CHERP Policy Briefs


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Improving End-of-Life Care for Veterans, 07/30/2009

Description:
The Department of Veterans Affairs (VA) provides health care to a rapidly-
aging population of five million Veterans. By 2010 the number of Veterans over the
age of 85 will be triple what it was in 2000. One of the challenges of providing care
to older patients is ensuring quality care at the end of life. While hospice and
palliative care provide many benefits critical to a “good death,” in 2002 few VA
health care facilities offered these services.

Patient Perceptions of Discrimination in Health Care Settings, 02/05/2009

Description:
Research by CHERP Investigator Leslie R.M. Hausmann, PhD suggests that perceptions of discrimination in health care settings are more common among African American patients and poor white patients. Her work also indicates that the experience of discrimination did not deter the pursuit of preventive health care services.

Racial Disparities in VA and Non-VA Hospital Outcomes among Elderly Patients, 06/10/2008

Description:
This research used VA and Medicare data to examine racial patterns in short- and long-term mortality outcomes for elderly male black and white patients hospitalized for heart attack, stroke, hip fracture, congestive heart failure, gastrointestinal bleeding, and pneumonia from 1998 to 2002. The researchers found that at 30 days after admission for five of the six conditions, racial patterns in mortality outcomes were similar in VA and non-VA settings, with black patients having a survival advantage. Among Medicare patients, relative to the mortality outcomes for whites, mortality outcomes for black patients deteriorated over time until black Medicare patients had worse 2-year mortality for all conditions except congestive heart failure. In contrast, among VA patients, the relative decline in mortality for blacks was less marked and statistically significant only for hip fracture and stroke. These findings suggest that factors unrelated to hospital care play important roles in longer term mortality rates for the examined conditions. The findings also suggest that the integrated health care delivery system of the VA may attenuate racial disparities in health by mitigating the environmental factors that contribute to mortality for up to two years after hospitalization.

Beyond Lab Data: Symptoms Matter for Hemodialysis Patients, 02/20/2008

Description:
Health care providers who treat hemodialysis patients appear to be unaware of the symptoms and resulting low quality of life that their patients endure.

Opportunities to Improve End-of-Life Care, 10/16/2007

Description:
Qualitative research demonstrates that patients and providers think differently about life-sustaining treatment and indicates that self-empowerment drives patient use of advance directives.

Policy and Consequences: Lessons from New Jersey Health Care Reform, 02/06/2007

Description:
Economic policy reform affecting New Jersey hospitals reduced the
quality of heart attack care among blacks and the uninsured, and also increased mortality for congestive heart failure and stroke among the uninsured.

Equity and New Medical Technologies, 08/11/2006

Description:
The latest innovations in medicine are not equally available to all patients and minorities are particularly less likely to receive the newest medical breakthroughs. This issue of the Policy Brief summarizes recent CHERP research to identify barriers to the equitable use of new medical technologies.

Making Practice Guidelines Work: Community Acquired Pneumonia, 02/20/2006

Description:
Guidelines only work if they are properly implemented. Fine and colleagues tested three guideline implementation strategies and found that a high-intensity strategy yielded the best compliance with community acquired pneumonia treatment guidelines.

U.S. Obesity, Weight Gain, and Socioeconomic Status, 12/05/2005

Description:
The current issue of the CHERP Policy Brief synthesizes two recent publications by CHERP investigator Virginia Chang, MD, PhD and colleagues that examine the relationships between income and income inequality and obesity and overweight.

Quality Initiative Sheds Light on Racial Disparities in Cardiovascular Care, 08/01/2005

Description:
The CRUSADE quality improvement initiative revealed racial disparities in the treatment of NSTE ACS, a common type of heart attack. These differences in treatment did not affect short-term outcomes and the long-term effects are unknown.

Pitfalls of Publicly Reported Quality Information, 04/26/2005

Description:
When the state of New York began releasing CABG report cards, it was thought that quality would improve. However, the initial result was an increase in racial and ethnic disparities in the receipt of the procedure. Though these differences in rates of CABG surgery attenuated over time, the findings by Werner and colleagues indicate that attention must be paid to the unintended consequences of publicly reported quality information.

Toward Understanding Bipolar Disorder, 01/11/2005

Description:
This issue of the CHERP Policy Brief focuses on Department of Veterans Affairs (VA) research concerning bipolar disorder. Indeed, the VA is a significant resource for increasing our knowledge about bipolar disorder. The researchers found that patients with bipolar disorder appear to be more at risk for treatable, chronic, general medical conditions than the general VA population. In addition, patients with bipolar disorder are often misdiagnosed and minority patients are particularly vulnerable to misdiagnoses. The implementation and standardization of guideline-based performance measures and the development of integrated treatment models customized for patients with bipolar disorder might alleviate some of these issues.

Optimizing Health Care for Women Veterans, 09/16/2004

Description:
Research by CHERP investigator Bevanne Bean-Mayberry, MD, MHS reveals usage patterns and satisfaction with VA health care among women veterans. VA might improve satisfaction and reduce use of non-VA health care among women veterans by ensuring that health care delivery models provide comprehensive services, either through women's clinics or through seamless integration of gynecological and traditional primary care.

Report from a Vulnerable Population: Alcohol Use and Abuse Among HIV-Infected Veterans, 07/08/2004

Description:
Research from the Veterans Aging Cohort Study 3-site Study (VACS-3) reveals that alcohol use and abuse among HIV-infected veterans is often unnoticed by physicians, despite its impact on medication adherance and overall health. Furthermore, there is little agreement between patient-reported drinking behavior and health care provider identification of that behavior.

The Importance of Understanding Patients’ Beliefs When Trying to Understand Disparities in Lung Cancer Surgery and Survival, 03/26/2004

Description:
The researchers found that the belief that tumors will spread at an accelerated rate upon surgery is widespread and that the belief is significantly more prevalent among African Americans than among Caucasians. These findings may be relevant to racial disparities in lung cancer surgery and survival.

Opportunities for Understanding Disparities in Joint Replacement Surgery, 12/17/2003

Description:
Said Ibrahim, MD, MPH and C. Kent Kwoh, MD explore the patient-level factors that may underlie racial differences in joint replacement utilization. The December 2003 Issue of the CHERP Policy Brief presents highlights from the results of their three-year study of Ethnic and Cultural Variations in the Management of Osteoarthritis.

Addressing Ethical Concerns about Patient Decision-Making Capacity at the End-of-Life, 09/08/2003

Description:
David Casarett, MD, MA proposes that ethical concerns about research among patients at the end of life can be addressed through guidelines that promote research but at the same time remain sensitive to the vulnerability of this patient population.