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Biomedical subjects

K W Kizer

Publications and source records attributed to K W Kizer.

At least 19 recordsLinked to original sources
PubMed1999

Geographic variations in utilization rates in Veterans Affairs hospitals and clinics.

BACKGROUND: In the United States, geographic variation in hospital use is common. It is uncertain whether there are similar geographic variations in the health care system of the Department of Veterans Affairs (VA), which differs from the private sector because it predominantly serves men with annual incomes below $20,000, has a central system of administration, and uses salaried physicians. Thus, it might be less likely to have geographic variations. METHODS: We used VA data bases to obtain information on patients treated for eight diseases (chronic obstructive pulmonary disease, pneumonia, congestive heart failure, angina, diabetes, chronic renal failure, bipolar disorder, and major depression). We analyzed their use of hospital and outpatient services by assessing the risk-adjusted numbers of hospital days (the average number of days a patient spent in the hospital per 12 months of follow-up, regardless of the number of hospital stays), hospital-discharge rates, and clinic-visit rates from 1991 through 1995 for the entire system and within the 22 geographically based health care networks. RESULTS: We found substantial geographic variation in hospital use for all eight cohorts of patients and all the years studied. Variations in the numbers of hospital days per person-year among the networks were greatest among patients with chronic obstructive pulmonary disease (ranging from a factor of 2.7 to a factor of 3.1) during a given year and smallest among patients with angina (ranging from a factor of 1.5 to a factor of 2.1). Levels of hospital use were highest in the Northeast and lowest in the West. The variation in the rates of clinic visits for principal medical care among the networks ranged from a factor of approximately 1.6 to a factor of 4.0; variations in the rates were greatest among patients with chronic renal failure and smallest among patients with chronic obstructive pulmonary disease. There was no clear geographic pattern in the rates of outpatient-clinic use. CONCLUSIONS: There are significant geographic variations in the use of hospital and outpatient services in the VA health care system. Because VA physicians are unable to increase their income by changing their patterns of practice, our findings suggest that their practice styles are similar to those of other physicians in their geographic regions.

Chronic Disease↗
PubMed1999

Research in the Veterans Health Administration: the report of the Research Realignment Advisory Committee.

In 1995 the Under Secretary for Health of the Department of Veterans Affairs constituted the Research Realignment Advisory Committee and charged it with reviewing the VA's research program. After meeting in 1995 and 1996, the committee identified 12 findings, which fall into four broad categories: allocation of research resources among VA research programs, acquisition and protection of resources, stability and maintenance of infrastructure, and outreach and communications. The most far-reaching recommendation was to establish designated research areas so that VA research could be focused more sharply on the specific needs of veterans while maintaining a research base for relatively less common conditions and needs integral to the VA's mission. The second major issue was that research funding should be increased (because it had fallen in inflation-adjusted dollars while the cost of doing research continued to rise). The third major area dealt with operational issues about how research was administered in the newly created system of geographically defined "veterans integrated service networks" and at the medical centers and how research monies flowed to medical centers. The final major area had to do with career development, for the committee considered the recruitment and retention of outstanding junior investigators to be a core function of VA research. The committee's recommendations, some of which have already been implemented, form the basis for strengthening the VA's research enterprise and for fully integrating it within the new structure of health care delivery in the VA.

Academic Medical Centers↗
PubMed1999

A survey of assaultive behavior in Veterans Health Administration facilities.

OBJECTIVE: To more clearly define the scope and impact of violence in health care facilities, national data on assaults in VA medical centers and freestanding clinics were examined. METHODS: A survey was distributed to all VA medical centers and freestanding clinics asking for cumulative data for one fiscal year (October 1990 through September 1991). Data were obtained on number, types, and locations of physical assaults and other assaultive behavior; the types of staff assaulted and number of workdays lost due to injuries; diagnoses of perpetrators; recommendations made after the incidents were reviewed; training in prevention and management of assaultive behavior; and the impact of training on rates of assaultive behavior. RESULTS: During the survey year, 24,219 incidents of assaultive behavior were reported by 166 VA facilities; 8,552 incidents involved battery or physical assault. Weapon possession by perpetrators was common (8.5 percent of incidents), and weapons were used in 130 assaults (1.5 percent of assaults). Assaults occurred most frequently in psychiatric units (43.1 percent), followed by long-term-care units (18.5 percent) and admitting or triage areas (13.4 percent). Assault-related injuries were most common among nursing personnel. Perpetrators of assaults were most typically diagnosed as having psychoses, substance use disorders, or dementia. On inpatient psychiatry units, an inverse correlation was found between expenditures on staffing and the frequency of assaultive incidents. Staff training on management of assaultive behavior varied widely. CONCLUSIONS: Assaultive behavior is a significant problem for health care workers. Staff in all clinical areas need to be prepared to deal with assaultive patients. More research is needed on staff training and interventions for preventing and limiting assaults.

Data Collection↗
PubMed1999

The health status of Gulf War veterans: lessons learned from the Department of Veterans Affairs Health Registry.

OBJECTIVE: To describe the demographic characteristics and postwar health status of U.S. Gulf War veterans who participated in the Department of Veterans Affairs health examination registry program. DESIGN: Case records of 52,835 veterans who participated in a standardized health examination program were reviewed. SETTING: Participants volunteered for physical examinations at a Department of Veterans Affairs medical treatment facility from August 1992 to September 1996. SUBJECTS: U.S. Gulf War veterans deployed to southwest Asia between August 1990 and 1996. MAIN OUTCOME MEASURE: Demographic, military, symptom, and International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic categories. RESULTS: A wide variety of symptoms and diagnoses were reported without apparent internal variation by military characteristics (branch and service component). The frequency of symptoms (fatigue, skin rash, headache, muscle and joint pain, and memory loss) reported increased over time, whereas the proportion of individuals with physician-diagnosed illnesses remained fairly constant. No single category of disease increased or decreased substantially over time. CONCLUSIONS: Veterans have experienced a wide variety of health problems since their Gulf War service. These problems, in aggregate, are different from what has been seen in other armed conflicts. The Department of Veterans Affairs registry is a very large case series and has failed to identify a single, unique syndrome or new illness after Gulf War service. An epidemiologic study would better define the prevalence of specific symptoms and medical conditions among Gulf War veterans and to what extent any of the conditions identified are associated with Gulf War military service. The knowledge provided by such studies would be important to development of preventive measures and future deployment medical surveillance planning.

Adult↗
PubMed1998

Oncology management by the "new" Veterans Health Administration.

BACKGROUND: The Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) manages the largest integrated health care system in the U.S. Cancer is second only to cardiovascular disease as a cause of patient mortality and morbidity. In the fiscal year 1996, malignancies accounted for 49,270 primary diagnoses at the time of discharge from acute hospitals. METHODS: VHA recently developed a national, uniform benefits package that provides oncologic services of prevention and screening, inpatient and outpatient services, rehabilitative care, reconstructive surgery, home health care, respite, and hospice care. VA classifies all hospitals according to American College of Surgeons (ACS) Commission on Cancer criteria and standards. One hundred four of 173 facilities are ACS-approved cancer centers. Eighty-six VA hospitals have cancer registries. RESULTS: VHA has developed a Prevention Index (PI) that consists of nine measures for prevention and early detection of influenza and pneumococcal diseases, tobacco consumption, alcohol abuse, and cancers of the breast, cervix, colon, and prostate. All cancer interventions in the PI showed substantial increases between 1996 and 1997, and all exceeded U.S. Public Health Healthy People 2000 goals. The Veterans Health Administration's performance measure regarding end-of-life planning calls for 95% of eligible patients to receive ongoing care. Current baseline performance is 52% nationally. Measures of patient satisfaction for oncology patients show overall satisfaction at 87%. CONCLUSIONS: The VA healthcare system has substantial expertise in the diagnosis and management of cancer. VHA's unprecedented transformation into a system of integrated networks supports and promotes that expertise. The VHA initiatives described in this article are synergistically working to enhance the consistency and comprehensiveness of high-quality, patient-centered oncologic services.

Delivery of Health Care, Integrated↗
PubMed1998

Emergency department diagnosis of abdominal disorders in the elderly.

To assess the accuracy of emergency department (ED) provisional diagnosis (ProDx) as compared with the hospital discharge diagnosis (HDDx) and the impact on hospital morbidity and mortality among nonelderly and elderly persons presenting with acute nontraumatic abdominal complaints, a retrospective review was conducted of 1,863 nonelderly (younger than 65 years) and 428 elderly (65 years or older) adults admitted to a university hospital from its ED. The sensitivity/ specificity of the ProDx was 82%/86% for patients younger than 65 versus 68%/76% for those 65 or older. When the ProDx and HDDx did not agree, the overall disease-related morbidity was 16% for patients younger than 65 versus 45% for those 65 or older (P < .02). There were no differences in mortality based on agreement of the ProDx and HDDx. Prospective studies to determine the factors that are most useful in the ED diagnosis of acute nontraumatic abdominal disorders in the elderly are needed to improve the accuracy of diagnosis and reduce the incidence of morbidity in this high-risk group.

Abdomen, Acute↗
PubMed1998

VA aligns health professions education with healthcare priorities.

In 1997, the Veterans Health Administration constituted the Associated Health Professions Education Review Committee to provide recommendations for its associated health training programs. The Committee recommended that support for the 54,000 trainees in over 45 non-physician disciplines that train every year in VA facilities be allocated based on patient-focused criteria that emphasize the VA's healthcare priorities. Such priorities include accessible primary care, geriatrics, treatment of substance abuse, chronic care, and rehabilitation. The Committee also placed a high priority on disciplines that demonstrate inter-professional strategies for healthcare delivery and training. Educational institutions and disciplines that address these needs in innovative ways will find opportunities for clinical training in VA settings.

Curriculum↗
PubMed1997

Pharmaceutical services in the Department of Veterans Affairs.

The status of pharmaceutical services in the Department of Veterans Affairs (VA) is described. The VA health care system is transforming itself from a hospital-based organization into 22 health care networks that emphasize primary and ambulatory care. The impact on VA pharmacy has been substantial. Roles of VA pharmacists and technicians have been enhanced, and a clinical career ladder for pharmacists was created. VA pharmacy officials and leaders from the University of Tennessee College of Pharmacy have been partnering since 1988 in strategic planning to determine how VA pharmacy can do business and serve patients better. Areas targeted for implementation or improvement include staff development, prescribing authority for pharmacists, automation, the physical design of VA pharmacies, residency programs, and a pharmacy benefit management (PBM) product line. The VA PBM is working to enhance the appropriate use of pharmaceuticals in the veteran population, reduce overall health care expenditures, and provide a more consistent quality of care. Specific PBM programs involve the implementation of drug treatment guidelines, a national formulary, and national contracts. There are plans for pharmacoepidemiologic and pharmacoeconomic research in the geriatric veteran population. The VA health care system and its pharmacy service are changing in ways intended to bring about easier access to care, higher quality, and increased responsiveness to patients' needs.

Automation↗
PubMed1997

The veterans healthcare system: preparing for the twenty-first century.

Since its establishment in 1946, the veterans healthcare system has greatly expanded in both size and responsibility. It is now the largest integrated healthcare system in the United States, the nation's largest provider of graduate medical and other health professionals training, and one of the largest research enterprises in America. It is also the nation's largest provider of services to homeless persons, an essential provider in the public healthcare safety net, and an increasingly important element in the federal response to disasters and national emergencies. Patterned after what was considered the best in American healthcare, for most of the past 50 years the Department of Veterans Affairs (VA) healthcare has focused primarily on acute inpatient care, high technology, and medical specialization. Now, in response to societal and industrywide forces, the Veterans Health Administration (VHA) is reengineering the veterans healthcare system, changing the operational and management structure from individual hospitals to 22 integrated service networks and transitioning the system to one that is grounded in ambulatory and primary care. This article briefly describes the history and functions of the veterans healthcare system, its service population, and key aspects of its restructuring.

Delivery of Health Care, Integrated↗
PubMed1996

Hospitalizations for firearm-related injuries. A population-based study of 9562 patients.

OBJECTIVE: To determine the incidence, nature, demographics, severity, and hospital charges associated with inpatient treatment of firearm-related injuries. DESIGN: A retrospective, 1-year, population-based study of firearm-related hospitalizations based on the 1991 California Hospital Discharge Abstract Data Tapes. SETTING: California acute care hospitals that reported firearm-related discharges. PATIENTS: A total of 9562 patients discharged with firearm-related injuries. MAIN OUTCOME MEASURES: Per capita hospital discharge rates, according to age, race, and sex. RESULTS: A total of 9562 firearm-injured persons were discharged from California hospitals in 1991, representing a rate of 32 discharges per 100 000 population. Males aged 15 to 24 years accounted for 72% of the hospitalizations. For all causes of firearm-related injury, the highest age- and race-specific discharge rate was 439 per 100,000 for black persons aged 15 to 24 years. The highest county discharge rate was 55 per 100,000 for Los Angeles County. Statewide, there were 1.8 hospital discharges per firearm-related fatality (both in the hospital and in the community). Assaults accounted for 74% of cases. Among black males aged 15 to 24 years, assaults accounted for 598 discharges per 100 000 population. Hospital charges for 9193 patients exceeded $164 million; mean and median charges per patient discharged were $17,888 and $8535, respectively. Publicly financed health insurance programs sponsored 56% of patients; 25% had private insurance, and 19% were uninsured. Fifty-three percent of the discharges occurred at 13 of the 371 hospitals that discharged patients with firearm-related injuries. CONCLUSIONS: Firearm-related violence is a major cause of hospitalization of young urban black males and represents a significant cost to publicly financed health care. The impact on individual hospitals is highly disproportionate. While hospital discharge data can be used for population-based surveillance of firearm-related trauma, there is need for improvement in local, state, and national surveillance of these injuries.

Adolescent↗