Nancy Oliva

California’s Digital Divide: Clinical Information Systems For The Haves And Have-Nots

Strong barriers prevent the financing of clinical information systems (CIS) in health care delivery system organizations in market segments serving disadvantaged patients. These segments include community health centers, public hospitals, unaffiliated rural hospitals, and some Medicaid-oriented solo and small-group medical practices. Policy interventions such as loans, grants, pay-for-performance and other reimbursement changes, and support services assistance will help lower these barriers. Without intervention, progress will be slow and worsen health care disparities between the advantaged and disadvantaged populations.

Facilitation of a Multihospital Community of Practice to Increase Enrollment in the Hospital to Home National Quality Improvement Initiative.

BACKGROUND Hospital to Home (H2H) is a national quality improvement (QI) initiative composed of three recommended hospital interventions to improve the transition of care for hospitalized patients with heart disease. A study was conducted to determine if enrollment of Department of Veterans Affairs (VA) hospitals in H2H and adoption of the recommended interventions would both increase following facilitation of an existing Heart Failure (HF) provider-based community of practice (COP) within the VA health care system. The VA HF COP includes more than 800 VA providers and other VA staff from VA inpatient medical centers. METHODS In 2010, 122 VA hospitals were randomized to facilitation using the VA HF COP (intervention) or no facilitation (control). COP members from intervention hospitals were invited to periodic teleconferences promoting H2H and received multiple e-mails asking members to report interest and then progress in H2H implementation. RESULTS Among the 61 hospitals randomized to HF COP facilitation, 33 (54%) enrolled in H2H, compared with 6 (10%) of 61 control hospitals (p<.001) at five months after randomization. Of 38 intervention hospitals responding to the follow-up survey, 13 stated they had initiated 22 QI projects as a result of the H2H campaign. Another 7 hospitals had planned H2H projects. Of 20 control hospitals that responded, 5 had initiated 9 projects as a result of H2H, and no additional hospitals had plans to do so. CONCLUSIONS Facilitation using the VA HF COP was successful in increasing enrollment in the H2H initiative and providing implementation support for recommended QI projects. Multihospital provider groups are a potentially valuable tool for implementation of national QI campaigns.

Impact of the Hospital to Home Initiative on Readmissions in the VA Health Care System.

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.

RESOLV: Development of a telephone-based program designed to increase socialization in older veterans

ABSTRACT We describe the development of a telephone-based program, Recreation, Education, and Socialization for Older Learning Veterans (RESOLV) that aims to connect Veterans with one another by phone and thereby reduce loneliness. The program was developed through a collaboration between VA and a community-based organization, Episcopal Senior Communities Senior Center Without Walls (SCWW). Semi-structured interviews were conducted with 18 rural and non-rural dwelling older Veterans to identify leisure interests and potential barriers to participating in leisure activities. Program feasibility was examined with questions about telephone use and interest in and perceived benefits of a telephone community. We conducted content analysis to quantify Veterans’ leisure interests and thematic analysis to characterize barriers to participation. Veterans expressed interest most frequently in groups focused on conversation, support, gratitude, and technology. Rural and non-rural participants did not differ significantly in interests. Barriers to current activity participation included limited access to activities, limitations due to physical conditions, and transportation difficulties, which were consistent themes for both rural and non-rural participants. Themes related to perceived benefits of socialization that emerged include connectedness, learning from others, being active despite limitations, and distraction from limitations. Our findings demonstrate how a telephone-based socialization program could be developed and tailored for older Veterans. It seems that such a program is feasible and may be of benefit for older Veterans in rural and non-rural areas. Further evaluation is needed to ascertain the direct benefit of such a program to older Veterans.