VA Information Resource Center

Background: Predialysis nephrology care is associated with lower mortality and rates of hospitalization following chronic dialysis initiation. Whether more frequent predialysis nephrology care is associated with other favorable outcomes for older adults is not known.

Methods: Retrospective cohort study of patients =66 years who initiated chronic dialysis in 2000–2001 and were eligible for VA and/or Medicare-covered services. Nephrology visits in VA and/or Medicare during the 12-month predialysis period were identified and classified by low intensity (<3 visits), moderate intensity (3–6 visits), and high intensity (>6 visits). Outcome measures included very low estimated glomerular filtration rate, severe anemia, use of peritoneal dialysis, and receipt of permanent vascular access at dialysis initiation and death and kidney transplantation within two years of initiation. Generalized linear models with propensity score weighting were used to examine the association between nephrology care and outcomes.

Results: Among 58,014 patients, 46 % had none, 22 % had low, 13 % had moderate, and 19 % had high intensity predialysis nephrology care. Patients with a greater intensity of predialysis nephrology care had more favorable outcomes (all p <0.001). In adjusted models, patients with high intensity predialysis nephrology care were less likely to have severe anemia (RR = 0.70, 99 % CI: 0.65–0.74) and more likely to have permanent vascular access (RR = 3.60, 99 % CI: 3.42–3.79) at dialysis initiation, and less likely to die within two years of dialysis initiation (RR = 0.80, 99 % CI: 0.77–0.82).

Conclusion: In a large cohort of older adults treated with chronic dialysis, greater intensity of predialysis nephrology care was associated with more favorable outcomes.

Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases.

Purpose: Our aim was to study how patients and their clinicians evaluated the usability of PatientViewpoint, a webtool designed to allow patient-reported outcome (PRO) measures to be used in clinical practice.

Methods: As part of a two-round quality improvement study, breast and prostate cancer patients and their medical and radiation oncology clinicians completed semi-structured interviews about their use of PatientViewpoint. The patient interview addressed different phases of the PRO completion workflow: reminders, completing the survey, and viewing the results. The clinician interviews asked about use of PatientViewpoint, integration with the clinical workflow, barriers to use, and helpful and desired features. Responses were recorded, categorized, and reviewed. After both rounds of interviews, modifications were made to PatientViewpoint.

Results: Across the two rounds, 42 unique patients (n=19 in round 1, n=23 in round 2) and 12 clinicians (all in both rounds) completed interviews. For patients, median age was 65, 81% were white, 69% were college graduates, 80% had performance status of 0, 69% had loco-regional disease, and 81% were regular computer users. In the quality improvement interviews, patients identified numerous strengths of the system, including its ability to flag issues for discussion with their provider. Comments included confusion about how scores were presented and that the value of the system was diminished if the doctor did not look at the results. Requests included tailoring questions to be applicable to the individual and providing more explanation about the score meaning, including having higher scores consistently indicating either better or worse status. Clinicians also provided primarily positive feedback about the system, finding it helpful in some cases, and confirmatory in others. Their primary concern was with impact on their workflow.

Conclusions: Systematically collected feedback from patients and clinicians was useful to identify ways to improve a system to incorporate PRO measures into oncology practice. The findings and evaluation methods should be useful to others in efforts to integrate PRO assessments into ambulatory care.

Implications for Cancer Survivors: Systems to routinely collect patient-reported information can be incorporated into oncology practices and provide useful information that promote patient and clinician partnership to improve the quality of care.

The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedented collaboration across diverse healthcare institutions including private, county, and state hospitals and health systems, a consortium of Federally Qualified Health Centers, and two Department of Veterans Affairs hospitals. CAPriCORN builds on the strengths of our institutions to develop a cross-cutting infrastructure for sustainable and patient-centered comparative effectiveness research in Chicago. Unique aspects include collaboration with the University HealthSystem Consortium to aggregate data across sites, a centralized communication center to integrate patient recruitment with the data infrastructure, and a centralized institutional review board to ensure a strong and efficient human subject protection program. With coordination by the Chicago Community Trust and the Illinois Medical District Commission, CAPriCORN will model how healthcare institutions can overcome barriers of data integration, marketplace competition, and care fragmentation to develop, test, and implement strategies to improve care for diverse populations and reduce health disparities.

Integrating community health workers (CHWs) into health care systems has been associated with enhanced patient experience, improved population health, and reduced costs and unnecessary utilization of resources. Under the Affordable Care Act (ACA), care provided by CHWs is eligible for reimbursement. However, optimal integration of CHWs into health care requires purposeful implementation. This health policy brief is focused on the benefits of integrating CHWs specifically into the patient-centered medical home (PCMH). CHWs in the PCMH can serve as primary providers of culturally relevant information and advocacy, assist providers in understanding the influence of patients’ environment on disease management, and enhance motivation for self-care management among patients with chronic diseases. Despite the important role of CHWs, there are some barriers to integration into existing systems of care. The Society of Behavioral Medicine (SBM) recommends overcoming these barriers by establishing standards that ensure a skilled CHW workforce, clearly defining roles for CHWs, and expanding the scope of reimbursable prevention and primary care services to include those provided by CHWs.

Background: Patient adherence to medication regimens is critical in most chronic disease treatment plans. This study uses a patient-centered tablet app, “My Interventional Drug-Eluting Stent Educational App (MyIDEA).” This is an educational program designed to improve patient medication adherence.

Objective: Our goal is to describe the design, methodology, limitations, and results of the MyIDEA tablet app. We created a mobile technology-based patient education app to improve dual antiplatelet therapy adherence in patients who underwent a percutaneous coronary intervention and received a drug-eluting stent.

Methods: Patient advisers were involved in the development process of MyIDEA from the initial wireframe to the final launch of the product. The program was restructured and redesigned based on the patient advisers’ suggestions as well as those from multidisciplinary team members. To accommodate those with low health literacy, we modified the language and employed attractive color schemes to improve ease of use. We assumed that the target patient population may have little to no experience with electronic tablets, and therefore, we designed the interface to be as intuitive as possible.

Results: The MyIDEA app has been successfully deployed to a low-health-literate elderly patient population in the hospital setting. A total of 6 patients have interacted with MyIDEA for an average of 17.6 minutes/session.

Conclusions: Including patient advisers in the early phases of a mobile patient education development process is critical. A number of changes in text order, language, and color schemes occurred to improve ease of use. The MyIDEA program has been successfully deployed to a low-health-literate elderly patient population. Leveraging patient advisers throughout the development process helps to ensure implementation success.

In the U.S., more than 400,000 individuals with end-stage renal disease (ESRD) require hemodialysis (HD) for renal replacement therapy. ESRD patients experience a high burden of morbidity, mortality, resource utilization, and poor quality of life (QOL). Under current care models, ESRD patients receive fragmented care from multiple providers at multiple locations. The Patient-Centered Medical Home (PCMH) is a team approach, providing coordinated care across the healthcare continuum. While this model has shown some early benefits for complex chronic diseases such as diabetes, it has not been applied to HD patients. This study is a non-randomized quasi-experimental intervention trial implementing a Patient-Centered Medical Home for Kidney Disease (PCMH-KD). The PCMH-KD extends the existing dialysis care team (comprised of a nephrologist, dialysis nurse, dialysis technician, social worker, and dietitian) by adding a general internist, pharmacist, nurse coordinator, and a community health worker, all of whom will see the patients together, and separately, as needed. The primary goal is to implement a comprehensive, multidisciplinary care team to improve care coordination, quality of life, and healthcare use for HD patients. Approximately 240 patients will be recruited from two sites; a non-profit university-affiliated dialysis center and an independent for-profit dialysis center. Outcomes include (i) patient-reported outcomes, including QOL and satisfaction; (ii) clinical outcomes, including blood pressure and diet; (iii) healthcare use, including emergency room visits and hospitalizations; and (iv) staff perceptions. Given the significant burden that patients with ESRD on HD experience, enhanced care coordination provides an opportunity to reduce this burden and improve QOL.

Purpose: Use of erythropoiesis-stimulating agents (ESAs) in US cancer care declined amidst post-marketing evidence of adverse effects and the Food and Drug Administration's (FDA) addition of a "black-box" warning to product labeling in March 2007. Because reduced ESA use may have led to more transfusions or increased anemia-related health care needs, we measured the policy's impact on health care costs of lung and colon cancer patients receiving chemotherapy.

Methods: In a retrospective cohort study of 13,630 lung and 3,198 colon cancer patients in the Department of Veterans Affairs (VA) between 2002 and 2008, we calculated anemia treatment (ESA and transfusion), cancer- and non-cancer-related, and total health care costs for the chemotherapy episode of care. We used multivariable regression to examine health care costs and utilization between patients whose chemotherapy was administered before (PRE) or after (POST) March 1, 2007.

Results: ESA costs declined and transfusion costs were similar, resulting in lower overall POST-period anemia treatment costs (lung, $526 lower, P <0.01; colon, $504 lower, P <0.01). Other cancer-related health care costs increased, resulting in markedly higher POST-period total health care costs (lung, $4,706 higher, P <0.01; colon, $11,414 higher, P <0.01).

Conclusions: Although chemotherapy episode anemia treatment costs declined after the black-box warning, the savings were offset by increases in other cancer-related costs. Those increases were mainly in outpatient services and pharmacy, suggesting that likely drivers include adoption of new high-cost diagnostic approaches and therapeutic modalities. Additional research is needed to determine the effects of anemia management changes on patient outcomes and to more fully understand cost-benefit relationships in cancer treatment.

The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedented collaboration across diverse healthcare institutions including private, county, and state hospitals and health systems, a consortium of Federally Qualified Health Centers, and two Department of Veterans Affairs hospitals. CAPriCORN builds on the strengths of our institutions to develop a cross-cutting infrastructure for sustainable and patient-centered comparative effectiveness research in Chicago. Unique aspects include collaboration with the University HealthSystem Consortium to aggregate data across sites, a centralized communication center to integrate patient recruitment with the data infrastructure, and a centralized institutional review board to ensure a strong and efficient human subject protection program. With coordination by the Chicago Community Trust and the Illinois Medical District Commission, CAPriCORN will model how healthcare institutions can overcome barriers of data integration, marketplace competition, and care fragmentation to develop, test, and implement strategies to improve care for diverse populations and reduce health disparities.

Objective: The PatientViewpoint website collects patient-reported outcomes (PROs) and links them with the electronic health record to aid patient management. This pilot-test evaluated PatientViewpoint’s use, usefulness, and acceptability to patients and clinicians.

Methods: This was a single-arm prospective study that enrolled breast and prostate cancer patients undergoing treatment and the clinicians who managed them. Patients completed PROs every two weeks, and clinicians could access the results for patient visits. Scores that were poor relative to norms or substantially worse than the previous assessment were highlighted. After three on-study visits, we assessed patient and clinician perspectives on PatientViewpoint using close-ended and open-ended questions.

Results: 11/12 eligible clinicians (92%) and 52/76 eligible patients (68%) enrolled. Patients completed a median of 71% of assigned questionnaires; clinicians reported using the information for 79% of patients, most commonly as a source of additional information (51%). At the median, score reports identified 3 potential issues, of which 1 was discussed during the visit. Patients reported the system was easy to use (92%), useful (70%), aided recall of symptoms/side effects (72%), helped them feel more in control of their care (60%), improved discussions with their provider (49%), and improved care quality (39%). Patients and clinicians desired more information on score interpretation and minor adjustments to site navigation.

Conclusions: These results support the feasibility and value of PatientViewpoint. An ongoing study is using a continuous quality improvement approach to further refine PatientViewpoint. Future studies will evaluate its impact on patient care and outcomes.

Background: The Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) has demonstrated how implementation science can enhance the quality of health care. During this time an increasing number of implementation research projects have developed or utilized health information technology (HIT) innovations to leverage the VA's electronic health record and information systems.

Objective: To describe the HIT approaches used and to characterize the facilitators and barriers to progress within implementation research projects in the VA QUERI program.

Participants: Nine case studies were selected from among 88 projects and represented 8 of 14 HIT categories identified. Each case study included key informants whose roles on the project were principal investigator, implementation science and informatics development.

Approach: We conducted documentation analysis and semistructured in-person interviews with key informants for each of the 9 case studies. We used qualitative analysis software to identify and thematically code information and interview responses.

Results: Thematic analyses revealed 3 domains or pathways critical to progression through the QUERI steps. These pathways addressed: (1) compliance and collaboration with information technology policies and procedures; (2) operating within organizational policies and building collaborations with end users, clinicians, and administrators; and (3) obtaining and maintaining research resources and approvals.

Conclusion: Sustained efforts in HIT innovation and in implementation science in the Veterans Health Administration demonstrates the interdependencies of these initiatives and the critical pathways that can contribute to progress. Other health care quality improvement efforts that rely on HIT can learn from the Veterans Health Administration experience.

Objective: This study examined employment outcomes of veterans with substance use disorders and comorbid general medical and psychiatric disorders following substance abuse treatment.

Methods: The authors obtained employment and other information reported by 5,729 veterans at intake and at follow-up three to nine months after receiving substance abuse treatment from the U.S. Department of Veterans Affairs during 2001-2010. Random-effects logistic regression models examined the probability of having employment earnings and days of paid work during the past 30 days among veterans with comorbid conditions.

Results: The percentage of veterans with any days of paid work rose from 28% at intake to 35% at follow-up. Veterans with comorbid anxiety and general medical conditions had lower odds of having earnings from employment or days of paid work at follow-up.

Conclusion: Veterans with substance use disorders, particularly those with comorbid general medical and anxiety disorders, may be at risk of employment problems.

Background: Demand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA), requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcomes are similar for veterans receiving dialysis from VA versus non-VA providers. We assessed the extent of chronic dialysis treatment utilization and differences in all-cause hospitalizations and mortality between veterans receiving dialysis from VA versus VA-outsourced providers.

Methods: We constructed a retrospective cohort of veterans in 2 VA regions who received chronic dialysis treatment financed by VA between January 2007 and December 2008. From VA administrative data, we identified veterans who received outpatient dialysis in (1) VA, (2) VA-outsourced settings, or (3) both (“dual”) settings. In adjusted analyses, we used two-part and logistic regression to examine associations between dialysis setting and all-cause hospitalization and mortality one-year from veterans’ baseline dialysis date.

Results: Of 1,388 veterans, 27% received dialysis exclusively in VA, 47% in VA-outsourced settings, and 25% in dual settings. Overall, half (48%) were hospitalized and 12% died. In adjusted analysis, veterans in VA-outsourced settings incurred fewer hospitalizations and shorter hospital stays than users of VA due to favorable selection. Dual-system dialysis patients had lower one-year mortality than veterans receiving VA dialysis.

Conclusion: VA expenditures for “buying” outsourced dialysis are high and increasing relative to “making” dialysis treatment within its own system. Outcomes comparisons inform future make-or-buy decisions and suggest the need for VA to consider veterans’ access to care, long-term VA savings, and optimal patient outcomes in its placement decisions for dialysis services.

Keywords: Veterans Dialysis Hospitalization Mortality

In this manuscript, we present our experiences using the Apache Hadoop framework for high data volume and computationally intensive applications, and discuss some best practice guidelines in a clinical informatics setting. There are three main aspects in our approach: (a) process and integrate diverse, heterogeneous data sources using standard Hadoop programming tools and customized MapReduce programs; (b) after fine-grained aggregate results are obtained, perform data analysis using the Mahout data mining library; (c) leverage the column oriented features in HBase for patient centric modeling and complex temporal reasoning. This framework provides a scalable solution to meet the rapidly increasing, imperative "Big Data" needs of clinical and translational research. The intrinsic advantage of fault tolerance, high availability and scalability of Hadoop platform makes these applications readily deployable at the enterprise level cluster environment.

This study examines labor market status of Veterans of the Iraq/Afghanistan-era and previous eras, and variations by age and by health status, using the Current Population Survey (CPS) March supplement from 2006 to 2011. Although this observational study does not demonstrate a causal effect of military service on labor market outcomes, the authors find that Iraq/Afghanistan-era service among the youngest Veterans (ages 18–24) was associated with higher earnings and greater odds of being enrolled in school, but also higher odds of unemployment. Military service in previous eras by older Veterans, particularly those in fair or poor health, was associated with higher odds of unemployment and lower earnings than their nonveteran counterparts. Future research should examine the reasons for the higher unemployment rates of the youngest Veterans and should examine whether receipt of services such as health care services, disability benefits, and military reintegration programs are associated with improved labor market outcomes.

The distributions of medical costs are often skewed to the right because small numbers of patients use large amounts of health care resources. Using data from a study of colon cancer costs, we show, by example, the impact and magnitude of outliers and influential observations on health care costs and compared the effects of statistical costing methods for addressing the disproportionate influence of outliers and influential observations. We used data from a retrospective cohort study of 3,842 elderly veterans with colon cancer who were enrolled in and used health care from, both the Department of Veterans Affairs and Medicare in 1999-2004. After calculating the average colon cancer episode cost and distribution for the full cohort, we used box-plot methods, Winsorization, DFBETAs, and Cook's distance to identify and assess or adjust the outlying and/or influential observations. The number of observations identified as outlying and/or influential ranged from 13 when the predicted DFBETA measurement was greater than 0.15 and the observation was a qualified box-plot outlier to 384 cases using the Winsorization method at the 5th and 95th percentiles. Average costs of colon cancer episodes using these methods were similar. The method of choice from the results of this particular analysis can be conditionally based on whether the purpose is to control only for influential observations or to simultaneously control for outliers and influential observations. Understanding how estimates could change with each approach is important in assessing the impact of a particular method on the results.

Humensky, J; Carretta, H; de Groot, K; Brown, MM; Tarlov, E; Hynes, DM. Service Utilization of Veterans Dually Eligible for VA and Medicare Fee-For-Service: 1999?2004. Medicare Care & Medicaid Research Review, 2012; 2(3): E1?E22.

Abstract

Tarlov E, Stroupe KT. Advancing Veterans' Healthcare Using Electronic Data: Lessons Learned From Researchers in the Field. J Rehabil Res Dev. November 2010; 47(8):vii-vxi.

Stroupe KT, Tarlov E, Zhang Q, Haywood T, Owens A, Hynes DM. Use of Medicare and DOD Data for Improving VA Race Data Quality. J Rehabil Res Dev. November 2010; 47(8): 781-795.

Abstract

Noel PH, Copeland LA, Perrin RA, Lancaster AE, Pugh MJ, Wang CP, et al. VHA Corporate Data Warehouse Height and Weight Data: Opportunities and Challenges for Health Services Research. J Rehabil Res Dev. November 2010; 47(8):739-750.

Abstract

Hynes DM, Weddle T, Smith N, Whittier E, Atkins D, Francis J. Use of Health Information Technology to Advance Evidence-Based Care: Lessons From the VA QUERI Program. J Gen Intern Med. January 2010; 25 (suppl) 1:44-49.

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Hynes DM, Koelling K, Stroupe KT, Arnold N, Mallin, K, Sohn, MW, et al. Veterans' Access to and Use of Medicare and Veterans Affairs Health Care. Med Care. March 2007; 45(3):214-223.

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Hynes DM, Koelling K, Stroupe KT, Arnold N, Mallin, K, Sohn, MW, et al. Veterans' Access to and Use of Medicare and Veterans Affairs Health Care. Med Care. March 2007; 45(3):214-223.

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Sohn MW, Zhang H, Arnold N, Stroupe KT, Taylor BC, Wilt TJ, et al. Transition to the New Race/Ethnicity Data Collection Standards in the Department of Veterans Affairs. Popul Health Metr. Jul 6 2006; 4:7.

Abstract

Sohn MW, Arnold N, Maynard C, Hynes DM. Accuracy and Completeness of Mortality Data in the Department of Veterans Affairs. Popul Health Metr. Apr 10 2006; 4:2.

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Kraft MR, Hynes DM. Decision Support Within the Veterans' Health Administration. Stud Health Technol Inform. July 2006; 122:100-104.

Abstract

Kraft MR, Androwich, I. Clinical Decision Support Systems. in Saba, VK; McCormick, KA, editors. Essentials of Nursing Informatics 4th Ed. 2006; New York: McGraw-Hill, Medical Pub. Division.

Sohn MW, Zhang H, Arnold N, Stroupe KT, Taylor BC, Wilt TJ, et al. Transition to the New Race/Ethnicity Data Collection Standards in the Department of Veterans Affairs. Popul Health Metr. Jul 6 2006; 4:7.

Abstract

Sohn MW, Arnold N, Maynard C, Hynes DM. Accuracy and Completeness of Mortality Data in the Department of Veterans Affairs. Popul Health Metr. Apr 10 2006; 4:2.

Abstract

Kraft MR, Hynes DM. Decision Support Within the Veterans' Health Administration. Stud Health Technol Inform. July 2006; 122:100-104.

Abstract

Kraft MR, Androwich, I. Clinical Decision Support Systems. in Saba, VK; McCormick, KA, editors. Essentials of Nursing Informatics 4th Ed. 2006; New York: McGraw-Hill, Medical Pub. Division.

Hynes DM, Perrin RA, Rappaport S, Stevens JM, Demakis JG. Informatics Resources to Support Health Care Quality Improvement in the Veterans Health Administration. J Am Med Inform Assoc. September 2004; 11(5):344-350.

Abstract

Perrin R, Stevens JM. Facilitating the Translation of Research Into Practice. QUERI Quarterly. March 2004;(6).

Cowper DC, Yu W, Kuebeler M, Kubal JD, Manheim LM, Ripley BA. Using GIS in Government: an Overview of the VHA's Healthcare Atlas, FY-2000. J Med Syst. Jun 2004; 28(3):257-269.

Abstract

Hynes DM, Perrin RA, Rappaport S, Stevens JM, Demakis JG. Informatics Resources to Support Health Care Quality Improvement in the Veterans Health Administration. J Am Med Inform Assoc. September 2004; 11(5):344-350.

Abstract

Perrin R, Stevens JM. Facilitating the Translation of Research Into Practice. QUERI Quarterly. March 2004;(6).

Cowper DC, Yu W, Kuebeler M, Kubal JD, Manheim LM, Ripley BA. Using GIS in Government: an Overview of the VHA's Healthcare Atlas, FY-2000. J Med Syst. Jun 2004; 28(3):257-269.

Abstract

Demakis JG. The Cost of VA Care: Lessons of the Evaluating VA Costs Study. Preface. Med Care. Jun 2003; 41(6 suppl):II-1.

Smith MW, Joseph GJ. Pharmacy Data in the VA Health Care System. Med Care Res Rev. Sep 2003; 60(3 suppl):92S-123S.

Abstract

Demakis JG. The Cost of VA Care: Lessons of the Evaluating VA Costs Study. Preface. Med Care. Jun 2003; 41(6 suppl):II-1.

Smith MW, Joseph GJ. Pharmacy Data in the VA Health Care System. Med Care Res Rev. Sep 2003; 60(3 suppl):92S-123S.

Abstract

Murphy PA. VIReC Begins Fifth Year With New Initiatives. VA Research Currents. Dec 2002.

Cowper DC, Kubal JD, Maynard C, Hynes DM. A Primer and Comparative Review of Major US Mortality Databases. Ann Epidemiol. October 2002; 12(7):462-468.

Abstract

Murphy PA, Cowper DC, Seppala G, Stroupe KT, Hynes DM. Veterans Health Administration Inpatient and Outpatient Care Data: an Overview. Eff Clin Pract. May 2002; 5(3 Suppl):E4.

Hynes DM, Cowper DC, Kerr M, Kubal JD, Murphy PA. Database and Informatics Support for QUERI: Current Systems and Future Needs. Quality Enhancement Research Initiative. Med Care. June 2000; 38(6 Suppl 1):I-114-I-128.

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Hynes DM. Research As a Key to Promoting and Sustaining Innovative Practice. Nurs Clin North A. June 2000; 35(2):453-459.

Abstract

Kubal JD, Webber S, Cowper DC, Hynes DM. VIReC: Promoting Information Sharing in the Health Services Research Community. Federal Practitioner. October 2000; 17(10):13-14.

Kubal JD. VA Information Resource Center: Your Guide to VA Data. Veterans Health Systems Journal. April 2000; 5(4):21-23.

Kubal JD. Database Information Available From New VA Center. Medical Geography Newsletter. January 2000; 17(1):7.

Cowper DC, Hynes DM. Solid Data, Solid Research: A Response From the VA Information Resource Center. Forum (Genova). November 1999.

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Cowper DC, Hynes DM, Kubal JD, Murphy PA. Using Administrative Databases for Outcomes Research: Select Examples From VA Health Services Research and Development. J Med Syst. June 1999; 23(3):249-259.

Abstract

Guihan M, Weaver FM, Cowper DC, Nydam T, Miskevics S. Using Department of Veterans Affairs Databases to Examine Long Term Care Utilization for Men and Women Veterans. J Med Syst. 1999; 23:201-218.

Abstract

Kubal JD, Guihan M, Hynes DM, Cowper DC. The Long-Term Care Database Guide: A Resource on VA Community Based Programs. Illinois Morbity and Mortality Review. 1998; 3(4):10-15.

The Future of Health Information Technology: Implications for Research

Authors: Atkins, David; Cullen, Theresa

Health Information Technology in VHA Quality Improvement Research Overview

Authors: Hynes, Denise M.

Health Information Technology and Implementation Science: Partners in Progress in the VHA

Authors: Hynes, Denise M.; Whittier, Erika R.; Owens, Arika

Using Patient-facing Kiosks to Support Quality Improvement at Mental Health Clinics

Authors: Cohen, Amy N.; Chinman, Matthew J.; Hamilton, Alison B.; Whelan, Fiona; Young, Alexander S.

Patient-Provider Secure Messaging in VA: Variations in Adoption and Association With Urgent Care Utilization

Authors: Shimada, Stephanie L.; Hogan, Timothy P.; Rao, Sowmya R.; Allison, Jeroan J.; Quill, Ann L.; Feng, Hua; Phillips, Barrett D.; Nazi, Kim M.; Haidary, Susan T.; Houston, Thomas K.

VHA Mental Health Information System: Applying Health Information Technology to Monitor and Facilitate Implementation of VHA Uniform Mental Health Services Handbook Requirements

Authors: Trafton, Jodie A.; Greenberg, Greg; Harris, Alex H. S.; Tavakoli, Sara; Kearney, Lisa; McCarthy, John; Blow, Fredric; Hoff, Rani; Schohn, Mary

Redesign of an Electronic Clinical Reminder to Prevent Falls in Older Adults

Authors: Spears, Gwendolyn V.; Roth, Carol P.; Miake-Lye, Isomi M.; Saliba, Debra; Shekelle, Paul G.; Ganz, David A.

Chronic Disease Management for Recently Homeless Veterans: A Clinical Practice Improvement Program to Apply Home Telehealth Technology to a Vulnerable Population

Authors: Gabrielian, Sonya; Yuan, Anita; Andersen, Ronald M.; McGuire, James; Rubenstein, Lisa; Sapir, Negar; Gelberg, Lillian

Evaluating Patient Access to Electronic Health Records: Results From a Survey of Veterans

Authors: Nazi, Kim M.; Hogan, Timothy P.; McInnes, D. Keith; Woods, Susan S.; Graham, Gail

Feasibility of Proactive Medical Device Surveillance: The VA Clinical Assessment Reporting and Tracking (CART) Program

Authors: Tsai, Thomas T.; Box, Tamara L.; Gethoffer, Hans; Noonan, Gregory; Varosy, Paul D.; Maddox, Thomas M.; Fihn, Stephan D.; Gross, Thomas P.; Jesse, Robert L.; Rumsfeld, John S.

Development and Evaluation of an Internet and Personal Health Record Training Program for Low-income Patients With HIV or Hepatitis C

Authors: McInnes, D. Keith; Solomon, Jeffrey L.; Shimada, Stephanie L.; Petrakis, Beth A.; Bokhour, Barbara G.; Asch, Steven M.; Nazi, Kim M.; Houston, Thomas K.; Gifford, Allen L.

Advancing Veterans' healthcare using electronic data: Lessons learned from researchers in the field

Authors: Tarlov, Elizabeth; Stroupe, Kevin

Transformation of VHA health data into clinically useful information to provide quality Veteran care

Authors: Eisen, Seth; Francis, Joseph

Using VA data for research in persons with spinal cord injuries and disorders (SCI/D): Lessons from SCI QUERI

Authors: Smith, Bridget; Evans, Charlesnika; Ullrich, Philip; Burns, Stephen; Guihan, Marylou

Accuracy of external cause-of-injury coding in VA polytrauma patient discharge records

Authors: Carlson, Kathleen; Nugent, Sean; Grill, Joseph; Sayer, Nina

Are VHA administrative location codes valid indicators of specialty substance use Disorder Treatment?

Authors: Harris, Alex; Reeder, Rachelle; Ellerbe, Laura; Bowe, Thomas

Mental illness-related disparities in length of stay: Algorithm choice influences results

Authors: Frayne, Susan; Berg, Eric; Holmes, Tyson; Laungani, Kaajal; Berlowitz, Dan

Can administrative data identify active diagnoses for the Minimum Data Set?

Authors: Berlowitz, Dan; Hickey, Elaine; Saliba, Debra

Matching prosthetics order records in the VA National Prosthetics Patient Database (NPPD) to health care utilization databases

Authors: Smith, Mark; Su, Pon; Phibbs, Ciaran

VHA corporate data warehouse height & weight data: Opportunities and challenges for health services research

Authors: Noel, Polly; Copeland, Laurel; Perrin, Ruth; Lancaster, Betsy; Pugh, Mary Jo

Validation of erythropoietin utilization data on Medicare's end-stage renal disease medical evidence report

Authors: Fischer, Michael; Stroupe, Kevin; Hynes, Denise; Blemur, Pierre; Sohn, Min-Woong; Browning, Margaret; PhD; Huo, Zhiping MS; O'Hare, Ann M. MD; Kaufman, James S.

Creating a sampling frame for population-based Veteran research: Representativeness and overlap of VA and Department of Defense databases

Authors: Washington, Donna; Sun, Su; Canning, Mark

What can Medicaid data add to research on VA patients?

Authors: Hendricks, Ann; Gardner, John; Gilden, Daniel; Prentice, Julia; Wolfsfeld, Lynn

Utility of Medicare and DoD data for improving VA race data quality

Authors: Stroupe, Kevin; Tarlov, Elizabeth; Zhang, Qiuying; Haywood, Thomas; Owens, Arika; Hynes, Denise

Using the Medicare current beneficiary survey to conduct research on Medicare-eligible Veterans

Authors: Jonk, Yvonne; O'Connor, Heidi; Schult, Tamara; Cutting, Andrea; Feldman, Roger

A brief report: A comparison of methods to identify Iraq and Afghanistan war Veterans using VA administrative data

Authors: Bangerter, AnnMarie; Gravely, Amy; Cutting, Andrea; Clothier, Barb; Sayer, Nina