scholarly journals Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1307 US academic medical centre inpatients and 427 224 US Medicare patients

2021 ◽  
pp. jech-2021-216697
Author(s):  
Joseph T King, Jr. ◽  
James S Yoon ◽  
Zachary M Bredl ◽  
Joseph P Habboushe ◽  
Graham A Walker ◽  
...  
Keyword(s):  
Characteristic Curve ◽  
Veterans Health Administration ◽  
Medical Centre ◽  
Veterans Health ◽  
Health Administration ◽  
Short Term ◽  
Academic Medical Centre ◽  
Academic Medical ◽  
All Cause Mortality ◽  
Short Term Mortality

BackgroundThe Veterans Health Administration COVID-19 (VACO) Index predicts 30-day all-cause mortality in patients with COVID-19 using age, sex and pre-existing comorbidity diagnoses. The VACO Index was initially developed and validated in a nationwide cohort of US veterans—we now assess its accuracy in an academic medical centre and a nationwide US Medicare cohort.MethodsWith measures and weights previously derived and validated in US national Veterans Health Administration (VA) inpatients and outpatients (n=13 323), we evaluated the accuracy of the VACO Index for estimating 30-day all-cause mortality using area under the receiver operating characteristic curve (AUC) and calibration plots of predicted versus observed mortality in inpatients at a single US academic medical centre (n=1307) and in Medicare inpatients and outpatients aged 65+ (n=427 224).Results30-day mortality varied by data source: VA 8.5%, academic medical centre 17.5%, Medicare 16.0%. The VACO Index demonstrated similar discrimination in VA (AUC=0.82) and academic medical centre inpatient population (AUC=0.80), and when restricted to patients aged 65+ in VA (AUC=0.69) and Medicare inpatient and outpatient data (AUC=0.67). The Index modestly overestimated risk in VA and Medicare data and underestimated risk in Yale New Haven Hospital data.ConclusionsThe VACO Index estimates risk of short-term mortality across a wide variety of patients with COVID-19 using data available prior to or at the time of diagnosis. The VACO Index could help inform primary and booster vaccination prioritisation, and indicate who among outpatients testing positive for SARS-CoV-2 should receive greater clinical attention or scarce treatments.

scholarly journals Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1,307 Yale New Haven Hospital inpatients and 427,224 Medicare patients

2021 ◽  
Author(s):  
Joseph T. King ◽  
James S. Yoon ◽  
Zachary M. Bredl ◽  
Joseph P. Habboushe ◽  
Graham A. Walker ◽  
...  
Keyword(s):  
Veterans Health Administration ◽  
Sensitivity Analyses ◽  
Veterans Health ◽  
Health Administration ◽  
New Haven ◽  
Short Term ◽  
Short Term Mortality ◽  
Patient Subgroups ◽  
Haven Hospital ◽  
Over Time

AbstractBackgroundThe Veterans Health Administration COVID-19 (VACO) Index incorporates age, sex, and pre-existing comorbidity diagnoses readily available in the electronic health record (EHR) to predict 30-day all-cause mortality in both inpatients and outpatients infected with SARS-CoV-2. We examined the performance of the Index using data from Yale New Haven Hospital (YNHH) and national Medicare data overall, over time, and within important patient subgroups.Methods and findingsWith measures and weights previously derived and validated in a national Veterans Healthcare Administration (VA) sample, we evaluated the accuracy of the VACO Index for estimating inpatient (YNHH) and both inpatient and outpatient mortality (Medicare) using area under the receiver operating characteristic curve (AUC) and comparisons of predicted versus observed mortality by decile (calibration plots). The VACO Index demonstrated similar discrimination and calibration in both settings, over time, and among important patient subgroups including women, Blacks, Hispanics, Asians, and Native Americans. In sensitivity analyses, we allowed component variables to be re-weighted in the validation datasets and found that weights were largely consistent with those determined in VA data. Supplementing the VACO Index with body mass index and race/ethnicity had no effect on discrimination.ConclusionAmong COVID-19 positive individuals, the VACO Index accurately estimates risk of short-term mortality among a wide variety of patients. While it modestly over-estimates risk in recent intervals, the Index consistently identifies those at greatest relative risk. The VACO Index could identify individuals who should continue practicing social distancing, help determine who should be prioritized for vaccination, and among outpatients who test positive for SARS-CoV-2, indicate who should receive greater clinical attention or monoclonal antibodies.

scholarly journals Survival and Causes of Death Among Veterans With Lower Extremity Revascularization With Paclitaxel‐Coated Devices: Insights From the Veterans Health Administration

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Jorge Antonio Gutierrez ◽  
Sunil V. Rao ◽  
William Schuyler Jones ◽  
Eric A. Secemsky ◽  
Aaron W. Aday ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Veterans Health Administration ◽  
Endovascular Intervention ◽  
Veterans Administration ◽  
Veterans Health ◽  
Coding System ◽  
Health Administration ◽  
Term Survival ◽  
All Cause Mortality

BACKGROUND The long‐term safety of paclitaxel‐coated devices (PCDs; drug‐coated balloon or drug‐eluting stent) for peripheral endovascular intervention is uncertain. We used data from the Veterans Health Administration to evaluate the association between PCDs, long‐term mortality, and cause of death. METHODS AND RESULTS Using the Veterans Administration Corporate Data Warehouse in conjunction with International Classification of Diseases, Tenth Revision ( ICD‐10 ) Procedure Coding System, Current Procedural Terminology, and Healthcare Common Procedure Coding System codes, we identified patients with peripheral artery disease treated within the Veterans Administration for femoropopliteal artery revascularization between October 1, 2015, and June 30, 2019. An adjusted Cox regression, using stabilized inverse probability–weighted estimates, was used to evaluate the association between PCDs and long‐term survival. Cause of death data were obtained using the National Death Index. In total, 10 505 patients underwent femoropopliteal peripheral endovascular intervention; 2265 (21.6%) with a PCD and 8240 (78.4%) with a non‐PCD (percutaneous angioplasty balloon and/or bare metal stent). Survival rates at 2 years (77.4% versus 79.7%) and 3 years (70.7% versus 71.8%) were similar between PCD and non‐PCD groups, respectively. The adjusted hazard for all‐cause mortality for patients treated with a PCD versus non‐PCD was 1.06 (95% CI, 0.95–1.18, P =0.3013). Among patients who died between October 1, 2015, and December 31, 2017, the cause of death according to treatment group, PCD versus non‐PCD, was similar. CONCLUSIONS Among patients undergoing femoropopliteal peripheral endovascular intervention within the Veterans Administration Health Administration, there was no increased risk of long‐term, all‐cause mortality associated with PCD use. Cause‐specific mortality rates were similar between treatment groups.

Suicide, Homicide, and All-Cause Mortality Among Transgender and Cisgender Patients in the Veterans Health Administration

LGBT Health ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 173-180
Author(s):  
Taylor L. Boyer ◽  
Ada O. Youk ◽  
Ann P. Haas ◽  
George R. Brown ◽  
Jillian C. Shipherd ◽  
...  
Keyword(s):  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
All Cause Mortality

scholarly journals Age, Race and Cardiovascular Outcomes in African American Veterans

2016 ◽  
Vol 26 (3) ◽  
pp. 305 ◽  
Author(s):  
Keith C. Norris ◽  
George A. Mensah ◽  
L. Ebony Boulware ◽  
Jun L. Lu ◽  
Jennie Z. Ma ◽  
...  
Keyword(s):  
Health Care ◽  
African American ◽  
Ischemic Stroke ◽  
African Americans ◽  
Lower Incidence ◽  
Veterans Health Administration ◽  
Cardiovascular Outcomes ◽  
Veterans Health ◽  
Health Administration ◽  
All Cause Mortality

<p><strong>Background: </strong>In the general population, compared wtih their White peers, African Americans suffer premature all-cause and cardiovascular (CV) deaths, attributed in part to reduced access to care and lower socioeconomic status. Prior reports indicated younger (aged 35 to 44 years) African Americans had a signficantly greater age-adjusted risk of death. Recent studies suggest that in a more egalitarian health care structure than typical United States (US) health care structures, African Americans may have similar or even better CV outcomes, but the impact of age is less well-known. <strong></strong></p><p><strong>Methods: </strong>We examined age stratified all-cause mortality, and incident coronary heart disease (CHD) and ischemic stroke in 3,072,966 patients (547,441 African American and 2,525,525 White) with an estimated glomerular filtration rate (eGFR)&gt;60 mL/min/1.73m2 receiving care from the US Veterans Health Administration. Outcomes were examined in Cox models adjusted for demographics, comorbidities, kidney function, blood pressure, socioeconomics and indicators of the quality of health care delivery. <strong></strong></p><p><strong>Results: </strong>African Americans had an overall 30% lower all-cause mortality (P&lt;.001) and 29% lower incidence of CHD (P&lt;.001) and higher incidence of ischemic stroke (aHR, 95%CI: 1.16, 1.13-1.18, P&lt;.001). The lower rates of mortality and CHD were strongest in younger African Americans and attenuated across patients aged <span style="text-decoration: underline;">&gt;</span>70 years. Stroke rates did not differ by race in persons aged &lt;70 years. <strong></strong></p><p><strong>Conclusions: </strong>Among patients with normal eGFR and receiving care in the Veterans Health Administration, younger African Americans had lower all-cause mortality and incidence of CHD and similar rates of stroke, independent of demographic, comorbidity and socioeconomic differences. The lower all-cause mortality persisted but attenuated with increasing age and the lower incidence of CHD ended at aged ≥80 years. The higher incidence of ischemic stroke in African Americans was driven by increasing risk in patients aged ≥70 years suggesting that the improved cardiovascular outcomes were most dramatic for younger African Americans. <em>Ethn Dis. </em>2016;26(3):305-314; doi:10.18865/ed.26.3.305 </p>

An Intervention With Meaning

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 376-383 ◽  
Author(s):  
Brooke A. Levandowski ◽  
Constance M. Cass ◽  
Stephanie N. Miller ◽  
Janet E. Kemp ◽  
Kenneth R. Conner
Keyword(s):  
High Risk ◽  
Qualitative Methodology ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Safety Planning ◽  
Health Administration ◽  
Suicide Method ◽  
Treatment Providers ◽  
Interactive Nature ◽  
Behavioral Health Treatment

Abstract. Background: The Veterans Health Administration (VHA) health-care system utilizes a multilevel suicide prevention intervention that features the use of standardized safety plans with veterans considered to be at high risk for suicide. Aims: Little is known about clinician perceptions on the value of safety planning with veterans at high risk for suicide. Method: Audio-recorded interviews with 29 VHA behavioral health treatment providers in a southeastern city were transcribed and analyzed using qualitative methodology. Results: Clinical providers consider safety planning feasible, acceptable, and valuable to veterans at high risk for suicide owing to the collaborative and interactive nature of the intervention. Providers identified the types of veterans who easily engaged in safety planning and those who may experience more difficulty with the process. Conclusion: Additional research with VHA providers in other locations and with veteran consumers is needed.

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