Journal articleMil Med · July 22, 2023
INTRODUCTION: Peer support is a well-established part of veteran care and a cost-effective way to support individuals pursuing health behavior change. Common models of peer support, peer coaching, and mutual peer support have limitations that could be mini ...
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Journal articleFam Syst Health · June 2023
INTRODUCTION: This program evaluation describes the use of implementation facilitation to support uptake of a telephone-based engagement coaching intervention, ACTIVATE, using paraprofessional staff, to support health behavior program enrollment. METHOD: T ...
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Journal articlePatient Educ Couns · September 2022
OBJECTIVE: We evaluated the impact of a low intensity web-based and intensive nurse-administered intervention to reduce systolic blood pressure (SBP) among patients with prior MI. METHODS: Secondary Prevention Risk Interventions via Telemedicine and Tailor ...
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Journal articlePsychol Serv · May 2022
Medical complexity and psychological distress are associated with frequent emergency department (ED) use. Despite this known association, our understanding is limited about which patients are at risk for persistent psychological distress and what patterns ...
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Journal articleHealth Services and Outcomes Research Methodology · December 1, 2021
Methods for identifying heterogeneity of treatment effects in randomized trials have seen recent advances, yet applying these methods to health services intervention trials has not been well investigated. Our objective was to compare two approaches—predict ...
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Journal articlePatient Educ Couns · November 2021
OBJECTIVES: To explore gender-based differences in experiences with a telehealth-delivered intervention for reduction of cardiovascular risk. METHODS: We conducted 23 semi-structured qualitative interviews by telephone with 11 women and 12 men who received ...
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Journal articleJ Am Geriatr Soc · January 2021
OBJECTIVE: This pilot study assessed feasibility of video-enhanced care management for complex older veterans with suspected mild cognitive impairment (CI) and their care partners, compared with telephone delivery. DESIGN: Pilot randomized controlled trial ...
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Journal articleJ Health Care Poor Underserved · 2021
African Americans are more likely than members of other racial groups to report perceived discrimination in health care settings, and discrimination is linked to depression. Using data from a randomized controlled trial of pain coping skills training (PCST ...
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Journal articleContemp Clin Trials Commun · September 2020
UNLABELLED: Protocol adherence in behavioral intervention clinical trials is critical to trial success. There is increasing interest in understanding which patients are more likely to adhere to trial protocols. The objective of this study was to demonstrat ...
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Journal articleBMC Musculoskelet Disord · August 14, 2020
BACKGROUND: Osteoarthritis (OA) disproportionately impacts African Americans compared to Caucasians, including greater pain severity. The Pain Coping Skills Training for African Americans with Osteoarthritis (STAART) study examined a culturally enhanced Pa ...
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Journal articleJ Med Internet Res · August 4, 2020
BACKGROUND: Though maintaining physical conditioning and a healthy weight are requirements of active military duty, many US veterans lose conditioning and rapidly gain weight after discharge from active duty service. Mobile health (mHealth) interventions u ...
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Journal articleJ Gen Intern Med · May 2020
BACKGROUND: Short-term health care costs following completion of health risk assessments and coaching programs in the VA have not been assessed. OBJECTIVE: To compare VA health care expenditures among veterans who participated in a behavioral intervention ...
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Journal articleBMC Musculoskelet Disord · February 3, 2020
BACKGROUND: A previous randomized clinical trial found that a Group Physical Therapy (PT) program for knee osteoarthritis yielded similar improvements in pain and function compared with traditional individual PT. Based on these findings the Group PT progra ...
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Journal articleJ Gen Intern Med · January 2020
BACKGROUND: Little research has been done on primary care-based models to improve health care use after an emergency department (ED) visit. OBJECTIVE: To examine the effectiveness of a primary care-based, nurse telephone support intervention for Veterans t ...
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Journal articleJ Gen Intern Med · October 2019
OBJECTIVE: To evaluate the effectiveness of Helping Invested Families Improve Veterans' Experiences Study (HI-FIVES), a skills training program for caregivers of persons with functional or cognitive impairments. DESIGN: A two-arm RCT. SETTING: Single Veter ...
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Journal articleClin Rheumatol · August 2019
INTRODUCTION: Recent research showed that physical activity (PA)-adjusted pain measures were more strongly associated with radiographic osteoarthritis (OA) severity than an unadjusted pain measure. This exploratory study examined whether PA-adjusted pain m ...
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Journal articlePain · June 2019
African Americans bear a disproportionate burden of osteoarthritis (OA), but they have been underrepresented in trials of behavioral interventions for pain. This trial examined a culturally tailored pain coping skills training (CST) program, compared to a ...
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Journal articleJ Gen Intern Med · April 2019
BACKGROUND: Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated. OBJECTIVE: To determine whether a telephone coachi ...
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Journal articleHealth Sci Rep · March 2019
BACKGROUND AND AIMS: Since May 2011, over 23Â 000 caregivers of Veterans seriously injured on or after September 11, 2001 have enrolled in the Program of Comprehensive Assistance for Family Caregivers (PCAFC). PCAFC provides caregivers training, a stipend, ...
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Journal articleMed Care Res Rev · February 2019
This study aimed to examine the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on Veteran health care utilization and costs. A pre-post cohort design including a nonequivalent control group was used to understand how ...
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Journal articleJMIR Res Protoc · January 29, 2019
BACKGROUND: Although maintaining a healthy weight and physical conditioning are requirements of active military duty, many US veterans rapidly gain weight and lose conditioning when they separate from active-duty service. Mobile health (mHealth) interventi ...
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Journal articleBMC Musculoskelet Disord · September 19, 2018
BACKGROUND: The Pain Coping Skills Training for African Americans with OsteoaRTthritis (STAART) trial is examining the effectiveness of a culturally enhanced pain coping skills training (CST) program for African Americans with osteoarthritis (OA). This dis ...
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Journal articleJ Gen Intern Med · September 2018
BACKGROUND: A large proportion of deaths and chronic illnesses can be attributed to three modifiable risk factors: tobacco use, overweight/obesity, and physical inactivity. OBJECTIVE: To test whether telephone-based health coaching after completion of a co ...
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Journal articleOphthalmic Epidemiol · June 2018
PURPOSE: The purpose of this study was to examine the association between oral statin use and the progression of open angle glaucoma. METHODS: Medical records of 847 Veterans were reviewed to collect statin use history, record demographic and comorbid medi ...
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Journal articlePrev Med Rep · June 2018
Peer support may be an effective strategy to improve heart healthy behaviors among populations who have a strong communal identity, such as women veterans. Women veterans are a particularly important group to target as they are the fastest growing sub-popu ...
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Journal articleAm Heart J · May 2018
BACKGROUND: Comprehensive programs addressing tailored patient self-management and pharmacotherapy may reduce barriers to cardiovascular disease (CVD) risk reduction. METHODS: This is a 2-arm (clinical pharmacist specialist-delivered, telehealth interventi ...
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Journal articleInt J Behav Med · April 2018
PURPOSE: Although non-pharmacological interventions have been shown to improve physical functioning in individuals with osteoarthritis (OA), the mechanisms by which this occurs are often unclear. This study assessed whether changes in arthritis self-effica ...
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Journal articleBMC Musculoskelet Disord · March 9, 2018
BACKGROUND: Few studies have examined patterns of specific sleep problems among individuals with osteoarthritis (OA). The primary objective of this study was to examine prevalence of symptoms of insomnia and obstructive sleep apnea (OSA) among Veterans wit ...
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Journal articlePilot Feasibility Stud · 2018
BACKGROUND: Arthritis affects approximately 50 million adults in the USA. Hispanics/Latinos have a higher prevalence of arthritis-attributed activity limitations primarily related to osteoarthritis (OA). Hispanic/Latinos are less likely to receive hip repl ...
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Journal articleAm J Manag Care · August 1, 2017
OBJECTIVES: To compare 2 methods of identifying patients at high-risk of repeat emergency department (ED) use: high Care Assessment Need (CAN) score (≥90), derived from a model using Veterans Health Administration (VHA) data, and "Super User" status, defin ...
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Journal articleJ Womens Health (Larchmt) · July 2017
BACKGROUND: Compared with men, women have poorer lipid control. Although potential causes of this disparity have been explored, it is unknown whether patient-centered factors such as satisfaction and confidence contribute. We evaluated (1) whether satisfac ...
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Journal articleTransl Behav Med · June 2017
The Telephone Lifestyle Coaching (TLC) program provided telephone-based coaching for six lifestyle behaviors to 5321 Veterans at 24 Veterans Health Administration (VHA) medical facilities. The purpose of the study was to conduct an evaluation of the TLC pr ...
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Journal articleContemp Clin Trials · April 2017
INTRODUCTION: A large proportion of deaths and many illnesses can be attributed to three modifiable risk factors: tobacco use, overweight/obesity, and physical inactivity. Health risk assessments (HRAs) are widely available online but have not been consist ...
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Journal articleLearn Health Syst · April 2017
Organizations have different levels of readiness to implement change in the patient care process. The Hypertension Telemedicine Nurse Implementation Project for Veterans (HTN-IMPROVE) is an example of an innovation that seeks to enhance delivery of care fo ...
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Journal articleAnn Intern Med · March 21, 2017
BACKGROUND: A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions. OBJECTIVE: To examine whether patient-based, prov ...
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Journal articleWomens Health Issues · 2017
BACKGROUND: Women veterans are at increased risk for cardiovascular disease (CVD), but little is known about comorbidities and healthcare preferences associated with CVD risk in this population. METHODS: We describe the prevalence of CVD-relevant health be ...
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Journal articleBMC Musculoskelet Disord · August 23, 2016
BACKGROUND: African Americans bear a disproportionate burden of osteoarthritis (OA), with higher prevalence rates, more severe pain, and more functional limitations. One key barrier to addressing these disparities has been limited engagement of African Ame ...
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Journal articlePhys Ther · May 2016
BACKGROUND: Efficient approaches are needed for delivering nonpharmacological interventions for management of knee osteoarthritis (OA). OBJECTIVE: This trial compared group-based versus individual physical therapy interventions for management of knee OA. D ...
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Journal articleJ Clin Hypertens (Greenwich) · April 2016
Telemedicine-based medication management improves hypertension control, but has been evaluated primarily in patients with low antihypertensive drug counts. Its impact on patients taking three or more antihypertensive agents is not well-established. To addr ...
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Journal articleAnn Intern Med · January 19, 2016
BACKGROUND: Management of osteoarthritis requires both medical and behavioral strategies, but some recommended therapies are underused. OBJECTIVE: To examine the effectiveness of a combined patient and provider intervention for improving osteoarthritis out ...
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Journal articleAm J Med Sci · January 2016
Primary care is the cornerstone of effective and efficient healthcare systems. Patients prefer a trusted primary care provider to serve as the first contact for all of their healthcare questions, to help them make important health decisions, to help guide ...
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Journal articleAnn Intern Med · June 16, 2015
BACKGROUND: Choosing a diet rather than being prescribed one could improve weight loss. OBJECTIVE: To examine whether offering choice of diet improves weight loss. DESIGN: Double-randomized preference trial of choice between 2 diets (choice) versus random ...
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Journal articleJ Manag Care Spec Pharm · June 2015
BACKGROUND: Many patients experience barriers that make it difficult to take cardiovascular disease (CVD)-related medications as prescribed. The Cardiovascular Intervention Improvement Telemedicine Study (CITIES) was a tailored behavioral pharmacist-admini ...
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Journal articleJ Gen Intern Med · January 2015
OBJECTIVES: Shared medical appointments (SMAs) are an increasingly used system-redesign strategy for improving access to and quality of chronic illness care. We conducted a systematic review of the existing literature on SMA interventions for patients with ...
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Journal articleBMC Musculoskelet Disord · December 6, 2014
BACKGROUND: The Patient and PRovider Interventions for Managing Osteoarthritis (OA) in Primary Care (PRIMO) study is one of the first health services trials targeting OA in a multi-site, primary care network. This multi-site approach is important for asses ...
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Journal articleContemp Clin Trials · November 2014
BACKGROUND: An explicit goal of Patient Aligned Care Teams (PACTs) within the Veterans Health Administration is to promote continuity of care in primary care clinics and thereby reduce Emergency Department (ED) utilization; however, there has been little r ...
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Journal articleContemp Clin Trials · July 2014
Within the Veterans Health Administration (VHA), the largest integrated health care system in the US, approximately 8.5 million Veteran patients receive informal care. Despite a need for training, half of VHA caregivers report that they have not received t ...
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Journal articleCirc Cardiovasc Qual Outcomes · March 2014
BACKGROUND: Hypertension self-management has been shown to improve systolic blood pressure (BP) control, but longer-term economic and clinical impacts are unknown. The purpose of this article is to examine clinical and economic outcomes 18 months after com ...
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Journal articleTelemed J E Health · February 2014
BACKGROUND: Hypertension, hyperlipidemia, and diabetes are significant, but often preventable, contributors to cardiovascular disease (CVD) risk. Medication and behavioral nonadherence are significant barriers to successful hypertension, hyperlidemia, and ...
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Journal articleRes Gerontol Nurs · 2014
During hospitalization, older adults are at high risk for cascade iatrogenesis, the serial development of complications. In this retrospective, descriptive, case-control pilot study, 28 patients (cases) who developed respiratory failure after an elective s ...
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Journal articleWomens Health Issues · 2014
BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality for U.S. women. Racial minorities are a particularly vulnerable population. The increasing female veteran population has an higher prevalence of certain cardiovascular risk factors ...
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Journal articleImplement Sci · September 8, 2013
BACKGROUND: Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. OBJECTIVES: Through implementation of an evidence-based nurse-delivered self-management phone inter ...
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Journal articleJ Am Geriatr Soc · September 2013
OBJECTIVES: To determine predictors of repeat health service use in older veterans treated and released from the emergency department (ED). DESIGN: Retrospective cohort study. SETTING: Veterans Affairs Medical Center (VAMC) EDs. PARTICIPANTS: Nationally re ...
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Journal articleCommunity Ment Health J · August 2013
Consumers' satisfaction with inpatient mental health care is recognized as a key quality indicator that prospectively predicts functional and clinical outcomes. Coercive treatment experience is a frequently cited source of dissatisfaction with inpatient ca ...
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Journal articleHealth Educ Res · June 2013
We explored whether the effects of a telephone-based osteoarthritis (OA) self-management support intervention differed by race and health literacy. Participants included 515 veterans with hip and/or knee OA. Linear mixed models assessed differential effect ...
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Journal articleContemp Clin Trials · May 2013
A variety of diet approaches achieve moderate weight loss in many individuals. Yet, most diet interventions fail to achieve meaningful weight loss in more than a few individuals, likely due to inadequate adherence to the diet. It is widely conjectured that ...
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Journal articleAm Heart J · April 2013
BACKGROUND: Patients with co-occurrence of hypertension, hyperlipidemia, and diabetes have an increased risk of cardiovascular disease (CVD) events. Comprehensive programs addressing both tailored patient self-management and pharmacotherapy are needed to a ...
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Journal articleContemp Clin Trials · March 2013
Physical therapy (PT) is a key component of treatment for knee osteoarthritis (OA) and can decrease pain and improve function. Given the expected rise in prevalence of knee OA and the associated demand for treatment, there is a need for models of care that ...
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Journal articleJ Gen Intern Med · December 2012
BACKGROUND: African Americans are significantly more likely than whites to have uncontrolled hypertension, contributing to significant disparities in cardiovascular disease and events. OBJECTIVE: The goal of this study was to examine whether there were dif ...
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Journal articleBMJ Qual Saf · October 2012
BACKGROUND: Study goals were to assess older veterans' understanding of their emergency department (ED) discharge information and to determine the association between understanding discharge information and patient assessment of overall quality of care. ME ...
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Journal articleAm Heart J · June 2012
BACKGROUND: Half of patients with hypertension have poor blood pressure (BP) control. Recent models for treating hypertension have integrated disease monitoring and telephone-based interventions delivered in patients' homes. This study evaluated the costs ...
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Journal articleBMC Musculoskelet Disord · April 24, 2012
BACKGROUND: Osteoarthritis (OA) of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some ...
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Journal articlePrev Chronic Dis · 2012
INTRODUCTION: Self-management support interventions can help improve osteoarthritis outcomes but are underused. Little is known about how participants evaluate the helpfulness of these programs. We describe participants' evaluations of a telephone-based, o ...
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Journal articlePLoS One · 2012
Following reports of an increased incidence of amyotrophic lateral sclerosis (ALS) in U.S. veterans, we have conducted a high-density genome-wide association study (GWAS) of ALS outcome and survival time in a sample of U.S. veterans. We tested ∼1.3 million ...
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Journal articleHypertension · October 2011
Clinical inertia represents a barrier to hypertension management. As part of a hypertension telemanagement trial designed to overcome clinical inertia, we evaluated study physician reactions to elevated home blood pressures. We studied 296 patients from th ...
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Journal articleArch Intern Med · July 11, 2011
BACKGROUND: To determine which of 3 interventions was most effective in improving blood pressure (BP) control, we performed a 4-arm randomized trial with 18-month follow-up at the primary care clinics at a Veterans Affairs Medical Center. METHODS: Eligible ...
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Journal articlePatient Educ Couns · July 2011
OBJECTIVE: Capitalizing on spousal support may enhance the effectiveness of interventions for chronic disease management. However, couples-based interventions present logistical challenges. We describe our experience and lessons learned while recruiting co ...
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Journal articleAnn Intern Med · June 21, 2011
BACKGROUND: The optimal setting and number of blood pressure (BP) measurements that should be used for clinical decision making and quality reporting are uncertain. OBJECTIVE: To compare strategies for home or clinic BP measurement and their effect on clas ...
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Journal articleAmerican Journal of Managed Care · June 1, 2011
Objective: To identify the frequency of, and risk factors for, repeat emergency department (ED) visits and hospitalizations following a treat-and-release ED visit in patients from Veterans Affairs Medical Centers (VAMCs). Study Design: Retrospective cohort ...
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Journal articleAm J Med · May 2011
BACKGROUND: Only one half of Americans have their blood pressure controlled, and there are significant racial differences in blood pressure control. The goal of this study was to examine the effectiveness of 2 patient-directed interventions designed to imp ...
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Journal articleAm Heart J · April 2011
BACKGROUND: Current guidelines recommend global risk assessment to guide vascular risk factor management; however, most provider-patient communication focuses on individual risk factors in isolation. We sought to evaluate the impact of personalized coronar ...
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Journal articleJ Patient Saf · March 2011
OBJECTIVES: To describe older patients' understanding of emergency department (ED) discharge information and to explore the relationship between understanding of ED discharge information and adverse outcomes. METHODS: Telephone interviews were conducted wi ...
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Journal articleCirc Cardiovasc Qual Outcomes · March 2011
BACKGROUND: Secondary prevention by risk factor modification improves patient outcomes, yet it is often not achieved in clinical practice. Reasons for failure stem from challenges of prioritizing risk factor reduction and engaging patients in changing thei ...
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Journal articleAnn Intern Med · November 2, 2010
BACKGROUND: Osteoarthritis is a leading cause of pain and disability, and self-management behaviors for osteoarthritis are underutilized. OBJECTIVE: To examine the effectiveness of a telephone-based self-management intervention for hip or knee osteoarthrit ...
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Journal articleCardiol Clin · November 2010
Cardiovascular diseases (CVDs) have become the leading cause of death and disability in most countries in the world. This article addresses how patient self-management is a crucial component of effective high-quality health care for hypertension and CVD. T ...
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Journal articleObesity (Silver Spring) · September 2010
Although obese individuals utilize health care at higher rates than their normal weight counterparts, they may be less likely to receive certain preventive services. We conducted a retrospective cohort study of veterans with visits to 136 national Veterans ...
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Journal articleAm Heart J · August 2010
BACKGROUND: Few telemedicine programs have undergone cost analyses, impeding their implementation into practice. We report on the economic analysis of a nurse-administered intervention designed to improve blood pressure control among hypertensive veterans. ...
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Journal articleImplement Sci · July 16, 2010
BACKGROUND: Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success. OBJECTIVES: We describe the design of a 'translational' study that examines the implemen ...
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Journal articleTelemed J E Health · June 2010
OBJECTIVE: The Veterans Health Administration has developed My HealtheVet (MHV), a Web-based portal that links veterans to their care in the veteran affairs (VA) system. The objective of this study was to measure diabetic veterans' access to and use of the ...
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Journal articleAm J Epidemiol · May 15, 2010
The authors conducted a 2003-2007 case-control study including 184 cases and 194 controls to examine the association between blood lead and the risk of amyotrophic lateral sclerosis (ALS) among US veterans and to explore the influence on this association o ...
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Journal articleJ Neurol Sci · April 15, 2010
OBJECTIVE: An increased risk of ALS has been reported for US veterans, but the cause is unknown. Since head injury and cigarette smoking are two previously implicated environmental risk factors that are more common in military than civilian study populatio ...
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Journal articleChronic Illn · March 2010
OBJECTIVES: To describe the informal care network of US veterans referred to home and community-based services (Homemaker Home Health services, H/HHA, or Home-Based Primary Care, HBPC) at the Durham Veterans Affairs Medical Center (VAMC), including: quanti ...
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Journal articleAm J Hypertens · February 2010
BACKGROUND: The Take Control of Your Blood Pressure trial evaluated the effect of a multicomponent telephonic behavioral lifestyle intervention, patient self-monitoring, and both interventions combined compared with usual care on reducing systolic blood pr ...
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Journal articleOsteoarthritis Cartilage · February 2010
OBJECTIVE: This study examined factors underlying racial differences in pain and function among patients with hip and/or knee osteoarthritis (OA). METHODS: Participants were n=491 African Americans and Caucasians enrolled in a clinical trial of telephone-b ...
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Journal articleArch Intern Med · January 25, 2010
BACKGROUND: Two potent weight loss therapies, a low-carbohydrate, ketogenic diet (LCKD) and orlistat therapy combined with a low-fat diet (O + LFD), are available to the public but, to our knowledge, have never been compared. METHODS: Overweight or obese o ...
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Journal articleAmyotroph Lateral Scler · 2010
Our objective was to determine the interval from symptom onset to diagnosis, and to evaluate associated factors in a cohort of U.S. Veterans with motor neuron diseases. We retrospectively evaluated 1359 patients enrolled in the National Registry of Veteran ...
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Journal articleAnn Intern Med · November 17, 2009
BACKGROUND: Fewer than 40% of persons with hypertension in the United States have adequate blood pressure (BP) control. OBJECTIVE: To compare 2 self-management interventions for improving BP control among hypertensive patients. DESIGN: A 2 x 2 randomized t ...
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Journal articleInt J Nurs Stud · November 2009
Older adults are at particular risk for injuries associated with hospitalization and the rate of adverse events increases significantly with age. The purpose of this paper is to review factors associated with the development of adverse events in hospitaliz ...
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Journal articleAm Heart J · September 2009
BACKGROUND: Cardiovascular disease (CVD) and diabetes account for over one third of the mortality difference between African Americans and white patients. The increased CVD risk in African Americans is due in large part to the clustering of multiple CVD ri ...
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Journal articleJ Gen Intern Med · August 2009
BACKGROUND: Although others have reported national disparities in the quality of diabetes care between the Veterans Affairs (VA) and private health care delivery systems, it is not known whether these differences persist among internal medicine resident pr ...
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Journal articleAm J Med · July 2009
BACKGROUND: Most patient chronic disease self-management interventions target single-disease outcomes. We evaluated the effect of a tailored hypertension self-management intervention on the unintended targets of glycosylated hemoglobin (HbA1c) and low-dens ...
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Journal articleHum Mol Genet · April 15, 2009
The cause of sporadic amyotrophic lateral sclerosis (ALS) is largely unknown, but genetic factors are thought to play a significant role in determining susceptibility to motor neuron degeneration. To identify genetic variants altering risk of ALS, we under ...
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Journal articleJ Am Geriatr Soc · April 2009
OBJECTIVES: To describe the relationship between symptom scores and mobility function measures, assess whether symptom scores and disease scores are similarly associated with mobility function, and identify clusters of symptoms that are most strongly assoc ...
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Journal articleAm Heart J · March 2009
BACKGROUND: Less than one third of the 65 million Americans with hypertension have adequate blood pressure (BP) control. This study examined the effectiveness of 2 interventions for improving patient BP control. METHODS: This was a 2-level (primary care pr ...
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Journal articleTrials · February 6, 2009
BACKGROUND: Almost 50% of Americans have elevated low-density lipoprotein cholesterol (LDL-C). The behaviors required to lower LDL-C levels may be difficult to adhere to if they are inconsistent with spouses' health practices, and, alternatively, may be en ...
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Journal articleAmyotroph Lateral Scler · February 2009
The increased incidence of ALS in military veterans of the first Persian Gulf War raised speculation that they may have a 'Persian Gulf' variant of ALS with atypical clinical features. Medical records of military veterans with ALS, previously identified in ...
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Journal articleJ Telemed Telecare · 2009
We examined the feasibility of using home blood pressure (BP) telemonitoring devices for managing patients with poor BP control. We enrolled 591 subjects with a diagnosis of hypertension. Patients were randomized to usual care (n = 147) or to the intervent ...
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Journal articleAmyotroph Lateral Scler · 2009
The clinical course of patients with ALS is highly variable. While the median survival time from symptom onset is 2-4 years, there are reports of survival ranging from less than a year to more than 40 years. Such variability makes planning difficult for pa ...
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Journal articleStat Med · December 20, 2008
Frequently, studies are conducted in a real clinic setting. When the outcome of interest is collected longitudinally over a specified period of time, this design can lead to unequally spaced intervals and varying numbers of assessments. In our study, these ...
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Journal articleBMC Health Serv Res · October 23, 2008
BACKGROUND: Limited literacy is common among patients with chronic conditions and is associated with poor health outcomes. We sought to determine the association between literacy and blood pressure in primary care patients with hypertension and to determin ...
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Journal articleJ Clin Hypertens (Greenwich) · September 2008
Self blood pressure monitoring (SBPM) can facilitate hypertension management, but determinants of SBPM are understudied. The authors examined the relationship of patient and social environment characteristics to monitor possession and frequency of SBPM in ...
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Journal articleMed Care · August 2008
BACKGROUND: Older adults who are discharged from the emergency department (ED) may be at risk for subsequent adverse outcomes; however, this has not been fully investigated in national, population-based samples. The goal of this study was to determine the ...
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Journal articleContemp Clin Trials · July 2008
BACKGROUND: Osteoarthritis (OA) is a leading cause of disability among adults. Although self-management behaviors such as exercise and weight management can improve pain and function, these behaviors are vastly underutilized. There is a need to implement e ...
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Journal articleJ Gen Intern Med · May 2008
OBJECTIVE: The objective of the study was to identify potential explanatory factors for racial differences in blood pressure (BP) control. DESIGN: The design of the study was a cross-sectional study PATIENTS/PARTICIPANTS: The study included 608 patients wi ...
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Journal articleJ Am Geriatr Soc · May 2008
OBJECTIVES: To determine whether suboptimal pharmacotherapy increases the risk of adverse outcomes in older adults discharged from the emergency department (ED). DESIGN: Retrospective, cohort study. SETTING: Academically affiliated Veterans Affairs Medical ...
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Journal articleJ Clin Hypertens (Greenwich) · April 2008
The purposes of this study were to determine whether there is a significant correlation between the perceived and actual stroke risk among hypertensive patients and to identify patient characteristics associated with inaccurate estimation of stroke risk. T ...
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Journal articlePatient Educ Couns · March 2008
OBJECTIVE: Evaluating a randomized controlled trial involving a tailored behavioral intervention conducted to improve blood pressure control. METHODS: Adults with hypertension from two outpatient primary care clinics were randomly allocated to receive a nu ...
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Journal articlePatient Prefer Adherence · February 2, 2008
OBJECTIVE: To describe hypertensive patients' experiences with sexual side effects and their consequences for antihypertensive medication adherence. METHODS: Data were from a study conducted to identify facilitators of and barriers to adherence to blood pr ...
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Journal articleNeuroepidemiology · 2008
BACKGROUND: In follow-up to recent reports of an elevated risk of amyotrophic lateral sclerosis (ALS) among 1991 Gulf War veterans, we analyzed the distribution of disease onset times to determine whether the excess risk was time limited. METHODS: This sec ...
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Journal articleNeuroepidemiology · 2008
Recent reports of a potentially increased risk of amyotrophic lateral sclerosis (ALS) for veterans deployed to the 1990-1991 Persian Gulf War prompted the Department of Veterans Affairs to establish a National Registry of Veterans with ALS, charged with th ...
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Journal articleNeuroepidemiology · 2008
BACKGROUND: The Department of Veterans Affairs (VA) Cooperative Studies Program has established a National Registry of Veterans with Amyotrophic Lateral Sclerosis (ALS). This article describes the objectives, methods, and sample involved in the registry. M ...
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Journal articleN C Med J · 2008
VA has a rich tradition in supporting research in areas that span basic science to health system implementation. Its unique success is tied to the fact that researchers are focused on issues that arise from a unique population--our nation's veterans. Moreo ...
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Journal articleJ Gen Intern Med · November 2007
BACKGROUND: An Emergency Department (ED) visit represents a time of significant risk for an older adult; however, little is known about adverse outcomes after an ED visit in the VA system. OBJECTIVES: 1) To describe the frequency and type of adverse health ...
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Journal articleJ Am Geriatr Soc · September 2007
OBJECTIVES: To determine the prevalence and type of suboptimal pharmacotherapy that older veterans discharged from the emergency department (ED) or urgent care clinic (UCC) receive and to examine factors associated with suboptimal pharmacotherapy in this p ...
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Journal articleContemp Clin Trials · September 2007
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OBJECTIVE: Characteristics that may influence participation in DNA banks are not well defined. The purpose of this study was to examine characteristics associated with participation in a DNA bank among veterans diagnosed with Amyotrophic Lateral Sclerosis ...
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Journal articleHypertension · September 2007
The extent to which chronic kidney disease (CKD) affects achievement of blood pressure targets is not comprehensively understood. We evaluated the effects of CKD (estimated glomerular filtration rate: <60 mL/min per 1.73 m(2)) on achievement of blood press ...
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Journal articleAm Heart J · June 2007
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BACKGROUND: Only 31% of Americans with hypertension have their blood pressure (BP) under effective control. We describe a study that tests 3 different interventions in a randomized controlled trial using home BP telemedicine monitoring. METHODS: A sample o ...
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Journal articleJ Clin Hypertens (Greenwich) · May 2007
This study examined patients' perceptions of their providers' participatory decision making (PDM) style and hypertension self-care behaviors and outcomes. Five hundred fifty-four veterans with hypertension enrolled in the Veterans' Study to Improve the Con ...
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Journal articleKidney Int · March 2007
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The relationship between blood pressure (BP) and clinical outcomes among hemodialysis patients is complex and incompletely understood. This study sought to assess the relationship between blood pressure changes with hemodialysis and clinical outcomes durin ...
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Journal articleJournal of the American Psychiatric Nurses Association · February 1, 2007
Background: Recent models integrating depression care management into primary care have demonstrated improved clinical outcomes and patient satisfaction. To date, none have examined psychiatric-mental health clinical nurse specialists (PCNSs) as providers ...
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Journal articleInternational Journal of Forensic Mental Health · January 1, 2007
Involuntary psychiatric treatment is sometimes necessary and beneficial, but may also exert negative effects. The impact of involuntary commitment on subsequent mental health treatment experience is poorly understood. We examined whether history of involun ...
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Journal articleContemp Clin Trials · January 2007
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BACKGROUND: Among the 65 million Americans with hypertension, only approximately 31% have their blood pressure under control (<140/90 mm/Hg). Despite the damaging impact of hypertension and the availability of evidence-based target values for blood pressur ...
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Journal articleJ Gerontol A Biol Sci Med Sci · August 2006
BACKGROUND: Screening for breast and cervical cancer reduces disease-specific mortality, but high rates of comorbidity and disability among elderly persons may alter the risks and benefits of screening. METHODS: We performed a mail survey of primary care p ...
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Journal articleJ Gen Intern Med · July 2006
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BACKGROUND: Integrative medicine is an individualized, patient-centered approach to health, combining a whole-person model with evidence-based medicine. Interventions based in integrative medicine theory have not been tested as cardiovascular risk-reductio ...
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Journal articleSchizophr Res · May 2006
The purpose of this study was to determine if patients with schizophrenia or schizoaffective disorders and comorbid posttraumatic stress disorder (PTSD) are at higher risk for suicidality than patients without comorbid PTSD. Participants were 165 male vete ...
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Journal articlePsychol Health Med · February 2006
Locus of control as a moderator of the relationship between medication barriers (e.g., side-effects, forgetting to take medication, and keeping track of pills) and anti-hypertensive medication adherence was examined. Baseline data were obtained from 588 hy ...
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Journal articleAm J Med · January 2006
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PURPOSE: Poor blood pressure control remains a common problem that contributes to significant cardiovascular morbidity and mortality, particularly among African Americans. We explored antihypertensive medication adherence and other factors that may explain ...
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Journal articleJ Natl Med Assoc · January 2006
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An understanding of racial differences in risk-related affect may help explain racial differences in health behaviors and outcomes and provide additional opportunities for intervention. In phone interviews with a random community sample of 197 whites, 155 ...
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Journal articleAMIA Annu Symp Proc · 2006
Factors contributing to low adherence to clinical guidelines by clinicians are not well understood. The user interface of ATHENA-HTN, a guideline-based decision support system (DSS) for hypertension, presents a novel opportunity to collect clinician feedba ...
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Journal articleJournal of Clinical Outcomes Management · December 1, 2005
• Objective: To measure the effect of an explicit pain management program on unscheduled patient visits, prescribing behavior, and opioid use. • Design: Retrospective cohort study. • Setting: General medicine practice of a university-affiliated Veterans Af ...
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Journal articleJ Aging Health · October 2005
OBJECTIVE: The congruence between self-rated health and objective health was examined for associations with health factors related to hypertension (health behaviors, medication barriers, and perceived blood-pressure control). METHODS: The Charlson Comorbid ...
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Journal articleJ Gen Intern Med · July 2005
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BACKGROUND: Access to health care varies according to a person's race and ethnicity. Delaying treatment is one measure of access with important health consequences. OBJECTIVE: Determine whether perceptions of unfair treatment because of race or ethnicity a ...
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Journal articleJ Gen Intern Med · July 2005
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BACKGROUND: Obtaining accurate blood pressure (BP) readings is a challenge faced by health professionals. Clinical trials implement strict protocols, whereas clinical practices and studies that assess quality of care utilize a less rigorous protocol for BP ...
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Journal articleArch Intern Med · June 27, 2005
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BACKGROUND: Increased body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) is a risk factor for coronary heart disease and is associated with lower preventive services utilization. The relationship between BMI ...
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Journal articleMed Care · May 2005
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OBJECTIVES: Chronically ill patients who are not satisfied with their care may change healthcare providers or systems, which could disrupt continuity of care and impede management of their conditions. We examined whether patient satisfaction affected subse ...
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Journal articlePatient Educ Couns · April 2005
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OBJECTIVES: A randomized controlled trial involving a nurse administered patient-tailored intervention is being conducted to improve blood pressure (BP) control. METHODS: Veterans with hypertension from an outpatient primary care clinic completed a baselin ...
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Journal articleContemp Clin Trials · April 2005
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BACKGROUND: Among the 60 million Americans with hypertension, only approximately 31% have their blood pressure (BP) under control (<140/90 mm Hg). Despite the damaging impact of hypertension and the availability of evidence-based target values for BP, inte ...
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Journal articleJournal of Clinical Outcomes Management · March 1, 2005
• Objective: To develop a valid, reproducible scale that quantifies a provider's reaction to uncontrolled blood pressure. • Design: Retrospective chart review. • Setting and participants: 70 patients with hypertension who were treated with antihypertensive ...
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Journal articleGen Hosp Psychiatry · 2005
BACKGROUND: Depression is common in older adults and often coexists with multiple chronic diseases, which may complicate its diagnosis and treatment. OBJECTIVE: To determine whether or not the presence of multiple comorbid medical illnesses affects patient ...
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Journal articleN C Med J · 2005
BACKGROUND: We sought to compare findings of a national survey of perceptions of racial/ethnic discrimination in healthcare to those of a community survey, with emphasis on the perceptions of Latinos. METHODS: Responses from a national survey were compared ...
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Journal articleAnn Pharmacother · 2005
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BACKGROUND: Hypertension is poorly controlled in the US due to medication nonadherence. Recent evidence suggests that nonadherence can be classified as intentional or unintentional and different patient characteristics, such as the experience of adverse ef ...
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Journal articleEthn Dis · 2005
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OBJECTIVE: The goal of this research was to examine racial differences in trust in various healthcare institutions. METHOD: In telephone interviews, 195 Whites, 183 Blacks, and 171 Latinos from Durham, NC indicated how often they trust various institutions ...
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Journal articleJ Gen Intern Med · December 2004
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BACKGROUND: There is controversy surrounding the issue of whether, and how, to screen adults for type 2 diabetes. Our objective was to measure the incidence of new diabetes among outpatients enrolled in a health care system, and to determine whether hemogl ...
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Journal articleAm J Med · November 15, 2004
PURPOSE: Little is known about how well clinicians are aware of their own adherence to clinical guidelines, an important indicator of quality. We compared clinicians' beliefs about their adherence to hypertension guidelines with data on their actual perfor ...
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Journal articlePsychology Health and Medicine · November 1, 2004
The main purpose of the current investigation is to examine the extent to which health care barriers are uniquely associated with individual differences in self-rated health. Self-rated health can be easily assessed and is predictive of mortality, health c ...
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Journal articlePharmacoepidemiol Drug Saf · October 2004
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PURPOSE: Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs for the treatment of osteoarthritis (OA). While there are documented racial differences in the use of opioid analgesics, little is known about racial differences ...
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Journal articleAmyotroph Lateral Scler Other Motor Neuron Disord · September 2004
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In response to concern about the development of ALS among veterans of the U.S. armed forces, particularly Gulf War veterans, the Department of Veterans Affairs established a national registry of veterans with ALS. This Registry will identify living veteran ...
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Journal articleControl Clin Trials · August 2004
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BACKGROUND: Racial distribution of clinical trial participants is important because results from these studies serve to define evidence-based practice. This report summarizes the experience of the VA Cooperative Studies Program (CSP) in enrolling white, bl ...
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Journal articleJournal of Clinical Outcomes Management · August 1, 2004
• Objective: To review telemedicine approaches for management of hypertension. • Methods: Review of studies that illustrate the use of telemedicine in hypertension and discussion of an ongoing clinical trial, the Take Control of Your Blood Pressure study, ...
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Journal articleJ Vasc Surg · July 2004
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BACKGROUND AND PURPOSE: Patient risk perception for surgery may be central to their willingness to undergo surgery. This study examined potential factors associated with patient aversion of surgery. METHODS: This is a secondary data analysis of a prospecti ...
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Journal articleJournal of Clinical Outcomes Management · April 1, 2004
• Objective: To assess the availability and use of technologies that facilitate the receipt of diagnostic test results in primary care offices, physicians' perceptions of delays in receiving results, and the effect of managed care market penetration on the ...
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Journal articleStudies in health technology and informatics · January 2004
Measurement of provider adherence to a guideline-based decision support system (DSS) presents a number of important challenges. Establishing a causal relationship between the DSS and change in concordance requires consideration of both the primary intentio ...
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Journal articleJ Vasc Surg · January 2004
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OBJECTIVE: The purpose of this study was to identify clinical and nonclinical factors associated with failure to perform carotid endarterectomy (CEA) in patients with clinically appropriate indications. We analyzed data from a prospective cohort study perf ...
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Journal articleTelemed J E Health · 2004
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The aim of this study was to assess satisfaction with and acceptance of a store and forward teledermatology consult system among patients, referring primary-care clinicians, and consultant dermatologists. As part of a randomized clinical trial that compare ...
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Journal articleAging Ment Health · January 2004
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Congestive heart failure (CHF) lowers survival and worsens the quality of life (QOL) of over four million older Americans. Both clinicians and standardized instruments used to assess the QOL of patients with CHF focus primarily on physical symptoms rather ...
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Journal articleStud Health Technol Inform · 2004
Measurement of provider adherence to a guideline-based decision support system (DSS) presents a number of important challenges. Establishing a causal relationship between the DSS and change in concordance requires consideration of both the primary intentio ...
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Journal articleAnn Pharmacother · 2004
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BACKGROUND: Previous studies have suggested that recommended gastroprotective strategies such as gastroprotective agents (GPAs) and cyclooxygenase (COX) 2 inhibitors may be underutilized among individuals at risk for nonsteroidal antiinflammatory drug (NSA ...
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Journal articleJ Am Med Inform Assoc · 2004
Information technology can support the implementation of clinical research findings in practice settings. Technology can address the quality gap in health care by providing automated decision support to clinicians that integrates guideline knowledge with e ...
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Journal articleJ Rheumatol · October 2003
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OBJECTIVE: Research has identified racial variations in certain aspects of osteoarthritis (OA) related medical care. We compared health services utilization between African American and white veteran outpatients with OA. METHODS: Subjects were 1612 white a ...
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Journal articleArch Intern Med · September 22, 2003
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BACKGROUND: Complications of Staphylococcus aureus bacteremia (SAB) are often difficult to identify. The ability to accurately predict the likelihood of these complications would impact patient management. This investigation sought to define readily availa ...
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Journal articleCirculation · July 8, 2003
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BACKGROUND: Mediastinitis is a complication of coronary artery bypass graft surgery (CABG) that can be difficult to diagnose. This study evaluated the utility of blood culture results in identifying patients with mediastinitis. METHODS AND RESULTS: All uni ...
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Journal articleJ Womens Health (Larchmt) · May 2003
OBJECTIVE: To examine access to and utilization of primary healthcare services with respect to gender. Greater family and child-rearing responsibilities are possible barriers to healthcare access and utilization for women with HIV infection. METHODS: This ...
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Journal articleAm Heart J · February 2003
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BACKGROUND: Implementation of the complex treatment strategies that have been shown to improve survival of patients with congestive heart failure (CHF) may require certain expertise. We wanted to examine the association between pattern of outpatient care a ...
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Journal articleDiabetes Care · February 2003
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OBJECTIVE: Screening for diabetes has the potential to be an effective intervention, especially if patients have intensive treatment of their newly diagnosed diabetes and comorbid hypertension. We wished to determine the process and quality of diabetes car ...
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Journal articleNeurology · January 28, 2003
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OBJECTIVE: To investigate whether there are differences in poststroke survival between African American and white patients, aged 65 and over, in the United States. METHODS: A biracial cohort of patients was selected from a random 20% national sample of Med ...
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Journal articleTelemed J E Health · 2003
Our objective was to assess the economic impact of store-and-forward teledermatology in a United States Department of Veterans Affairs (VA) health care setting. Patients being referred to the Dermatology Consult Service from the Primary Care Clinics at the ...
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Journal articleGen Hosp Psychiatry · 2003
We describe the daily work activities of 13 Depression Clinical Specialists (DCSs) at 7 national sites who served as care managers in an effective multisite randomized trial of a disease management model for depression in primary care. DCSs carried portabl ...
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Journal articlePsychiatr Q · 2003
groups and semi-structured individual interviews with all Depression Clinical Specialists (DCSs) working with Project IMPACT (Improving Mood: Promoting Access to Collaborative Treatment), a study testing a collaborative care intervention for late life depr ...
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Journal articleStroke · December 2002
BACKGROUND AND PURPOSE: Carotid endarterectomy (CE) has been proved to reduce the risk of stroke for certain patients, but black patients are less likely than whites to receive CE. The purpose of this work was to determine the importance of clinical indica ...
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Journal articleStroke · December 2002
BACKGROUND AND PURPOSE: Most quality improvement methods implicitly assume that facilities with high complication rates are likely to have substandard processes of care, a stable characteristic that, in the absence of intervention, will persist over time. ...
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Journal articleInternational Journal of Angiology · October 16, 2002
We sought to determine clinical examination features that predict an abnormal ankle-brachial index (ABI). Eleven United States and Canadian university-affiliated practices participated. Patients over age 55 (n = 218) presenting for an outpatient appointmen ...
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Journal articleJ Am Geriatr Soc · October 2002
OBJECTIVES: To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people. DESIGN: Sixth annual follow-up of a community-based survey with 4,162 participants aged 65 a ...
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Journal articleAm J Med · July 2002
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Randomized trials have indicated that well-managed anticoagulation with warfarin could prevent more than half of the strokes related to atrial fibrillation. However, many patients with atrial fibrillation who are eligible for this therapy either do not rec ...
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Journal articleDiabetes Care · June 2002
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OBJECTIVE: Diagnosis of a chronic illness can have a negative impact on patients' perception of their well-being ("labeling" effect). We sought to determine the effects of a new diagnosis of diabetes, discovered by systematic screening, on patients' health ...
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Journal articleJ Natl Med Assoc · April 2002
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Hypertension is a major modifiable risk factor for stroke, congestive heart failure, and end-stage renal disease. Hypertension is particularly prevalent and deadly among African Americans. Effective treatment for hypertension has been available for decades ...
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Journal articleMed Care · January 2002
CONTEXT: Black patients and Hispanic patients receive carotid endarterectomy (CEA) at lower rates than white patients. It is unclear whether worse surgical outcomes are influencing clinical decision-making regarding use of the operation among minority grou ...
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Journal articleTelemed J E Health · 2002
The aim of this study was to determine if a teledermatology consult system, using store-and-forward digital imaging technology, results in patients achieving a shorter time from referral date to date of initial definitive intervention when compared to a tr ...
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Journal articleJ Gen Intern Med · January 2002
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BACKGROUND: Opportunistic disease screening is the routine, asymptomatic disease screening of patients at the time of a physician encounter for other reasons. While the prevalence of unrecognized diabetes in community populations is well known, the prevale ...
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Journal articleJ Gen Intern Med · September 2001
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OBJECTIVE: To measure the impact of a teaching intervention and to compare process and outcomes of care for HIV-infected patients randomly assigned to a general medicine clinic (GMC) or an infectious disease clinic (IDC) for primary care. DESIGN: Prospecti ...
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Journal articleMed Care · June 2001
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Although well-designed randomized controlled trials (RCT) provide the strongest evidence regarding causation, only relatively recently have they been used by health services researchers to study the organization, delivery, quality, and outcomes of care. Mo ...
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Journal articleJ Natl Med Assoc · November 2000
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Dietary and behavioral needs of special populations are rarely considered in traditional weight loss programs. This study assessed the impact of culturally-sensitive modifications to the Duke University Rice Diet weight loss program for African-American di ...
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Journal articleJ Clin Epidemiol · November 2000
OBJECTIVE: To determine clinical and patient-centered factors predicting non-elective hospital readmissions. DESIGN: Secondary analysis from a randomized clinical trial. CLINICAL SETTING: Nine VA medical centers. PARTICIPANTS: Patients discharged from the ...
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Journal articleJ Thromb Thrombolysis · June 2000
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We describe the design of the Managing Anti-coagulation Services Trial (MAST), a practice-improvement trial testing whether anticoagulation services are a preferred method of managing anticoagulation for stroke prevention among patients with atrial fibrill ...
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Journal articleMed Care · June 2000
Stroke is the third leading cause of death and a leading cause of adult disability in the United States. Both within and outside of the Veterans Health Administration (VHA), the lack of a systematic approach to stroke prevention and treatment may have cont ...
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Journal articleJ Natl Med Assoc · May 2000
Epidemiologic studies suggest that African-American women may be less likely to obtain mental health services. Racial differences were explored in wanting and obtaining mental health services among women in an equal access primary care clinic setting after ...
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Journal articleStroke · March 2000
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BACKGROUND AND PURPOSE: Blacks experience greater morbidity and mortality from stroke than do whites. The degree to which this is due to the severity of the initial stroke is not known. The objective of this study is to determine whether there is a racial ...
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Journal articleStroke · July 1999
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BACKGROUND AND PURPOSE: We sought to determine whether there are racial differences in use of carotid artery imaging after controlling for clinical factors and to ascertain racial differences in presenting signs and symptoms and overall appropriateness for ...
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Journal articleMed Care · April 1999
OBJECTIVES: The interest in the economic impact of new health care interventions has increased dramatically over recent years; however, the results can be highly variable depending upon the economic assumptions made and the approaches taken in collecting t ...
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Journal articleEff Clin Pract · 1999
OBJECTIVE: To determine whether enhanced access to primary care affects the diagnostic evaluation, pharmacologic management, or health outcomes of patients hospitalized with congestive heart failure (CHF). DESIGN: Multisite randomized, controlled trial. SE ...
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Journal articleDiabetes Educ · 1999
PURPOSE: The purpose of this study was to evaluate an intensive diabetes foot education program for veterans at high risk for foot ulcer. METHODS: We invited 100 consecutive patients with diabetes from a Department of Veterans Affairs Medical Center clinic ...
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Journal articleStroke · April 1998
BACKGROUND AND PURPOSE: The benefit of carotid endarterectomy is highly dependent on surgical risk. However, little data are available concerning factors affecting the risk of endarterectomy performed for asymptomatic carotid artery stenosis outside the se ...
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Journal articleControl Clin Trials · April 1998
The Department of Veterans Affairs, through its Cooperative Studies Program, has a long history of conducting large-scale, multihospital biomedical clinical trials. The agency's Health Services Research and Development Service, although newer, has a distin ...
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Journal articleJ Natl Med Assoc · January 1998
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Previous studies indicate that African-American patients undergo carotid endarterectomy at one fourth the rate of white patients. This study was undertaken to determine if differences in aversion to carotid endarterectomy might account for some of the raci ...
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Journal articleClin Perform Qual Health Care · 1998
OBJECTIVE: Hospital credentialing standards for laparoscopic cholecystectomy were established to improve surgical outcomes, but standards vary by hospital. We hypothesized that more stringent credentialing would result in better outcomes. DESIGN: Univariat ...
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Journal articleJ Gen Intern Med · September 1997
OBJECTIVE: To determine the value of the history, physical examination, and magnetic resonance imaging (MRI) in predicting successful primary healing of a foot ulcer in a diabetic patient. DESIGN: Prospective cohort study. SETTING: Durham (NC) Veterans Aff ...
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Journal articleHealth Serv Res · August 1997
OBJECTIVE: To examine specifically the influence of estimated perioperative mortality and stroke rate on the assessment of appropriateness of carotid endarterectomy. DATA SOURCES/STUDY SETTING: An expert panel convened to rate the appropriateness of a vari ...
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Journal articleHealth Services Research · August 1, 1997
Objective. To examine specifically the influence of estimated perioperative mortality and stroke rate on the assessment of appropriateness of carotid endarterectomy. Data Sources/Study Setting. An expert panel convened to rate the appropriateness of a vari ...
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Journal articleJ Gen Intern Med · October 1996
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OBJECTIVES: To describe a new quality assessment method used to classify the preventability of hospitalization in terms of patient, clinician, or system factors. DESIGN: The instrument was developed in two phases. Phase 1 was a prospective comparison of ad ...
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Journal articleJ Gen Intern Med · October 1996
MAIN RESULTS: Compared with younger patients, patients aged 50 years or older were less likely to have acquired HIV via intravenous drug use or homosexual contact (p = .0001). Older patients were more likely to have comorbid diseases (12% vs 4%; p = .0001) ...
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Journal articleDiabetes Care · July 1996
OBJECTIVE: To determine which elements of clinical history, physical examination, and diagnostic tests are important to primary care physicians in their management of foot ulcers in diabetic patients. RESEARCH DESIGN AND METHODS: We conducted a national ma ...
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Journal articleN Engl J Med · May 30, 1996
BACKGROUND: For chronically ill patients, readmission to the hospital can be frequent and costly. We studied the effect of an intervention designed to increase access to primary care after discharge from the hospital, with the goals of reducing readmission ...
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Journal articleJ Clin Epidemiol · February 1996
While measures of health-related quality of life (HRQOL) are increasingly being used as outcomes in clinical trials, it is unknown whether HRQOL assessments are influenced by the method of administration. We compared telephone, face-to-face, and self-admin ...
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Journal articleDrug Information Journal · 1996
The Genie score is a summary laboratory score derived from the average of a patient's deviations from specified normal laboratory values. The ability of the Genie score to predict important inpatient resource use, functional status, and patient comorbidity ...
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Journal articleJournal of Investigative Medicine · January 1, 1996
We conducted a national mail survey of 600 primary care physicians to determine which elements of the clinical history and physical examination, and which diagnostic tests, influence their decisions to order radiology studies, surgical referral, and hospit ...
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Journal articleAnn Intern Med · December 15, 1995
PURPOSE: To summarize the literature on the clinical utility of antineutrophil cytoplasmic antibody (c-ANCA) as a diagnostic marker for Wegener granulomatosis. DATA SOURCES: A structured literature search was done using MEDLINE; this search, combined with ...
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Journal articleStroke · September 1995
BACKGROUND AND PURPOSE: Stroke is largely a preventable disease. However, there are little data available concerning the use of stroke prevention diagnostic and treatment modalities by practicing physicians. These data are critical for the rational allocat ...
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Journal articleJ Clin Epidemiol · August 1995
Determining research-related costs from intervention-related costs is important for both clinical and health services research. Often this task involves estimating what proportion of the workday personnel spend on a variety of activities. We used a portabl ...
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Journal articleAnn Intern Med · March 1, 1995
PURPOSE: To compare the operating characteristics of six noninvasive tests for carotid artery stenosis. DATA SOURCES: A structured search was done using MEDLINE, reference lists from selected articles, and bibliographies from neurology textbooks that focus ...
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Journal articleJAMA: The Journal of the American Medical Association · 1995
Because the number of patients screened (42 000) greatly exceeded the number of patients randomized (1662), the generalizability of the ACAS results needs to be examined more closely. Although the ACAS authors were careful in their report, they failed to h ...
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Journal articleMilbank Q · 1995
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Despite a higher risk of stroke, blacks are less likely than whites to receive the invasive procedures that are used to diagnose and treat cerebrovascular disease, particularly carotid endarterectomy. Explanations for the lower rate of procedural use inclu ...
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Journal articleClin Perform Qual Health Care · 1995
BACKGROUND: Pneumocystis carinii pneumonia (PCP) has been the most common and most costly complication of acquired immunodeficiency syndrome (AIDS). Because of concern over the high costs of care for persons with AIDS, policy makers have instituted a numbe ...
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Journal articleJ Clin Epidemiol · November 1994
Identifying patients at increased risk for hospital readmission is important for clinicians, health policy-makers, hospital administrators, and researchers. We used a retrospective case-control design to compare the clinimetric properties of five validated ...
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Journal articleStroke · June 1994
BACKGROUND AND PURPOSE: Randomized clinical trials have shown that carotid endarterectomy decreases the risk of subsequent stroke in patients with high-grade carotid stenosis and ipsilateral transient ischemic attack or minor stroke. The benefit of surgery ...
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Journal articleJ Gen Intern Med · May 1994
OBJECTIVE: To describe a novel method of time analysis for health care settings by quantifying internal medicine housestaff's work activities and contacts. DESIGN: Observational work sampling study based on random sampling technique. SETTING: General medic ...
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Journal articleAmerican Statistician · January 1, 1994
A course in writing and critical appraisal of medical papers that uses statistics is described, and its relationship to the goal of better integrating scientific writing into the statistics curriculum is discussed. It is concluded that writing should play ...
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Journal articleMed Decis Making · 1994
A widely used method for evaluating the appropriateness of medical procedures and practices is the "modified Delphi" approach using expert panelists' global ratings. However, several difficulties in the assignment of global ratings have led to a search for ...
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Journal articleArch Intern Med · December 27, 1993
BACKGROUND: Carotid endarterectomy is emerging as the treatment of choice for patients with symptomatic carotid artery stenosis at low operative risk. We sought to determine if racial variations in the rate of carotid angiography and endarterectomy exist i ...
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Journal articleBMJ · November 20, 1993
OBJECTIVE--To compare cost effectiveness of early and later treatment with zidovudine for patients infected with HIV. DESIGN--Markov chain analysis of cost effectiveness based on results of use of health care and efficacy from a trial of zidovudine treatme ...
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Journal articleAcad Med · November 1993
BACKGROUND: Accurately quantifying housestaff's workday activities is acquiring increasing importance as resources become constrained and programs become more accountable for medical education. The authors compared a traditional method of time analysis bas ...
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Journal articleAm J Med · October 1993
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PURPOSE: To evaluate the effectiveness of a teaching program designed to improve interns' cardiovascular examination skills. PARTICIPANTS: All 56 interns rotating on a mandatory 4-week inpatient cardiology service during 1 academic year (July 1989-June 199 ...
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Journal articleStroke · September 1993
BACKGROUND AND PURPOSE: Carotid endarterectomy has been shown to be beneficial in patients with high-grade carotid stenosis and ipsilateral transient ischemic attack or stroke. This benefit will be realized only if the operation is performed safely. We sou ...
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Journal articleHealth Serv Res · April 1993
OBJECTIVE: Our objective was to assess the cost effectiveness of hepatitis B vaccine in predialysis patients. DATA SOURCES: Costs were calculated from estimated rates of health services use and unit costs of resource use. Efficacy data were based on probab ...
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Journal articleAnn Intern Med · November 1, 1992
OBJECTIVE: To assess the cardiovascular physical examination skills of internal medicine housestaff. DESIGN: Cross-sectional assessment of housestaff performance on three valvular abnormality simulations conducted on the cardiology patient simulator, "Harv ...
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Journal articleClin Geriatr Med · February 1992
Cancer screening of the elderly is warranted for those cancers for which early detection and treatment improve life expectancy. There is excellent evidence to include screening for breast cancer with clinical examination and mammography for elderly women. ...
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Journal articleRev Infect Dis · 1989
Actinobacillus actinomycetemcomitans is a small fastidious gram-negative coccobacillus that fails to grow on MacConkey's agar. Slow growth in broth may lead to delays in diagnosis. First described in 1912, A. actinomycetemcomitans has been recognized since ...
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