Regional data exchange to improve care for veterans after non-VA hospitalization: a randomized controlled trial

BACKGROUND: Coordination of care, especially after a patient experiences an acute care event, is a challenge for many health systems. Event notification is a form of health information exchange (HIE) which has the potential to support care coordination by alerting primary care providers when a patient experiences an acute care event. While promising, there exists little evidence on the impact of event notification in support of reengagement into primary care. The objectives of this study are to 1) examine the effectiveness of event notification on health outcomes for older adults who experience acute care events, and 2) compare approaches to how providers respond to event notifications. METHODS: In a cluster randomized trial conducted across two medical centers within the U.S. Veterans Health Administration (VHA) system, we plan to enroll older patients (≥ 65 years of age) who utilize both VHA and non-VHA providers. Patients will be enrolled into one of three arms: 1) usual care; 2) event notifications only; or 3) event notifications plus a care transitions intervention. In the event notification arms, following a non-VHA acute care encounter, an HIE-based intervention will send an event notification to VHA providers. Patients in the event notification plus care transitions arm will also receive 30 days of care transition support from a social worker. The primary outcome measure is 90-day readmission rate. Secondary outcomes will be high risk medication discrepancies as well as care transitions processes within the VHA health system. Qualitative assessments of the intervention will inform VHA system-wide implementation. DISCUSSION: While HIE has been evaluated in other contexts, little evidence exists on HIE-enabled event notification interventions. Furthermore, this trial offers the opportunity to examine the use of event notifications that trigger a care transitions intervention to further support coordination of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT02689076. "Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization." Registered 23 February 2016

Use of Preventive Care by Elderly Male Veterans Receiving Care Through the Veterans Health Administration, Medicare Fee-for-Service, and Medicare HMO Plans

Objectives. We compared use of preventive care among veterans receiving care through the Veterans Health Administration (VHA), Medicare fee-for-service (FFS) plans, and Medicare health maintenance organizations (HMOs)

BRIEF REPORT: β-Blocker Use Among Veterans with Systolic Heart Failure

Numerical results for kinetic and thermal energy dissipation rates in bubbly Rayleigh-Bénard convection are reported. Bubbles have a twofold effect on the flow: on the one hand, they absorb or release heat to the surrounding liquid phase, thus tending to decrease the temperature differences responsible for the convective motion; but on the other hand, the absorbed heat causes the bubbles to grow, thus increasing their buoyancy and enhancing turbulence (or, more properly, pseudoturbulence) by generating velocity fluctuations. This enhancement depends on the ratio of the sensible heat to the latent heat of the phase change, given by the Jakob number, which determines the dynamics of the bubble growth