Advancing veterans’ healthcare using electronic data Lessons learned from researchers in the field.docx

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1、E1izabethTar1ov,RN,PhD:KevinT.Stroupe,PhDGuestEditOria1vtdJAdvancingveterans9hea1thcareusinge1ectronicdata:1essons1earnedfromresearchersinthefie1dTheDepartmentofVeteransAffairs(VA)providesnationwideaccess,1ifetimecoverage,andanintegratedcarestructuretoitsenro11ees.ThosekeyaspectsofVAhea1thcare-toget

2、herwithdatacontainedinVA,se1ectronicinformationsystemssupportingovereightmi11ionveteransprovideuniqueopportunitiestostudyprocesses,outcomes,andcostsofcare.Recent1y,forexamp1e,VAdatahavebeenusedtostudyoutcomesassociatedwithacutepostoperativeinpatientreIiabi1itationandcareinspecia1izedrehabi1itationbe

3、dunitsafterIower-1imbamputation1-2,medicationadherenceandre1apseamongpatientsdischargedfromaVAposttraumaticstressdisorder(PTSD)treatmentprogram3,theprovisionandcostsofassistivetechno1ogydevicestoveteransafterstroke4,anduseofmenta1hea1thservicesbyveteransdisab1edbyauditorydisorders5.UNDERPINNINGSOFSI

4、NG1E-TOPICISSUEONDATAQUA1ITYIn1998,theVAHea1thServicesResearch&Deve1opmentServicefundedtheVAInfbnnationResourceCenter(VIReC)tofaci1itatetheuseofVAadministrativedataforresearch.Sincethattime,VIReChasdeve1opedanddisseminatedresearch-re1evantinformationaboutVAdatabasesandinformationsystems.Know1edge-bu

5、i1dingactivitiesinc1udedataqua1ityinvestigationsconductedwithinV1ReC.Thissing1e-topicissuerecognizesthevaststoresofinformationaboutVAdatathatVAinvestigatorsgeneratenationwide,inthenorma1courseoftheirdataana1ysisactivities,andseeksto1everagethatinformationtoadvancee1ectronic-data-bascdresearch.Aca11f

6、orabstractswasissuedinthespringof2009forinvestigationsofthequa1ityandresearchuti1ityofe1ectronicdatausedinresearchtoadvancethecareofveterans.VAinvestigatorsrespondedmanymoreworthyabstractsweresubmittedthancou1dbeinc1udedinoneJRRDissue.Ref1ectingstrongresearch-communitysupportforVAresearch,54scho1ars

7、readi1yacceptedinvitationstopeerreviewanda1mostIOOindividua1sparticipatedasauthors,reviewers,oreditors.VAresearchershave1ongbeenmajorcontributorstothemethodo1ogica11iteratureintheareaofadministrativedatause6-17.Thisissueadvancesthat1iteraturebyfocusingspecifica11yonthequa1ityandresearchuti1ityofdata

8、basesusedinveteransresearch.Weviewdataqua1ityrough1y,thecomp1etenessandaccuracyofthedataco11ectedandentered-asanecessarybutnotsufficientfeatureofaitresearch-usefuP,dataset18.TheresearchJRRD1Vo1ume47.Number8,2010uti1ityofadatasetentai1sadditiona1factorssuchascoverageofthepopu1ationofinterestanddegree

9、ofva1idityachievab1ewhenspecificdatae1ementsareusedasproxiesforimportantbutabsentinfbrma-tion.Researchuti1ityquestiOns,therefore,re1atetotheinevitab1echa11engesinvo1vedintheuseofsecondarydata一i.e.,datathatwereco11ectedforadifferentpurpose-ratherthanadeficiencyinthedataperse.VITA1VETERANSRESEARCHANDV

10、AHEA1THINFORMATIONSYSTEMSThequestionsofdataqua1ityandresearchuti1ityaddressedintheinc1udedartic1eswereencounteredduringresearchtack1ingkeyissuesinthecareandrehabi1itationofwoundedwarveterans.Promotinghigh-qua1itycareandprovidingthetoo1sforindependent1ivingtoveteranswithspina1cordinjury(SCI)19,po1ytr

11、auma20,PTSD,sub-stance-usedisorderandothermenta1hea1thcondi-tions21-23andtoothersneedingrehabi1itativeandassistiveservices24-25arehighVApriorities.Investigatingobesityandchronickidneydiseaseanditsantecedentsareimportantbecausetheseareamongthemostcommonchronicconditionsaff1ictingveteransseekingcarein

12、theVA26-27.Understandingthehea1thcareneedsandensuringaccessib1ecareforwomenandothervu1nerab1epopu1ations23,28-30areamongtheVA,stopresearchpriorities.Identifyingcost-effectiveapproachestoveteranshea1thcare25,29,31iscritica1to1ong-termviabi1ityoftheVAhea1thcaresystem.Studiesinc1udedinthisissuewerederi

13、vedfromresearchinvestigatingtheseissuesusingdatafromsourcesinsideandoutsidetheVA.Theinc1udedartic1esa1sospot1ightthegreatva1uethatVA,shea1thinformationsystemshaveforresearch.Chiefamongthedatasourcesminedforresearchisthee1ectronicmedica1record(EMR),portionsofwhichareextractedtocreatetheVANationa1Pati

14、entCareDatabase,providingc1inica1andhea1thservicesuti1izationinformation.Conditionbasedregistriesmaintainedforc1inica1andadministrativepurposesandothercase-reportingsystemsprovideadditiona1c1inica1andtreatmentdetai1andsoarea1sorichdatasources.Dataoriginatingout-sidetheVAarecritica1for1earningaboutca

15、rereceivedandcostsofcareforveteransobtainingservicesintheprivatesectorandhe1ptofi11agapininformationformanystudies.InadditiontotheNationa1PatientCareDatabase19-21,24,30,datasourceseva1uatedinc1udetheVeteransHea1thAdministrationCorporateDataWarehouse26,theVA,sNationa1Spina1CordDysfunctionRegistry19,t

16、heMinimumDataSet(1ong-termcareresidentassessment)24,Mcdicare,sEnd-StagcRena1DiseaseMedica1EvidenceReport27,MedicaidandMedicarec1aims29-30,andtheMedicareCurrentBeneficiarySurvey31.SPOT1IGHTONDATAQUA1ITYANDRESEARCHUTI1ITYSTUDIESSevera1studiesexaminedthecomp1etenessand/orva1idityofthesedataresources.Somecommonobservationsemergefromamongthissetofstudies.First,findingssuggestsubstantia1variabi1ityinrecordcomp1etene