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This perspective paper seeks to lay out an efficient approach for health care providers, researchers, and other stakeholders involved in interventions aimed at improving care coordination to partner in locating and using applicable care coordination theory. The objective is to learn from relevant theory-based literature about fit between intervention options and coordination needs, thereby bringing insights from theory to enhance intervention design, implementation, and troubleshooting. To take this idea from an abstract notion to tangible application, our workgroup on models and measures from the Veterans Health Administration (VA) State of the Art (SOTA) conference on care coordination first summarizes our distillation of care coordination theoretical frameworks (models) into three common conceptual domains-context of an intervention, locus in which an intervention is applied, and specific design features of the intervention. Then we apply these three conceptual domains to four cases of care coordination interventions ("use cases") chosen to represent various scopes and stages of interventions to improve care coordination for veterans. Taken together, these examples make theory more accessible and practical by demonstrating how it can be applied to specific cases. Drawing from theory offers one method to anticipate which intervention options match a particular coordination situation.

Objective: To examine changes in hospitalization trends and healthcare utilization among Veterans following Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act implementation. Data Sources and Study Setting: VA Corporate Data Warehouse and Centers for Medicare and Medicaid Services datasets. Study Design: Retrospective cohort study to compare 7‐ and 30‐day rates for unplanned readmission and emergency department visits following index hospital stays based on payor type (VHA facility stay, VA‐funded stay in community facility [CC], or Medicare‐funded community stay [CMS]). Segmented regression models were used to compare payors and estimate changes in outcome levels and slopes following MISSION Act implementation. Data Collection/Extraction Methods: Veterans with active VA primary care utilization and ≥1 acute hospitalization between January 1, 2016 and December 31, 2021. Principal Findings: Monthly index stays increased for all payors until MISSION Act implementation, when VHA and CMS admissions declined while CC admissions accelerated and overtook VHA admissions. In December 2021, CC admissions accounted for 54% of index admissions, up from 25% in January 2016. From adjusted models, just prior to implementation (May 2019), Veterans with CC admissions had 47% greater risk of 7‐day readmission (risk ratio [RR]: 1.47, 95% confidence interval [CI]: 1.43, 1.51) and 20% greater risk of 30‐day readmission (RR: 1.20, 95% CI: 1.19, 1.22) compared with those with VHA admissions; both effects persisted post‐implementation. Pre‐implementation CC admissions were also associated with higher 7‐ and 30‐day ED visits, but both risks were substantially lower by study termination (RR: 0.90, 95% CI: 0.88, 0.91) and (RR: 0.89, 95% CI: 0.87, 0.90), respectively. Conclusions: MISSION Act implementation was associated with substantial shifts in treatment site and federal payor for Veteran hospitalizations. Post‐implementation readmission risk was estimated to be higher for those with CC and CMS index admissions, while post‐implementation risk of ED utilization following CC admissions was estimated to be lower compared with VHA index admissions. Reasons for this divergence require further investigation. [ABSTRACT FROM AUTHOR]

The study aims to investigate the progress that has taken place in the treatment and control of hypertension in the United States during the period 1988-2008. The results indicate that 50.1% of patients with hypertension had their blood pressure controlled in 2007-2008, and most of the improvement taking place after 1999-2000. Hypertension control was found to be lower among the younger age group and Hispanic individuals.

This perspective paper seeks to lay out an efficient approach for health care providers, researchers, and other stakeholders involved in interventions aimed at improving care coordination to partner in locating and using applicable care coordination theory. The objective is to learn from relevant theory-based literature about fit between intervention options and coordination needs, thereby bringing insights from theory to enhance intervention design, implementation, and troubleshooting. To take this idea from an abstract notion to tangible application, our workgroup on models and measures from the Veterans Health Administration (VA) State of the Art (SOTA) conference on care coordination first summarizes our distillation of care coordination theoretical frameworks (models) into three common conceptual domains-context of an intervention, locus in which an intervention is applied, and specific design features of the intervention. Then we apply these three conceptual domains to four cases of care coordination interventions ("use cases") chosen to represent various scopes and stages of interventions to improve care coordination for veterans. Taken together, these examples make theory more accessible and practical by demonstrating how it can be applied to specific cases. Drawing from theory offers one method to anticipate which intervention options match a particular coordination situation. [ABSTRACT FROM AUTHOR]

The article presents a commentary on how the Veterans Administration (VA) healthcare system is leveraging telehealth to provide continued access to care for rural veterans. Topics include disruptions in transportation and other non-medical services, and widespread isolation due to recommended social distancing guidelines; and impact access to care and outcomes for individuals with chronic medical and mental health disorders.

BackgroundHypertension (HTN) is a prevalent and important risk factor for both cardiovascular and all-cause mortality. Depression is often present in hypertensive patients and has also been associated with increased mortality risk. The aim of this study was to evaluate the association of depressive symptoms with all-cause mortality and ischemic heart disease (IHD) mortality among adults with self-reported HTN.MethodsWe studied 10,025 participants in the National Health and Nutrition Epidemiologic Follow-up Study (NHANES I) who were alive and interviewed in 1982 and had complete data for the Center for Epidemiologic Studies Depression Scale (CES-D). Four groups were identified based screening status at initial interview: (i) no HTN, no depression (reference group); (ii) HTN, no depression; (iii) no HTN, depression; and (iv) both HTN and depression. Cox proportional hazards regression was used to calculate multivariate-adjusted hazard ratios (HRs) of death for each group.ResultsOver an average of 8 years (83,943 person-years) of follow-up, patients with both self-reported HTN and depressive symptoms had the highest multivariate-adjusted HR for all-cause mortality at 1.39 (95% confidence interval (CI) 1.14, 1.69) as well as for IHD mortality at 1.59 (95% CI 1.08, 2.34). In post hoc analysis, nondepressed hypertensive patients had significantly lower adjusted HR for all-cause mortality compared to depressed hypertensive patients (HR 0.85; 95% CI 0.73–1.00), but the HR for IHD mortality was not significant (HR 0.87, 95% CI 0.63–1.20).ConclusionComorbid depressive symptoms are associated with increased all-cause mortality in patients with self-reported HTN.American Journal of Hypertension 2010; doi:10.1038/ajh.2009.199 [ABSTRACT FROM AUTHOR]

Objectives: This study assessed the prevalence and specific costs associated with discrete multimorbid mental health disease clusters in adults with diabetes mellitus (DM)., Study Design: Longitudinal analysis of a retrospective cohort., Methods: We performed a 5-year longitudinal analysis of a retrospective cohort of 733,071 patients with DM from the US Veterans Health Administration (VHA) between 2002 and 2006. The mental health comorbidities (MHCs) examined included depression, substance abuse, and psychosis. Our primary outcomes of interest were total inpatient, outpatient, and pharmacy costs measured in 2012 US$ from the perspective of the VHA., Results: DM was present with comorbid depression, substance abuse, and psychosis in 12.1%, 3.7%, and 4.2% of patients, respectively. Overall, 13.5% of patients had 1 MHC, 2.5% had 2 MHCs, and 0.5% had all MHCs. Total inpatient ($1,435,651,415), outpatient ($366,137,435), and pharmacy ($90,064,725) costs were highest for patients with DM and comorbid depression alone. At the per-patient level, DM plus psychosis and substance abuse had the highest inpatient costs ($35,518), DM plus all MHCs had the highest outpatient costs ($6962), and DM plus depression and psychosis had the highest pharmacy costs ($1753)., Conclusions: DM with comorbid depression is the most prevalent MHC combination and is associated with the highest total VHA healthcare costs. However, other comorbidity clusters are associated with higher mean per patient costs, and may therefore benefit from more intensive intervention. Analysis of healthcare expenditures by multimorbid disease clusters can be a useful tool for healthcare policy planning.