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•Veterans reported high satisfaction with both VA and community care.•Most veterans preferred the VA for their general healthcare.•Veterans demonstrated no statistically significant difference in preference between VA and community cardiovascular care.•Satisfaction linked to communication, coordination, and staff quality. The MISSION Act of 2018 expanded veterans' access to necessary care at non-Veterans Affairs (VA) facilities. The policy is intended to improve access to timely, high-quality care—particularly for specialized procedures like transcatheter aortic valve replacement (TAVR). However, veterans' preferences regarding specialty care in the community vs within the VA system remain unexplored. This cross-sectional quality improvement study surveyed veterans at an urban VA heart center who received referrals to community hospitals between 2018 and 2023 for structural heart disease care. The 14-item survey evaluated satisfaction across 3 key domains—communication, quality, and care coordination—along with overall satisfaction with community and VA care, and preferences for future care delivery settings. Of 47 veterans who completed the survey, most (78.7%) preferred receiving care at a VA hospital (P < .0001). Veterans reported high satisfaction with both community (mean score 9.15/10) and VA-based care (9.19/10; P = .876). While 64% preferred the VA for future cardiovascular care, this trend did not reach statistical significance (P = .079). In contrast, 78.7% preferred the VA for general healthcare (P < .001). Satisfaction with community care was most strongly associated with staff competence (r = 0.839) and feeling their concerns were heard (r = 0.818). VA satisfaction correlated most strongly with care coordination (r = 0.789) and clear follow-up instructions (r = 0.729). Transportation challenges were reported by 17% of respondents and were significantly associated with preference for community care for general health (P < .001). Veterans referred for cardiovascular procedures through the MISSION Act reported high satisfaction across settings but expressed a clear preference for VA-based care for general healthcare. These findings suggest that while community care is a valuable tool for improving access, investments in VA-based services remain critical to meeting veteran expectations and preserving care quality.

Background The USA is undergoing a suicide epidemic for its youngest Veterans (18-to-34-years-old) as their suicide rate has almost doubled since 2001. Veterans are at the highest risk during their first-year post-discharge, thus creating a “deadly gap.” In response, the nation has developed strategies that emphasize a preventive, universal, and public health approach and embrace the value of community interventions. The three-step theory of suicide suggests that community interventions that reduce reintegration difficulties and promote connectedness for Veterans as they transition to civilian life have the greatest likelihood of reducing suicide. Recent research shows that the effectiveness of community interventions can be enhanced when augmented by volunteer and certified sponsors (1-on-1) who actively engage with Veterans, as part of the Veteran Sponsorship Initiative (VSI). Method/design The purpose of this randomized hybrid type 2 effectiveness-implementation trial is to evaluate the implementation of the VSI in six cities in Texas in collaboration with the US Departments of Defense, Labor and Veterans Affairs, Texas government, and local stakeholders. Texas is an optimal location for this large-scale implementation as it has the second largest population of these young Veterans and is home to the largest US military installation, Fort Hood. The first aim is to determine the effectiveness of the VSI, as evidenced by measures of reintegration difficulties, health/psychological distress, VA healthcare utilization, connectedness, and suicidal risk. The second aim is to determine the feasibility and potential utility of a stakeholder-engaged plan for implementing the VSI in Texas with the intent of future expansion in more states. The evaluators will use a stepped wedge design with a sequential roll-out to participating cities over time. Participants ( n =630) will be enrolled on military installations six months prior to discharge. Implementation efforts will draw upon a bundled implementation strategy that includes strategies such as ongoing training, implementation facilitation, and audit and feedback. Formative and summative evaluations will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and will include interviews with participants and periodic reflections with key stakeholders to longitudinally identify barriers and facilitators to implementation. Discussion This evaluation will have important implications for the national implementation of community interventions that address the epidemic of Veteran suicide. Aligned with the Evidence Act, it is the first large-scale implementation of an evidence-based practice that conducts a thorough assessment of TSMVs during the “deadly gap.” Trial registration ClinicalTrials.gov ID number: NCT05224440 . Registered on 04 February 2022.

\"[This book] explores the topic of mental illness in the military\"--Provided by publisher.

Procedure-related cardiac electronic implantable device (CIED) infections have high morbidity and mortality, highlighting the urgent need for infection prevention efforts to include electrophysiology procedures. We developed and validated a semi-automated algorithm based on structured electronic health records data to reliably identify CIED infections. A sample of CIED procedures entered into the Veterans’ Health Administration Clinical Assessment Reporting and Tracking program from FY 2008–2015 was reviewed for the presence of CIED infection. This sample was then randomly divided into training (2/3) validation sets (1/3). The training set was used to develop a detection algorithm containing structured variables mapped from the clinical pathways of CIED infection. Performance of this algorithm was evaluated using the validation set. 2,107 unique CIED procedures from a cohort of 5,753 underwent manual review; 97 CIED infections (4.6%) were identified. Variables strongly associated with true infections included presence of a microbiology order, billing codes for surgical site infections and post-procedural antibiotic prescriptions. The combined algorithm to detect infection demonstrated high c-statistic (0.95; 95% confidence interval: 0.92–0.98), sensitivity (87.9%) and specificity (90.3%) in the validation data. Structured variables derived from clinical pathways can guide development of a semi-automated detection tool to surveil for CIED infection.

To model future use of chiropractic services and predict clinical resource needs within the Veterans Health Administration (VA) over the next 5 years. A serial cross-sectional analysis of chiropractic use data from VA's Corporate Data Warehouse for fiscal years (FY) 2017 through 2022 (10/1/2016-9/30/2022). We calculated the proportion of VA chiropractic users-via care provided on-station and/or purchased from Community Care Network (CCN) providers-compared to overall VA healthcare users for each FY. We calculated the historical year-over-year compound annual growth rate (CAGR), which was used to predict use in FY2023 through 2027 (10/1/2022-9/30/2027). VA's chiropractic use rate increased from 1.4% in FY2017 to 3.5% in FY2022, at which point 2.0% of VA users received only CCN chiropractic care, 1.3% only on-station, and 0.2% both. During the 6-year observation period, the CAGRs were overall 17.9%, CCN only 23.8%, on-station only 12.4%, and both 27.7%. Using those rates to extrapolate, by the end of FY2027 overall use will be 8.9%, with 5.9% only CCN, 2.3% only on-station, and 0.6% both. Overall use of VA chiropractic services is projected to more than double from FY 2022 to FY2027. These findings underscore the need for proactive resource planning to address the expected increased use of both CCN and on-station care.

\"The hallmarks of America's War on Terror have been repeated long deployments and a high percentage of troops returning with psychological problems. Family members of combat veterans are at a higher risk of potentially lethal domestic violence than almost any other demographic; it's estimated that one in four children of active-duty service members have symptoms of depression; and nearly one million veterans of Iraq and Afghanistan require increased care due to physical or psychological trauma. But, despite these staggering trends, civilian America has not been mobilized to take care of the families left behind; the American homefront, which traditionally has been rallied to support the nation's war efforts, has disappeared. In Homefront 911 Stacy Bannerman, a nationally-recognized advocate for military families, provides an insider's view of how more than a decade of war has contributed to the emerging crisis we are experiencing in today's military and veteran families as they battle with overwhelmed VA offices, a public they feel doesn't understand their sacrifices, and a nation that still isn't fully prepared to help those who have given so much. Bannerman, whose husband served in Iraq, describes how extended deployments cause cumulative, long-lasting strain on families who may not see their parent, child, or spouse for months on end. She goes on to share the tools she and others have found to begin to heal their families, and advocates policies for advancing programs, services, and civilian support, all to help repair the broken agreement that the nation will care for its returning soldiers and their families\"-- Provided by publisher.

Introduction: The Age-Friendly Health Systems initiative (AFHS) was developed to spread principles of high-quality care for older adults using the 4Ms Framework: What Matters, Medications, Mentation and Mobility. In 2020, the Veterans Health Affairs (VA) set a goal to become an AFHS, given nearly half of Veterans are over aged 65. Methods: This quality improvement study followed the Model for Improvement which guided a series of Plan Do Study Act (PDSA) cycles to implement and spread the AFHS model within the VA, as measured by clinical sites receiving AFHS recognition from the Institute for Healthcare Improvement (IHI). A national AFHS Steering Committee was formed, followed by a 4Ms note template and dashboard. VA ran 3 AFHS Action Communities which included synchronous training sessions and coaching calls in 4Ms care. IHI recognition was tracked over 5 years for VA sites. The Standards for Quality Improvement Reporting Excellence 2.0 guidelines (SQuIRE) were used. Results: From 2020 to 2025, 455 VA care settings earned Level 1 recognition from IHI at 138/139 (99%) of VA parent facilities. 268/455 (59%) sites have gone on to achieve Level 2 recognition. 66% of Level 1 sites are ambulatory, 7% are acute care, and 24% are nursing homes. Since 2022 when the VA AFHS note template was implemented, 163 000 unique Veterans have been recorded as having been reached with 4Ms care, of whom 71% reside in urban areas, 23% are aged 85 and older, and 59% are aged 65 to 84. Conclusion: The VA implemented the AFHS initiative at nearly all VA parent facilities over 5 years, spreading the 4Ms model of Age-Friendly care across geographic and care settings. Further study is needed on the clinical impact of and optimal implementation strategies for AFHS. The VA experience offers a promising model for health systems seeking to implement AFHS.