Publications by authors named "Catherine Battaglia"

58 Publications

The Effect of the Affordable Care Act on Women's Postpartum Insurance and Depression in 5 States That Did Not Expand Medicaid, 2012-2015.

Med Care 2021 Oct 19. Epub 2021 Oct 19.

Departments of Health Systems, Management, and Policy Psychiatry Community & Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL.

Background: Before the Affordable Care Act (ACA), most women who gained pregnancy-related Medicaid were not eligible for Medicaid as parents postpartum. The ACA aimed to expand health insurance coverage, in part, by expanding Medicaid; introducing mandates; reforming regulations; and establishing exchanges with federal subsidies. Federal subsidies offer a means to coverage for individuals with income at 100%-400% of the federal poverty level who do not qualify for Medicaid.

Objective: The objective of this study was to identify the effects of the ACA's non-Medicaid provisions on women's postpartum insurance coverage and depressive symptoms in nonexpansion states with low parental Medicaid thresholds.

Participants: Women with incomes at 100%-400% of the federal poverty level who had prenatal insurance and completed the Pregnancy Risk Assessment Monitoring System (2012-2015).

Setting: Five non-Medicaid expansion states with Medicaid parental eligibility thresholds below the federal poverty level.

Design: Interrupted time-series analyses were conducted to examine changes between pre-ACA (January 2012-November 2013) and post-ACA (December 2013-December 2015) trends for self-reported loss of postpartum insurance and symptoms of postpartum depression.

Results: The sample included 9,472 women. Results showed significant post-ACA improvements where the: (1) trend for loss of postpartum insurance reversed (change of -0.26 percentage points per month, P=0.047) and (2) level of postpartum depressive symptoms decreased (change of -3.5 percentage points, P=0.042).

Conclusions: In these 5 states, the ACA's non-Medicaid provisions were associated with large increases in retention of postpartum insurance and reductions in postpartum depressive symptoms, although depressive symptoms findings are sensitive to model specification.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MLR.0000000000001652DOI Listing
October 2021

A dissemination strategy to promote relational coordination in the veterans health administration: a case study.

BMC Health Serv Res 2021 Sep 27;21(1):1018. Epub 2021 Sep 27.

Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, 1700 N. Wheeling St, Aurora, CO, 80045, USA.

Background: Large healthcare institutions like the Veterans Health Administration (VA) continually seek best practices to improve clinical care. Relational coordination is an evidence-based organizational theory of communicating and relating to coordinate work and drive performance outcomes. Implementing relational coordination-guided practices can be difficult due to challenges with spreading information across large systems. Using social marketing theory and evidence-based dissemination strategies, we developed an evidence-based dissemination plan to educate and motivate researchers and operational staff to study and implement relational coordination in the VA.

Methods: In this case study, we used the four Ps (product, price, place, promotion) of social marketing theory to develop a 2-phase dissemination strategy. In phase one, we created and distributed relational coordination information and invited VA staff to join the Relational Coordination Research Collaborative. In phase two, dissemination efforts targeted researchers ready to implement relational coordination within existing programs of research. Process and outcome measures included dissemination, engagement and adoption data and a post-project survey. Quantitative results were calculated using descriptive statistics. Survey text responses were analyzed using deductive content analysis and a structured categorization matrix.

Results: Phase one included social media dissemination, virtual and in-person presentations, as well as phone and email communication between project staff and the target audience. In total, 47 VA staff became members of the Relational Coordination Research Collaborative and 27 routinely participated in online research seminars. In phase 2, 13 researchers expressed interest in studying relational coordination and 5 projects were selected to participate. Multiple relational coordination-related trainings and publications originated from this program.

Conclusions: Dissemination approaches that involved personalized, one-on-one efforts (e.g., phone or email) seemed to be more effective at disseminating relational coordination compared to social media or online presentations. Participants in phase 2 agreed that relational coordination should be adopted in the VA but indicated that cost would be a barrier. Results support the importance of evidence-based dissemination planning that address the unique costs and benefits of programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12913-021-07009-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8474939PMC
September 2021

Impact of State Prioritization of Safe Infant Sleep Programs on Supine Sleep Positioning for Non-Hispanic White and Non-Hispanic Black Infants.

Am J Perinatol 2021 Sep 20. Epub 2021 Sep 20.

Department of Biostatistics, Colorado School of Public Health, Aurora, Colorado.

Objective:  Investigate whether safe infant sleep prioritization by states through the Title V Maternal and Child Block Grant in 2010 differentially impacted maternal report of supine sleep positioning (SSP) for Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) U.S.-born infants.

Methods:  We analyzed retrospective cross-sectional data from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2005 to 2015 from 4 states: WV and OK (Intervention) and AR and UT (Control). PRAMS is a population-based surveillance system of maternal perinatal experiences which is linked to infant birth certificates. Piece-wise survey linear regression models were used to estimate the difference in the change in slopes of SSP percents in the pre- (2005-2009) and post- (2011-2015) periods, controlling for maternal and infant characteristics. Models were also stratified by race/ethnicity.

Results:  From 2005 to 2015, for NHW infants, SSP improved from 61.5% and 70.2% to 82.8% and 82.3% for intervention and control states, respectively. For NHB infants, SSP improved from 30.6% and 26.5% to 64.5% and 53.1% for intervention and control states, respectively. After adjustment for maternal characteristics, there was no difference in the rate of SSP change from the pre- to post- intervention periods for either NHW or NHB infants in intervention or control groups.

Conclusions And Relevance:  Compared with control states that did not prioritize safe infant sleep in their 2010 Title V Block Grant needs assessment, intervention states experienced no difference in SSP improvement rates for NHW and NHB infants. While SSP increased for all infants during the study period, there was no causal relationship between states' prioritization of safe infant sleep and SSP improvement. More targeted approaches may be needed to reduce the racial/ethnic disparity in SSP and reduce the risk for sleep-associated infant death.

Key Points: · Supine sleep positioning improved for Black and White infants in the U.S.. · State prioritization of safe infant sleep did not directly impact SSP for NHB or NHW infants.. · More targeted approaches may be needed to reduce racial/ethnic disparities in safe sleep practices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0041-1735262DOI Listing
September 2021

Assessing the impact of remote work during COVID-19 on clinical and translational scientists and staff in Colorado.

J Clin Transl Sci 2020 Dec 21;5(1):e71. Epub 2020 Dec 21.

Colorado Clinical & Translational Sciences Institute, Aurora, CO, USA.

The COVID-19 pandemic has required many clinical and translational scientists and staff to work remotely to prevent the spread of the virus. To understand the impact on research programs, we assessed barriers to remote work and strategies implemented to support virtual engagement and productivity. A mixed-methods RedCap survey querying the remote work experience was emailed to Colorado Clinical and Translational Sciences Institute (CCTSI) scientists and staff in April 2020. Descriptive analyses, Fisher's Exact tests, and content analysis were conducted. Respondents ( = 322) were primarily female ( = 240; 75%), 21-73 years old (mean = 42 years) with a PhD ( = 139; 44%) or MD ( = 56; 55%). Prior to COVID-19, 77% ( = 246) never or rarely (0-1 day a week) worked remotely. Remote work somewhat or greatly interfered with 76% ( = 244) of researchers' programs and 71% ( = 231) reported slowing or stopping their research. Common barriers included missing interactions with colleagues ( = 198; 62%) and the absence of routines ( = 137; 43%). Strategies included videoconferencing ( = 283; 88%), altering timelines and expectations ( = 180; 56%). Scientists and staff experienced interference with their research when they shifted to remote work, causing many to slow or stop research programs. Methods to enhance communication and relationships, support productivity, and collectively cope during remote work are available.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/cts.2020.570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027555PMC
December 2020

Caregiver Experiences and Roles in Care Seeking During COPD Exacerbations: A Qualitative Study.

Ann Behav Med 2021 Jun 24. Epub 2021 Jun 24.

Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.

Background: 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 that may be particularly important during acute exacerbations in monitoring symptoms and seeking medical intervention. However, little is known about caregivers' roles and experiences as they support their patients during exacerbations.

Purpose: To explore the experiences, roles in care seeking, and needs of caregivers during COPD exacerbations.

Methods: Semi-structured interviews were conducted with 24 caregivers of Veterans with COPD who experienced a recent exacerbation. Interviews were recorded, transcribed, and analyzed using inductive content analysis.

Results: Five themes arose: (a) caregivers reported continuously monitoring changes in patients symptom severity to identify exacerbations; (b) caregivers described emotional reactions evoked by exacerbations and constant vigilance; (c) caregivers described disagreements with their patient in interpreting symptoms and determining the need for care seeking; (d) caregivers noted uncertainty regarding their roles and responsibilities in pursuing care and their approaches to promote care varied; and (e) expressed their need for additional information and support. Caregivers of patients with COPD often influence whether and when patients seek care during exacerbations. Discrepancies in symptom evaluations between patients and caregivers paired with the lack of information and support available to caregivers are related to delays in care seeking. Clinical practice should foster self-management support to patient-caregiver dyads to increase caregiver confidence and patient openness to their input during exacerbations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/abm/kaab045DOI Listing
June 2021

The Impacts of COVID-19 on Veterans Affairs Catheterization Laboratory Staff During the First Months of the US Response.

J Cardiovasc Nurs 2021 Nov-Dec 01;36(6):595-598

Background: The COVID-19 pandemic has altered catheterization laboratory (cath lab) practices in diverse ways.

Objective: The aim of this study was to understand the impact of COVID-19 on Veterans Affairs (VA) procedural volume and cath lab team experience.

Methods: Procedural volume and COVID-19 patient data were obtained from the Clinical, Assessment, Reporting and Tracking Program. A mixed methods survey was emailed to VA cath lab staff asking about the COVID-19 response. Descriptive and manifest content analyses were conducted.

Results: Procedural volume decreased from April to September 2020. One hundred four patients with known COVID-19 were treated. Survey response rate was 19% of staff (n = 170/902) from 83% of VA cath labs (n = 67/81). Reassignment to other units, confusion regarding COVID-19 testing, personal protective equipment use, and low patient volume were reported. Anxiety, burnout, and leadership's role on team morale were described.

Conclusions: Some teams adapted. Others expressed frustration over the lack of control over their practice. Leaders should routinely assess staff needs during the current and future crises.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JCN.0000000000000828DOI Listing
October 2021

Information Needs of Skilled Nursing Facility Staff to Support Heart Failure Disease Management.

AMIA Annu Symp Proc 2020 25;2020:878-885. Epub 2021 Jan 25.

Institute for Health Research, Kaiser Permanente, Aurora, CO.

Objectives: Characterize key tasks and information needs for heart failure disease management (HF-DM) in the distinct care setting of skilled nursing facility (SNF) staff in partnership with community-based clinical stakeholders. Develop design recommendations contextualized to the SNF setting for informatics interventions for improved HF-DM in the SNF setting.

Methods: Semi-structured interviews with fifteen participants (registered nurses, licensed practical nurses, certified nursing aides and physicians) from 8 Denver-metro SNFs. Data coded using a data-driven, inductive approach.

Results: Key tasks of HF-DM: symptom assessment, communicating change in condition, using equipment, documentation of daily weights, and monitoring patients. Themes: 1) HF-DM is challenged by a culture of verbal communication; 2) staff face knowledge barriers in HF-DM that are partially attributed to unmet information needs. HF-DM information needs: identification of HF patients, HF signs and symptoms, purpose of daily weights, indicators of worsening HF, purpose of sodium restricted diet, and materials to improve patients' understanding of HF.

Discussion And Conclusions: HF-DM information needs are not fully supported by current SNF information systems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075486PMC
June 2021

A pilot study to assess the learning environment and use of reliability enhancing work practices in VHA cardiac catheterization laboratories.

Learn Health Syst 2021 Apr 8;5(2):e10227. Epub 2020 Apr 8.

Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care VHA Eastern Colorado Healthcare System Aurora Colorado USA.

Introduction: A learning health system (LHS) harnesses data and analytics to learn from clinical encounters to implement the best care with high reliability. The 81 Veterans Health Administration (VHA) cardiac catheterization laboratories (cath lab) are a model LHS. The quality and safety of coronary procedures are monitored and reported by the Clinical Assessment, Reporting and Tracking (CART) Program, which has identified variation in care across cath labs. This variation may be due to underappreciated aspects of LHSs, the learning environment and reliability enhancing work practices (REWPs). Learning environments are the educational approaches, context, and settings in which learning occurs. REWPs are the organizational practices found in high reliability organizations. High learning environments and use of REWPs are associated with improved outcomes. This study assessed the learning environments and use of REWPs in VHA cath labs to examine factors supportive of learning and high reliability.

Methods: In 2018, the learning organization survey-27 and the REWP survey were administered to 732 cath lab staff. Factor analysis and linear models were computed. Unit-level analyses and site ranking (high, low) were conducted on cath labs with >40% response rate using Bayesian methods.

Results: Surveys from 40% of cath lab staff (n = 294) at 84% of cath labs (n = 68) were included. Learning environment and REWP strengths across cath labs include the presence of training programs, openness to new ideas, and respectful interaction. Learning environment and REWP gaps include lack of structured knowledge transfer (eg, checklists) and low use of forums for improvement. Survey dimensions matched established factor structures and demonstrated high reliability (Cronbach's alpha >.76). Unit-level analyses were conducted for 29 cath labs. One ranked as high and four as low learning environments.

Conclusions: This work demonstrates an approach to assess local learning environments and use of REWPs, providing insights for systems working to become a LHS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lrh2.10227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051348PMC
April 2021

Association Between Increased Hospital Reimbursement for Cardiac Rehabilitation and Utilization of Cardiac Rehabilitation by Medicare Beneficiaries: An Interrupted Time Series.

Circ Cardiovasc Qual Outcomes 2021 03 8;14(3):e006572. Epub 2021 Mar 8.

School of Medicine - Cardiology (P.M.H., P.N.P.).

Background: Although cardiac rehabilitation (CR) is a Class I Guideline recommendation, and has been shown to be a cost-effective intervention after a cardiac event, it has been reimbursed at levels insufficient to cover hospital operating costs. In January 2011, Medicare increased payment for CR in hospital outpatient settings by ≈180%. We evaluated the association between this payment increase and participation in CR of eligible Medicare beneficiaries to better understand the relationship between reimbursement policy and CR utilization.

Methods: From a 5% Medicare claims sample, we identified patients with acute myocardial infarction, coronary artery bypass surgery, percutaneous coronary intervention, or cardiac valve surgery between January 1, 2009 and September 30, 2012, alive 30 days after their event, with continuous enrollment in Medicare fee-for-service, Part A/B for 4 months. Trends and changes in CR participation were estimated using an interrupted time series approach with a hierarchical logistic model, hospital random intercepts, adjusted for patient, hospital, market, and seasonality factors. Estimates were expressed using average marginal effects on a percent scale.

Results: Among 76 695 eligible patients, average annual CR participation was 19.5% overall. In the period before payment increase, adjusted annual participation grew by 1.1 percentage points (95% CI, 0.48-2.4). No immediate change occurred in CR participation when the new payment was implemented. In the period after payment increase, on average, 20% of patients participated in CR annually. The annual growth rate in CR participation slowed in the post-period by 1.3 percentage points (95% CI, -2.4 to -0.12) compared with the prior period. Results were somewhat sensitive to time window variations.

Conclusions: The 2011 increase in Medicare reimbursement for CR was not associated with an increase in participation. Future studies should evaluate whether payment did not reach a threshold to incentivize hospitals or if hospitals were not sensitive to reimbursement changes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCOUTCOMES.120.006572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035974PMC
March 2021

Persistent Racial/Ethnic Disparities in Supine Sleep Positioning among US Preterm Infants, 2000-2015.

J Pediatr 2021 06 4;233:51-57.e3. Epub 2021 Mar 4.

Department of Biostatistics, Colorado School of Public Health, Aurora, CO.

Objective: To assess trends in racial disparity in supine sleep positioning (SSP) across racial/ethnic groups of infants born early preterm (Early preterm; <34 weeks) and late preterm (Late preterm; 34-36 weeks) from 2000 to 2015.

Study Design: We analyzed Pregnancy Risk Assessment Monitoring System data (a population-based perinatal surveillance system) from 16 US states from 2000 to 2015 (Weighted N = 1 020 986). Marginal prevalence of SSP by year was estimated for infants who were early preterm and late preterm, adjusting for maternal and infant characteristics. After stratifying infants who were early preterm and late preterm, we compared the aOR of SSP trends across racial/ethnic groups by testing the time-race interaction.

Results: From 2000 to 2015, Non-Hispanic Black infants had lower odds of SSP compared with Non-Hispanic White infants for early preterm (aOR 0.61; 95% CI 0.47-0.78) and late preterm (aOR 0.44; 95% CI 0.34-0.56) groups. For Hispanic infants, there was no statistically significant difference for either preterm group when compared with Non-Hispanic White infants. aOR of SSP increased (on average) annually by 10.0%, 7.3%, and 7.7%, respectively, in Non-Hispanic White, Non-Hispanic Black, and Hispanic early preterm infants and by 5.8%, 5.9%, and 4.8% among Non-Hispanic White, Non-Hispanic Black, and Hispanic late preterm infants. However, there were no significant between-group differences in annual changes (Early preterm: P = .11; Late preterm: P = .25).

Conclusions: SSP increased for all racial/ethnic preterm groups from 2000 to 2015. However, the racial/ethnic disparity in SSP among early preterm and late preterm groups persists.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2021.02.070DOI Listing
June 2021

A preliminary evaluation of full practice authority of advance practice registered nurses in the Veterans Health Administration.

Nurs Outlook 2021 Mar-Apr;69(2):147-158. Epub 2020 Dec 30.

Nursing Innovations Center for Evaluation (NICE), Research and Development Service, James A Haley Veterans' Hospital and Clinics, Tampa FL.

Background: Responding to National Academy of Medicine and National Council of State Boards of Nursing recommendations, the Department of Veterans Health Affairs (VHA) implemented full practice authority (FPA) for Advanced Practice Registered Nurses in VHA medical centers (VAMCs) in 2017.

Purpose: To evaluate FPA policy implementation's impact on quality indicators including access to care as measured by new patient appointments in primary, specialty and mental health services.

Methods: Linear growth models compared early (n = 85) vs. late (n = 55) FPA implementing VAMCs on the trajectories of each of the three quality indicators.

Findings: Early FPA implementing VAMCs showed greater rates of improvement over time in new patient appointments completed within 30 days of preferred date for primary care (p = .003), specialty care (p = 0.05), and mental health (p = 0.001).

Discussion: VAMCs that started implementation of FPA policy early showed greater improvement in access to care for Veterans over time than VAMCs that did not.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.outlook.2020.11.005DOI Listing
April 2021

Safe patient handling and mobility (SPHM) for increasingly bariatric patient populations: Factors related to caregivers' self-reported pain and injury.

Appl Ergon 2021 Feb 12;91:103300. Epub 2020 Nov 12.

Veterans Health Administration, USA.

This study was conducted at 5 Veterans Administration Medical Centers (VAMCs). A cross sectional survey was administered to 134 workers who routinely lift and mobilize patients within their workplaces' safe patient handling and mobility (SPHM) programs, which are mandated in all VAMCs. The survey was used to examine a comprehensive list of SPHM and non-SPHM variables, and their associations with self-reported musculoskeletal injury and pain. Previously unstudied variables distinguished between "bariatric" (≥300 lb or 136 kg) and "non-bariatric" (<300 lb or 136 kg) patient handling. Significant findings from stepwise and logistic regression provide targets for workplace improvements, predicting: lower injury odds with more frequently having sufficient time to use equipment, higher back pain odds with more frequent bariatric handling, lower back pain odds with greater ease in following SPHM policies, and lower odds of upper extremity pain with more bariatric equipment, and with higher safety climate ratings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.apergo.2020.103300DOI Listing
February 2021

Practices to support relational coordination in care transitions: Observations from the VA rural Transitions Nurse Program.

Health Care Manage Rev 2020 Nov 11. Epub 2020 Nov 11.

Heather M. Gilmartin, PhD, NP, is Investigator, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, and Health Systems, Management and Policy, University of Colorado School of Public Health, Aurora. E-mail: Catherine Battaglia, PhD, RN, is Investigator, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, and Health Systems, Management and Policy, University of Colorado School of Public Health, Aurora. Theodore Warsavage, MS, is Statistician, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora. Brigid Connelly, BA, is Research Assistant, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora. Robert E. Burke, MD, MS, is Investigator, Center for Health Equity Research and Promotion, Corporal Crescenz Veterans Health Administration Medical Center, Philadelphia, Pennsylvania, and Hospital Medicine Section-Division of General Internal Medicine, University of Pennsylvania Perelmann School of Medicine, Philadelphia.

Background: Ensuring safe transitions of care around hospital discharge requires effective relationships and communication between health care teams. Relational coordination (RC) is a process of communicating and relating for the purpose of task integration that predicts desirable outcomes for patients and providers. RC can be measured using a validated survey.

Purpose: The aim of the study was to demonstrate the application of RC practices within the rural Transitions Nurse Program (TNP), a nationwide transitions of care intervention for Veterans, and assess relationships and mechanisms for developing RC in teams.

Methodology/approach: TNP implemented practices expected to support RC. These included creation of a transition nurse role, preimplementation site visits, process mapping to understand workflow, creation of standardized communication templates and protocols, and inclusion of teamwork and shared accountability in job descriptions and annual reviews. We used the RC Survey to measure RC for TNP health care teams. Associations between the months each site participated in TNP, number of Veterans enrolled, and adherence to the TNP intervention were assessed as possible mechanisms for developing high RC using Spearman (rs) correlations.

Results: The RC Survey was completed by 44 providers from 11 Veterans Health Administration medical centers. RC scores were high across sites (mean = 4.19; 1-5 Likert scale) and were positively correlated with months participating in TNP (rs = .66) and number of enrollees (rs = .63), but not with adherence to the TNP intervention (rs = .12).

Practice Implications: The impact of practices to support RC can be assessed using the RC Survey. Our findings suggest scale-up time is a likely mechanism to the development of high-quality relationships and communication within teams.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HMR.0000000000000300DOI Listing
November 2020

An interdisciplinary postdoctoral fellowship model: Opportunities for nurse PhDs.

J Nurs Educ Pract 2020 ;10(2)

Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation, Aurora, Colorado, USA.

Interdisciplinary postdoctoral fellowships can provide rich opportunities for nurses to receive additional training and develop diverse professional academic and research partnerships. They provide a structure for learning in which team science is emphasized and complex health issues are addressed. This paper presents an interdisciplinary postdoctoral fellowship model and highlights the development of one nurse fellow's network during the program. The fellowship curriculum is outlined and the three focus areas (education, research, and experience) are further explained. A social network analysis approach was used to illustrate the growth in one nurse fellow's network during a two-year postdoctoral fellowship. The first year of the fellowship showed an increase in the number of professional connections, while in the second year the relationships deepened as collaborations were established and strengthened.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5430/jnep.v10n2p33DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590921PMC
January 2020

Patient Characteristics Are Not Associated With Documentation of Weight and Heart Failure Related Sign and Symptom Assessment in Skilled Nursing Facilities.

J Am Med Dir Assoc 2021 06 16;22(6):1265-1270.e1. Epub 2020 Oct 16.

Institute for Health Research, Kaiser Permanente, Aurora, CO, USA.

Objective: Monitoring body weight and signs and symptoms related to heart failure (HF) can alert clinicians to a patient's worsening condition but the degree to which these practices are performed in skilled nursing facilities (SNFs) is unknown. This study analyzed the frequency of these monitoring practices in SNFs and explored associated factors at both the patient and SNF level.

Design: An observational study of data from the usual care arm of the SNF Connect Trial, a randomized cluster trial of a HF disease management intervention. The data extracted from charts were combined with publicly available facility data. A linear regression model was estimated to evaluate the frequency of HF disease management conditional on patient and facility covariates.

Setting: Data from 28 SNFs in Colorado.

Participants: Patients discharged from hospital to SNFs with a primary or secondary diagnosis of HF.

Measurements: Patient-level covariates included demographics, New York Heart Association class, type of HF, and Charlson comorbidity index. Facility-level covariates were from Nursing Home Compare.

Results: The sample (n = 320) was majority female (66%), white (93%), with mean age 80 ± 10 years and a Charlson comorbidity index of 3.2 ± 1.5. Seventy percent had HF with preserved ejection fraction, mean ejection fraction of 50 ± 16% and 40% with a New York Heart Association class III-IV. On average, patients were weighed 40% of their days in the SNF and had documentation of at least 1 HF-related sign or symptom 70% of their days in the SNF. Patient-level factors were not associated with frequency of documenting weight and assessments of HF-related signs/symptoms. Health Inspection Star Rating was positively associated with weight monitoring (P < .05) but not associated with symptom assessment.

Conclusions And Implications: Patient-level factors are not meaningfully associated with the documentation of weight tracking or sign/symptom assessment. Monitoring weight was instead associated with the Health Inspection Star Rating.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jamda.2020.08.033DOI Listing
June 2021

VA Care Coordination Program Increased Primary Care Visits and Improved Transitional Care for Veterans Post Non-VA Hospital Discharge.

Am J Med Qual 2021 Jul-Aug 01;36(4):221-228

Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO University of Colorado, Anschutz Medical Campus, Aurora, CO University of California San Diego, San Diego, CA.

Veterans are increasingly eligible for non-VA care through the Veteran Health Administration (VA) Maintaining Internal Systems and Strengthening Integrated Outside Networks Act while maintaining care in the VA. Continuity of care is challenging when delivered across multiple systems resulting in avoidable complications. The Community Hospital Transitions Program (CHTP) intervention was developed to address challenges veterans face post non-VA hospitalization. Propensity score-matched analysis was used to compare outcomes between 334 intervention and matched control patients who were discharged from non-VA hospitals. Veterans in CHTP were more likely than matched controls to receive a follow-up appointment within 14 days (mean: 0.43 vs 0.34, P < .05) and 30 days (mean: 0.62 vs 0.50, P < .05). There were no significant differences in 30-day readmissions or 30-day emergency department visits. CHTP veterans received timely follow-up care post discharge in VA facilities. Providing quality care to dual-use veterans is dependent on coordinated transitional care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1062860620946362DOI Listing
November 2021

Making Implementation Science More Rapid: Use of the RE-AIM Framework for Mid-Course Adaptations Across Five Health Services Research Projects in the Veterans Health Administration.

Front Public Health 2020 27;8:194. Epub 2020 May 27.

Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, San Diego, CA, United States.

Implementation science frameworks have helped advance translation of research to practice. They have been widely used for planning and evaluation, but seldom to inform and guide mid-course adjustments to intervention and implementation strategies. This study developed an innovative methodology using the RE-AIM framework and related tools to guide mid-course assessments and adaptations across five diverse health services improvement projects in the Veterans Health Administration (VA). Using a semi-structured guide, project team members were asked to assess the importance of and progress on each RE-AIM dimension (i.e., reach, effectiveness, adoption, implementation, maintenance) at the current phase of their project. Based on these ratings, each team identified one or two RE-AIM dimensions for focused attention. Teams developed proximal goals and implementation strategies to improve progress on their selected dimension(s). A follow-up meeting with each team occurred approximately 6 weeks after the goal setting meeting to evaluate the usefulness of the iterative process. Results were evaluated using both descriptive quantitative analyses and qualitative assessments from interviews and meeting notes. A median of seven team members participated in the two meetings. Qualitative and descriptive data revealed that the process was feasible, understandable and useful to teams in adjusting their interventions and implementation strategies. The RE-AIM dimensions identified as most important were adoption and effectiveness, and the dimension that had the largest gap between importance and rated progress was reach. The dimensions most frequently selected for improvement were reach and adoption. Examples of action plans were summarizing stakeholder interviews for leadership, revising exclusion criteria, and conducting in-service trainings. Follow-up meetings indicated that teams found the process very useful and were able to implement the action plans they set. The iterative use of RE-AIM to support adjustments during project implementation proved feasible and useful across diverse projects in the VA setting. Building on this and related examples, future research should replicate these findings and further develop the methodology, as well as explore the optimal frequency and timing for these iterative applications of RE-AIM. More generally, greater focus on more rapid and iterative use of implementation science frameworks is encouraged to facilitate successful translation of research to practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpubh.2020.00194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266866PMC
May 2021

Making Implementation Science More Rapid: Use of the RE-AIM Framework for Mid-Course Adaptations Across Five Health Services Research Projects in the Veterans Health Administration.

Front Public Health 2020 27;8:194. Epub 2020 May 27.

Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, San Diego, CA, United States.

Implementation science frameworks have helped advance translation of research to practice. They have been widely used for planning and evaluation, but seldom to inform and guide mid-course adjustments to intervention and implementation strategies. This study developed an innovative methodology using the RE-AIM framework and related tools to guide mid-course assessments and adaptations across five diverse health services improvement projects in the Veterans Health Administration (VA). Using a semi-structured guide, project team members were asked to assess the importance of and progress on each RE-AIM dimension (i.e., reach, effectiveness, adoption, implementation, maintenance) at the current phase of their project. Based on these ratings, each team identified one or two RE-AIM dimensions for focused attention. Teams developed proximal goals and implementation strategies to improve progress on their selected dimension(s). A follow-up meeting with each team occurred approximately 6 weeks after the goal setting meeting to evaluate the usefulness of the iterative process. Results were evaluated using both descriptive quantitative analyses and qualitative assessments from interviews and meeting notes. A median of seven team members participated in the two meetings. Qualitative and descriptive data revealed that the process was feasible, understandable and useful to teams in adjusting their interventions and implementation strategies. The RE-AIM dimensions identified as most important were adoption and effectiveness, and the dimension that had the largest gap between importance and rated progress was reach. The dimensions most frequently selected for improvement were reach and adoption. Examples of action plans were summarizing stakeholder interviews for leadership, revising exclusion criteria, and conducting in-service trainings. Follow-up meetings indicated that teams found the process very useful and were able to implement the action plans they set. The iterative use of RE-AIM to support adjustments during project implementation proved feasible and useful across diverse projects in the VA setting. Building on this and related examples, future research should replicate these findings and further develop the methodology, as well as explore the optimal frequency and timing for these iterative applications of RE-AIM. More generally, greater focus on more rapid and iterative use of implementation science frameworks is encouraged to facilitate successful translation of research to practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpubh.2020.00194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266866PMC
May 2021

Making Implementation Science More Rapid: Use of the RE-AIM Framework for Mid-Course Adaptations Across Five Health Services Research Projects in the Veterans Health Administration.

Front Public Health 2020 27;8:194. Epub 2020 May 27.

Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, San Diego, CA, United States.

Implementation science frameworks have helped advance translation of research to practice. They have been widely used for planning and evaluation, but seldom to inform and guide mid-course adjustments to intervention and implementation strategies. This study developed an innovative methodology using the RE-AIM framework and related tools to guide mid-course assessments and adaptations across five diverse health services improvement projects in the Veterans Health Administration (VA). Using a semi-structured guide, project team members were asked to assess the importance of and progress on each RE-AIM dimension (i.e., reach, effectiveness, adoption, implementation, maintenance) at the current phase of their project. Based on these ratings, each team identified one or two RE-AIM dimensions for focused attention. Teams developed proximal goals and implementation strategies to improve progress on their selected dimension(s). A follow-up meeting with each team occurred approximately 6 weeks after the goal setting meeting to evaluate the usefulness of the iterative process. Results were evaluated using both descriptive quantitative analyses and qualitative assessments from interviews and meeting notes. A median of seven team members participated in the two meetings. Qualitative and descriptive data revealed that the process was feasible, understandable and useful to teams in adjusting their interventions and implementation strategies. The RE-AIM dimensions identified as most important were adoption and effectiveness, and the dimension that had the largest gap between importance and rated progress was reach. The dimensions most frequently selected for improvement were reach and adoption. Examples of action plans were summarizing stakeholder interviews for leadership, revising exclusion criteria, and conducting in-service trainings. Follow-up meetings indicated that teams found the process very useful and were able to implement the action plans they set. The iterative use of RE-AIM to support adjustments during project implementation proved feasible and useful across diverse projects in the VA setting. Building on this and related examples, future research should replicate these findings and further develop the methodology, as well as explore the optimal frequency and timing for these iterative applications of RE-AIM. More generally, greater focus on more rapid and iterative use of implementation science frameworks is encouraged to facilitate successful translation of research to practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpubh.2020.00194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266866PMC
May 2021

The advanced care coordination program: a protocol for improving transitions of care for dual-use veterans from community emergency departments back to the Veterans Health Administration (VA) primary care.

BMC Health Serv Res 2019 Oct 22;19(1):734. Epub 2019 Oct 22.

Department of Veterans Affairs, Eastern Colorado Health Care System, 1700 N. Wheeling St, Aurora, CO, 80045, USA.

Background: Veterans who access both the Veterans Health Administration (VA) and non-VA health care systems require effective care coordination to avoid adverse health care outcomes. These dual-use Veterans have diverse and complex needs. Gaps in transitions of care between VA and non-VA systems are common. The Advanced Care Coordination (ACC) quality improvement program aims to address these gaps by implementing a comprehensive longitudinal care coordination intervention with a focus on Veterans' social determinants of health (SDOH) to facilitate Veterans' transitions of care back to the Eastern Colorado Health Care System (ECHCS) for follow-up care.

Methods: The ACC program is an ongoing quality improvement study that will enroll dual-use Veterans after discharge from non-VA emergency department (EDs), and will provide Veterans with social worker-led longitudinal care coordination addressing SDOH and providing linkage to resources. The ACC social worker will complete biopsychosocial assessments to identify Veteran needs, conduct regular in-person and phone visits, and connect Veterans back to their VA care teams. We will identify non-VA EDs in the Denver, Colorado metro area that will provide the most effective partnership based on location and Veteran need. Veterans will be enrolled into the ACC program when they visit one of our selected non-VA EDs without being hospitalized. We will develop a program database to allow for continuous evaluation. Continuing education and outreach including the development of a resource guide, Veteran Care Cards, and program newsletters will generate program buy-in and bridge communication. We will evaluate our program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, supported by the Practical, Robust Implementation and Sustainability Model, Theoretical Domains Framework, and process mapping.

Discussion: The ACC program will improve care coordination for dual-use Veterans by implementing social-work led longitudinal care coordination addressing Veterans' SDOH. This intervention will provide an essential service for effective care coordination.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12913-019-4582-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805730PMC
October 2019

Perspectives of Clinicians, Staff, and Veterans in Transitioning Veterans from non-VA Hospitals to Primary Care in a Single VA Healthcare System.

J Hosp Med 2019 Oct 23;14:E1-E7. Epub 2019 Oct 23.

Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado.

Background: Veterans with healthcare needs utilize both Veterans Health Administration (VA) and non-VA hospitals. These dual-use veterans are at high risk of adverse outcomes due to the lack of coordination for safe transitions.

Objectives: The aim of this study was to understand the barriers and facilitators to providing high-quality continuum of care for veterans transitioning from non-VA hospitals to the VA primary care setting.

Design: Guided by the practical robust implementation and sustainability model (PRISM) and the ideal transitions of care, we conducted a qualitative assessment using semi-structured interviews with clinicians, staff, and patients.

Setting: This study was conducted at a single urban VA medical center and two non-VA hospitals.

Participants: A total of 70 participants, including 52 clinicians and staff (23 VA and 29 non-VA) involved in patient transition and 18 veterans recently discharged from non-VA hospitals, were included in this study.

Approach: Data were analyzed using a conventional content analysis and managed in Atlas.ti (Berlin, Germany).

Results: Four major themes emerged where participants consistently discussed that transitions were delayed when they were not able to (1) identify patients as veterans and notify VA primary care of discharge, (2) transfer non-VA hospital medical records to VA primary care, (3) obtain follow-up care appointments with VA primary care, and (4) write VA formulary medications for veterans that they could fill at VA pharmacies. Participants also discussed factors involved in smooth transition and recommendations to improve care coordination.

Conclusions: All participants perceived the current transition-of-care process across healthcare systems to be inefficient. Efforts to improve quality and safety in transitional care should address the challenges clinicians and patients experience when transitioning from non-VA hospitals to VA primary care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12788/jhm.3320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064299PMC
October 2019

Newer Forms of Tobacco Products: Characteristics of Poly Users Among Adults Living in Colorado-A Secondary Data Analysis of the Attitudes and Behaviors Survey on Health 2015.

Tob Use Insights 2019 9;12:1179173X19874811. Epub 2019 Sep 9.

Rocky Mountain Regional Medical Center, Denver-Seattle Center of Innovation (COIN), Aurora, CO, USA.

Aims: Data from The Attitudes and Behaviors Survey (TABS) conducted in 2015 were used to investigate the prevalence of different forms of tobacco use and marijuana use among adults in Colorado.

Methods: A secondary analysis of TABS on health data was conducted. A representative sample of 8616 adults 18 years and older participated in the survey, with sample weights used to adjust for oversampling.

Results: Lifetime prevalence of cigarette-only use was 25.8%, compared with 10.6% for hookah use, 7.0% for both hookah and cigarettes, 12.6% for anything except cigarettes, and 43.0% for marijuana. The typical hookah user was a single/living alone (15.9%), English-speaking (11.6%), male (16.7%), age < 30 years (24.2%), with some college education (13.0%), and income less than 35 000 per year (14.3%). Hookah users, whether or not they also used cigarettes, were similar to those who used any other noncigarette tobacco products. The typical marijuana user was a single/living alone (50.2%), white (46.0%), English-speaking (46.7%), male (48.5%), age < 30 years (50.1%), with a graduate degree (40.8%) and salary of at least 50 000 per year (43.4%).

Implications: In Colorado, in 2015, cigarette use was still highest among all forms of tobacco, but the use of other tobacco products such as vaping and hookah is on the rise, especially among young adults. Marijuana and hookah users were demographically similar to each other, and different from the typical cigarette user. These results indicate the need for further study of alternative tobacco product use, especially among young adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1179173X19874811DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734605PMC
September 2019

Accurate preoperative prediction of unplanned 30-day postoperative readmission using 8 predictor variables.

Surgery 2019 11 2;166(5):812-819. Epub 2019 Jul 2.

Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora. Electronic address:

Background: Unplanned postoperative readmissions are associated with high costs, may indicate poor care quality, and present a substantial opportunity for healthcare quality improvement. Patients want to know their risk of unplanned readmission, and surgeons need to know the risk to adequately counsel their patients. The Surgical Risk Preoperative Assessment System tool was developed from the American College of Surgeons National Surgical Quality Improvement Program dataset and is a parsimonious model using 8 predictor variables. Surgical Risk Preoperative Assessment System is applicable to >3,000 operations in 9 surgical specialties, predicts 30-day postoperative mortality and morbidity, and is incorporated into our electronic health record.

Methods: A Surgical Risk Preoperative Assessment System model was developed using logistic regression. It was compared to the 28 nonlaboratory variables model from the American College of Surgeons National Surgical Quality Improvement Program 2012 to 2017 dataset using the c-index as a measure of discrimination, the Hosmer-Lemeshow observed-to-expected plots testing calibration, and the Brier score, a combined metric of discrimination and calibration.

Results: Of 4,861,370 patients, 188,150 (3.98%) experienced unplanned readmission related to the index operation. The Surgical Risk Preoperative Assessment System model's c-index, 0.728, was 99.3% of that of the full model's, 0.733; the Hosmer-Lemeshow plots indicated good calibration; and the Brier score was 0.0372 for Surgical Risk Preoperative Assessment System and 0.0371 for the full model.

Conclusion: The 8 variable Surgical Risk Preoperative Assessment System model detects patients at risk for postoperative unplanned, related readmission as accurately as the full model developed from all 28 nonlaboratory preoperative variables in the American College of Surgeons National Surgical Quality Improvement Program dataset. Therefore, unplanned readmission can be integrated into the existing Surgical Risk Preoperative Assessment System tool providing moderately accurate prediction of postoperative readmission.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.surg.2019.05.022DOI Listing
November 2019

Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs.

Transl Behav Med 2019 11;9(6):1002-1011

Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA.

There is consensus in dissemination and implementation (D&I) science that addressing contextual factors is critically important for understanding translation of health care delivery interventions but little agreement on which contextual factors are key determinants of implementation outcomes. We describe the application of the Practical Robust Implementation and Sustainability Model (PRISM), which expands the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to identify contextual factors across four diverse programs. Multiple qualitative methods were used to collect multilevel, multistakeholder perspectives from the adopting organizations and staff. We identified measures for evaluating context through the various domains of PRISM to guide health services research across the phases of program implementation. The PRISM domains of Recipients, Implementation and Sustainability Infrastructure, and External Environment identified important multilevel contextual factors, including variability in operational processes and available resources. These domains helped to facilitate planning and implementation phases of the four interventions and guide purposeful adaptations. We found assessments of PRISM domains useful to systematically assess multilevel contextual factors across various content areas as well as phases of program implementation. Additionally, these contextual factors were found to be relevant to RE-AIM outcomes. Lessons learned can be applied to future research as there is a need to investigate the measurement properties of PRISM and continue to test which contextual factors are most important to successful implementation and for which outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/tbm/ibz085DOI Listing
November 2019

Herpes Zoster and Herpes Zoster Vaccine Rates Among Adults Living With and Without HIV in the Veterans Aging Cohort Study.

J Acquir Immune Defic Syndr 2018 12;79(4):527-533

Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado, Aurora, CO.

Background: Despite historically high rates of herpes zoster among people living with HIV (PLWH), comparative studies of herpes zoster by HIV serostatus are lacking since the advent of combination antiretroviral therapy and availability of zoster vaccine.

Methods: Annual rates (2002-2015) of first-episode herpes zoster and zoster vaccination were calculated for PLWH and uninfected adults in the Veterans Aging Cohort Study and stratified by HIV serostatus and age. Herpes zoster was captured using ICD9 codes and vaccine receipt with procedural codes and pharmacy data.

Results: Of 45,177 PLWH and 103,040 uninfected veterans, rates of herpes zoster decreased among PLWH (17.6-8.1/1000) over the study period but remained higher than uninfected adults (4.1/1000) at the end of study period. Rates were higher in PLWH with lower CD4 (<200 vs >500 cells/µL: 18.0 vs 6.8/1000) and unsuppressed vs suppressed HIV-1 RNA (21.8 vs 7.1/1000). Restricted to virologically suppressed participants with CD4 >350 cells per microliter, herpes zoster rates were similar among PLWH aged younger than 60 years and aged 60 years and older in 2015 (6.6 vs 6.7/1000) but higher than all uninfected age groups. At study end, cumulative receipt of zoster vaccine for PLWH aged 60 years and older was less than half that of uninfected veterans: 98.7 vs 215.2/1000.

Conclusions: Herpes zoster rates among PLWH have markedly decreased, but, even in cART-treated individuals, remain 50% higher than uninfected adults. Lower rates of zoster vaccine receipt combined with high rates of herpes zoster support the need for a safe and effective vaccine against herpes zoster for PLWH, formal zoster vaccine guidelines for PLWH, and consideration for expanded use at younger ages.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/QAI.0000000000001846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203599PMC
December 2018

Research productivity following nursing research initiative grants.

Nurs Outlook 2019 Jan - Feb;67(1):6-12. Epub 2018 Jul 11.

VHA Office of Nursing Services, Washington DC.

Background: In 1995, VA's Office of Research and Development launched the Nursing Research Initiative (NRI), to encourage nurses to apply for research funding and to increase the role of nurse investigators in the VA's research mission. This program provides novice nurse researchers the opportunity to further develop their research skills with the guidance of a mentor.

Purpose: Since the NRI's inception, its impact on the research career trajectory of budding nurse researchers had never been fully explored.

Methods: An electronic quality improvement survey was developed to collect information about the scope of work and research trajectory of VA nurse researchers undertaken since they received NRI funding.

Findings: NRI awardees demonstrated research productivity in several areas including research funding, peer-reviewed publications; participation on journal editorial boards and grant review committees; and mentorship. The majority of past NRI grant recipients (78%) have maintained employment within the VA system and benefit from the expertise, mentoring, and support of other nurse researchers. NRI grant recipients confirm the value of the VA NRI mentored grant funding mechanism and its association with a productive research trajectory with survey respondents demonstrating an average return on investment of $7.7 million in research funding per person.

Conclusion: The experiences derived from the NRI accelerated the professional growth and research productivity of this group and it guided future opportunities to design, implement, and test nurse-led interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.outlook.2018.06.011DOI Listing
May 2019

Feasibility of a Telemedicine-Delivered Cognitive Behavioral Therapy for Insomnia in Rural Breast Cancer Survivors.

Oncol Nurs Forum 2018 09;45(5):607-618

University of Colorado.

Objectives: To evaluate a nurse-led, telemedicine-delivered cognitive behavioral therapy for insomnia (CBTI) in rural breast cancer survivors (BCSs).

Sample & Setting: 18 BCSs diagnosed with stage I-III breast cancer in the rural western United States.

Methods & Variables: In this prospective, pre-/post-test, quasiexperimental feasibility pilot trial, BCSs attended six weekly sessions of CBTI via Internet videoconference. Feasibility was assessed using recruitment and acceptability of the intervention. Primary outcomes were diary-based sleep efficiency (SE), sleep latency (SL), total sleep time, wake after sleep onset, and number of nightly awakenings; secondary outcomes included quality of life (QOL), mental health, and daily functioning.

Results: Following the intervention, participants reported improvements in sleep outcomes, including SE and SL. QOL and daily functioning improved, but anxiety and depression did not.

Implications For Nursing: Nurse-led, telemedicine-delivered CBTI for rural BCSs is feasible and may be effective in managing insomnia. Additional research is needed to determine widespread effectiveness and best practices for dissemination and implementation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1188/18.ONF.607-618DOI Listing
September 2018

Pragmatic dissemination and implementation research models, methods and measures and their relevance for nursing research.

Nurs Outlook 2018 09 6;66(5):430-445. Epub 2018 Aug 6.

Department of Veterans Affairs Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Family Medicine, School of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO; Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Eastern Colorado Health Care System, Denver, CO.

Background: Pragmatic dissemination and implementation (D&I) research approaches can benefit patient care because they emphasize real-world settings and populations. Nurse scientists have an opportunity to reduce the gap between science and practice by using pragmatic D&I research and sustainability strategies.

Purpose: This article discusses pragmatic models, methods, and measures used in D&I research and their relevance for nursing research and enhancing population health.

Methods: Summary of pragmatic D&I models and related methods for designing a pragmatic studies. We discuss the RE-AIM framework and the PRECIS-2 planning aid and figure in detail. A case study is provided and application to nursing research is discussed.

Discussion: Successful translation of pragmatic D&I research demands an approach that addresses external validity, and customization at multiple levels including the patient, clinician, and setting. Context is critically important, and it is never too early to design for dissemination.

Conclusions: Pragmatic D&I approaches are needed to speed research translation, reduce avoidable waste of funding, improve clinical care, and enhance population health. Pragmatic D&I research is an area of tremendous opportunity for the nursing science community.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.outlook.2018.06.007DOI Listing
September 2018

African Americans Are Less Likely to Receive Care by a Cardiologist During an Intensive Care Unit Admission for Heart Failure.

JACC Heart Fail 2018 05;6(5):413-420

Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Division of Cardiology, Denver Health Medical Center, Denver, Colorado.

Objectives: This study sought to determine whether the likelihood of receiving primary intensive care unit (ICU) care by a cardiologist versus a noncardiologist was greater for Caucasians than for African Americans admitted to an ICU for heart failure (HF). The authors further evaluated whether primary ICU care by a cardiologist is associated with higher in-hospital survival, irrespective of race.

Background: Increasing data demonstrate an association between better HF outcomes and care by a cardiologist. It is unclear if previously noted racial differences in cardiology care persist in an ICU setting.

Methods: Using the Premier database, adult patients admitted to an ICU with a primary discharge diagnosis of HF from 2010 to 2014 were included. Hierarchical logistic regression models were used to determine the association between race and primary ICU care by a cardiologist, adjusting for patient and hospital variables. Cox regression with inverse probability weighting was used to assess the association between cardiology care and in-hospital mortality.

Results: Among 104,835 patients (80.3% Caucasians, 19.7% African Americans), Caucasians had higher odds of care by a cardiologist than African Americans (adjusted odds ratio: 1.42; 95% confidence interval: 1.34 to 1.51). Compared with a noncardiologist, primary ICU care by a cardiologist was associated with higher in-hospital survival (adjusted hazard ratio: 1.20, 95% confidence interval: 1.11 to 1.28). The higher likelihood of survival did not differ by patient race (interaction p = 0.32).

Conclusions: Among patients admitted to an ICU for HF, African Americans were less likely than Caucasians to receive primary care by a cardiologist. Primary care by a cardiologist was associated with higher survival for both Caucasians and African Americans.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jchf.2018.02.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940011PMC
May 2018

Systematic, Multimethod Assessment of Adaptations Across Four Diverse Health Systems Interventions.

Front Public Health 2018 9;6:102. Epub 2018 Apr 9.

Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), Denver VHA Medical Center, Denver, CO, United States.

Background: Many health outcomes and implementation science studies have demonstrated the importance of tailoring evidence-based care interventions to local context to improve fit. By adapting to local culture, history, resources, characteristics, and priorities, interventions are more likely to lead to improved outcomes. However, it is unclear how best to adapt evidence-based programs and promising innovations. There are few guides or examples of how to best categorize or assess health-care adaptations, and even fewer that are brief and practical for use by non-researchers.

Materials And Methods: This study describes the importance and potential of assessing adaptations before, during, and after the implementation of health systems interventions. We present a promising multilevel and multimethod approach developed and being applied across four different health systems interventions. Finally, we discuss implications and opportunities for future research.

Results: The four case studies are diverse in the conditions addressed, interventions, and implementation strategies. They include two nurse coordinator-based transition of care interventions, a data and training-driven multimodal pain management project, and a cardiovascular patient-reported outcomes project, all of which are using audit and feedback. We used the same modified adaptation framework to document changes made to the interventions and implementation strategies. To create the modified framework, we started with the adaptation and modification model developed by Stirman and colleagues and expanded it by adding concepts from the RE-AIM framework. Our assessments address the intuitive domains of to classify and organize adaptations. For each case study, we discuss how the modified framework was operationalized, the multiple methods used to collect data, results to date and approaches utilized for data analysis. These methods include a real-time tracking system and structured interviews at key times during the intervention. We provide descriptive data on the types and categories of adaptations made and discuss lessons learned.

Conclusion: The multimethod approaches demonstrate utility across diverse health systems interventions. The modified adaptations model adequately captures adaptations across the various projects and content areas. We recommend systematic documentation of adaptations in future clinical and public health research and have made our assessment materials publicly available.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpubh.2018.00102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5900443PMC
April 2018
-->