EHR-based interventions have potential for HF monitoring and case management, and may be feasible in improving QoL for patients.
Much remains to be done for effective HT integration in HBPC. Improving communication between HT and HBPC programs and establishing a system for identifying suitable patients for HT are vital. Future studies need to delineate operational processes and gather data on the added value of HT in HBPC to guide evidence-based integration of HT in VA and Medicare HBPC programs.
Background: Menopause is a time often fraught with changes and symptoms, which may require difficult choices and decision-making. During this period, women would benefit from a better understanding and indepth discussions with providers regarding menopause, associated conditions, and appropriate therapy. Patient portals offer a potential means to improve knowledge and shared decision-making (SDM) about menopause. Materials and Methods: This protocol article explores the feasibility of using the secure messaging (SM) function of the Veterans Affairs (VA) Patient Portal, ''My HealtheVet'' to implement an educational intervention and measure its impact on knowledge and SDM in the management of menopause. Results: This is a quality improvement pilot study in which women veterans of menopausal age in the Miami VA are offered an educational intervention via a patient portal, while women veterans in two neighboring VA facilities are not. Intervention participants receive weekly SMs with information on menopause symptoms, and treatment. After 6-months, all participants are surveyed on menopause knowledge, SDM, and satisfaction with the program. Conclusion: This study is among the first to assess the impact of an innovative patient portal intervention to improve knowledge and SDM between patients and providers regarding menopause. If successful, our program will add to the ''meaningful use'' of patient portals and offer a scalable and timely resource for SDM about menopause.
Using predictive analytic modelling, the Veterans Affairs has identified Veterans considered to be High Need High Risk (HNHR) requiring increased support. This pilot study sent needs assessment questionnaires to 1112 HNHR Veterans to better understand gaps regarding technology use, access, physical function, and mobility. There were 341(30.7%) respondents: 270(80.4%) Non-Hispanic, 64(18.8%) Hispanic/Latino; 210(61.6%) White, 119(34.9%) Black/African Americans; and 310(90.4%) had ≥high school education. Average Barthel(ADL) score was 81.5±22.8 and Lawton(IADL) score was 5.8±2.2. Younger Veterans (age<70) were more likely able to use Internet ((117(65%) vs 74(46%)),(p≤0.01) and email (106(58.9%) vs 67(41.6%),( p≤0.01). They were also more likely enrolled in MyHealtheVet (87(48.3%) vs 58(36%),(p=0.043). Secure messaging was used by 62(34.3%) younger and 37(23%) older Veterans,(p=0.026). More higher functioning Veterans (140(55.1%)) used email than lower functioning (33(37.9%)),(p=0.018). Among higher functioning Veterans, 148(58.3%) were willing to use videoconference for care coordination and 116(45.7%) owned a smartphone or computer with camera for this; more than lower functioning Veterans (33(37.9%) and 28(32.2%)), (p≤0.01 for both). Less dependent Veterans preferred to be contacted via cellphone (88(62.4%)) or Internet (10(7.1%)) compared to the more dependent (96(48%) and 6(3%)) respectively (p=0.01). Only 71(44.1%) of older Veterans were willing to use videoconference (p≤0.01) and 54(33.5%) owned a smartphone or computer with camera,(p≤0.01). There are significant variations in technology use by age and ethnicity. However, although there are differences by functional ability, a significant number of disabled veterans are willing and able to use technology, and this may provide a way to address access barriers in this population.
Using predictive analytic modeling, the Veterans Affairs has identified vulnerable Veterans, labeled as High Need High Risk (HNHR), as those who need greater services and support. To better understand their need gaps, we assessed function, mobility, mood, and caregiver status using a mailed needs assessment questionnaire to 1112 HNHR Veterans. Among the 341(30.7%) respondents, they were primarily 274(80.4%) Non-Hispanics; 210(61.6%) Whites, and 119(34.9%) Black or African Americans; average age was 69.5±9.6 years old; 310(90.4%) had ≥high school education. The average Barthel ADL score was 81.5±22.8 and average Lawton IADL score was 5.8±2.2. Walking or balance issues were present among 260(75.8%), 227(66.2%) said they use an assistive device, and 167(48.7%) had suffered ≥1 fall, 43(12.5%). Regarding depression, 117(34.3%) screened positive (PHQ2 score≥3). These were significantly younger (66.7±9.1) than those who did not (70.8±9.3, p≤0.01). They were also significantly lower functioning (5.37±2.1 vs.6.38±2 Lawton IADL score, p≤0.01), more dependent (77.8±23.1 vs 86±19.2 Barthel ADL score, p≤0.01). We also observed significant differences in their telephone contact with family (never to once/week) [35(29.9%) vs. 27(13.4%), (p≤0.01)]; in meeting with friends or relatives ≥3times a week [12(10.3%) vs. 69(34.3%), (p≤0.01)]; and in likelihood of attending meetings with clubs or other organizations [94(80.3%) vs. 138(68.7%), p=0.040]. Detecting depression is a priority among HNHR Veterans. There is an urgent need to devise viable strategies to offer interventions that incorporate mental health needs and reduce social isolation, potentially addressing mobility, function, and transportation.
An increasingly diverse population warrants an innovative and transformational educational approach to prepare the baccalaureate nurse to practice and lead. This article describes an innovation for teaching population health to meet complex community health needs and provide interprofessional collaborative opportunities and diverse leadership experiences. Course revision for clinical and didactic courses included the incorporation of cross-sector and interdisciplinary collaboration in the community, along with a strong emphasis on social determinants of health.
There is little research on the transition of experienced nurses from acute/clinical practice to academia. The transition into a faculty role can be overwhelming, isolating, and intimidating, even for expert nurse leaders and clinicians. This article presents the journey of two experienced nurse leaders who transitioned into academia and explores how to overcome challenges during the transition period.
When the Institute of Medicine released its report, commonly known as the Future of Nursing report, every state was challenged to take on the work of implementing the 8 recommendations. The Texas Team Action Coalition achieved measurable results in many areas; however, sustainability of efforts was challenging due to the volunteer nature of the work. As Robert Wood Johnson Foundation's focus shifted from Advancing Health Through Nursing to Building a Culture of Health for All, the Texas Team sought to realign its work accordingly. This article details initiatives of the Texas Team over the past 10 years and describes current efforts to position itself to champion anticipated recommendations from the 2020-2030 Future of Nursing report from the National Academy of Medicine.
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