Journal Article Immigration, Skill Mix, and Capital Complementarity Get access Ethan Lewis Dartmouth College Search for other works by this author on: Oxford Academic Google Scholar The Quarterly of Economics, Volume 126, Issue 2, May 2011, Pages 1029–1069, https://doi.org/10.1093/qje/qjr011 Published: 01 2011

Concerns about opioid-related adverse events, including overdose, prompted the Veterans Health Administration (VHA) to launch an Opioid Safety Initiative and Overdose Education Naloxone Distribution program. To mitigate risks associated with opioid prescribing, a holistic approach that takes into consideration both risk factors (e.g., dose, substance use disorders) mitigation interventions urine drug screening, psychosocial treatment) is needed. This article describes Stratification Tool for...

To develop and evaluate a clinical decision support system (CDSS) named Assessment Treatment in Healthcare: Evidenced-Based Automation (ATHENA)-Opioid Therapy, which encourages safe effective use of opioid therapy for chronic, noncancer pain.CDSS development iterative evaluation using the analysis, design, development, implementation, process including simulation-based in-clinic assessments usability providers followed by targeted revisions.Volunteers provided detailed feedback to guide...

The volume of opioid medications being prescribed in the United States is increasing rapidly. Problems associated with misuse are also increasing, part because medication diversion from legitimate prescriptions. However, little known about what patients do any unused medications. This paper uses a qualitative analysis patients' self-report storage and retention habits to begin address this gap.We analyzed responses Prescription Drug Use Questionnaire conjunction other data on prescription...

Objective. This study aims to determine 1) the epidemiology of perioperative opioid use; and 2) association between patterns preoperative use time-to-cessation postoperative opioids. Design. Retrospective, cohort study. Setting. National, population-level Veterans Healthcare Administration (VHA) electronic clinical data. Subjects. All VHA patients (n = 64,391) who underwent surgery in 2011, discharged after stays ≥1 day, receiving prescription within 90 days discharge. Methods. Patients'...

Background. With the growth in opioid therapy for treatment of chronic pain, health care providers have focused their attention on avoiding over-use medications, specifically to avoid addiction, dependency, and other misuse. Qualitative quantitative reviews medication adherence, contrast, focus primarily why patients under-use or do not take medications as prescribed find nonadherence rates approximately 25%.

Previous research indicates women Veterans have a potentially large, unmet need for alcohol-related care but are under-represented in treatment settings. The purpose of this study was to identify factors associated with Veterans' receptivity recommendation when they present Affairs (VA) primary alcohol misuse. Semi-structured interviews were conducted from 2012-2013 30 at two VA facilities who screened positive misuse during visit and discussed their use primary-care provider. Qualitative...

Women experience chronic pain and use pain-related health care at higher rates than men. It is not known whether the female veterans receive consistent with clinical practice guideline recommendations or receipt of this differs between men women.The aim study was to identify sex differences in management exist for patients served by Veterans Health Administration (VHA).Data on patient demographics, diagnostic criteria, utilization were extracted from VHA administrative databases fiscal year...

Background In an effort to prevent opioid overdose mortality among Veterans, Department of Veterans Affairs (VA) facilities began implementing education and naloxone distribution (OEND) in 2013 a national program 2014. VA is the first health care system implement OEND. The goal this study examine patient perceptions OEND training kits. Methods Four focus groups were conducted between December 2014 February 2015 with 21 patients trained Participants recruited from residential facility...

The UK Government has identified six industrial locations with the highest concentrations of carbon dioxide (CO2) production to be part Industrial Decarbonisation Challenge (IDC) and labelled them 'Industrial Clusters'. To achieve net zero by 2050, heavy industry across must move away from fossil fuels as a power source. Carbon capture storage (CCS) low-carbon hydrogen in have prospect removing upwards 40MtCO2 per year producing more than 25GW power. This article introduces IDC Clusters. It...

The United States is facing an opioid crisis in which overdose the leading cause of injury death—misuse opioids constitutes vast majority those deaths. In 2016 alone, over 42,000 people died from overdose, increase 27% prior year. Deployment Stratification Tool for Opioid Risk Mitigation (STORM), a clinical decision support tool to improve safety, one response by Veterans Health Administration (VHA) crisis. STORM identifies VHA patients at very high risk opioid-related adverse events and...

Background/Objectives: The opioid crisis has disproportionately impacted U.S. military veterans, who face heightened risks of use disorder and overdose due to chronic pain mental health conditions. pharmaceutical industry's role in misrepresenting risks-leading over USD 50 billion legal settlements-has included targeted marketing vulnerable populations. This study examines Janssen Pharmaceuticals' "Imagine the Possibilities Pain Coalition" (IPPC), which aimed increase among veterans with...

<h3>Importance</h3> Skin cancer screening may improve melanoma outcomes and keratinocyte carcinoma morbidity, but little is known about the feasibility of skin training clinical examination (CSE) by primary care practitioners (PCPs) in large health systems. <h3>Objective</h3> To assess association PCPs with dermatology referral patterns rates biopsies. <h3>Design, Setting, Participants</h3> In this pilot interventional study performed at Veterans Affairs Palo Alto Health Care System,...

To determine an association between opioid use upon hospital discharge (ongoing and newly started) in surgical patients risks of overdose delirium for the first year.Retrospective, cohort study.Population-level study Veterans Health Administration patients.All (N = 64,391) who underwent surgery 2011, discharged after one or more days, without a diagnosis from 90 days before admission through 30 postdischarge (to account additional dosing context chronic use).Patients' was categorized as 1)...

The safe and effective prescribing of opioid therapy for chronic pain has become a significant health care priority over the last several years. Substantial research focused on patient-oriented interventions toward preventing problematic use, but provider system level factors may be more amenable to quality improvement approaches. Here, we outline administrative data-based metrics that are intended assess adherence key practices outlined in 2010 Department Veterans Affairs/Department Defense...

Objective To characterize diseases that are described as most bothersome by individuals with multiple chronic conditions and to identify themes their experiences condition. Methods In a survey of patients at an academic center Veterans Affairs hospital, we asked condition describe why it is challenging. Standard content analysis methods were used code responses reflecting characteristics conditions. Results The commonly cited pain (52%), diabetes (43%), post-traumatic stress disorder (25%),...

Abstract Background In 2018, the Department of Veterans Affairs (VA) issued Notice 2018-08 requiring facilities to complete “case reviews” for identified in Stratification Tool Opioid Risk Mitigation (STORM) dashboard as high risk adverse outcomes among patients prescribed opioids. Half were randomly assigned a version including additional oversight. We evaluated implementation strategies used, whether differed by randomization arm, and which associated with case review completion rates....

Background: Engaging patients as partners in their care is clinically appealing, yet challenging to implement, and we lack a measurement framework that applicable vulnerable populations. To address this gap, conducted qualitative study refine conceptual reflects an individual’s propensity engage with care. Objectives: Our objectives were the framework’s domains of engagement behavior; identify key behaviors within each domain describe providers, health systems or settings; illustrate...

Aim To better understand barriers and facilitators that hinder or help women veterans discuss their alcohol use with providers in primary care order to identify problematic drinking enhance provider–patient communication about harmful drinking. Background Women presenting may be less likely than men disclose potentially use. No studies have qualitatively examined the perspectives of factors affect accurate disclosure by during routine clinic visits. Methods Providers ( n =14) were recruited...

Objectives: The purpose of this study was to determine baseline adherence key recommendations from the 2010 VA/DOD Clinical Practice Guideline for Opioid Therapy Chronic Pain at Veterans Health Administration (VA) facilities. We hoped understand practice patterns time guideline release guide quality improvement and implementation efforts. Methods: Overall were examined each 140 VA Care Systems based on metrics developed assess Guideline. Results: varied widely across facilities measures use...