Browsing by Subject "Department of Veterans Affairs"

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    Association between pain outcomes and race and opioid treatment: Retrospective cohort study of Veterans
    (2016) Burgess, Diana J.; Gravely, Amy A.; Nelson, David B.; Bair, Matthew J.; Kerns, Rol D.; Higgins, Diana M.; Farmer, Melissa M.; Partin, Melissa R.; Department of Medicine, IU School of Medicine
    We examined whether pain outcomes (pain interference, perceived pain treatment effectiveness) vary by race and then whether opioid use moderates these associations. These analyses are part of a retrospective cohort study among 3,505 black and 46,203 non-Hispanic, white Department of Veterans Affairs (VA) patients with diagnoses of chronic musculoskeletal pain who responded to the 2007 VA Survey of Healthcare Experiences of Patients (SHEP). We used electronic medical record data to identify prescriptions for pharmacologic pain treatments in the year after diagnosis (Pain Diagnosis index visit) and before the SHEP index visit (the visit that made one eligible to complete the SHEP); pain outcomes came from the SHEP. We found no significant associations between race and pain interference or perceived effectiveness of pain treatment. VA patients with opioid prescriptions between the Pain Diagnosis index visit and the SHEP index visit reported greater pain interference on the SHEP than those without opioid prescriptions during that period. Opioid prescriptions were not associated with perceived treatment effectiveness for most patients. Findings raise questions about benefits of opioids for musculoskeletal pain and point to the need for alternative treatments for addressing chronic noncancer pain.
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    Heterogeneity in COVID-19 patient volume, characteristics and outcomes across US Department of Veterans Affairs facilities: an observational cohort study
    (BMJ, 2021) Bravata, Dawn M.; Myers, Laura J.; Perkins, Anthony J.; Keyhani, Salomeh; Zhang, Ying; Zillich, Alan J.; Dysangco, Andrew; Lindsey, Reese; Sharmitha, Dev; Myers, Jennifer; Austin, Charles; Sexson, Ali; Arling, Greg; Medicine, School of Medicine
    Objective Studies describe COVID-19 patient characteristics and outcomes across populations, but reports of variation across healthcare facilities are lacking. The objectives were to examine differences in COVID-19 patient volume and mortality across facilities, and understand whether facility variation in mortality was due primarily to differences in patient versus facility characteristics. Design Observational cohort study with multilevel mixed effects logistic regression modelling. Setting The Veterans Health Administration (VA) is the largest healthcare system in the USA. Participants Patients with COVID-19. Main outcome All-cause mortality within 45 days after COVID-19 testing (March–May, follow-up through 16 July 2020). Results Among 13 510 patients with COVID-19, 3942 (29.2%) were admitted (2266/3942 (57.5%) ward; 1676/3942 (42.5%) intensive care unit (ICU)) and 679/3942 (17.2%) received mechanical ventilation. Marked heterogeneity was observed across facilities in median age (range: 34.3–83.9 years; facility mean: 64.7, SD 7.2 years); patient volume (range: 1–737 at 160 facilities; facility median: 48.5, IQR 14–105.5); hospital admissions (range: 1–286 at 133 facilities; facility median: 11, IQR 1–26.5); ICU caseload (range: 1–85 at 115 facilities; facility median: 4, IQR 0–12); and mechanical ventilation (range: 1–53 at 90 facilities; facility median: 1, IQR 0–5). Heterogeneity was also observed in facility mortality for all patients with COVID-19 (range: 0%–29.7%; facility median: 8.9%, IQR 2.4%–13.7%); inpatients (range: 0%–100%; facility median: 18.0%, IQR 5.6%–28.6%); ICU patients (range: 0%–100%; facility median: 28.6%, IQR 14.3%–50.0%); and mechanical ventilator patients (range: 0%–100%; facility median: 52.7%, IQR 33.3%–80.6%). The majority of variation in facility mortality was attributable to differences in patient characteristics (eg, age). Conclusions Marked heterogeneity in COVID-19 patient volume, characteristics and mortality were observed across VA facilities nationwide. Differences in patient characteristics accounted for the majority of explained variation in mortality across sites. Variation in unadjusted COVID-19 mortality across facilities or nations should be considered with caution.