Use of General Primary Care, Specialized Primary Care, and Other Veterans Affairs Services Among High-Risk Veterans

Chang, Ernest S.; Zulman, Donna M.; Nelson, Karin M.; Rosland, Ann‐Marie; Ganz, David A.; Fihn, Stephan D.; Piegari, Rebecca; Rubenstein, Lisa V.

doi:10.1001/jamanetworkopen.2020.8120

Cited by 25 publications

(29 citation statements)

References 65 publications

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“…However, we expect that, like the PC-PTSD, the PC-PTSD-5 will retain its strong psychometric properties across nonveteran samples. 20 , 24 , 26 Second, although participants were demographically representative of VA primary care users, 48 , 49 nonresponse bias may limit generalizability to this population. Third, other subgroups beyond and within gender may benefit from further study; this is an important future direction.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Among US Veterans

et al. 2021

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Key Points Question Is the Primary Care Posttraumatic Stress Disorder (PTSD) Screen, as revised for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5), diagnostically accurate and acceptable to Veterans Affairs primary care patients? Findings In this diagnostic study of 396 primary care–seeking veterans, the 5-item PC-PTSD-5 was both diagnostically accurate and acceptable to participants. A cut point score of 4 best balanced the false negatives and false positives, although women may require a lower cut point (ie, a score of 3). Meaning Like its predecessor, the PC-PTSD-5 is an effective and efficient tool for PTSD screening in Veterans Affairs primary care clinics.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Among US Veterans

et al. 2021

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“…Previous VA and non-VA telehealth studies have examined telehealth use and outcomes in situations where patients and clinicians had a choice between virtual and in-person services [ 3 - 10 ]. With the onset of COVID-19, however, the use of telehealth quickly became a necessity rather than a choice.…”

Section: Introductionmentioning

confidence: 99%

Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study

Der‐Martirosian¹,

Wyte-Lake²,

Balut³

et al. 2021

JMIR Form Res

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Background At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020. Objective We compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020). Methods We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes. Results Prior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted. Conclusions Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic.

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“…Since the VHA Primary care Intensive Management demonstration's end in September 2018, the demonstration has provided the VHA with lessons to incorporate into patient‐centered medical homes. Most high‐risk Veterans are already managed in general primary care, 44 so building on care in existing medical homes to provide case management functions may be feasible 45 . The VHA Office of Primary Care leadership acknowledges that providing intensive case management services, such as risk stratification, comprehensive assessment, and transitional care management, in addition to routine primary care and panel management within patient‐centered medical homes will be challenging.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of a randomized quality improvement trial for high‐risk Veterans in year two

Chang

Yoon²,

Esmaeili³

et al. 2021

Health Services Research

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Objective The Veterans Health Administration (VHA) conducted a randomized quality improvement evaluation to determine whether augmenting patient‐centered medical homes with Primary care Intensive Management (PIM) decreased utilization of acute care and health care costs among patients at high risk for hospitalization. PIM was cost‐neutral in the first year; we analyzed changes in utilization and costs in the second year. Data sources VHA administrative data for five demonstration sites from August 2013 to March 2019. Data sources Administrative data extracted from VHA's Corporate Data Warehouse. Study design Veterans with a risk of 90‐day hospitalization in the top 10th percentile and recent hospitalization or emergency department (ED) visit were randomly assigned to usual primary care vs primary care augmented by PIM. PIM included interdisciplinary teams, comprehensive patient assessment, intensive case management, and care coordination services. We compared the change in mean VHA inpatient and outpatient utilization and costs (including PIM expenses) per patient for the 12‐month period before randomization and 13‐24 months after randomization for PIM vs usual care using difference‐in‐differences. Principal findings Both PIM patients (n = 1902) and usual care patients (n = 1882) had a mean of 5.6 chronic conditions. PIM patients had a greater number of primary care visits compared to those in usual care (mean 4.6 visits/patient/year vs 3.7 visits/patient/year, p < 0.05), but ED visits (p = 0.45) and hospitalizations (p = 0.95) were not significantly different. We found a small relative increase in outpatient costs among PIM patients compared to those in usual care (mean difference + $928/patient/year, p = 0.053), but no significant differences in mean inpatient costs (+$245/patient/year, p = 0.97). Total mean health care costs were similar between the two groups during the second year (mean difference + $1479/patient/year, p = 0.73). Conclusions Approaches that target patients solely based on the high risk of hospitalization are unlikely to reduce acute care use or total costs in VHA, which already offers patient‐centered medical homes.

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Use of General Primary Care, Specialized Primary Care, and Other Veterans Affairs Services Among High-Risk Veterans

Cited by 25 publications

References 65 publications

Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Among US Veterans

Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Among US Veterans

Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study

Outcomes of a randomized quality improvement trial for high‐risk Veterans in year two

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