A5104105610- Primary Care and Health Outcomes
- Health Policy Implementation Science
- Family and Patient Care in Intensive Care Units
- Palliative Care and End-of-Life Issues
- Substance Abuse Treatment and Outcomes
- Emergency and Acute Care Studies
- Mental Health Treatment and Access
- Chronic Disease Management Strategies
- Healthcare Policy and Management
- Childhood Cancer Survivors' Quality of Life
- Mental Health and Patient Involvement
- Frailty in Older Adults
- Telemedicine and Telehealth Implementation
- Diabetic Foot Ulcer Assessment and Management
- Patient Dignity and Privacy
- Prosthetics and Rehabilitation Robotics
- Evaluation and Performance Assessment
- Chronic Obstructive Pulmonary Disease (COPD) Research
- Patient Satisfaction in Healthcare
- Grief, Bereavement, and Mental Health
- Diabetes Management and Education
- Digital Mental Health Interventions
- Healthcare Operations and Scheduling Optimization
- Religion, Spirituality, and Psychology
- Opioid Use Disorder Treatment
VA Puget Sound Health Care System
2015-2025
Center for Innovation
2024-2025
VA Eastern Colorado Health Care System
2024
United States Department of Veterans Affairs
2022-2023
Health Services Research & Development
2016-2023
Veterans Health Administration
2016-2023
Rhode Island Hospital
2021
Louisiana State University
2018
Cambia
2015
University of Washington
2008-2012
Communication with family of critically ill patients is often poor and associated distress.To determine if an intensive care unit (ICU) communication facilitator reduces distress intensity end-of-life care.We conducted a randomized trial at two hospitals. Eligible had predicted mortality greater than or equal to 30% surrogate decision maker. Facilitators supported between clinicians families, adapted needs, mediated conflict.Outcomes included depression, anxiety, post-traumatic stress...
Background: Surveys and anecdotes suggest that patients family members sometimes feel abandoned by their physicians at the transition to end-of-life care.To our knowledge, no prior studies describe abandonment prospectively.Methods: We conducted a longitudinal, qualitative study of patients, caregivers, physicians, nurses using community-based sample.Using purposive strategy, we recruited 31 who identified 55 with incurable cancer or advanced chronic obstructive pulmonary disease, 36 25...
Background: Physicians often report that they are reluctant to discuss prognosis for life-threatening illnesses with patients and family out of concern destroying their hope, yet there is little empirical research describing how incorporate needs hope desires prognostic information. Objective: We conducted a qualitative study examine the perspectives patients, family, physicians, nurses on simultaneous need supporting discussing prognosis. Methods: in-depth longitudinal interviews either...
Abstract Background The use of rapid qualitative methods has increased substantially over the past decade in quality improvement and health services research. These have gained traction implementation research practice, wherein real-time adjustments are often made to optimize processes outcomes. This brisk increase begs questions: what does rigor entail projects that analysis (RQA)? How do we define a pragmatic framework help teams design conduct rigorous valid projects? can authors...
Veterans Health Administration (VHA) initiatives aim to provide veterans timely access quality health care. The focus of this analysis was provider and staff perspectives on women veterans' in the context national efforts improve care.We completed 21 site visits at medical facilities evaluate implementation a initiative. Qualitative data collection included semistructured interviews (n = 127), groups 81), observations with local leadership, administrators, providers, support across primary...
Abstract Patients who receive earlier treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD) have a better prognosis, including symptom resolution and reduced risk future emergency-department visits (ED) or hospitalizations. However, many patients delay seeking care do not report worsening symptoms to their healthcare provider. In this study, we aimed understand how perceived breathing identify factors that led delaying an exacerbation COPD. We conducted...
Although the benefits of integrating behavioral health (BH) services into primary care are well established (World Health Organization and World Family Doctors, 2012; Chiles et al. in Clin Psychol-Sci Pr 6:204-220, 1999; Cummings 1997; O'Donohue 2003; Olfson Aff 18:79-93, Katon Ann Intern Med 124:917-925, 2001; Simon Arch Gen Psychiatry 52:850-856, 1995; Anderson Diabetes Care 24:1069-1078, Ciechanowski 160:3278-3285, 2000; Egede 25:464-470, 2002), research has focused primarily on...
Background Alcohol use disorders (AUDs) are common and have worse consequences for racial/ethnic minority groups than whites. AUDs often underrecognized in clinical settings, but it is unknown whether the prevalence of clinically recognized AUD varies across groups. We describe overall age‐ gender‐stratified documented 3 a national sample Veterans Health Administration (VA) patients. Methods Data from VA's National Patient Care Database identified all patients who used VA care Fiscal Year...
<i>Pressure exists in health services research for teams to collect and synthesize qualitative data rapidly. Lacking is a standard process aid team-based debriefings during the early stages of collection real time. We propose systematic template use phase studies demonstrate utility approach using Veteran’s Administration evaluation study. Guided Team Discussion (GTD) can improve efficiency team debriefing through facilitated that standardizes discussion format sharing learnings...
The purpose of the study was to determine whether multidimensional perceptual-cognitive skills training, including situational awareness, anticipation, and decision making, improves on-court performance in older adults when compared with a physical training program, stroke footwork development. Senior tennis players (N = 27) were randomly assigned one three groups: technique-footwork or no training. Results indicated that participants receiving had significantly faster response speeds,...
Sarcoidosis is a multisystem disorder characterised by noncaseating granulomatous inflammation of unknown aetiology. It may resolve spontaneously, but ∼30% patients have progressive disease with significant organ damage [1]. Although any vulnerable, the lungs are frequently involved resulting in shortness breath and dry cough. Fatigue an overarching symptom sarcoidosis, originating from multiple combined causes mental fatigue physical [2]. This also true psychosocial impact which include...
THE role of the liver in metabolism estrogens has been focus numerous studies which have recently reviewed by Pearlman (1) and Glass (2). Incubation estradiol with slices, homogenate or cell-free extracts tissue effects a marked reduction biologic activity incubated estrogen (3, 4, 5, 6). Conversely, various types experimental clinical hepatic injury shown to be associated evidence increased exogenous endogenous Golden Sevringhaus (7) that produced an ovary transplanted into drainage area...
Abstract Escalating global mental health demand exceeds existing clinical capacity. Scalable digital solutions will be essential to expand access high-quality healthcare. This study evaluated the effectiveness of a intervention alleviate mild, moderate and severe symptoms generalized anxiety. structured, evidence-based program combined an Artificial Intelligence (AI) driven conversational agent deliver content with human oversight user support maximize engagement effectiveness. The was...
Women Veterans with amputation are a group unique needs whose numbers have grown over the last 5 years, accounting for nearly 3% of all in 2019. Although identified as national priority by Health Administration, this population remained largely underrepresented research.To describe experiences women lower extremity (LEA) related to prosthetic care provision and devices.National qualitative study using semi-structured individual interviews.Thirty LEA who had been prescribed prosthesis at...
ABSTRACT Introduction The Veterans Health Administration’s (VHA) history of enhancing Veterans’ healthcare access continued in 2016 with the launch ChooseVA (née: MyVA Access). This initiative was designed to transform VHA and rapidly increase Veteran’s care across all facilities. Relevant this article include mandates improve patient-centered scheduling. In prioritizing scheduling, other large systems have paradoxical task providing health that meets not only needs individual patients but...
Chronic obstructive pulmonary disease (COPD) is a progressive, debilitating illness characterized by exacerbations that require timely intervention. COPD patients often rely on informal caregivers-relatives or friends-for assistance with functioning and support. Caregivers perform roles may be particularly important during acute in monitoring symptoms seeking medical However, little known about caregivers' experiences as they support their exacerbations.To explore the experiences, care...
Abstract Background Effective behavioral and pharmacological treatments are available recommended for patients with alcohol use disorders (AUD) but rarely received. Barriers to receipt provision of evidence‐based AUD delivered by specialists may be greatest in rural areas. Methods A targeted subanalysis qualitative interview data collected from primary care providers at 5 Veterans Affairs clinics was conducted identify differences provider perceptions practices regarding treatment across...
Currently integrating mental health, substance abuse, and health behavior into Patient-Centered Medical Homes (PCMH) is being advocated with increasing frequency. There are no current reports describing efforts to accomplish this. A theory-based project was developed integrate services the fabric culture of an NCQA-certified level-three PCMH using funding from Vermont legislature. mixed methods case report data first 34 months reviews planning, development, implementation, care model,...
Aims To describe how patients respond to early signs of foot problems and the factors that result in delays care. Methods Semi-structured interviews were conducted with a large sample Veterans from across United States diabetes mellitus who had undergone toe amputation. Data analyzed using inductive content analysis. Results We interviewed 61 male patients. Mean age was 66 years, 41% married, 37% high school education or less. The patient-level related delayed care included: 1) not knowing...
ABSTRACT Introduction The Veterans Health Administration (VHA) is tasked with providing access to health care veterans of military service. However, many eligible have either not yet enrolled or underutilized VHA services. Further study barriers before enroll in necessary understand how address this issue. ChooseVA (née MyVA Access) initiative aims achieve mission improve veterans’ access. Although veteran outreach was specifically addressed by the initiative, it a critical component...