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Many health institutions that have adopted electronic health record systems (EHRs) eventually decide to switch to a different one. Cordasco et al. interviewed primary care providers, primary care nurses, and specialty providers involved in referrals following VA's EHR transition. Through stakeholder engagement, Cogan et al. build on these past findings in describing a new and thoughtful research agenda for EHR transitions, taking into account health system priorities and the need to be proactive in optimizing the success of implementation. [Extracted from the article]

The article announces the contributions of time and expertise provided by the individuals served as reviewers for calendar year 2020.

BACKGROUND: Clinical performance measurement has been a key element of efforts to transform the Veterans Health Administration (VHA). However, there are a number of signs that current performance measurement systems used within and outside the VHA may be reaching the point of maximum benefit to care and in some settings, may be resulting in negative consequences to care, including overtreatment and diminished attention to patient needs and preferences. Our research group has been involved in a long-standing partnership with the office responsible for clinical performance measurement in the VHA to understand and develop potential strategies to mitigate the unintended consequences of measurement. OBJECTIVE: Our aim was to understand how the implementation of diabetes performance measures (PMs) influences management actions and day-to-day clinical practice. DESIGN: This is a mixed methods study design based on quantitative administrative data to select study facilities and quantitative data from semi-structured interviews. PARTICIPANTS: Sixty-two network-level and facility-level executives, managers, front-line providers and staff participated in the study. APPROACH: Qualitative content analyses were guided by a team-based consensus approach using verbatim interview transcripts. A published interpretive motivation theory framework is used to describe potential contributions of local implementation strategies to unintended consequences of PMs. KEY RESULTS: Implementation strategies used by management affect providers' response to PMs, which in turn potentially undermines provision of high-quality patient-centered care. These include: 1) feedback reports to providers that are dissociated from a realistic capability to address performance gaps; 2) evaluative criteria set by managers that are at odds with patient-centered care; and 3) pressure created by managers' narrow focus on gaps in PMs that is viewed as more punitive than motivating. CONCLUSIONS: Next steps include working with VHA leaders to develop and test implementation approaches to help ensure that the next generation of PMs motivate truly patient-centered care and are clinically meaningful. [ABSTRACT FROM AUTHOR]

The article presents abstract on medical topics which include, "Subclinical Hyperthyroidism and Mortality," by Tinh-Hai Collet and colleagues, "Interpersonal Discrimination and Health Utility Scores Among Black and White Men and Women in the United States," Janel Hanmer and colleagues, and "Duration of the Risk of VTE in US Medical Patients," by Alpesh Amin and colleagues.

Background: Smoking cessation services in the Department of Veterans Affairs (VA) are currently provided via outpatient groups, while inpatient cessation programs have not been widely implemented.Objective: The objective of this paper is to describe the implementation of the Tobacco Tactics program for inpatients in the VA.Methods: This is a pre-/post-non-randomized control study initially designed to teach inpatient staff nurses on general medical units in the Ann Arbor and Detroit VAs to deliver the Tobacco Tactics intervention using Indianapolis as a control group. Coupled with cessation medication sign-off, physicians are reminded to give patients brief advice to quit.Results: Approximately 96% (210/219) of inpatient nurses in the Ann Arbor, MI site and 57% (159/279) in the Detroit, MI site have been trained, with an additional 282 non-targeted personnel spontaneously attending. Nurses' self-reported administration of cessation services increased from 57% pre-training to 86% post-training (p = 0.0002). Physician advice to quit smoking ranged between 73-85% in both the pre-intervention and post-intervention period in both the experimental and control group. Volunteers made follow-up telephone calls to 85% (n = 230) of participants in the Ann Arbor site. Hospitalized smokers (N = 294) in the intervention group are reporting an increase in receiving and satisfaction with the selected cessation services following implementation of the program, particularly in regards to medications (p < 0.05).Conclusion: A large proportion of inpatient nursing staff can rapidly be trained to deliver tobacco cessation interventions to inpatients resulting in increased provision of services. [ABSTRACT FROM AUTHOR]

The Department of Veterans Affairs (VA) and other federal agencies require funded researchers to include women in their studies. Historically, many researchers have indicated they will include women in proportion to their VA representation or pointed to their numerical minority as justification for exclusion. However, women's participation in the military-currently 14% of active military-is rapidly changing veteran demographics, with women among the fastest growing segments of new VA users. These changes will require researchers to meet the challenge of finding ways to adequately represent women veterans for meaningful analysis. We describe women veterans' health and health-care use, note how VA care is organized to meet their needs, report gender differences in quality, highlight national plans for women veterans' quality improvement, and discuss VA women's health research. We then discuss challenges and potential solutions for increasing representation of women veterans in VA research, including steps for implementation research. [ABSTRACT FROM AUTHOR]