Phoenix VA Health Care System

Phoenix, AZ, United States

Phoenix VA Health Care System

Phoenix, AZ, United States
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Dr. Yehia is leading the VA in its transformational journey to provide Veterans with easy access to personalized care from a robust network of federal and private providers. "Partnerships between VA and private providers are essential to delivering care in the diverse geographies where Veterans live," he said. This sentiment is echoed by TriWest, one of VA's partners in administering the Veterans Choice Program. President and Chief Executive Officer of TriWest, David J. McIntyre, Jr. states, "TriWest values greatly the partnership with community providers who share our commitment to providing Veterans timely, high quality, and convenient health care." "This new public-private collaboration between CVS, TriWest and the VA is an important step forward in enhancing choice and flexibility in Veterans' health care," said Senator John McCain. "I've long believed that Veterans in need of routine health care services should not have to wait in line for weeks to get an appointment when they can visit community health centers like MinuteClinic to receive timely and convenient care. Thanks to the leadership of CVS Health and the VA, Phoenix's nearly 120,000 Veterans will now be served at 24 different area MinuteClinic locations for minor health care services." This innovative program provides Veterans with more options and access points for receiving care for a wide array of minor illnesses and injuries. "We are thrilled to have this new partnership for Phoenix area Veterans. Increasing access and availability of care is crucial. In sending Veterans out into the community, however, we are always conscious of providing the best care coordination we can. We are working to leverage technology to share important clinical information and ensure care continuity," said Dr. Maureen McCarthy, PVAHCS Chief of Staff. To facilitate care coordination, the partnership will share electronic health information in the same manner that proved successful in a similar program launched in 2016 with the Palo Alto VA Health Care System. MinuteClinic visit summaries will be sent to a Veteran's VA primary care physician. This ensures the VA physician has the clinical information necessary for follow-up services in the VA, if appropriate. Veterans who call the Phoenix VA Health Care System Help Line at 602-222-6550 or 800-574-7174 (toll free) can be referred to one of the 24 MinuteClinic locations in the Phoenix area for treatment of common acute illnesses. "We believe in the MinuteClinic model of care and are excited to offer our health care services as one potential solution for the Phoenix VA Health Care System and its patients with minor illnesses and injuries," said CVS MinuteClinic Chief Medical Officer, Tobias Barker, M.D. "We're looking forward to working with the Phoenix VA Health Care System team to ensure that their patients have additional options for high-quality acute care at times and locations that are convenient for them." To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/phoenix-va-health-care-system-triwest-and-cvs-health-partner-to-increase-veteran-access-to-health-care-services-300440626.html


Cohen A.L.,Banner Good Samaritan Medical Center | Sarid R.,Phoenix VA Health Care System
Thrombosis Research | Year: 2010

Introduction: Monoclonal gammopathy of undetermined significance (MGUS) has been proposed to be a risk factor for venous thromboembolic disease (VTE). However, no series published to date has been population-based or included a control group with similar comorbidities to people with MGUS. Patients/Methods: We reviewed the records of all the male veterans in a single VA healthcare system with MGUS between January 1, 1996 and December 31, 2005. We compared the rate of VTE in 166 patients with MGUS with the rate of VTE in an age-matched control group of 465 patients who had tested negative for monoclonal gammopathy by serum protein electrophoresis (SPEP). Results: The VTE rate in the MGUS group was 2.2 per 100 person-years, which was not significantly different from the rate in the control group, 1.4 per 100 person-years (HR 1.38, CI 0.63-3.01, p = 0.42). Most VTE events occurred within 4 months of the diagnosis of MGUS. In univariate analysis, albumin level (HR 0.21, CI 0.1-0.41, p < 0.001), abnormal leukocyte count (HR 2.53, CI 1.09-5.86, p = 0.03), and history of prior VTE (HR 4.41, CI 1.69-11.54, p = 0.003) were associated with increased risk of VTE. On multivariate analysis, albumin level and history of prior VTE remained significant, but presence of MGUS was still not significantly associated with VTE risk. Conclusion: Our results suggest that the increased rate of VTE in people with MGUS may be primarily due to other underlying conditions that led to testing for a monoclonal gammopathy rather than to the monoclonal gammopathy itself. © 2009 Elsevier Ltd.


Saremi A.,Phoenix VA Health Care System | Bahn G.D.,Cooperative Studies Program Coordinating Center | Reaven P.D.,Phoenix VA Health Care System
Diabetes Care | Year: 2016

OBJECTIVE To determine whether a link exists between serious hypoglycemia and progression of atherosclerosis in a substudy of the Veterans Affairs Diabetes Trial (VADT) and to examine whether glycemic control during the VADT modified the association between serious hypoglycemia and coronary artery calcium (CAC) progression. RESEARCH DESIGN AND METHODS Serious hypoglycemia was defined as severe episodes with loss of consciousness or requiring assistance or documented glucose <50 mg/dL. Progression of CAC was determined in 197 participants with baseline and follow-up computed tomography scans. RESULTS During an average follow-up of 4.5 years between scans, 97 participants reported severe hypoglycemia (n = 23) or glucose <50mg/dL (n = 74). Serious hypoglycemia occurred more frequently in the intensive therapy group than in the standard treatment group (74%vs. 21%, P <0.01). Serious hypoglycemiawas not associated with progression of CAC in the entire cohort, but the interaction between serious hypoglycemia and treatment was significant (P <0.01). Participants with serious hypoglycemia in the standard therapy group, but not in the intensive therapy group, had ∼50% greater progression of CAC than those without serious hypoglycemia (median 11.15 vs. 5.4 mm 3, P = 0.02). Adjustment for all baseline differences, including CAC, or time-varying risk factors during the trial, did not change the results. Examining the effect of serious hypoglycemia by on-trial HbA1c levels (cutoff 7.5%) yielded similar results. In addition, a dose-response relationship was found between serious hypoglycemia and CAC progression in the standard therapy group only. CONCLUSIONS Despite a higher frequency of serious hypoglycemia in the intensive therapy group, serious hypoglycemia was associated with progression of CAC in only the standard therapy group. © 2016 by the American Diabetes Association.


Saremi A.,Phoenix VA Health Care System | Bahn G.,Cooperative Studies Program Coordinating Center | Reaven P.D.,Phoenix VA Health Care System
Diabetes Care | Year: 2012

OBJECTIVE - To determine the effect of statin use on progression of vascular calcification in type 2 diabetes (T2DM). RESEARCH DESIGN AND METHODS - Progression of coronary artery calcification (CAC) and abdominal aortic artery calcification (AAC) was assessed according to the frequency of statin use in 197 participants with T2DM. RESULTS - After adjustment for baseline CAC and other confounders, progression of CAC was significantly higher in more frequent statin users than in less frequent users (mean ± SE, 8.2 ± 0.5 mm 3 vs. 4.2 ± 1.1 mm3; P < 0.01). AAC progression was in general not significantly increased with more frequent statin use; in a subgroup of participants initially not receiving statins, however, progression of both CAC and AAC was significantly increased in frequent statin users. CONCLUSIONS - More frequent statin use is associated with accelerated CAC in T2DM patients with advanced atherosclerosis. © 2012 by the American Diabetes Association.


Hayward R.A.,Veterans Affairs Center for Clinical Management Research | Reaven P.D.,Phoenix VA Health Care System | Wiitala W.L.,Veterans Affairs Center for Clinical Management Research | Bahn G.D.,Hines Veterans Administration Hospital | And 5 more authors.
New England Journal of Medicine | Year: 2015

BACKGROUND: The Veterans Affairs Diabetes Trial previously showed that intensive glucose lowering, as compared with standard therapy, did not significantly reduce the rate of major cardiovascular events among 1791 military veterans (median follow-up, 5.6 years). We report the extended follow-up of the study participants. METHODS: After the conclusion of the clinical trial, we followed participants, using central databases to identify procedures, hospitalizations, and deaths (complete cohort, with follow-up data for 92.4% of participants). Most participants agreed to additional data collection by means of annual surveys and periodic chart reviews (survey cohort, with 77.7% follow-up). The primary outcome was the time to the first major cardiovascular event (heart attack, stroke, new or worsening congestive heart failure, amputation for ischemic gangrene, or cardiovascular-related death). Secondary outcomes were cardiovascular mortality and all-cause mortality. RESULTS: The difference in glycated hemoglobin levels between the intensive-therapy group and the standard-therapy group averaged 1.5 percentage points during the trial (median level, 6.9% vs. 8.4%) and declined to 0.2 to 0.3 percentage points by 3 years after the trial ended. Over a median follow-up of 9.8 years, the intensive-therapy group had a significantly lower risk of the primary outcome than did the standardtherapy group (hazard ratio, 0.83; 95% confidence interval [CI], 0.70 to 0.99; P = 0.04), with an absolute reduction in risk of 8.6 major cardiovascular events per 1000 person-years, but did not have reduced cardiovascular mortality (hazard ratio, 0.88; 95% CI, 0.64 to 1.20; P = 0.42). No reduction in total mortality was evident (hazard ratio in the intensive-therapy group, 1.05; 95% CI, 0.89 to 1.25; P = 0.54; median follow-up, 11.8 years). CONCLUSIONS: After nearly 10 years of follow-up, patients with type 2 diabetes who had been randomly assigned to intensive glucose control for 5.6 years had 8.6 fewer major cardiovascular events per 1000 person-years than those assigned to standard therapy, but no improvement was seen in the rate of overall survival. (Funded by the VA Cooperative Studies Program and others; VADT ClinicalTrials.gov number, NCT00032487.) Copyright © 2015 Massachusetts Medical Society. All rights reserved.


Goldfine A.B.,Harvard University | Conlin P.R.,Brigham and Women's Hospital | Halperin F.,Harvard University | Koska J.,Phoenix VA Health Care System | And 5 more authors.
Diabetologia | Year: 2013

Aims/hypothesis: Chronic sub-acute inflammation contributes to the pathogenesis of type 2 diabetes mellitus and cardiovascular disease. High doses of salicylate reduce inflammation, glucose and triacylglycerols, and may improve insulin sensitivity, suggesting therapeutic potential in impaired fasting glucose and/or impaired glucose tolerance. This trial aimed to evaluate the effect of salsalate vs placebo on insulin resistance and glycaemia in impaired fasting glucose and/or impaired glucose tolerance. Methods: We conducted a 12 week, two-centre, randomised, placebo-controlled study to evaluate the effect of salsalate (up to 4 g/day) vs placebo on systemic glucose disposal. Secondary objectives included treatment effects on glycaemia, inflammation and cardiovascular risk factors. Seventy-eight participants with impaired fasting glucose and/or impaired glucose tolerance from two VA healthcare systems were enrolled. Randomisation assignment was provided by the coordinating center directly to site pharmacists, and participants and research staff were blinded to treatment assignment. Results: Seventy-one individuals were randomised to placebo (n = 36) or salsalate (n = 35). Glucose disposal did not change in either group (salsalate 1% [95% CI -39%, 56%]; placebo 6% [95% CI -20%, 61%], p = 0.3 for placebo vs salsalate). Fasting glucose was reduced by 6% during the study by salsalate (p = 0.006) but did not change with placebo. Declines in glucose were accompanied by declines in fasting C-peptide with salsalate. Insulin clearance was reduced with salsalate. In the salsalate group, triacylglycerol levels were lower by 25% (p = 0.01) and adiponectin increased by 53% (p = 0.02) at the end of the study. Blood pressure, endothelial function and other inflammation markers did not differ between groups. Adipose tissue nuclear factor κB (NF-κB) activity declined in the salsalate group compared with placebo (-16% vs 42%, p = 0.005), but was not correlated with metabolic improvements. The frequency of tinnitus was low but tended to be higher with salsalate therapy (n = 4 vs n = 2). Conclusions/interpretation: In summary, salsalate therapy was well tolerated, lowered fasting glucose, increased adiponectin and reduced adipose tissue NF-κB activity. These changes were not related to changes in peripheral insulin sensitivity, suggesting additional mechanisms for metabolic improvement. Trial registration: ClinicalTrials.gov NCT00330733 Funding: Office of Research and Development, Medical Research Service, Department of Veterans Affairs and NIH K24 DK63214 © 2013 Springer-Verlag (outside the USA).


Dev S.,Phoenix VA Health Care System | Clare R.M.,Duke Clinical Research Institute | Felker G.M.,Duke Clinical Research Institute | Fiuzat M.,Duke Clinical Research Institute | And 2 more authors.
European Journal of Heart Failure | Year: 2012

Aims Survival preferences, ascertained from time-trade-off utilities, have not been studied in heart failure patients who designate a 'do not resuscitate' (DNR) status. Therefore, the aim of this study was to determine the association of heart failure patients resuscitation preferences with survival preferences and mortality in the ESCAPE trial. Methods and results We analysed the association of resuscitation orders at 1 month with time-trade-off utilities and 6-month mortality. There were 26 and 349 patients with a DNR order and Full Code order, respectively. DNR patients were older, had more coronary artery disease, hypertension, renal impairment, and poorer exercise capacity than Full Code patients. DNR patients also experienced longer hospitalization and higher 6-month mortality. In multivariate analysis, DNR preference was associated with 10-fold higher odds of willingness to trade survival time (lower time-trade-off utility) in favour of improved quality of life [odds ratio 10.33, 95 confidence interval (CI) 1.6564.80]. DNR preference was the best predictor of mortality (χ 2 26.12, P < 0.0001, hazard ratio 6.88, 95 CI 3.2814.41), despite adjustment for known predictors including brain natriuretic peptide. Conclusions Heart failure patients requests to forgo resuscitation may signify more than simply 'what-if' directives for emergency care. DNR decisions may reflect preferences for intervention to enhance quality rather than prolong survival, which is particularly important as these patients have high early mortality. © 2011 The Author.


Deer J.,Phoenix VA Health Care System | Koska J.,Phoenix VA Health Care System | Ozias M.,Phoenix VA Health Care System | Reaven P.,Phoenix VA Health Care System
Metabolism: Clinical and Experimental | Year: 2015

Insulin resistance is a significant factor in the development of type 2 diabetes mellitus, however the connection between the Western diet and the development of insulin resistance has not been fully explained. Dietary macronutrient composition has been examined in a number of articles, and diets enriched in saturated fatty acids, and possibly in fructose, appear to be most consistently associated with the development of insulin resistance. However, mechanistic insights into the metabolic effects of such diets are lacking, and merit further study. © 2015 Elsevier Inc. All rights reserved.


Schwartz E.A.,Phoenix VA Health Care System | Reaven P.D.,Phoenix VA Health Care System
Biochimica et Biophysica Acta - Molecular and Cell Biology of Lipids | Year: 2012

Epidemiological and interventional studies have implicated elevated triglyceride-rich lipoprotein (TGRL) levels as a risk factor for cardiovascular disease and vascular inflammation, though the results have not been entirely consistent. This appears particularly relevant in model systems where the lipolysis occurs in the setting of established inflammation (e.g., in pre-existing atherosclerotic plaques), rather than in the tissue capillary beds where lipolysis normally occurs. Two main mechanisms seem to link TGRL lipolysis to vascular inflammation. First, lipolysis of TGRL leaves behind partially lipolyzed remnant particles which are better able to enter the vessel wall than nascent TGRL, have a rate of egress substantially lower than their rate of entry, and contain 5-20 times more cholesterol per particle than LDL. Furthermore, remnants do not require oxidation or other modifications to be phagocytized by macrophages, enhancing foam cell formation. Second, saturated fatty acids and oxidized phospholipids released by lipolysis induce inflammation by activating Toll-like receptors of the innate immune system, via oxidative stress, or by greatly amplifying existing pro-inflammatory signals (caused by subclinical endotoxemia) via mitogen-activated protein kinases. However, n-3 and unbound n-9 unsaturated fatty acids released by lipolysis have anti-inflammatory effects. Thus, the contribution of TGRL lipolysis to inflammation likely depends less on the TGRL concentration than on the balance between pro- and anti-inflammatory factors, and on the setting in which the lipolysis occurs. In the setting of the typical "Western" diet, enriched in saturated and oxidized fatty acids and excessive in size, this balance is likely to be tilted towards increased vascular inflammation and atherosclerosis. This article is part of a Special Issue entitled Triglyceride Metabolism and Disease.


Koska J.,Phoenix VA Health Care System | Schwartz E.A.,Phoenix VA Health Care System | Mullin M.P.,Phoenix VA Health Care System | Schwenke D.C.,Phoenix VA Health Care System | Reaven P.D.,Phoenix VA Health Care System
Diabetes Care | Year: 2010

OBJECTIVE - Endothelial dysfunction is frequently present in individuals with insulin resistance or type 2 diabetes and can be induced by high-fat or high-carbohydrate meals. Because exenatide reduces postprandial glucose and lipid excursions, we hypothesized that it may also improve postprandial endothelial function. RESEARCH DESIGN AND METHODS - In a double-blinded randomized crossover design, postprandial endothelial function was examined in 28 individuals with impaired glucose tolerance or recent-onset type 2 diabetes after a single injection of exenatide or placebo given just before a high-fat meal. Endothelial function was determined with peripheral arterial tonometry pre- and postprandially. RESULTS - Postprandial endothelial function was higher after exenatide compared with placebo (P = 0.0002). In the placebo phase, postprandial change in endothelial function was inversely associated with mean postprandial concentrations of triglycerides (r = -0.62, P = 0.0004). Changes in postprandial triglyceride concentrations explained 64% of exenatide's effect on postprandial endothelial function. CONCLUSIONS - Exenatide ameliorates postprandial endothelial dysfunction after a high-fat meal. © 2010 by the American Diabetes Association.

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