Case of the Veterans Health Administration Telehealth Expansion

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics, 2013.This thesis was scanned as part of an electronic thesis pilot project.Cataloged from PDF version of thesisIncludes bibliographical references (p. 164-169).This research applies an implementation framework derived from enterprise systems thinking to the Veterans Health Administration (VHA) Telehealth Expansion in order to characterize and evaluate the implementation methods used to expand Telehealth nation-wide. An in-depth, multi-disciplinary literature review was conducted to identify how enterprise-wide implementations are characterized in the literature and then was used to inform the development of a baseline enterprise implementation framework, the Timeline Implementation Framework. Said framework aims to characterize enterprise-wide implementations over time, from conceptualization to evaluation and sustainment, by breaking down an implementation into four phases (Enterprise Analysis, Implementation Planning, Implementation Execution and Innovation Evaluation) based on the nature of the activities and concepts that occur during each phase. The Timeline Implementation Framework was then applied to the VHA Telehealth Expansion. The framework guided study methods and facilitated analysis of a Clinical Video Telehealth clinic implementation. Further analysis was conducted in order to understand the VHA Telehealth expansion by considering an enterprise perspective of Telehealth's impact on VHA, and vice versa. Data collection included qualitative and quantitative evidence sources (e.g., interviews, observation, internal documents, and archival records) in order to gather information required to populate the developed framework. Fifteen interviews were conducted with VHA employees to allow for various perspectives emerging from multiple stakeholders with different roles across the enterprise. Conclusions aim to improve VHA implementation strategies in three key ways. First, by applying the framework to a Telehealth clinic, study findings help depict Telehealth expansion at a facility level. Second, results are used to provide constructive recommendations regarding implementation strategies throughout VHA. Third, this study tests the generalizability of the framework before applying it in further implementations.by Julie C. Andren.S.M

Early probiotic supplementation and the risk of celiac disease in children at genetic risk

Abstract Probiotics are linked to positive regulatory effects on the immune system. The aim of the study was to examine the association between the exposure of probiotics via dietary supplements or via infant formula by the age of 1 year and the development of celiac disease autoimmunity (CDA) and celiac disease among a cohort of 6520 genetically susceptible children. Use of probiotics during the first year of life was reported by 1460 children. Time-to-event analysis was used to examine the associations. Overall exposure of probiotics during the first year of life was not associated with either CDA (n = 1212) (HR 1.15; 95%CI 0.99, 1.35; p = 0.07) or celiac disease (n = 455) (HR 1.11; 95%CI 0.86, 1.43; p = 0.43) when adjusting for known risk factors. Intake of probiotic dietary supplements, however, was associated with a slightly increased risk of CDA (HR 1.18; 95%CI 1.00, 1.40; p = 0.043) compared to children who did not get probiotics. It was concluded that the overall exposure of probiotics during the first year of life was not associated with CDA or celiac disease in children at genetic risk