the infection group. Death rate was higher in the nosocomial infection group (30.11% versus 10.77%; P = .004), but the association did not achieve significance in the Cox proportional hazards model (P = .12). CONCLUSIONS Nosocomial infections have serious subsequent consequences that result in future hospitalization and shorter survival. Efforts to prevent nosocomial infections are needed to reduce long-term adverse effects in persons who have SCI&D.
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Affiliation(s)
- Sherri L LaVela
- Spinal Cord Injury Quality Enhancement Research Initiative, Midwest Center for Health Services and Policy Research, Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA.
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Jelinek CS, O'Connell S, Miskevics S, Budiman-Mak E, Collins EG. Functional Outcomes More Associated With Body Fatness Than Weight In Obese Elderly With Knee Osteoarthritis. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000273956.93348.c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Weaver FM, Collins EG, Kurichi J, Miskevics S, Smith B, Rajan S, Gater D. Prevalence of obesity and high blood pressure in veterans with spinal cord injuries and disorders: a retrospective review. Am J Phys Med Rehabil 2007; 86:22-9. [PMID: 17304685 DOI: 10.1097/phm.0b013e31802b8937] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A frequent cause of mortality in spinal cord injuries and disorders (SCI&D) is cardiovascular disease (CVD). Obesity and high blood pressure (BP) are modifiable risk factors for CVD. DESIGN Retrospective review of clinical and administrative data for 7959 veterans with SCI&D. Data elements included height, weight, blood pressure, demographics, and level of injury. Analyses included descriptive statistics and generalized logistic regressions. RESULTS Twenty percent of veterans were obese according to their body mass index (BMI), and 33% were overweight; 22% had high BP (> or = 140/90 mm Hg). Because BMI underestimates obesity in SCI&D, adjusted BMIs for overweight (23-27 kg/m2) and obesity (28+ kg/m2) indicate that those overweight increased to 37%, and 31% were obese. Veterans ages 50-64 or who had paraplegia were more likely to be overweight and obese than others; being white or age 65+ was associated with a higher likelihood of being overweight. Veterans who were overweight or obese, black, older (age 50+), and paraplegic were more likely to have higher blood pressure. CONCLUSIONS Obesity and high BP rates were lower for veterans with SCI&D than the general population. However, because BMI underestimates body adiposity in SCI&D, obesity is likely a much more prevalent problem in this population and warrants attention.
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Affiliation(s)
- Frances M Weaver
- From the Midwest Center for Health Services & Policy Research and Research, Hines VA Hospital, Hines, Illinois 60141, USA
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Weaver FM, LaVela SL, Miskevics S, Clemmons N, Janke EA, Spring B. Smoking behavior and readiness to change in male veterans with spinal cord injuries. Rehabil Psychol 2007. [DOI: 10.1037/0090-5550.52.3.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
BACKGROUND Shoulder pain in individuals with traumatic spinal cord injury (TSCI) is common and frequently results in chronic debilitating pain recalcitrant to treatment. OBJECTIVE Our objectives were to identify the risk factors associated with shoulder pain in the TSCI population. METHODS A telephone survey and medical record review were conducted on a convenience sample of patients with TSCI. Data variables included: Shoulder Pain and Disability Index (SPADI), demographics, injury type, treatment histories for shoulder pain/dysfunction, assistive device use, and radiographic imaging. RESULTS Respondents (n=63) were male (96%) and tetraplegia (51%) with a mean age of 58.1 years. The majority of patients (70%) currently had shoulder pain, one third had previous injury to the shoulder, and 52% reported bilateral pain. Tetraplegics had higher prevalence (80%) of shoulder pain and higher total SPADI scores than paraplegics (P=0.001). Previous shoulder trauma increased the likelihood of shoulder pain. Self-care posed their most difficult task. Use of a manual wheelchair (71%) and/or trapeze bar (51%) was common. However, no differences were found in wheelchair or trapeze bar use or average body mass index between groups with and without pain. Respondents with pain tended to use trapeze bars less. Of the respondents reporting shoulder pain, an estimated 57% received physical therapy and massage with most reporting some benefit; 53% had pharmaceutical treatment with variable effect. CONCLUSION Shoulder pain is common in patients with TSCI. Tetraplegics fared worse than paraplegics. Pain may limit transfer because respondents with pain used trapeze bars less. Understanding and addressing the factors contributing to shoulder pain in this vulnerable population is sorely needed.
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Affiliation(s)
- Leslie D McCasland
- Department of Rheumatology, Loyola University Medical Center, Maywood, and Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois 60141-9910, USA
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LaVela S, Evans C, Miskevics S, Mike P, Jorge P. Blue Ribbon Abstract Award. Am J Infect Control 2006. [DOI: 10.1016/j.ajic.2006.05.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bammert CS, OʼConnell S, Miskevics S, Collins EG, Budiman-Mak E. Increased Mobility in Obese Elderly with Knee Osteoarthritis-A Home-Based Walking and Strength Program. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-02641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Evans CT, Lavela SL, Smith B, Miskevics S, Weaver FM, Goldstein B. Influenza diagnosis and treatment in veterans with spinal cord injury. Arch Phys Med Rehabil 2006; 87:291-3. [PMID: 16442987 DOI: 10.1016/j.apmr.2005.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 07/28/2005] [Accepted: 10/10/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess influenza diagnosis and treatment behaviors and prescribing practices for antiviral medications among spinal cord injury (SCI) practitioners. DESIGN Anonymous cross-sectional survey of practitioners and retrospective review of administrative diagnostic and prescription databases. SETTING Department of Veterans Affairs health care facilities. PARTICIPANTS One hundred practitioners participated (response rate, 65%). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Strategies for diagnosing and treating influenza and type of antivirals prescribed. RESULTS Ninety-seven percent of practitioners reported using clinical symptoms to diagnose a patient with influenza. The most common treatments included symptom relievers (94%), followed by antivirals (21%). Antivirals reportedly used included amantadine (64%), rimantadine (36%), oseltamivir (32%), and zanamivir (11%). Twenty-one prescriptions for antivirals were identified during the influenza season and all were for amantadine. CONCLUSIONS Despite recommendations by the U.S. Centers for Disease Control and Prevention and high risks of respiratory complications after SCI, antiviral medications and diagnostic tests for influenza are seldom used in the treatment of influenza in this population. Research is needed to identify barriers to diagnosing and administering antivirals in people with SCI.
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Affiliation(s)
- Charlesnika T Evans
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative, Midwest Center for Health Services and Policy Research, Edward Hines Jr VA Hospital, Hines, IL 60141, USA.
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Lavela SL, Weaver FM, Goldstein B, Chen K, Miskevics S, Rajan S, Gater DR. Diabetes mellitus in individuals with spinal cord injury or disorder. J Spinal Cord Med 2006; 29:387-95. [PMID: 17044389 PMCID: PMC1864854 DOI: 10.1080/10790268.2006.11753887] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 05/15/2006] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE To examine diabetes prevalence, care, complications, and characteristics of veterans with a spinal cord injury or disorder (SCI/D). METHODS A national survey of veterans with an SCI/D was conducted using Behavioral Risk Factor Surveillance System (BRFSS) survey questions. Data were compared with national Centers for Disease Control and Prevention BRFSS data for veteran and nonveteran general populations. RESULTS Overall prevalence of diabetes in individuals with an SCI/D was 20% (3 times higher than in the general population). Veterans with an SCI/D and veterans, in general, had a higher prevalence of diabetes across all age groups; however, those with an SCI/D who were 45 to 59 years of age had a higher prevalence than other veterans. One fourth of the persons with an SCI/D and diabetes reported that diabetes affected their eyes or that they had retinopathy (25%), and 41% had foot sores that took more than 4 weeks to heal. More veterans, both with (63%) and without an SCI/D (60%), took a class on how to manage their diabetes than the general population (50%). Veterans with an SCI/D and diabetes were more likely to report other chronic conditions and poorer quality of life than those without diabetes. CONCLUSIONS Diabetes prevalence is greater among veterans with an SCI/D compared with the civilian population, but is similar to that of other veterans, although it may occur at a younger age in those with an SCI/D. Veterans with an SCI/D and diabetes reported more comorbidities, more slow-healing foot sores, and poorer quality of life than those without diabetes. Efforts to prevent diabetes and to provide early intervention in persons with SCI/D are needed.
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Affiliation(s)
- Sherri L Lavela
- Spinal Cord Injury Quality Enhancement Research Initiative, Midwest Center for Health Services and Policy Research, Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois 60141, USA.
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Weaver FM, Goldstein B, Evans CT, Legro MW, LaVela S, Smith B, Miskevics S, Hammond MC. Influenza vaccination among veterans with spinal cord injury: Part 2. Increasing vaccination rates. J Spinal Cord Med 2004; 26:210-8. [PMID: 14997959 DOI: 10.1080/10790268.2003.11753684] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [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] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Respiratory complications are the leading cause of morbidity and mortality among individuals with spinal cord injury (SCI). Influenza vaccination is effective in reducing the likelihood of contracting influenza and of subsequent respiratory complications, hospitalizations, and deaths. Historically, vaccination rates for veterans with SCI treated in Veterans Affairs (VA) facilities have been low. The objective of this study was to increase vaccination rates in this population using a multipronged strategy. METHODS A quasi-experimental design involving 2,284 veterans treated at 8 VA SCI Centers was used. Patients at 4 centers received reminder letters and educational materials tailored to SCI. Provider education included mailed reminders and posters in SCI clinical areas. Clinical champions were identified at each site. Four other centers, matched to the study sites in program size and prior vaccination rates, served as comparison sites providing usual care. Vaccination rates were assessed using mailed surveys with telephone follow-up. RESULTS The influenza vaccination rate was significantly higher in the intervention group than in the comparison group (60.5% vs 54.3%; P = 0.01 ). Vaccine recipients were older than nonrecipients (mean age 60.8 vs 53.1 years; P < 0.0001). Reasons for not receiving a vaccination included refusal, feeling that being vaccinated was not worth the trouble, and not believing that the vaccine would prevent influenza. CONCLUSIONS Use of low-cost mailed reminders and educational materials resulted in significantly higher vaccination rates. Further efforts to reach targeted subgroups of nonrecipients, such as patients who are younger or from an ethnic minority, are warranted.
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Affiliation(s)
- Frances M Weaver
- Midwest Center for Health Services and Policy Research, Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois 60141, USA.
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Guihan M, Weaver FM, Cowper DC, Nydam T, Miskevics S. Using Department of Veterans Affairs Administrative databases to examine long-term care utilization for men and women veterans. J Med Syst 1999; 23:201-18. [PMID: 10554736 DOI: 10.1023/a:1020571504693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We examined long-term care (LTC) utilization by male and female veterans using administrative databases maintained by VA. Research questions included: (1) Which LTC services are utilized? (2) Do utilization patterns of older veterans differ from those of elderly persons in the general U.S. population? (3) Do LTC needs of veterans vary by gender? We were unable to track LTC utilization of individuals across administrative databases. Some databases could only provide information at the national level, or alternatively, were available only at local facilities, or only at the patient or program-level data--making it impossible to get a clear picture of all the services received by an individual. Those planning to use administrative databases to conduct research must: (1) take more time than expected; (2) be flexible/willing to compromise, (3) "ferret out" information, and (4) recognize that because of dynamism inherent in information systems, results may change over time.
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Affiliation(s)
- M Guihan
- Midwest Center for Health Services and Policy Research, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
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