Journal of general internal medicine
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The COVID-19 pandemic, and vaccine hesitancy, pose a significant public health threat. The Veterans Health Administration system is uniquely situated to provide insights into the implementation of a population health approach to vaccine acceptance. ⋯ A population health approach to vaccine acceptance using EHR-based tools can impact vaccination rates, and this approach may be of practical utility to other large healthcare systems with EHR.
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Frailty is often cited as a factor influencing oral anticoagulation (OAC) prescription in patients with non-valvular atrial fibrillation (NVAF). We sought to determine the prevalence of frailty and its association with OAC prescription in older veterans with NVAF. ⋯ There are high rates of frailty among older veterans with NVAF. Frailty using an EHR-derived index is associated with decreased OAC prescription.
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Asian Americans are the fastest-growing ethnic minority in the USA, but we know little about the end-of-life care for this population. ⋯ Compared to White decedents, Asian Medicare decedents are more likely to receive IMV when hospitalized at the end-of-life, especially among patients with non-cancer admitting diagnoses. Future research to better understand the reasons for these differences and perceived quality of end-of-life care among Asian Americans is urgently needed.
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Missed appointments diminish the continuity and quality of care. ⋯ Characteristics of the places where patients reside are associated with missing scheduled appointments, including high levels of racial/ethnic segregation, poverty, and violent crime and low levels of perceived neighborhood safety. As such, targeting efforts to improve access for patients living in such neighborhoods will be particularly important to address underlying social determinants of access to health care.
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Long-term health effects have been indicated following COVID-19; however, the impact of COVID-19 on health-related quality of life (HRQOL), including who may experience ongoing symptoms, is unknown. ⋯ A quarter of patients with COVID-19 experienced meaningful reductions in HRQOL. Reductions in global mental and physical health were modest, although significantly worse than a control group. Additionally, identified predictors of patients who worsen may assist clinicians when counseling patients of their risk of worse HRQOL following COVID-19.