scholarly journals Clostridium difficile Infection Among Veterans Health Administration Patients

2015 ◽  
Vol 36 (9) ◽  
pp. 1038-1045 ◽  
Author(s):  
Yinong Young-Xu ◽  
Jennifer L Kuntz ◽  
Dale N. Gerding ◽  
Julia Neily ◽  
Peter Mills ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Descriptive Analysis ◽  
Outpatient Setting ◽  
Nucleic Acid Amplification ◽  
Veterans Health ◽  
Healthcare Administration ◽  
Health Administration ◽  
Term Care ◽  
Veterans Healthcare Administration

OBJECTIVETo report on the prevalence and incidence of Clostridium difficile infection (CDI) from 2009 to 2013 among Veterans Healthcare Administration patientsDESIGNA retrospective descriptive analysis of data extracted from a large electronic medical record (EMR) databaseSETTINGData were acquired from VHA healthcare records from 2009 to 2013 that included outpatient clinical visits, long-term care, and hospitalized care as well as pharmacy and laboratory information.RESULTSIn 2009, there were 10,207 CDI episodes, and in 2013, there were 12,143 CDI episodes, an increase of 19.0%. The overall CDI rate increased by 8.4% from 193 episodes per 100,000 patient years in 2009 to 209 episodes per 100,000 patient years in 2013. Of the CDI episodes identified in 2009, 58% were identified during a hospitalization, and 42% were identified in an outpatient setting. In 2013, 44% of the CDI episodes were identified in an outpatient setting.CONCLUSIONThis is one of the largest studies that has utilized timely EMR data to describe the current CDI epidemiology at the VHA. Despite an aging population with greater burden of comorbidity than the general US population, our data show that VHA CDI rates stabilized between 2011 and 2013 following increases likely attributable to the introduction of the more sensitive nucleic acid amplification tests (NAATs). The findings in this report will help establish an accurate benchmark against which both current and future VA CDI prevention initiatives can be measured.Infect. Control Hosp. Epidemiol. 2015;36(9):1038–1045

scholarly journals Clostridium difficile Infections in Veterans Health Administration Long-Term Care Facilities

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Jeffrey Reeves ◽  
Martin Evans ◽  
Loretta Simbartl ◽  
Stephen Kralovic ◽  
Gary Roselle
Keyword(s):  
Clostridium Difficile ◽  
Long Term Care ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Term Care ◽  
Care Facilities

Evaluating the Effect of a Clostridium difficile Infection Prevention Initiative in Veterans Health Administration Long-Term Care Facilities

2018 ◽  
Vol 39 (3) ◽  
pp. 343-345 ◽  
Author(s):  
Maninder B. Singh ◽  
Martin E. Evans ◽  
Loretta A. Simbartl ◽  
Stephen M. Kralovic ◽  
Gary A. Roselle
Keyword(s):  
Clostridium Difficile ◽  
Infection Prevention ◽  
Long Term Care ◽  
Care Facility ◽  
Veterans Health ◽  
Health Administration ◽  
Term Care ◽  
Long Term Care Facility ◽  
Care Facilities

We evaluated rates of clinically confirmed long-term-care facility-onset Clostridium difficile infections from April 2014 through December 2016 in 132 Veterans Affairs facilities after the implementation of a prevention initiative. The quarterly pooled rate decreased 36.1% from the baseline (P<.0009 for trend) by the end of the analysis period.Infect Control Hosp Epidemiol 2018;39:343–345

scholarly journals Automated Nationwide Benchmarking Dashboard for Antimicrobial Stewardship Programs within the Veterans’ Health Administration

2021 ◽  
Vol 1 (S1) ◽  
pp. s23-s24
Author(s):  
Michihiko Goto ◽  
Eli Perencevich ◽  
Alexandre Marra ◽  
Bruce Alexander ◽  
Brice Beck ◽  
...  
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Risk Adjustment ◽  
Long Term Care ◽  
Antimicrobial Use ◽  
Veterans Health ◽  
Health Administration ◽  
Term Care ◽  
Patient Level

Group Name: VHA Center for Antimicrobial Stewardship and Prevention of Antimicrobial Resistance (CASPAR) Background: Antimicrobial stewardship programs (ASPs) are advised to measure antimicrobial consumption as a metric for audit and feedback. However, most ASPs lack the tools necessary for appropriate risk adjustment and standardized data collection, which are critical for peer-program benchmarking. We created a system that automatically extracts antimicrobial use data and patient-level factors for risk-adjustment and a dashboard to present risk-adjusted benchmarking metrics for ASP within the Veterans’ Health Administration (VHA). Methods: We built a system to extract patient-level data for antimicrobial use, procedures, demographics, and comorbidities for acute inpatient and long-term care units at all VHA hospitals utilizing the VHA’s Corporate Data Warehouse (CDW). We built baseline negative binomial regression models to perform risk-adjustments based on patient- and unit-level factors using records dated between October 2016 and September 2018. These models were then leveraged both retrospectively and prospectively to calculate observed-to-expected ratios of antimicrobial use for each hospital and for specific units within each hospital. Data transformation and applications of risk-adjustment models were automatically performed within the CDW database server, followed by monthly scheduled data transfer from the CDW to the Microsoft Power BI server for interactive data visualization. Frontline antimicrobial stewards at 10 VHA hospitals participated in the project as pilot users. Results: Separate baseline risk-adjustment models to predict days of therapy (DOT) for all antibacterial agents were created for acute-care and long-term care units based on 15,941,972 patient days and 3,011,788 DOT between October 2016 and September 2018 at 134 VHA hospitals. Risk adjustment models include month, unit types (eg, intensive care unit [ICU] vs non-ICU for acute care), specialty, age, gender, comorbidities (50 and 30 factors for acute care and long-term care, respectively), and preceding procedures (45 and 24 procedures for acute care and long-term care, respectively). We created additional models for each antimicrobial category based on National Healthcare Safety Network definitions. For each hospital, risk-adjusted benchmarking metrics and a monthly ranking within the VHA system were visualized and presented to end users through the dashboard (an example screenshot in Figure 1). Conclusions: Developing an automated surveillance system for antimicrobial consumption and risk-adjustment benchmarking using an electronic medical record data warehouse is feasible and can potentially provide valuable tools for ASPs, especially at hospitals with no or limited local informatics expertise. Future efforts will evaluate the effectiveness of dashboards in these settings.Funding: NoDisclosures: None

scholarly journals Effectiveness of a third dose of BNT162b2 or mRNA-1273 vaccine for preventing post-vaccination COVID-19 infection: an observational study

2021 ◽  
Author(s):  
Aditya Sharma ◽  
Gina Oda ◽  
Mark Holodniy
Keyword(s):  
Incidence Rate Ratio ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Term Care ◽  
Post Vaccination ◽  
Primary Series ◽  
Waning Immunity ◽  
Hispanic White

Background BNT162b2 and mRNA-1273 vaccines are highly protective against COVID-19. Concern about waning immunity and reduced effectiveness against SARS-COV-2 variants led to use of a third dose six months after completing the primary series. We used data from the Veterans Health Administration to evaluate the effectiveness of a third dose of BNT162b2 or mRNA-1273 compared to the primary series in preventing post-vaccination COVID-19. Methods During January 1 - November 22, 2020, third dose recipients were matched (1:1) to demographically similar controls who did not receive a third dose. Eligible participants had completed the primary series at least six months (180 days) before recruitment date. Long-term care residents were excluded. Primary outcomes were documented SARS-CoV-2 infection and COVID-19 hospitalization. Effectiveness was estimated as 1-incidence rate ratio. Findings Following matching, the BNT162b2 group included 99,856 pairs and the mRNA-1273 group included 74,116 pairs. In BNT162b2 and mRNA-1273 groups, median age was 72 (interquartile range [IQR]: 65-75) and 72 (IQR: 67-76) years, 94,990 (95.1%) and 71,213 (96.1%) were male, and 61,261 (61.3%) and 52,170 (70.4%) were non-Hispanic White, respectively. Effectiveness of a third dose of BNT162b2 or mRNA-1273 compared to the primary series was 49.4% (95% confidence interval [CI]: 41.2-56.5%) and 46.0% (95% CI: 33.5-56.2%) for documented SARS-CoV-2 infection and 52.3% (95% CI: 33.8-65.6%) and 44.7% (95% CI: 10.7-65.7%) for COVID-19 hospitalization, respectively. Interpretation A third dose of BNT162b2 or mRNA-1273 is moderately effective against post-vaccination COVID-19 infection compared to the primary series.

Long‐term care service mix in the Veterans Health Administration after home care expansion

2021 ◽  
Author(s):  
Josephine C. Jacobs ◽  
Todd H. Wagner ◽  
Ranak Trivedi ◽  
Karl Lorenz ◽  
Courtney H. Van Houtven
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
Care Service ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Term Care
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