scholarly journals Impact of Self-Reported Patient Characteristics Upon Assessment of Glycemic Control in the Veterans Health Administration

Diabetes Care ◽  
2007 ◽  
Vol 30 (2) ◽  
pp. 245-251 ◽  
Author(s):  
M. Maney ◽  
C.-L. Tseng ◽  
M. M. Safford ◽  
D. R. Miller ◽  
L. M. Pogach
Keyword(s):  
Glycemic Control ◽  
Patient Characteristics ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration

Glycemic Control and Hypoglycemia in Veterans Health Administration Patients Converted from Glyburide to Glipizide

2011 ◽  
Vol 17 (9) ◽  
pp. 664-671 ◽  
Author(s):  
Rachel A. Skoff ◽  
Nancee V. Waterbury ◽  
Robert F. Shaw ◽  
Jason A. Egge ◽  
Matthew Cantrell
Keyword(s):  
Glycemic Control ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration

scholarly journals The Use of Rifampin Therapy to Treat Diabetic Patients with Osteomyelitis of the Foot in the Veterans Health Administration: Patient Characteristics and Clinical Outcomes

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S101-S101
Author(s):  
Brigid Wilson ◽  
Elie Saade ◽  
Gheorghe Doros ◽  
John Hermos ◽  
Mary Bessesen ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Composite Endpoint ◽  
Patient Characteristics ◽  
Veterans Health Administration ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Veterans Health ◽  
Health Administration ◽  
Short Treatment ◽  
Research Grant

Abstract Background Nearly 25% of Veterans Health Administration (VHA) patients are diagnosed with diabetes mellitus (DM). Among DM patients, the lifetime incidence of foot ulcers is 15%. Infection is a common complication of foot ulcers and 20–60% of infections result in diabetic foot osteomyelitis (DFO). Current treatment guidelines do not endorse any specific antibiotic agent for DFO, but small clinical trials suggest the addition of rifampin to antimicrobial regimens results in improved cure rates for osteomyelitis. Methods Using VHA databases, we identified index DFO cases from 2009 to 2013 and extracted patient and infection characteristics including demographics, comorbidities, chronic medications, antibiotic regimens, and microbiology data when present. We analyzed the subset of patients alive, without high-level amputation, and treated with antibiotics at 90 days after diagnosis. We summarized patient characteristics and compared a composite endpoint of amputation or death within 2 years of DFO diagnosis among those treated with rifampin to those not treated with rifampin. Results In total, 10,736 DFO cases met our criteria (Figure). Of these, 151 were considered treated with rifampin, based on 14 or more days of rifampin initiated within 90 days of diagnosis; 10,551 were unexposed to rifampin; and 34 were excluded for late or short treatment with rifampin. We observed significant differences between patients treated with and without rifampin (Table) and 44% of rifampin-treated patients were seen in 14 facilities. Amputation or death at 2 years was observed in 44 (29%) of patients treated with rifampin and 4,007 (38%) of patients not treated with rifampin (P = 0.03). Conclusion Rifampin was rarely used in the treatment of DFO in the VHA and a few facilities accounted for a large proportion of rifampin-treated cases. We observed higher rates of amputation-free survival in patients treated with rifampin, but in the presence of notable confounders including age, comorbidities, and organism. Disclosures E. Saade, Steris: Grant Investigator, Grant recipient. Janssen: Grant Investigator, Research grant. Sequiris: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. R. A. Bonomo, Entasis: Grant Investigator, Research grant. Allecra: Grant Investigator, Research grant. Wockhardt: Grant Investigator, Research grant. Merck: Grant Investigator, Research grant. Roche: Grant Investigator, Research grant. GSK: Grant Investigator, Research grant. Allergan: Grant Investigator, Research grant. Shionogi: Grant Investigator, Research grant

scholarly journals Trends and Patient Characteristics Associated with Tobacco Pharmacotherapy Dispensed in the Veterans Health Administration

2017 ◽  
Vol 20 (10) ◽  
pp. 1173-1181 ◽  
Author(s):  
Rosalinda V Ignacio ◽  
Paul G Barnett ◽  
Hyungjin Myra Kim ◽  
Mark C Geraci ◽  
Carol A Essenmacher ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration

scholarly journals Patient Characteristics Associated With the Receipt of Hormone Therapy Among Transgender Patients in the Veterans Health Administration

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A794-A794
Author(s):  
Denise H Wong ◽  
Varsha G Vimalananda ◽  
Joel I Reisman ◽  
Sowmya R Rao ◽  
Jillian C Shipherd ◽  
...  
Keyword(s):  
Gender Identity ◽  
Hormone Therapy ◽  
Sexual Trauma ◽  
Patient Characteristics ◽  
Veterans Health Administration ◽  
Sex Characteristics ◽  
Military Sexual Trauma ◽  
Veterans Health ◽  
Health Administration ◽  
Social Stressors

Abstract Background: Many transgender patients experience gender dysphoria as a result of an incongruence between their gender identity and sex assigned at birth. Gender-affirming hormone therapy improves the quality of life for transgender patients seeking to increase alignment of their secondary sex characteristics and gender identity. However, little is known about the patient factors that are associated with receipt of this therapy which is critical to identifying areas for improvement in care for transgender patients. Objective: To evaluate patient characteristics associated with transgender patients’ receipt of hormone therapy from the Veterans Health Administration (VHA). Methods: Inpatient and outpatient data were reviewed for transgender patients, identified through ICD-9/ICD-10 diagnosis codes for gender identity disorder (GID), receiving VHA health care from January 2006 to December 2018. We evaluated receipt of hormone therapy (testosterone or estrogen +/- spironolactone) from the VHA, socio-demographics, comorbidities, social stressors, military sexual trauma, and documented suicide attempts. Adjusted Odds Ratios (aOR) and 95% Confidence Intervals (CI) were obtained from a multivariable logistic regression model used to ascertain the relationship between patient characteristics and hormone therapy. Results: Of 9,406 patients with documented GID, 5,487 (58.3%) received hormone therapy from the VHA. Compared to patients not receiving hormone therapy, a higher proportion of patients receiving hormone therapy were younger (21-29 years: 18.1% vs. 11.6%; 30-39 years: 20.0% vs. 14.6%; 40-49 years: 16.2% vs. 13.6%), had documentation of a positive military sexual trauma screening (22.2% vs. 16.2%; p<0.0001), and a suicide attempt (11.4% vs. 9.9%; p=0.0067). There were significant associations between receipt of hormone therapy and: 1) younger age (aOR: 1.33; 95% CI: 1.29-1.36; p<0.0001); 2) Black non-Hispanic patients (aOR: 0.58; 95% CI: 050-0.68; p<0.0001); 3) increasing number of comorbidities (aOR: 0.86; 95% CI: 0.84-0.88; p<0.0001); and 4) increasing number of social stressors (aOR: 0.86; 95% CI: 0.83-0.90; p<0.0001). Conclusions: Age, race/ethnicity, comorbidities, and social stressors among other factors are associated with receipt of hormone therapy among transgender patients in the VHA. Subsequent efforts should focus on understanding clinician- and site-level determinants to facilitate the design of effective quality improvement measures that optimize gender affirming hormone therapy through VHA for transgender patients.

scholarly journals 544. Using Active Surveillance to Identify Monoclonal Antibody Candidates Among COVID-19 Positive Veterans, Atlanta VA Healthcare System

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S373-S374
Author(s):  
Alexander T Paras ◽  
Kathryn E DeSilva ◽  
Nora T Oliver ◽  
Lauren H Epstein ◽  
Nadine M Harris ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Patient Characteristics ◽  
Veterans Health Administration ◽  
Study Data ◽  
Clinical Team ◽  
Veterans Health ◽  
Health Administration ◽  
Post Infusion ◽  
Test Result ◽  
Pcr Test

Abstract Background Monoclonal antibody (Mab) infusions have reduced hospitalization and mortality among higher risk patients with mild to moderate COVID-19 symptoms. Using an interdisciplinary team approach, we created a clinical team to proactively screen and outreach patients with COVID-19 to equitably offer Mab. Methods From December 28, 2020 - May 3, 2021, a clinical team consisting of an Infectious disease pharmacist and physician, reviewed each outpatient with a positive SARS-CoV-2 PCR test at the Atlanta VA Healthcare System (AVAHCS) daily. The clinical team used the published Emergency Use Authorization criteria to determine eligibility. Eligible patients were prioritized using the Veterans Health Administration (VACO) Index for COVID-19 Mortality, which estimates the risk of 30-day mortality after COVID-19 infection using pre-COVID-19 health status (Figure 1). Eligible patients were contacted via telephone to confirm eligibility and obtain verbal consent. We performed SARS-CoV-2 IgG antibody tests when possible prior to Mab infusion, but results did not preclude Mab receipt. Telehealth follow-up occurred at 1- and 7-days post infusion. Figure 1. Veterans Health Administration COVID-19 (VACO) Index for COVID-19 Mortality Overview of the elements of the VACO index, part 1 of 2. Figure 1 continued. Veterans Health Administration COVID-19 (VACO) Index for COVID-19 Mortality Overview of the elements of the VACO index, part 2 of 2. Results In total, 1,346 COVID-19 patients were identified; 86 (6%) patients were eligible, and 48/86 (55%) received Mab infusions (Figure 2). The median time from symptom-onset to positive COVID-19 PCR test result was 6 days (0-9) and the median time from positive COVID-19 PCR test result to Mab infusion was 2 days (0-8). SARS-CoV-2 IgG antibodies were detected in 4 of 24 (17%) patients tested. The most common comorbidities were hypertension (73%) and diabetes, (42%) (Table). Five (10%) patients required hospitalization for worsening COVID-19 symptoms post infusion. No deaths occurred. Figure 2. Overview of COVID-19 Monoclonal Antibody (Mab) infusion Process Summary of Mab Infusion Screening Process Table. Patient Characteristics of Monoclonal (Mab) Infusion Recipients (N = 48) Descriptive Statistics and Findings of Study Data, part 1 of 2 Table continued. Patient Characteristics of Monoclonal (Mab) Infusion Recipients (N = 48) Descriptive Statistics and Findings of Study Data, part 2 of 2 Conclusion This approach of combining laboratory surveillance and active screening minimized delay in symptoms onset to Mab infusion, thereby optimizing outpatient treatment of COVID-19 disease. Our approach successfully treated a more diverse patient population compared to clinical trials. Mab infusions overall was well tolerated with few hospitalizations and no deaths in this cohort. Disclosures All Authors: No reported disclosures

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