Abstract
Patient and provider perceptions about a clopidogrel adherence intervention in the Veterans Health Administration
Marina McCreight, MPH1, Emily Lawrence, MPH2, Katherine Williams, MPH3, Anne Lambert-Kerzner, PhD, MSPH4 and Michael Ho, MD, PhD3
(1)Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, Aurora, CO, (2)VA Eastern Colorado Health Care System, Aurora, CO, (3)Eastern Colorado Health Care System, Denver, CO, (4)University of Colorado Anschutz Medical Campus, Aurora, CO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Objectives: Clopidogrel is prescribed to prevent patients with coronary stents from developing potentially fatal blood clots. Though it is recommended that patients take clopidogrel for a year or longer, adherence is often poor. As part of an ongoing hybrid effectiveness-implementation study, we interviewed providers and patients at participating Veterans Health Administration (VHA) hospitals to better understand contextual factors and assess their experience with a clopidogrel adherence improvement strategy.
Methods:The study intervention entailed clopidogrel brought to patients' bedsides before hospital discharge. Participants then received automated interactive-voice response (IVR) calls to remind them to place subsequent refills. We interviewed 41 cardiac catheterization laboratory providers and inpatient pharmacists from 16 sites at baseline, 6 and 12 months post-implementation. Patients (n=21) from six sites were interviewed at 2-3 months post study enrollment. We conducted descriptive qualitative analysis using the ATLAS.ti software.
Results: Providers described participating in the study as a positive experience and “worth the effort.” Implementation barriers included lack of staff time and poor post-discharge communication between tertiary hospitals and primary care referral facilities regarding the need for continuous clopidogrel treatment. Patients expressed appreciation for the intervention. Providers and patients offered recommendations to improve the intervention for sequential roll-out at other sites, including: 1) standardizing the number of days supplied for refills; 2) obtaining more buy-in from pharmacy staff; and 3) implementing follow-up phone calls to patients to reinforce the information received at discharge.
Conclusions: These interim findings have been used to make changes to improve the intervention and the implementation process across multiple VHA sites.
Chronic disease management and prevention Implementation of health education strategies, interventions and programs
Abstract
Utilization of Mental Health Services by Veterans Living in Rural Areas
Mir M Ali, PhD1, Judith Teich, MSW2, Sean Lynch, PhD, LCSW1 and Ryan Mutter, PhD2
(1)Substance Abuse & Mental Health Services Administration, Rockville, MD, (2)Substance Abuse and Mental Health Services Administration, Rockville, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Purpose: There is concern that veterans living in rural areas may not be receiving needed mental health (MH) treatment. This study uses recent national survey data to examine utilization of MH treatment among military veterans with a MH condition living in rural areas, providing comparisons with estimates of veterans living in urban areas.
Methods: Multivariable logistic regression analysis is utilized to examine differences in MH service use by urban/rural residence, controlling for other factors. Rates of utilization of inpatient and outpatient treatment, psychotropic medication, any MH treatment, and perceived unmet need for MH care are examined.
Findings: There were significant differences in MH treatment utilization among veterans by rural/urban status. Multivariable estimates indicate that compared to veterans with MH condition living in urban areas, veterans in rural areas are 70% less likely to receive any MH treatment. For outpatient treatment and prescription medications, veterans in rural areas are approximately 52% and 64% less likely to receive them compared to those living in urban areas. Although, rural veterans were less likely to receive inpatient mental treatment and had higher likelihood of perceiving unmet need for mental health treatment those estimates were not statistically significant.
Conclusions: While other research indicates that recent efforts to improve MH service delivery have resulted in overall improvement, this study found that veterans' rates of MH treatment are lower in rural areas, compared to urban areas.
Administer health education strategies, interventions and programs Administration, management, leadership Planning of health education strategies, interventions, and programs Program planning Provision of health care to the public Public health administration or related administration
Abstract
Improving veterans' access to influenza vaccination: Modeling effectiveness of public-private partnerships
Patrick Finley1, Mercy Demenno, MBA1, Walt Beyeler1, Tamar Wyte-Lake, DPT, MPH2 and Aram Dobalian, PhD, JD, MPH3
(1)Sandia National Laboratories, Albuquerque, NM, (2)Veterans Health Administration, Sepulveda, CA, (3)U.S. Department of Veterans Affairs, North Hills, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Public-private partnerships provide a mechanism to improve access and efficiency of government public health programs. We applied a System Dynamics model to explore and evaluate the role of community-level public-private partnerships in enhancing seasonal and pandemic influenza vaccination capacity. The model calculates potential changes in healthcare services utilization as a function of assumed system configurations. Inputs include partnership structure, population demographics, perceived benefit of services provided through the public-private partnership. Output metrics include number of persons expected to take advantage of partnership programs, perceptions of participants, and efficiency of service provision. As a test case, we examined plans by the U.S., the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) to provide influenza vaccination to veterans through private pharmacies. The model indicates that augmenting the VA's vaccination capacity with private pharmacy providers should increase vaccination rates, improve participants' perceptions of the VA, and provide useful experience in collaboration which could be leveraged to provide rapid mass vaccination to veterans in a pandemic influenza scenario. While this model was constructed specifically to examine public-private partnerships being considered by VA, the results demonstrate (a) Properly designed public-private partnerships have potential to deliver improved service levels at lower costs, and (b) This process-based modeling approach is valuable for quantifying potential effects of such partnerships.
Administration, management, leadership Provision of health care to the public Public health or related public policy Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Application of Lean Six Sigma Framework in the Evaluation of Veterans Choice Program
Anne Lambert-Kerzner, PhD, MSPH1, Amy Ladebue, BA2, Marina McCreight, MPH3, Lauren Stevenson, PhD4, Emily Lawrence, MPH2 and Sherry Ball, PhD5
(1)VA Eastern Colorado Health Care System, Denver, CO, (2)VA Eastern Colorado Health Care System, Aurora, CO, (3)Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, Aurora, CO, (4)Louis Stokes Cleveland VA Medical Center, Cleveland, OH, (5)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Objective:
The Veterans' Choice Program (VCP) aimed to improve access to timely healthcare and medical services for patients in Veterans' Healthcare Administration (VHA) facilities by expanding care options to include non-VHA providers. This evaluation assessed the implementation of the VCP at three VHA Medical Centers, utilizing the Lean Six Sigma (LSS) framework to identify mutable process defects to promote greater efficiency and effectiveness.
Methods:
Lean Six Sigma (LSS) framework guided this evaluation focusing on the DMAIC (Define, Measure, Analyze, Improve, and Control) toolkit. To measure the current process, a qualitative inquiry was used to collect the opinions and perspectives of Veterans (47), VHA key informants (6),VHA staff (12), VHA providers (17) and non-VHA providers (13), and Third Party Insurance Administrators (1), emphasizing the ‘voice of the customer' in the LSS framework.
Results:
Using LSS methodology, we identified key barriers and facilitators to the implementation at all three sites. Overall, the interviewees agreed that the VCP had the potential to improve access and care for Veterans. Commonly reported barriers included: poor exchange of clinical information between the VHA, TPAs, and non-VHA providers; inadequate dissemination of information and resources about VCP to VHA staff, TPA, and Veterans; poor communication of non-VHA appointments to Veterans; shortages of available and qualified non-VHA providers, inappropriate scheduling practices resulting in duplication of appointments at VHA and non-VHA facilities; and a decline in the coordination of care.
Conclusions:
This evaluation illustrates both the benefits and challenges of using LSS framework to evaluate the implementation of a nationally mandated healthcare program.
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs
Abstract
Partnering for Improved Care: Delivery of Concurrent Care between the VHA and Community Hospices for Veteran Cancer Patients
Leah Haverhals, MA, PhD Candidate, Chelsea Manheim, LCSW and Cari Levy, MD, PhD
VA Eastern Colorado Health Care System, Denver, CO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The Veterans Health Administration (VHA) allows patients with terminal cancer to receive hospice care concurrently with disease modifying treatments such as radiation and chemotherapy. This differs from the Medicare Hospice Benefit, where patients must choose to continue receiving disease modifying treatment or enroll in hospice. The objective of this project is to describe care coordination for veterans with terminal cancer between VHA providers and community hospices. For this qualitative study, five VHA sites across the U.S. were selected for site visits, representative of low, medium, and high volume of concurrent care based on 2012 VHA data. Individual and small group interviews were conducted with 52 individuals: VHA oncologists and oncology staff (21); VHA palliative care providers and staff (15); and community hospice providers and staff (16). Four themes emerged influencing smoother care coordination at and following hospice referrals between the integrated VHA system and external hospice organizations. These included: 1) Community hospice partners understood and accepted VHA's position on offering concurrent care to eligible Veterans; 2) New community hospice staff unfamiliar with concurrent care received ongoing education through Hospice-Veteran Partnership programs and informal communication with VHA providers and staff; 3) A motivated and accessible VHA liaison coordinated care between VHA and community hospices; and 4) Hospice providers and staff readily contacted VHA oncologists when questions arose. As concurrent care increases in the VHA, knowledge of these themes will assist VHA providers in making effective referrals to community hospices which will lead to improved care coordination for Veterans receiving concurrent care.
Conduct evaluation related to programs, research, and other areas of practice Provision of health care to the public Public health or related research