Journal of general internal medicine
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We conducted a review of the peer-reviewed literature since 2003 to catalogue reported methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research. ⋯ To improve on the quality and content of reporting, we developed a 7-Item Stakeholder Engagement Reporting Questionnaire. We recommend three directions for future research: 1) descriptive research on stakeholder-engagement in research; 2) evaluative research on the impact of stakeholder engagement on the relevance, transparency and adoption of research; and 3) development and validation of tools that can be used to support stakeholder engagement in future work.
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Randomized Controlled Trial Multicenter Study
Intensive blood pressure control, falls, and fractures in patients with type 2 diabetes: the ACCORD trial.
There are few rigorous studies to confirm or refute the commonly cited concern that control of blood pressure to lower thresholds may result in an increased risk of falls and fractures. ⋯ We conclude that intensive antihypertensive treatment that lowered mean systolic blood pressure to below 120 mmHg was not associated with an increased risk of falls or non-spine fractures in patients age 40 to 79 years with type 2 diabetes.
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Pain is the most common presenting problem in primary care. Opioid therapy (OT) for chronic pain has increased dramatically over the past decade, as have related negative outcomes. Despite the development and dissemination of policy and clinical practice guidelines for pain management and OT, adoption has been variable. The Veterans Health Administration (VHA) has established a Stepped Care Model of Pain Management (SCM-PM) as an evidence-based framework and single standard of pain care to promote guideline-concordant care, but to date its adoption and related outcomes have not been systematically examined. ⋯ We demonstrate improvements in the management of veterans receiving OT that are consistent with the SCM-PM and published practice guidelines. We highlight how partnerships among funders, researchers, clinicians, and administrators contributed to the project's design and implementation, and to the dissemination strategy and future directions for improving opioid management and pain care.
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Randomized Controlled Trial
A randomized controlled pilot trial of the functional assessment screening tablet to engage patients at the point of care.
Healthcare providers play an important role in encouraging healthy behaviors and improving health-related quality of life (HRQoL). They are most effective when they partner with informed, engaged patients. ⋯ Providing patients with immediate, personalized, guideline-based feedback prior to the clinical encounter can increase patient-initiated discussions regarding mental HRQoL. Future work should test FAST-Feedback in a larger population and evaluate the impact on tobacco cessation, increased physical activity, and improvements in HRQoL.
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Multicenter Study
Making housing first happen: organizational leadership in VA's expansion of permanent supportive housing.
While most organizational literature has focused on initiatives that transpire inside the hospital walls, the redesign of American health care increasingly asks that health care institutions address matters outside their walls, targeting the health of populations. The US Department of Veterans Affairs (VA)'s national effort to end Veteran homelessness represents an externally focused organizational endeavor. ⋯ Key organizational practices correlated with more successful implementation of HF for homeless Veterans. Medical Center directors substantively influenced the success of this endeavor through their actions to foster impetus, demonstrate commitment and support alignment and integration.