Participation in the community eligibility provision - a universal free school meals policy in the United States in 2014-2020.

We assessed the association of participation in the Community Eligibility Provision, a universal free school meals policy in the United States, with school and area-level characteristics, and how these associations changed between 2014 and 2020. Using logistic regression models with district-clustered standard errors, in 53,391 eligible schools nationwide, adjusted prevalence of participation was 3.8 percentage points (pp) lower among high schools relative to elementary schools (95% CI: 1.

Guiding Technology Adoption in Rehabilitation: A Framework from the Rehabilitation Technology Implementation for Promising Solutions (Rehab TIPS) Workgroup.

There is an unprecedented growth in health and rehabilitation technologies influencing service delivery. While adopting emergent or existent technologies may add value to rehabilitation services and outcomes, clinicians face uncertainties on whether and how to adopt new technologies. Because of these challenges, rehabilitation stakeholders need to be active agents in the development, adoption, and ongoing evaluation of a given technology's impact.

Collaborative Care for Opioid Use Disorder in Primary Care: A Hybrid Type 2 Cluster Randomized Clinical Trial.

Importance: The criterion-standard treatment for opioid use disorder (OUD) is medications for OUD (MOUD). However, less than a quarter of people with OUD receive MOUD. The collaborative care model (CCM) is an evidence-based practice that integrates mental and physical health treatment in primary care settings.

Patient Attitudes Toward Substance Use Screening and Discussion in Primary Care: Comparison Across Demographic Characteristics.

Introduction: Screening for unhealthy alcohol and drug use is recommended in primary care, and effective implementation requires understanding patients' perspectives. Failure to identify and address potential differences in attitudes toward screening across demographic groups may result in care gaps, but research examining this is limited.

Methods: We surveyed 977 adult patients in 9 primary care clinics that participated in a screening implementation study.

The use of cost analysis in examinations of health coaching interventions: a scoping review protocol.

Introduction: Health coaching is the process of working with a trained coach, peer, or healthcare professional towards self-determined health and wellness goals. Health coaching is being increasingly adopted in multiple healthcare settings and has been shown to improve overall health outcomes and long-term maintenance of chronic conditions in multiple countries and healthcare settings. Research surrounding the costs of implementing health coaching and its effects on healthcare costs, particularly long-term costs, has been limited.

High Users of Primary Care Secure Messaging in the Veterans Health Administration.

Purpose: Secure messaging has increased in primary care, but we lack information on who uses it at a high level. Characterizing this population is important to inform policy about patients most likely to be affected by secure messaging reimbursement and coverage decisions; to contextualize the secure messaging work burden for primary care; and to understand how secure messaging complements use of other primary care access points. Our objectives were to describe characteristics of high users, assess their overall primary care and emergency department use, and determine the proportion of total Veterans Health Administration primary care messages exchanged by this group.

Engaging Patients in Organ Transplant Listing Meetings: A Survey Study.

Organ transplant listing decisions are made by multidisciplinary selection committees using structured, deliberative processes to evaluate candidate eligibility. Engaging patients in these meetings has been proposed as a strategy to enhance transparency, trust, and patient-centered care. This study assessed patient and professional perspectives via an online survey of 1,349 American Society of Transplantation (AST) and National Kidney Foundation (NKF) members (907 patients, caregivers, family; 442 transplant team members).

Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005-2022: a repeated cross-sectional study.

Background: We investigated whether the associations of state medical and recreational cannabis legalization (MCL, RCL enactment) with increasing prevalence of Cannabis Use Disorder (CUD) differed among patients in the United States (US) Veterans Health Administration (VHA) who did or did not have common psychiatric disorders.

Methods: Electronic medical record data (2005-2022) were analyzed on patients aged 18-75 with ≥1 VHA primary care, emergency department, or mental health visit and no hospice/palliative care within a given year (sample sizes ranging from 3,234,382 in 2005 to 4,436,883 in 2022). Patients were predominantly male (>80%) and non-Hispanic White (>60%).

Associations Between Contraceptive Counseling Quality and Contraceptive Use in a National Survey of Women Veterans.

Contraceptive counseling quality is associated with trust in providers, method satisfaction, and method continuation. Little is known, however, about associations between counseling quality and method choice, particularly for methods requiring a high level of involvement of providers to initiate and stop the method. Investigate associations between experiences of high- or low-quality counseling and contraceptive method type.

Complementary and Integrative Health Therapies and Pain: Delivery Through Veterans Affairs and Community Care.

Background: Complementary and Integrative Health (CIH) services are a national priority for the Department of Veterans Affairs (VA) healthcare system and can be effective in reducing chronic pain. Eligible VA patients can receive their CIH care through a VA clinic, or through community care (CC) funded by the VA. The present study compares the effectiveness of 3 CIH services (acupuncture, chiropractic, and medical massage therapy) delivered in direct care by VA vs CC providers at improving veterans' chronic pain.

Ethnoracial inequities in social stressors and patterns of alcohol use in a population of United States transgender Veterans.

Background: Due to marginalization, transgender and people of color living in the United States (U.S.) experience disparities in social determinants of health and mental health outcomes.

Understanding Patient Preferences Regarding Limb Salvage for Diabetic Foot Ulcers: A Discrete Choice Experiment.

Objective: Diabetic foot ulcers (DFUs) often lead to amputations. Limb salvage aims to preserve the lower extremity, but the complexity of care and uncertainty of healing can delay patients' return to normal activities. This study aimed to understand military veterans' preferences regarding limb salvage for DFUs, using a discrete choice experiment (DCE).

"All it's gonna tell you is if it has fentanyl or not:" Perceptions of fentanyl and drug checking among first responders and people who use drugs.

Introduction: Fentanyl contamination in the unregulated drug supply contributes to high rates of opioid overdose among people who use drugs (PWUD). Drug checking is a harm reduction strategy that provides PWUD with information about the contents of their substances. Although drug checking has broad utility, this study focused specifically on drug checking to test for fentanyl, with a particular emphasis on fentanyl test strips (FTS) and point-of-care testing at community service organizations.

System-Level Predictors of Long-Acting Reversible Contraception Provision in the Veterans Health Administration.

Objective: To examine the provision of long-acting reversible contraceptive (LARC) methods across the Veterans Health Administration's (VA) 140 regional healthcare systems and investigate system-level correlates of low provision as an indicator of potential access barriers.

Study Setting And Design: We conducted a cross-sectional analysis of national VA electronic health record (EHR) data. For each regional healthcare system, we calculated the percentage of pregnancy-capable Veterans who received a LARC method (intrauterine device or contraceptive implant).

Cannabis Legalization and Opioid Use Disorder in Veterans Health Administration Patients.

Importance: In the context of the US opioid crisis, factors associated with the prevalence of opioid use disorder (OUD) must be identified to aid prevention and treatment. State medical cannabis laws (MCL) and recreational cannabis laws (RCL) are potential factors associated with OUD prevalence.

Objective: To examine changes in OUD prevalence associated with MCL and RCL enactment among veterans treated at the Veterans Health Administration (VHA) and whether associations differed by age or chronic pain.

Alcohol Use and COVID-19 Outcomes.

Background: There is increasing recognition that health behaviors may contribute to outcomes following COVID-19, but information on the role of alcohol use is limited.

Research Question: Are different severity levels of preexisting alcohol use disorder (AUD), alcohol consumption, and their combination associated with 30-day COVID-19 outcomes?

Study Design And Methods: Using data from a US national cohort (Veterans Health Administration), we determined the risk associated with AUD, based on diagnostic codes including alcohol abuse, alcohol dependence, and alcohol-related disease (ARD) for COVID-19-related outcomes: mild (outpatient management), moderate (hospitalization), critical (hospitalization with indicators of critical illness), or death. We determined the modification of this risk for different levels of self-reported alcohol consumption, using categories defined by an alcohol use screening tool (Alcohol Use Disorders Identification Test-Consumption).

Staff Experiences With Implementation of the Referral Coordination Initiative.

Objective: To understand VHA staff experiences with the referral coordination initiative (RCI) following nationwide dissemination.

Study Setting And Design: RCI uses a team-based approach to improve the timeliness, efficiency, and patient-centeredness of specialty care referrals, while redistributing the time-intensive triage tasks from specialist providers to nurses. To assess frontline experiences with RCI, we purposively sampled four VHA sites for qualitative interviews, ensuring variability around the use of nurses in triage and the organization of scheduling staff within three high-volume specialties: cardiology, gastroenterology, and pulmonary.

Veteran Mental Health Emergency Care Utilization Following SARS-CoV-2 Infection.

Objective: To evaluate whether Veterans infected with SARS-CoV-2 have an elevated risk for needing mental health emergency care (MHEC) relative to uninfected comparators, as measured by emergency department or urgent care clinic utilization for a mental health diagnosis.

Data Sources/extraction: Data from Veterans Health Administration (VHA), VHA-paid, and Centers for Medicare & Medicaid-paid services were used to identify incident MHEC use within 1 year of infection for Veterans with a SARS-CoV-2 infection and matched comparators.

Study Design: This was a national, retrospective cohort study that leveraged a target trial emulation framework to examine long-term outcomes of SARS-CoV-2 infection among Veterans enrolled in VHA care.

Special Topic Burnout: Examining Health Professional Trainee Burnout: Lessons Learned Using Qualitative Inquiry to Elicit Rich Data.

Background: Health professional (HP) trainee burnout is hard to capture. There are many validated quantitative tools to assess trainee burnout, but fewer qualitative methodological tools that can elicit rich and trustworthy qualitative data on HP trainee burnout.

Objective: Report the process, results, and lessons learned while developing and pilot testing a qualitative tool to assess HP trainee experiences of burnout to complement quantitative tools.

Overloaded: How task switching, information synthesis, and poor relational trust make interhospital transfers challenging.

Background: Complex and inefficient information and task organization contribute to high cognitive load for clinicians in interhospital transfer (IHT) care. High cognitive load can lead to medical errors and clinician stress.

Objective: Our study aims to highlight areas of high cognitive load experienced by hospital medicine physicians and advanced practice providers who care for IHT patients.

Using the implementation research logic model to examine high-intensity resistance rehabilitation implementation in skilled nursing facilities: a mixed methods multi-site case study.

Background: Implementing evidence-based rehabilitation in skilled nursing facilities (SNFs) is essential for enhancing physical function outcomes and mitigating risk of adverse events. Best implementation approaches in this complex setting are unknown. This study uses the Implementation Research Logic Model (IRLM) to retrospectively examine the implementation of high-intensity resistance rehabilitation (HIR) in SNFs, aiming to elucidate contextual factors and pathways that could enhance future HIR implementation endeavors.

Veterans' Experiences with COVID-19 and How Providers Can Shape Care and Perception with Empathy.

Background: The COVID-19 pandemic challenged healthcare systems like the Department of Veterans Affairs (VA) to pivot to new models of care and keep up with rapidly evolving practice and treatment guidelines. These challenges were amplified by the context of a polarized society and widespread mistrust of government and traditional media communication.

Objective: We sought to better understand experiences with COVID-specific care and the role of patient-provider interactions.