The morbidity and mortality conference (M&MC) appears to have sprung from the efforts of physicians improve practice through examination medical errors bad outcomes. modern M&MC has had limited (and almost none outside surgery anesthesia), but may be straying precepts which it evolved. Learning one's is important, confronting them difficult particularly delicate when done in conference. If effort successful, can serve as a model. unsuccessful, instead convey lesson that attempting learn...

Angioedema is a rare but potentially serious complication of angiotensin-converting enzyme inhibitor (ACE) use. We conducted study to estimate incidence ACE-related angioedema and explore its determinants in large racially diverse patient population. used linked medical pharmacy records identify all patients the US Veterans Affairs Health Care System from April 1999 through December 2000 who received first prescriptions for antihypertensive medications. studied 195 192 ACE initiators 399 889...

The objective of the study was to develop a self-reported measure patients' comorbid illnesses that could be readily administered in ambulatory care settings and would improve assessment their health-related quality life utilization health services. Data were analyzed from Veterans Health Study, an observational outcomes patients receiving Administration (VA) care. Patients who received services 4 VA outpatient clinics greater Boston area between August 1993 March 1996 eligible for...

The goal of the Veterans Health Study (VHS) was to extend work Medical Outcomes (MOS) into VA, by developing methodology for monitoring patient-based outcomes care use in ambulatory outpatient care. principal objective VHS valid and reliable measures assess general health-related quality life (HRQoL) identifying presence selected health conditions, their severity, impact on HRQoL. In this article, we provide an overview historical context, framework, objectives, applications purpose...

The Veterans Health Study (VHS) had as its overarching goal the development, testing, and application of patient-centered assessments for monitoring patient outcomes in ambulatory care large integrated systems such Department Affairs (VA). Unlike other previous studies, VHS has capitalized on rich administrative databases restricted to VA linked outcomes. developed a comprehensive set general disease-specific measures use by patients. Chief among these is SF-36 Survey measuring...

<h3>Importance</h3> Pulmonary nodules are common, and more will be found with implementation of lung cancer screening. How potentially malignant pulmonary evaluated may affect patient outcomes, health care costs, effectiveness screening programs. Guidelines for evaluating exist, but little is known about how in the usual setting. <h3>Objective</h3> To characterize nodule evaluation concordance guidelines. <h3>Design, Setting, Participants</h3> A retrospective cohort study was conducted...

The purpose of this study was to compare health status and disease profiles ambulatory patients in specific Veterans Administration (VA) civilian healthcare settings. A random sample 2425 male veterans seeking care at 4 Boston-area VA outpatient clinics, who took part the Health Study (VHS) 1993–1995, were compared 1318 3 major metropolitan areas covered Medical Outcomes (MOS) 1986. MOS sampled had 1 5 conditions—hypertension, non–insulin-dependent diabetes, recent myocardial infarction,...

OBJECTIVE To evaluate the relationship between diabetes care and types of comorbidity, classified by degree to which their treatment is concordant with that for diabetes. RESEARCH DESIGN AND METHODS Retrospective cohort study (fiscal year [FY] 2001 FY 2004) 42,826 veterans new-onset in 2003. Veterans were into five chronic comorbid illness groups (CCIGs): none, only, discordant both discordant, dominant. Five diabetes-related measures assessed 2004 (guideline-consistent testing goals HbA1c...

Approximately 600,000 persons are released from prison annually in the United States. Relatively few receive sufficient re-entry services and at risk for unemployment, homelessness, poverty, substance abuse relapse recidivism. Persons leaving who have a mental illness and/or use disorder particularly challenged. This project aims to create peer mentor program extend reach effectiveness of reentry provided by Department Veterans' Affairs (VA). We will implement support veterans sequentially...

Objectives: To identify the extent of inappropriate prescribing using criteria for proper use developed by Agency Healthcare Research and Quality (AHRQ) dose‐limitation defined Beers, as well to describe duration patient characteristics associated with older people. Design: Retrospective national Veterans Health Administration (VA) administrative database analysis. Setting: VA outpatient facilities during fiscal year 2000 (FY00). Participants: aged 65 having at least one visit in FY00...

To develop and compare three operational definitions of polypharmacy using a large prescription database.We defined Cumulative as all prescriptions filled during 178 day window--which captured 95% eventual refills calculated from Kaplan-Meier cumulative incidence curves. Continuous was in two such windows 6 months apart. Simultaneous the number active on particular day, determined by fill dates amount medication given. We applied these to outpatient files New England veterans compared...

Diabetic foot infections are common, serious, and varied. Diagnostic treatment strategies correspondingly diverse. It is unclear how patients managed in actual practice outcomes might be improved. Clarification will require study of large numbers patients, such as available medical databases. We have developed evaluated a system for identifying classifying diabetic that can used this purpose.We the (VA) Diabetes Epidemiology Cohorts (DEpiC) database to conduct retrospective observational...

Successful coordination of specialty care requires understanding the perspectives patients, primary providers, and specialists—that is, “triad.” This study used qualitative methods to compare these in an integrated health system, using diabetes as exemplar. Primary providers endocrinologists relied on interclinician relationships coordinate care. Clinicians rarely included patients or other staff their conceptualization coordination. Patients often assumed responsibility for but struggled...

This study aims to develop a patient-based measure of the complications type 2 diabetes that can be used in examining its relationship with health-related quality life (HRQOL) and utilization health services. Using questions analogous those typically employed by clinicians, we developed 17-item questionnaire identify prior diagnoses current symptoms 6 common diabetes. We administered it 419 patients who were part Veterans Health Study, larger prospective investigation veterans receiving...

Hypertension, hyperlipidemia, diabetes, and obesity in middle adulthood each elevate the long-term risk of cardiovascular disease (CVD). The prevalence these conditions among women veterans is incompletely described.To describe CVD factors adulthood.Serial cross-sectional studies data from Diabetes Epidemiologic Cohorts (DEpiC), a national, longitudinal set including information on all patients Veterans Health Administration (VA).Women (n = 255,891) men 2,271,605) aged 35-64 receiving VA...

It has been stated that faculty development programmes which are closely linked to particular teaching contexts most likely be effective. Over the past 10 years we have developed a model of 'co-teaching' for is based upon this premise and can applied any clinical rotation. In paper describe our model, in paired physicians focus on developing their skills while sharing supervision residents medical students. Through iterative phases teaching, debriefing planning, co-teachers gain experience...

Background: Many studies have identified patient characteristics associated with potentially inappropriate prescribing in the elderly (PIPE), however, little attention has been directed toward how health care system factors such as geriatric may affect this safety issue. Objective: This study examines association between and PIPE a community dwelling population. Research Design: Cross-sectional retrospective database study. Subjects: Veterans age ≥65 years who received VA during Fiscal Years...