It is important to understand the needs of those veterans who are homeless. We describe characteristics of homeless male veterans and factors associated with needing VA benefits from a two-city, community survey of 531 homeless adults. Overall, 425 were male, of whom 127 were veterans (29.9%). Significantly more veterans had a chronic medical condition and two or more mental health conditions. Only 35.1% identified a community clinic for care compared with 66.8% of non-veterans (P <.01); 47.7% identified a shelter-based clinic and 59.1% reported needing VA benefits. Those reporting this need were less likely to report a medical comorbidity (58.7% vs 76.9%; P =.04), although 66.7% had a mental health comorbidity and 82.7% met Diagnosic Screening Manual (DSM)-IIIR criteria for substance abuse/dependence. They were also significantly more likely to access shelter clinics compared with veterans without this need. Homeless veterans continue to have substantial health issues. Active outreach is needed for those lacking access to VA services. (+info)
Critical gaps in the world's largest electronic medical record: Ad Hoc nursing narratives and invisible adverse drug events.
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The Veterans Health Administration (VHA), of the U.S. Department of Veteran Affairs, operates one of the largest healthcare networks in the world. Its electronic medical record (EMR) is fully integrated into clinical practice, having evolved over several decades of design, testing, trial, and error. It is unarguably the world's largest EMR, and as such it makes an important case study for a host of timely informatics issues. The VHA consistently has been at the vanguard of patient safety, especially in its provider-oriented EMR. We describe here a study of a large set of adverse drug events (ADEs) that eluded a rigorous ADE survey based on prospective EMR chart review. These numerous ADEs were undetected (and hence invisible) in the EMR, missed by an otherwise sophisticated ADE detection scheme. We speculate how these invisible nursing ADE narratives persist and what they portend for safety re-engineering. (+info)
The multimedia electronic patient record: current issues.
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Complete online patient data including both traditional medical chart information and clinical images is essential in providing healthcare in a multi-facility environment. To meet this need, the Department of Veterans Affairs has developed a multimedia online patient record that includes traditional medical chart information as well as a wide variety of medical images from specialties such as cardiology, pulmonary and gastrointestinal medicine, pathology, radiology, hematology, and nuclear medicine. The ability to perform direct image acquisition from DICOM devices combined with diagnostic radiology reading from high resolution workstations allows hospitals to operate without making xray film. The wide area network connection supports ad hoc queries to records at other VA sites. The practicing physician has all of the information needed, anywhere in the hospital, at any time. (+info)
VA's Integrated Imaging System on three platforms.
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The DHCP Integrated Imaging System provides users with integrated patient data including text, image and graphics data. This system has been transferred from its original two screen DOS-based MUMPS platform to an X window workstation and a Microsoft Windows-based workstation. There are differences between these various platforms that impact on software design and on software development strategy. Data structures and conventions were used to isolate hardware, operating system, imaging software, and user-interface differences between platforms in the implementation of functionality for text and image display and interaction. The use of an object-oriented approach greatly increased system portability. (+info)
Health care informatics research implementation of the VA-DHCP Spanish version for Latin America.
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The VA DHCP, hospital computer program represents an integral solution to the complex clinical and administrative functions of any hospital world wide. Developed by the Department of Veterans Administration, it has until lately run exclusively in mainframe platforms. The recent implementation in PCs opens the opportunity for use in Latinamerica. Detailed description of the strategy for Spanish, local implementation in Colombia is made. (+info)
While the Department of Veteran's Affairs Decentralized Hospital Computer Program (DHCP) is one of the most widely disseminated and successful hospital information systems in existence, it currently is accessed through a user interface which is not as mature as the rest of the system. This interface is a VT-100 compatible, character oriented interface using menus accessed by typed commands for feature access. This project demonstrated that a mature graphical user interface (MailMinder) can be successfully used as a "front-end" to DHCP. MailMinder is completely compatible with the existing unmodified DHCP electronic mail program, Mailman. MailMinder allows the user to be more efficient than the current interface and offers additional features over the current mail system. The program has undergone evaluation and limited deployment at five separate sites. The feature set of this program and its operation will be shown at this demonstration. The demonstration has implications for all current hospital information systems. (+info)
Impact of race on health care utilization and outcomes in veterans with congestive heart failure.
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OBJECTIVES: The objectives of this study were to determine racial differences in mortality in a national cohort of patients hospitalized with congestive heart failure (CHF) within a financially "equal-access" healthcare system, the Veterans Health Administration (VA), and to examine racial differences in patterns of healthcare utilization following hospitalization. BACKGROUND: To explain the observed paradox of increased readmissions and lower mortality in black patients hospitalized with CHF, it has been postulated that black patients may have reduced access to outpatient care, resulting in a higher number of hospital admissions for lesser disease severity. METHODS: In a retrospective study of 4,901 black and 17,093 white veterans hospitalized with CHF in 153 VA hospitals, we evaluated mortality at 30 days and 2 years, and healthcare utilization in the year following discharge. RESULTS: The risk-adjusted odds ratios (OR) for 30-day and 2-year mortality in black versus white patients were 0.70 (95% confidence interval [CI] 0.60 to 0.82) and 0.84 (95% CI 0.78 to 0.91), respectively. In the year following discharge, blacks had the same rate of readmissions as whites. Blacks had a lower rate of medical outpatient clinic visits and a higher rate of urgent care/emergency room visits than whites, although these differences were small. CONCLUSIONS: In a system where there is equal access to healthcare, the racial gap in patterns of healthcare utilization is small. The observation of better survival in black patients after a CHF hospitalization is not readily explained by differences in healthcare utilization. (+info)
Impact of policies and performance measurement on development of organizational coordinating strategies for chronic care delivery.
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OBJECTIVE: To examine the impact of policy directives and performance feedback on the organization (specifically the coordination) of foot care programs for veterans, as mandated by public law within the Department of Veterans Affairs Health Care System (VA). STUDY DESIGN: Case study of 10 VA medical centers performing diabetes-related amputations. PATIENTS AND METHODS: Based on expert consensus, we identified 16 recommended foot care delivery coordination strategies. Structured interview protocols developed for primary care, foot care, and surgical providers, as well as administrators, were adapted from a prior study of surgical departments. RESULTS: Although performance measurement results for foot risk screening and referral were high at all study sites over 2 calendar years (average 85%, range 69% to 92%), the number of coordination strategies implemented by any site was relatively low, averaging only 5.4 or 34% (range 1-12 strategies). No facility had systematically collected data to evaluate whether preventive foot care was provided to patients with high-risk foot conditions, or whether these patients had unmet foot care needs. CONCLUSIONS: Although foot care policies and data feedback resulted in extremely high rates of adherence to foot-related performance measurement, there remained opportunities for improvement in the development of coordinated, technology-supported, data-driven, patient-centered foot care programs. (+info)