Greater Los Angeles VA Health Care System

Los Angeles, CA, United States

Greater Los Angeles VA Health Care System

Los Angeles, CA, United States
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Goebel J.R.,California State University, Long Beach | Ahluwalia S.C.,Oregon State University | Chong K.,Quality Improvement Resource Center | Shreve S.T.,Lebanon VA Health Care System | And 6 more authors.
Journal of Palliative Medicine | Year: 2014

Background: Increasing emphasis in performance-based payment, public reporting, and quality improvement (QI) has led to widespread interest in measuring and improving the quality of care. By 2014, hospice programs will be required to report quality data to the federal government or incur financial penalties. With this increased interest in quality reporting comes an opportunity to develop informatics tools to capture data that reflect the complex practices involved in palliative care (PC). Therefore, there is a need to disseminate information on developing tools that facilitate capturing data and fostering improved performance. The Veterans Health Care Administration, a national leader in health information technology (HIT) and PC, established the Quality Improvement Resource Center (QuIRC) to develop innovative HIT tools to standardize and improve PC practices throughout the 153 Department of Veterans Affairs (VA) medical centers nationwide. Objective: The aim of the paper is to describe the development of the Palliative Care-National Clinical Template (PC-NCT) for documenting initial PC consults. Results: Domains of quality of life provided the foundation for this template. Principles of user-centered informatics design guided development activities. A national consensus panel of PC experts prioritized quality indicators as targets for QI. An interdisciplinary team of PC providers identified desired aspects of template functionality. QuIRC balanced PC providers' desired aspects of functionality against the feasibility within the VA HIT system. Formal pilot and usability testing contributed to numerous iterations of the PC-NCT currently piloted in five geographically distributed sites. Conclusion: This paper presents a robust approach to developing an informatics tool for PC practice. Data collected via the PC-NCT will bring variations in current practice into view and assist in directing resources at "important targets" for QI. Although the development of HIT tools to quantify PC practice is complex, there is enormous potential to improve the quality of care for patients and families facing serious illnesses. © 2014 Mary Ann Liebert, Inc.


Heidenreich P.A.,Veterans Administration Palo Alto Health Care System | Sahay A.,Veterans Administration Palo Alto Health Care System | Oliva N.,Veterans Administration Palo Alto Health Care System | Gholami P.,Veterans Administration Palo Alto Health Care System | And 3 more authors.
Quality Management in Health Care | Year: 2016

Background: Hospital to Home (H2H) is a national quality improvement initiative sponsored by the Institute for Healthcare Improvement and the American College of Cardiology, with the goal of reducing readmission for patients hospitalized with heart disease. We sought to determine the impact of H2H within the Veterans Affairs (VA) health care system. Methods: Using a controlled interrupted time series, we determined the association of VA hospital enrollment in H2H with the primary outcome of 30-day all-cause readmission following a heart failure hospitalization. VA heart failure providers were surveyed to determine quality improvement projects initiated in response to H2H. Secondary outcomes included initiation of recommended H2H projects, follow-up within 7 days, and total hospital days at 30 days and 1 year. Results: Sixty-five of 104 VA hospitals (66%) enrolled in the national H2H initiative. Hospital characteristic associated with H2H enrollment included provision of tertiary care, academic affiliation, and greater use of home monitoring. There was no significant difference in mean 30-day readmission rates (20.0% ± 5.0% for H2H vs 19.3% ± 5.9% for non-H2H hospitals; P =.48) The mean fraction of patients with a cardiology visit within 7 days was slightly higher for H2H hospitals (3.0% ± 2.4% for H2H vs 2.0% ± 1.9% for non-H2H hospitals; P =.05). Patients discharged from H2H hospitals had fewer mean hospitals days during the following year (7.6% ± 2.6% for H2H vs 9.2% ± 3.0 for non-H2H; P =.01) early after launch of H2H, but the effect did not persist. Conclusions: VA hospitals enrolling in H2H had slightly more early follow-up in cardiology clinic but no difference in 30-day readmission rates compared with hospitals not enrolling in H2H. © Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.


Li Z.,University of California at Los Angeles | Li Z.,Greater Los Angeles VA Health Care System | Treyzon L.,University of California at Los Angeles | Chen S.,University of California at Los Angeles | And 3 more authors.
Nutrition Journal | Year: 2010

Background. There is concern that recommending protein-enriched meal replacements as part of a weight management program could lead to changes in biomarkers of liver or renal function and reductions in bone density. This study was designed as a placebo-controlled clinical trial utilizing two isocaloric meal plans utilizing either a high protein-enriched (HP) or a standard protein (SP) meal replacement in an outpatient weight loss program. Subjects/methods. 100 obese men and women over 30 years of age with a body mass index (BMI) between 27 to 40 kg/m2 were randomized to one of two isocaloric weight loss meal plans 1). HP group: providing 2.2 g protein/kg of lean body mass (LBM)/day or 2). SP group: providing 1.1 g protein/kg LBM/day. Meal replacement (MR) was used twice daily (one meal, one snack) for 3 months and then once a day for 9 months. Body weight, lipid profiles, liver function, renal function and bone density were measured at baseline and 12 months. Results. Seventy subjects completed the study. Both groups lost weight (HP -4.29 5.90 kg vs. SP -4.66 6.91 kg, p < 0.01) and there was no difference in weight loss observed between the groups at one year. There was no significant change noted in liver function [AST (HP -2.07 10.32 U/L, p = 0.28; SP 0.27 6.67 U/L, p = 0.820), ALT (HP -1.03 10.08 U/L, p = 0.34; SP -2.6 12.51 U/L, p = 0.24), bilirubin (HP 0.007 0.33, U/L, p = 0.91; SP 0.07 0.24 U/L, p = 0.120), alkaline phosphatase (HP 2.00 9.07 U/L, p = 0.240; SP -2.12 11.01 U/L, p = 0.280)], renal function [serum creatinine (HP 0.31 1.89 mg/dL, p = 0.380; SP -0.05 0.15 mg/dL, p = 0.060), urea nitrogen (HP 1.33 4.68 mg/dL, p = 0.130; SP -0.24 3.03 mg/dL, p = 0.650), 24 hour urine creatinine clearance (HP -0.02 0.16 mL/min, p = 0.480; SP 1.18 7.53 mL/min, p = 0.400), and calcium excretion (HP -0.41 9.48 mg/24 hours, p = 0.830; SP -0.007 6.76 mg/24 hours, p = 0.990)] or in bone mineral density by DEXA (HP 0.04 0.19 g/cm2, p = 0.210; SP -0.03 0.17 g/cm2, p = 0.320) in either group over one year. Conclusions. These studies demonstrate that protein-enriched meals replacements as compared to standard meal replacements recommended for weight management do not have adverse effects on routine measures of liver function, renal function or bone density at one year. Clinicaltrial.gov: NCT01030354. © 2010 Li et al; licensee BioMed Central Ltd.


Yusin J.S.,Greater Los Angeles VA Health Care System | Klaustermeyer W.,University of California at Los Angeles | Simmons C.W.,Greater Los Angeles VA Health Care System | Baum M.,Greater Los Angeles VA Health Care System
Allergologia et Immunopathologia | Year: 2013

Background: Patients with a history of beta-lactam antibiotic allergy are often admitted to the hospital with severe or life-threatening infections requiring beta-lactam antibiotics. Strict avoidance of beta lactams to such patients may prevent them from getting adequate coverage and can lead to an increase in the use of alternative antibiotics, which can predispose to antibiotic resistance. Past studies revealed a lower incidence of pen allergy then patients' histories suggest. Fortunately today, there are three options for patients presenting with a history of beta-lactam allergy. Penicillin skin testing, beta-lactam challenge or beta-lactam desensitization. Recently Pre Pen has been FDA re-approved and when combined with Pen G is a valid way to determine if patients are able to tolerate beta-lactam antibiotic. When these agents are not available one must decide about desensitization or challenge. When a patient has a positive penicillin skin test, desensitization or beta-lactam avoidance are the only options. This paper reviews the safety of beta-lactam desensitization. Objective: To perform a chart review on patients desensitised with beta lactam to determine if desensitizations can be performed safely without minimal complications. Methods: A retrospective chart review was performed on allergy and immunology inpatient consultations for beta-lactam desensitization between September 2003 and August 2006 at the Cedars-Sinai Medical Centre in Los Angeles. Patient data and outcomes of desensitization were analysed. Results: A total of 13 intravenous desensitizations were performed on 12 patients. The patients consisted of eight females and four males with an average age of 65 years. Age range was 36-92 years old. All 13 intravenous desensitizations were completed without complications. No patient required a slower rate of desensitization or discontinuance of the desensitization. Patients were able to tolerate the initial therapeutic dose of their beta-lactam antibiotic and were then able to complete full therapeutic courses of their antibiotic. Conclusion: Beta-lactam antibiotic sensitivity continues to present a challenging problem for physicians. Patients with drug resistant infections who are unable to obtain skin testing or who test positive to skin tests may need either a challenge or desensitization. Desensitization, saved for those with a convincing beta-lactam hypersensitivity history is often the choice of last resort given the associated cost and risk of anaphylaxis. However, once desensitization is complete, patients are usually able to tolerate full doses of antibiotics for full treatment length with minimal side effects. © 2012.

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