Healthcare Expenditures Associated With Implementing an External Facilitation Program to Increase the Prescribing of Medications Used for the Treatment of Opioid Use Disorder Among Veterans.

Background: To address the opioid use disorder (OUD) public health crisis, the ADvancing Pharmacological Treatments for OUD (ADaPT-OUD) external facilitation randomized trial was conducted in 8 intervention and 27 matched control low-performing Veterans Health Administration (VHA) facilities to increase the prescribing of medications for OUD (MOUD). Facilities were considered low-performers if they were in the bottom quartile of the facility ratio of Veterans with OUD who received MOUD. The objective of this analysis was to evaluate the healthcare expenditures of Veterans with OUD who received care in ADaPT-OUD intervention facilities compared to those receiving care in matched control facilities.

Human-centered design for smart home technologies: a framework for aging and mental health.

Smart home technologies (SHTs) offer promising ways to support older adults with both mobility challenges and mental health needs, yet high costs, complex interfaces, and uncertain data practices often limit adoption. This paper addresses these challenges by proposing a human-centered design (HCD) framework focused on affordability, inclusive design for physical and cognitive variations, and transparent data governance. Through illustrative examples of low-cost sensor networks and culturally tailored voice interfaces, we argue that thoughtfully designed SHTs can promote independent living, strengthen mental health interventions, and foster user trust.

Caregiver Communication and Preparedness During Transitions in Care: Results from a Randomized Controlled Trial.

Patients with severe and life-limiting illnesses transitioning out of the hospital often rely on family caregivers (FCGs) to manage communication with health care teams during hospitalizations and outpatient care. However, FCGs infrequently receive adequate training or support to prepare for these responsibilities. Effective communication between FCGs and health care teams is critical for preparing FCGs and reducing risks for poor outcomes.

Advancing the impact of research through a dissemination-focused special interest group.

Background: The proverbial gap between research and translation to the real world is a complex and multi-factorial issue that persists and threatens the impact of research. Dissemination and implementation science emerged as significant contributors to knowledge translation. Much attention has been focused on implementation, with less developed methods and work dedicated on dissemination.

Identifying Patient, Care Partner, and Clinician Needs for Functional Recovery Following Hospitalization When Dementia is Present.

Objectives: Persons with dementia are frequently hospitalized, which threatens their ability to return to and live at home. Current post-acute paradigms tend to default to short-term rehabilitation in a nursing home. Still, alternative post-acute care models are crucial for veterans with dementia to recover at home.

Feasibility of Group Telerehabilitation for Older Adults: A Quality Improvement Project.

A growing body of evidence suggests group rehabilitation may empower patients to achieve functional goals by leveraging social connectivity. From previous work, we adapted an in-person group for older Veterans to a telerehabilitation group called Fit for Life. The current quality improvement project aimed to evaluate the feasibility of implementing Fit for Life.

Feasibility and acceptability of post-hospitalization discharge calls to caregivers of Veterans with dementia: A quality improvement project.

Informal caregivers hold an important role in ensuring a smooth transition from hospital to home for persons with dementia. In this quality improvement project we evaluated the feasibility and acceptability of a caregiver-focused, nurse-led post discharge call to caregivers of Veterans with dementia recently discharged from a single medical center. The call focused on assessing caregiver preparedness and identifying unmet needs.

Assessing Family Caregiver Readiness for Hospital Discharge of Patients With Serious or Life-Limiting Illness Using Electronic Health Record (EHR) and Self-Reported Data.

Objective: To assess how patient and caregiver factors influence caregiver readiness for hospital discharge in palliative care patients.

Study Setting And Design: This transitional care study uses cross-sectional data from a randomized controlled trial conducted from 2018 to 2023 testing an intervention for caregivers of hospitalized adult patients with a serious or life-limiting illness who received a palliative care consult prior to transitioning out of the hospital.

Data Sources And Analytical Sample: Caregiver readiness was measured with the Family Readiness for Hospital Discharge Scale (n = 231).

Identifying factors influencing emerging innovations in hospital discharge decision making in response to system stress: a qualitative study.

Background: The purpose of this qualitative study was to identify emergent rehabilitation innovations and clinician perceptions influencing their implementation and outcomes related to hospital discharge decision-making during the Coronavirus 2019 pandemic.

Methods: Rehabilitation clinicians were recruited from the Veterans Affairs Health Care System and participated in individual semi-structured interviews guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Data were analyzed using a rapid qualitative, deductive team-based approach informed by directed content analysis.

The impact of internet connectivity when conducting a virtual clinical trial with participants living in rural areas.

Aim: The purpose of this secondary analysis was to describe issues related to internet connections during a virtual randomized clinical trial (v-RCT) that included family caregiver participants living in rural areas.

Background: Success of v-RCTs depends on reliable, high-quality internet access, which can be problematic in rural areas.

Methods: Interventionists documented connectivity issues and corrections made to address connectivity in a narrative note after each virtual visit with family caregivers enrolled in a v-RCT.

Economic Value of Unpaid Family Caregiver Time Following Hospital Discharge and at End of Life.

Context: Family caregivers (FCGs) play a crucial role in care for people with serious illness, yet unpaid care is often overlooked in estimates of care recipient (CR) care costs.

Objectives: This study quantifies the economic value of unpaid caregiving by FCGs between hospital discharge and end of life.

Methods: Trial participants were rural FCGs of CRs receiving palliative care during hospitalization.

Transitional Palliative Care for Family Caregivers: Outcomes From a Randomized Controlled Trial.

Context: Patients receiving inpatient palliative care often face physical and psychological uncertainties during transitions out of the hospital. Family caregivers often take on responsibilities to ensure patient safety, quality of care, and extend palliative care principles, but often without support or training, potentially compromising their health and well-being.

Objectives: This study tested an eight-week intervention using video visits between palliative care nurse interventionists and caregivers to assess changes in caregiver outcomes and patient quality of life.

Leveraging and learning from the long COVID experience: Translating telerehabilitation into practice.

Background: Telerehabilitation, or the delivery of rehabilitation services through telehealth platforms, has existed since the late 1990 s. Telerehabilitation was characterized by unprecedented, exponential growth at the beginning of the novel coronavirus-2019 (COVID-19) pandemic. Medical systems sought to reduce the likelihood of disease transmission by using telerehabilitation to limit physical proximity during routine care.

Caregiver recruitment strategies for interventions designed to optimize transitions from hospital to home: lessons from a randomized trial.

Challenges to recruitment of family caregivers exist and are amplified when consent must occur in the context of chaotic healthcare circumstances, such as the transition from hospital to home. The onset of the COVID-19 pandemic during our randomized controlled trial provided an opportunity for a natural experiment exploring and examining different consent processes for caregiver recruitment. The purpose of this publication is to describe different recruitment processes (in-person versus virtual) and compare diversity in recruitment rates in the context of a care recipient's hospitalization.

Reimagining How We Synthesize Information to Impact Clinical Care, Policy, and Research Priorities in Real Time: Examples and Lessons Learned from COVID-19.

Real-time clinical care, policy, and research decisions need real-time evidence synthesis. However, as we found during the COVID-19 pandemic, it is challenging to rapidly address key clinical and policy questions through rigorous, relevant, and usable evidence. Our objective is to present three exemplar cases of rapid evidence synthesis products from the Veterans Healthcare Administration Evidence Synthesis Program (ESP) and, in the context of these examples, outline ESP products, challenges, and lessons learned.

A Novel Behavioral Intervention to Enhance Physical Activity for Older Veterans in a Skilled Nursing Facility.

Physical activity levels during skilled nursing facility (SNF) rehabilitation fall far below what is needed for successful community living and to prevent adverse events. This feasibility study's purpose was to evaluate the feasibility, acceptability, and preliminary effectiveness of an intervention designed to improve physical activity in patients admitted to SNFs for short-term rehabilitation. High-Intensity Rehabilitation plus Mobility combined a high-intensity (i.

Healthcare use and out-of-pocket costs for rural family caregivers and care recipients in a randomized controlled trial.

Background: Rural family caregivers (FCGs) in the United States often experience high economic costs. This randomized controlled trial compared a transitional palliative care intervention (TPC) to support FCGs of seriously ill care recipients (CRs) to an attention control condition. We evaluated the TPC's effect on healthcare use and out-of-pocket spending for both FCGs and CRs.

Using brief reflections to capture and evaluate end-user engagement: a case example using the COMPASS study.

Background: Use of participatory research methods is increasing in research trials. Once partnerships are established with end-users, there is less guidance about processes research teams can use to successfully incorporate end-user feedback. The current study describes the use of a brief reflections process to systematically examine and evaluate the impact of end-user feedback on study conduct.

Evidence Map of Non-Pharmacological Dementia Care Partner Interventions Implemented in the US: Gaps and Impact Opportunities.

There are 200+ tested interventions for care partners (family, friends, and fictive kin) of people living with dementia (PLWD). But these interventions do not systematically cover relevant settings. Nor do these interventions affect all relevant outcomes that matter to people and healthcare systems.

Admission Cognition and Function Predict Change in Physical Function Following Skilled Nursing Rehabilitation.

Objectives: Many older adults are discharged from skilled nursing facilities (SNFs) at functional levels below those needed for safe, independent home and community mobility. There is limited evidence explaining this insufficient recovery. The purpose of this secondary analysis was to determine predictors of physical function change following SNF rehabilitation.

Applying i-PARIHS to Identify Emerging Innovations in Hospital Discharge Decision Making in Response to System Stress: A Qualitative Study.

Background: The purpose of this qualitative study was to use a Learning Health System approach to identify factors influencing the emergence of innovation in rehabilitation hospital discharge decision-making during the Coronavirus 2019 (COVID-19) pandemic.

Methods: Rehabilitation clinicians were recruited from the Veterans Affairs Health Care System and participated in individual semi-structured interviews guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Data were analyzed using a rapid qualitative, deductive team-based approach informed by directed content analysis.