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The purpose of this project was to improve dysphagia-screening processes in a tertiary Veterans Affairs Medical Center. The dysphagia-screening tool was redesigned on the basis of frontline clinician feedback, clinical guidelines, user satisfaction, and multidisciplinary expertise. The revised tool triggered a speech-language consult for positive screens and demonstrated higher scores in user satisfaction and task efficiency. Systems redesign processes were effective for redesigning the tool and implementing practice changes with clinicians involved in dysphagia screening. [ABSTRACT FROM AUTHOR]

The article focuses on the clinical study that compares the use of Department of Veterans Affairs (VA) inpatient and outpatient services of cancer patients enrolled in a Cancer Care Coordination/Home-Telehealth (CCHT) program in the U.S. Using a matched case-control design, two control patients per case were selected and matched by tumor type and cancer stage. The study revealed that their were 43 cancer CCHT patients and 82 control group patients.

This study examined the effectiveness of a veterans affairs (VA) patient-centered care coordination/home-telehealth (CC/HT) program as an adjunct to treatment for veterans with diabetes. Using an adapted version of the Chronic Care Model, we analyzed the differences in healthcare service use between a cohort of 400 veterans with diabetes who were enrolled in a VA CC/HT program and a matched comparison cohort of 400 veterans with diabetes who received no CC/HT intervention. Propensity scores were used to improve the balance between the treatment and comparison groups. Service use outcomes were assessed at 12 months before and after enrollment. A difference-in-differences approach was used in the multivariate models to assess the treatment effect for patients in the CC/HT programs. Twelve months after enrollment, there was a significant difference between the treatment and comparison groups in terms of need-based primary care visits (newly scheduled visits that enable the veteran to be seen ‘just in time,’ where the health status is monitored and met before health deteriorates), increasing in the treatment group and decreasing in the comparison group (P < .01 ). In a subgroup analysis, where we were able to control for the patients' Hb A1c values, we found that the treatment group had a lower likelihood of having 1 or more hospitalizations than patients in the comparison group. Our findings have implications for management in that the CC/HT program appears to improve the ability of older veterans with diabetes to receive appropriate, timely care, thereby improving the quality of care for them and making more efficient use of VA healthcare resources. [ABSTRACT FROM AUTHOR]

The Institute of Medicine report, Crossing the Quality Chasm, called for significant improvements in 6 elements of healthcare performance: safety, effectiveness, patient centeredness, timeliness, efficiency, and equity. To meet the changing care needs of older veterans, many of whom are trying to manage the complexities of their chronic diseases in their own homes, the Veterans Health Administration (VHA) has promoted many of the Institute of Medicine elements by implementing health information technology (health IT), such as telehealth and a personal health record (PHR). To that end, approximately 5 years ago, VHA created the Office of Care Coordination and in particular a patient-centered Care Coordination/Home Telehealth (CCHT) program, which uses telehealth technologies (eg, messaging devices) to coordinate care directly from a patient's home to help self-manage their chronic diseases. VHA has also developed a PHR, My HealtheVet, which is a secure web-based portal that provides veterans the capability to access and manage health information. This article discusses the mechanisms by which these forms of health IT have been implemented to improve access to care and improve health. For telehealth, we present the outcomes from some of the published literature. For PHRs, we outline what is known to date and future research directions. The article also examines some structural, policy-related, and organizational barriers to health IT implementation and offers suggestions for future research.

The aim of this new statement is to provide a comprehensive and evidence-based review of the scientific data evaluating the use of telemedicine for stroke care delivery and to provide consensus recommendations based on the available evidence. The evidence is organized and presented within the context of the American Heart Association's Stroke Systems of Care framework and is classified according to the joint American Heart Association/American College of Cardiology Foundation and supplementary American Heart Association Stroke Council methods of classifying the level of certainty and the class of evidence. Evidence-based recommendations are included for the use of telemedicine in general neurological assessment and primary prevention of stroke; notification and response of emergency medical services; acute stroke treatment, including the hyperacute and emergency department phases; hospital-based subacute stroke treatment and secondary prevention; and rehabilitation.

Background: There are currently over half a million end-stage renal disease patients and >70,000 patients listed to receive a deceased donor kidney transplant in the United States. To receive a deceased donor transplant, patients are placed on a waiting list at one of approximately 240 centers. Although candidate decisions to list at a particular center may often be made passively (based on proximity or physician referral), the important question remains as to whether the center of listing has a significant impact on patient outcomes., Methods: The study evaluated adult kidney transplant candidates in the United States listed from 1995 to 2000 (n = 108,928) with follow-up through 2006. The primary outcome of patient survival was investigated with survival models evaluated with respect to 4 center characteristics (volume, donor quality, waiting time, past performance). Center characteristics derived from years preceding listing, simulating information that could be attainable for prospective candidates., Results: Center waiting time had a marked association with survival (Adjusted hazard ratio = 1.32, 95% confidence interval: 1.27-1.38 for the longest waiting times). Past performance and donor quality also had significant association with survival; center volume was not a significant factor. The cumulative impact of center factors resulted in an average 4-year difference in life expectancy. Center characteristics at listing were strongly correlated with levels at the time of transplantation and centers with the "best" characteristics were located in every region of the country., Conclusions: Center characteristics have significant impact on kidney transplant candidate survival. Information regarding the variability and importance of center factors should be clearly disseminated to transplant candidates.

The cancer care dialogues model emphasizes daily telehealth interactions between patients and a care coordinator (a registered nurse serving as a liaison to the oncologist) to assist patients in the management of common chemotherapy-related symptoms at home. We examined the impact of the dialogues on age-related differences in health-related quality of life (HRQOL) among newly diagnosed cancer patients receiving chemotherapy. We assessed HRQOL among 34 patients, including 15 older adults (65 years or older) and 19 younger adults who were followed for 6 months. Older patients consistently reported better HRQOL scores over the treatment period. In multivariate analysis, older patients reported 10.35 points higher in HRQOL (P = .007). In addition, patients who reported no nervousness while undergoing chemotherapy had an 8.60-point increase in HRQOL scores (P = .012). The dialogues model can make important improvement in symptom management and HRQOL, especially in older adults receiving chemotherapy. Older and younger adults with cancer may benefit equally in cancer treatment in a setting with appropriately managed symptoms. The dialogues model offers promising potential for promoting nurses' better understanding of both the patient needs as the patient receives treatment and innovative technologies in patient management.

This study examined the effectiveness of a veterans affairs (VA) patient-centered care coordination/home-telehealth (CC/HT) program as an adjunct to treatment for veterans with diabetes. Using an adapted version of the Chronic Care Model, we analyzed the differences in healthcare service use between a cohort of 400 veterans with diabetes who were enrolled in a VA CC/HT program and a matched comparison cohort of 400 veterans with diabetes who received no CC/HT intervention. Propensity scores were used to improve the balance between the treatment and comparison groups. Service use outcomes were assessed at 12 months before and after enrollment. A difference-in-differences approach was used in the multivariate models to assess the treatment effect for patients in the CC/HT programs. Twelve months after enrollment, there was a significant difference between the treatment and comparison groups in terms of need-based primary care visits (newly scheduled visits that enable the veteran to be seen "just in time," where the health status is monitored and met before health deteriorates), increasing in the treatment group and decreasing in the comparison group (P < .01). In a subgroup analysis, where we were able to control for the patients' Hb A1c values, we found that the treatment group had a lower likelihood of having 1 or more hospitalizations than patients in the comparison group. Our findings have implications for management in that the CC/HT program appears to improve the ability of older veterans with diabetes to receive appropriate, timely care, thereby improving the quality of care for them and making more efficient use of VA healthcare resources.