Abstract Rising physician burnout has adverse effects on healthcare. This study aimed to identify remediable stressors associated with using the 10‐item Mini‐Z and Maslach Burnout Inventory (MBI), compare performance of Mini‐Z's single‐item metric against 22‐item MBI. Surveys were emailed 4,118 clinicians affiliated an academic health system; 1,252 clicked link, 557 responded (completion rate 44%). Four hundred seventy‐five practicing physicians included: faculty (372), hospital employed...

Transitions from one EHR to another can be enormously disruptive care. Nurses are the largest group of users, but nurse experiences with transitions have not been well documented. We sought understand an transition at US Department Veterans Affairs. used a mixed methods design, combining cumulative 26 longitudinal interviews 317 survey free-text responses and quantitative measures repeated cross-sectional survey, all nurses first facilities Affairs' homegrown commercial system. conducted...

Guidelines recommend early referral to pulmonary hypertension (PH) experts for patients with confirmed or suspected arterial (PAH) chronic thromboembolic PH (CTEPH), among others. Yet, often have advanced disease at the time of referral. The drivers these delays are not well known. Building upon our prior qualitative findings on barriers timely care along continuum, we sought identify patient-level factors associated experts. We leveraged Massachusetts All-Payer Claims Database all incident...

Burnout is a maladaptive response to work-related stress that associated with negative consequences for patients, clinicians, and the health care system. Critical nurses are at especially high risk burnout. Previous studies of burnout have used survey methods simultaneously measure factors outcomes burnout, potentially introducing common method bias.To evaluate frequency individual organizational characteristics among critical across national integrated system using data from an annual avoid...

Biomass fuel used for cooking results in widespread exposure to indoor air pollution (IAP), affecting nearly 3 billion people throughout the world. Few studies, however, have tested an exposure–response relationship between biomass and health outcomes. The aim of this study was explore fuel, infant mortality, children’s respiratory symptoms. Eighty households a rural community Ecuador were selected based on their use questioned regarding history mortality Carbon monoxide (CO) particulate...

Thiazolidinediones (TZDs) are oral antihyperglycemic medications that selective agonists to peroxisome proliferator-activated receptor gamma and have been shown potent anti-inflammatory effects in the lung.The purpose of this study was assess whether exposure TZDs is associated with a decreased risk chronic obstructive pulmonary disease (COPD) exacerbation.A cohort performed by collecting data on all US veterans diabetes COPD who were prescribed during from period October 1, 2005 September...

In order to create a parasite prevention program for Santa Ana, Ecuador, we worked with local physicians identify the prevalence and risk factors intestinal parasitic infection among children. Two hundred households were randomly selected asked submit three stool samples from child. Information direct observation questionnaires was used determine environmental behavioral infection. Prevalence of any 65.6% 189 children who submitted fecal samples. Parasitic infections included Entamoeba...

Thiazolidinediones are oral diabetes medications that selectively activate peroxisome proliferator-activated receptor gamma and have potent anti-inflammatory properties. While a few studies found improvements in pulmonary function with exposure to thiazolidinediones, there no of their impact on asthma exacerbations. Our objective was assess whether thiazolidinediones associated decreased risk exacerbation. We performed cohort study diabetic Veterans who had diagnosis were taking during the...

Care of patients with pulmonary hypertension is complex. Although vasodilators are effective for Group 1 hypertension, clinical guidelines and the Choosing Wisely Campaign recommend against routine use Groups 2 3 (the most common types hypertension) because a lack benefit, potential harm, high cost ($10,000-$13,000 per patient year treated). Little known about how these medications used in practice.To determine national patterns phosphodiesterase-5 inhibitor prescribing Veterans Health...

Abstract Background Healthcare organizations regularly manage external stressors that threaten patient care, but experiences handling concurrent are not well characterized. Objective To evaluate the experience of Veterans Affairs (VA) clinicians and staff navigating simultaneous organizational stressors—an electronic health record (EHR) transition COVID-19 pandemic—and identify potential strategies to optimize management co-occurring stressors. Design Qualitative case study describing...

Abstract Background Electronic health record (EHR) transitions are increasingly widespread and often highly disruptive. It is imperative we learn from past experiences to anticipate mitigate such disruptions. Veterans Affairs (VA) undergoing a large-scale transition its homegrown EHR (CPRS/Vista) commercial (Cerner), creating unique opportunity of shedding light on EHR-to-EHR challenges. Objective To explore one facet the organizational impact VA’s transition: implications for employees’...

Electronic health record (EHR) transitions are common and complex organizational changes, yet limited published literature is available to guide systems that changing from one EHR another. Clinicians staff end users at sites have undergone may critical insights could inform future transitions.

Background The Department of Veterans Affairs (VA), the largest nationally integrated health system in United States, is transitioning from its homegrown electronic record (EHR) to a new vendor-based EHR, Oracle Cerner. Experiences first VA site transition have been widely discussed media, but in-depth accounts based on rigorous research are lacking. Objective We sought explore employee perspectives rationale for, and value of, VA-tailored EHR product. Methods As part larger mixed methods,...

The majority of emerging infectious diseases are zoonotic (transmissible between animals and humans) in origin, therefore integrated surveillance disease events humans has been recommended to support effective global response emergence. While the past decade there extensive for highly pathogenic avian influenza (HPAI) infection both humans, have few attempts compare these data streams evaluate utility such integration.We compared reports bird outbreaks HPAI H5N1 Egypt 2006-2011 compiled by...

Rationale: The Centers for Medicare and Medicaid Services recently implemented financial penalties to reduce hospital readmissions select conditions, including chronic obstructive pulmonary disease (COPD). Despite growing pressure COPD readmissions, it is unclear how readmission rates are related other measures of quality, which could inform efforts on common organizational factors that affect high-quality care.Objectives: To examine the association between quality measures.Methods: We...

Chronic obstructive pulmonary disease (COPD) is one of the most common causes readmission at Veterans Affairs (VA) hospitals. Previous studies demonstrate worse outcomes for veterans with multisystem health care, though impact non-VA care on COPD readmissions unknown.To examine association use outpatient 30-day and follow-up among admitted to VA COPD.This a retrospective cohort study using administrative data Medicare claims.In total, 20,472 Medicare-eligible who were hospitals during...

Objective To compare two approaches to measuring racial/ethnic disparities in the use of high-quality hospitals. Data Sources Simulated data. Study Design Through simulations, we compared "minority-serving" approach assessing differences risk-adjusted outcomes at minority-serving and non-minority-serving hospitals with a "fixed-effect" that estimated reduction adverse if distribution minority white patients across was same. We evaluated each method's ability detect measure disparity caused...