Nature of the Study
This study will be quantitative in nature. It will be an observational retrospective cohort study using an existing National VA database to examine differences in health service utilization by gender for U.S. veterans diagnosed with AKI while hospitalized at Veterans Affairs Medical Centers (VAMCs). Differences in short-term outcomes, such as length of inpatient stay and inpatient mortality, by gender, will also be examined. This study will also thoroughly describe study population of hospitalized VA patients diagnosed with AKI.
Sample
The population for this study design will be veterans diagnosed with AKI at a VAMC in the U.S. during a five-year period, January 2009 and December 2014. The sample will come from secondary
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The VA IRB is a three-step process, requiring approval from the IRB, the Research & Development (R&D) Committee, and the Associate Chief of Staff of Research. VA IRB approval is needed to get data use agreements executed and approved for data release for collection and analysis purposes. The proposed study poses a minimal risk because it uses existing data from an existing cohort with no identifiers. This study poses minimal risk, so I will request an exemption from the full IRB review and request an expedited review instead. I must also obtain IRB approval with Walden University as well as part of my student research requirement.
Using an existing National VA AKI-CKD study cohort extracted from the VA CDW containing electronic medical records, I will identify those in the cohort diagnosed with AKI using KDIGO along with associated International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes for AKI or acute renal failure as inclusion criteria in my study population (Kidney Disease Improving Global Outcomes (KDIGO), 2012). I will exclude those who do not fit the set cohort criteria.
Gender will be the independent variable while socio-demographic and military service variables (e.g., age, race, marital status, service branch) will serve as covariates. The health services used while hospitalized with AKI will be the dependent variables. I will identify these services using inpatient hospital data codes or Current Procedural Terminology (CPT) codes.
Data
In many cases, soldiers didn’t seek treatment in fear that their military careers would come to an end. Others were on waiting lists or were directed to the bottom of the list among treatment providers without getting consistent care, or seemed to slip under the radar completely.
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Veterans often experience long wait times to schedule an appointment for PTSD. Through additional research I have found that according to a study in 2003 by the American Legion, of approximately 300,000 veterans waiting for health care, over half of them had been waiting over eight months for an appointment (American Legion, 2013). I further researched how many VA facilities in the United States offer specialized treatment for PTSD. In all 50 states, and Washington, DC, there are a total of 139 facilities (US Department of Veterans Affairs, 2015). I propose to conduct a telephone
Under 38 C.F.R. § 4.130, Diagnostic Code 9411, a 50 percent schedular rating is said to be appropriate when there is evidence of occupational and social impairment due to a variety of symptoms such as, flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short- and long-term memory, impaired judgment, impaired abstract thinking, disturbances of motivation and mood, and difficulty in establishing effective work and social relationships. Given that our veteran was reported by the VA psychiatrist as exhibiting symptoms of memory impairment, difficulty in establishing relationships, and twice-weekly panic attacks, it is clear that a 50 percent rating should be given for the time frame
There are over 45 percent of the 1.6 million veterans from the wars in Iraq and Afghanistan that are seeking compensation for injuries they claim are related to their military service. That is over double the 21 percent of veterans that filed service-connected claims after the Gulf War in the early 1990s. Additionally, these new veterans are claiming on average eight to nine issues and the most recent ones received by the VA are claiming 11 to 14 ailments. In comparison, the Vietnam veterans are averaging compensation for fewer than four ailments and those from World War II and Korea average only two.
About 57,436 Veterans chose to use Non-VA (Department of Veterans Affairs) facilities for healthcare service while waiting more than 90 days for appointments with their VA clinicians (Couzner, Ratcliffe, & Crotty 2012). Since post-hospitalization follow-up with primary care providers has a great impact on theses Veterans’ health outcome by promoting recovery and preventing readmissions (Martinez, 2014). The Patient Aligned Care Teams track Veterans’ admission and discharge in VA facilities through the VA’s electronic medical record to ensure timely post-hospitalization with Veterans’ primary care providers. There are no data about post-hospitalization follow up among Veterans who is admitted into Non-VA facilities.
In July 2008, the Veteran reported muscle aches and swollen, stiff, or painful joints, which were still bothering him. He rated his overall health as Good, but indicated that his health was much worse than before deployment. Also in June 2008 (while still in service), the Veteran filed a claim for entitlement to service connection for a neck condition. Two days later. (again while still in service), the Veteran reported “stiff and tightness, neck pain” for which he claimed to have seen a healthcare provider during deployment on sick call and which still bothered him. I found out the hard way that been on a FOB, forward moving base, meaning your attach to a different unit and not with your own unit medical records never follow you. I was attach
Approximately 2.8 million VA patients are affected by a service related injury with 1,027,000 or 36% of them coming from rural areas. Many of the vets living in rural areas do not get the help they need and are entitled to due to barriers to healthcare with the main barrier being the distance to the nearest VHA facility. This can cause vets to seek more expensive care at non VA
He has been diagnosed with Persistent Depression Disorder, which is self-reported to have gotten worse since the TBI. The veteran has attempted to make appointments with a psychologist at the VA, but he reports that those appointments have been canceled. He wears hearing aids and has a knee injury, which he will have surgery on in the future.
Today, the Department of Veteran Affairs (VA) cares for over 19.3 million veterans, including 3.8 million disabled veterans, and 239,000 veterans with a 100 percent disability rating. Veterans of the US military often face challenges with readjusting to civilian life. For instance, the VA estimates that up to 20 percent of returning veterans from Iraq have post traumatic stress disorder. Fortunately, the VA provides numerous benefits to these veterans. In most cases, veterans qualify for free healthcare at outpatient clinics and VA hospitals across the country.
The United States of America has one of the largest military forces on earth, employing nearly 1.5 million active personnel (Armed Forces). However, that number represents more than just a dedicated group; it represents citizens that will eventually become veterans and transition back into civilian life. For some this comes easily, but for others the struggles impede their ability to thrive. These hurdles can include the following: physical and psychological ailments; difficulties finding support; and trouble affording necessary treatment. In order to improve upon this lacking state of veteran care in the U.S., the government needs to expand current services within health care, as well as research new ways to make re-entry into everyday life
numbers were used to link OEF/OIF Roster data to VA clinical data contained in the VA National Patient Care Database (NPCD) through March 31, 2008.” (Cohen, etal, 2009). The data contained in the national database consisted of outpatient and inpatient visits, this included the time and date the visit occurred, using the code system to classify the visit, and the diagnoses which were associated with the visit.
This system was used to determine if a member who has had some kind of illness or disability while in the military that is normally disqualifying from military service, can still serve. We had a large backlog of people in the process for a variety of reasons. This was unacceptable as it impacted not only mission readiness, but also real people 's lives (Orenich, 2015).
Veteran has four admission and discharges in CAVHS in her record: June 2012 (3K); August 2012 (3K); March 2014 (SICU); July 2014 (3K). She has also received care from Biloxi and Texas VAMC 's in the past. Veteran served in the US Army between October/2004 to March/2004, with an Entry Level Separation (ELS- Medical) discharge and her highest rank were an E-3. Veteran reported she received an injury while
The patient does not need to retrieve any medical information on their own; and would not need to transport from their home. The providers will monitor the patient carefully, and help connect them to any prolonged service he/she needs. This process helps reduce any associated shame or stigma from a veteran actively getting the care they need and deserve. Further, it may lessen developing suicidal thoughts (Wilson et. al, 2015).