No abstract

Objective-Nonadherence to CPAP increases health and functional risks of obstructive sleep apnea. The study purpose was to examine if disease and treatment cognitive perceptions influence short-term CPAP use.Methods-A prospective longitudinal study included 66, middle-aged (56.7 yr ± 10.7) subjects (34 [51.5%] Caucasians; 30 [45.4%] African Americans) with severe OSA (AHI 43.5 events/hr ± 24.6). Following full-night diagnostic/CPAP polysomnograms, home CPAP use was objectively measured at 1 week and 1 month. The Self Efficacy Measure for Sleep Apnea questionnaire (SEMSA), measuring risk perception, outcome expectancies, and self-efficacy, was collected at baseline, post-CPAP education, and after 1 week CPAP treatment. Regression models were used.Results-CPAP use at one week was 3.99 hr/night ± 2.48 and 3.06 hr/night ± 2.43 at one month. No baseline SEMSA domains influenced CPAP use. Post-education self-efficacy influenced one week CPAP use (1.52±0.53, p=0.007). Self-efficacy measured post-education and after one week CPAP use also influenced one month CPAP (1. 40±0.52, p=0.009; 1.20±0.50, p=0.02, respectively). Practice Implications-Patient education is important to OSA patients' formulation of accurate and realistic disease and treatment perceptions which influence CPAP adherence. Conclusion-CognitiveCorresponding Author: Amy M. Sawyer, Ph.D., R.N., University of Pennsylvania, School of Nursing, Claire M. Fagin Hall, Rm 307b, 418 Curie Blvd, Philadelphia, PA 19104, 215-573-2391, 215-888-2384, asawyer@nursing.upenn.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptStudies that have examined cognitive factors as influential on CPAP use have measured these variables at baseline and after treatment exposure. (20-22) When measured at baseline, these cognitive factors have not been consistently identified as influential on subsequent CPAP use. After 1 week of treatment exposure though, there is evidence to suggest that cognitive perceptions of disease and treatment are influential on both short-(i.e., 1 month) (20) and long-term CPAP use (i.e., 6 months). (21) The primary objective of our study was to determine if disease-specific cognitive perceptions influence CPAP use, specifically examining these factors not only at baseline and after 1 week of CPAP exposure, but also after the delivery of a standardized, disease-and treatment-specific patient education program provided prior to any treatment exposure. We addressed this objective by measuring cognitive perceptions with th...

Daily alarms combined with individual or partner feedback reports improved statin medication adherence. While neither an individual feedback nor partner feedback strategy created a sustainable medication adherence habit, the intervention itself is relatively easy to implement and low cost.

In Veterans who were reliant on the VA for services, increasing continuity with a VA PCP and high-functioning team-based care clinics was associated with fewer ED visits and hospitalizations. Furthermore, leveraging combined data from VA and Medicare allowed to better measure continuity and assess high-cost utilization among Veterans who are and are not reliant on the VA for services.

No abstract

Objective. To evaluate the effect of medical home implementation on primary care delivery in the Veterans Health Administration (VHA). Data Sources/Study Setting/Study Design. We link interview-based qualitative data on medical home implementation to quantitative outcomes from VHA clinical encounter data. We use a longitudinal analysis with provider fixed effects (taking advantage of variation in timing of implementation and allowing each provider to serve as a control for him or herself) to test whether patient-aligned care team (PACT) implementation was associated with changes in organizational processes and patient outcomes. Principal Findings. Among 683 PCPs, caring for 321,295 patients, the uptake of eight of nine PACT structural changes significantly increased from July 2010 to June 2012 as did the percentage of primary care appointments occurring by telephone and hospital discharges contacted within 2 days of discharge. We found that PACT implementation was associated with significant improvements in 2-day post-hospital discharge contact, but not primary care visits occurring by telephone or within 3 days of the requested date. We found no association between medical home implementation and rates of emergency department use by patients. Conclusions. Medical home implementation at the VHA resulted in large changes in the structure of care but few changes in patient-level outcomes. These results highlight both the complexity of studying the effect of the medical home as well as implementing this model to change primary care delivery.

No abstract

BACKGROUND As the veteran population ages, more veterans are receiving post‐acute care in skilled nursing facilities (SNFs). However, the outcomes of these transitions across Veterans Affairs (VA) and non‐VA settings are unclear. OBJECTIVE To measure adverse outcomes in veterans transitioning from hospital to SNF in VA and non‐VA hospitals and SNFs. DESIGN Retrospective observational study using the 2012 to 2014 Residential History File, which concatenates VA, Medicare, and Medicaid data into longitudinal episodes of care for veterans. SETTING VA and non‐VA hospitals and SNFs in four categories: non‐VA SNFs, VA‐contracted SNFs, VA Community Living Centers (CLCs), and State Veterans Homes. PARTICIPANTS Veterans, aged 65 years or older, who were acutely hospitalized and discharged to an SNF; one transition was randomly selected per patient. MEASUREMENTS Adverse “transitional care” outcomes were a composite of hospital readmission, emergency department visit, or mortality within 7 days of hospital discharge. RESULTS More than four in five veteran transitions (81.7%) occurred entirely outside the VA system. The overall 7‐day outcome rate was 10.7% in the 388 339 veterans included. Adverse outcomes were lowest in VA hospital–CLC transitions (7.5%; 95% confidence interval [CI] = 7.1%‐7.8%) and highest in non‐VA hospital to VA‐contracted nursing home transitions (17.5%; 95% CI = 16.0%‐18.9%) in unadjusted analysis. In multivariate analyses adjusted for patient and hospital characteristics, VA hospitals had lower adverse outcome rates than non‐VA hospitals (odds ratio [OR] = 0.80; 95% CI = 0.74‐0.86). In comparison to VA hospital–VA CLC transitions, non‐VA hospital to VA‐contracted nursing homes (OR = 2.51; 95% CI = 2.09‐3.02) and non‐VA hospital to CLC (OR = 2.25; 95% CI = 1.81‐2.79) had the highest overall adverse outcome rates. CONCLUSION Most veteran hospital‐SNF transitions occur outside the VA, although adverse transitional care outcomes are lowest inside the VA. These findings raise important questions about the VA's role as a provider and payer of post‐acute care in SNFs. J Am Geriatr Soc 67:1820–1826, 2019