Lisa V Rubenstein
Datos Biográficos
| ID | 330094 |
|---|---|
| NOMBRE | Lisa V Rubenstein |
| NOMBRES | Lisa V |
| APELLIDO | Rubenstein |
| FIRMA | RUBENSTEIN L V |
| AFILIACIONES | RAND Corporation |
| ORCID | 0000-0002-4186-7191 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 31 |
| TOTAL DE CITAS | 17 |
| TOTAL COMO AUTOR | 31 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1992 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2020 |
| ÍNDICE H | 3 |
Use of the Veterans’ Choice Program and Attrition From Veterans Health Administration Primary Care
BACKGROUND: Concerns over timely access and waiting times for appointments in the Veterans Health Administration (VHA) spurred the push towards greater privatization. In 2014, VHA increased the provision of care from community providers through the Veterans' Choice Program (Choice). OBJECTIVES: We examined the characteristics of patients and practices more likely to use Choice care and whether using Choice care affected patients' attrition from V…
Sequelae of an Evidence-based Approach to Management for Access to Care in the Veterans Health Administration
BACKGROUND: Access to health care is a critical concept in the design, delivery, and evaluation of high quality care. Meaningful evaluation of access requires research evidence and the integration of perspectives of patients, providers, and administrators. OBJECTIVE: Because of high-profile access challenges, the Department of Veterans Affairs (VA) invested in research and implemented initiatives to address access management. We describe a 2-year…
High Quality of Care Persists With Shifting Depression Services From VA Specialty to Integrated Primary Care
BACKGROUND/OBJECTIVE: Offering depression collaborative care services in primary care (PC) settings can reduce use of nonintegrated mental health care resources and improve mental health care access, particularly for vulnerable PC patients. Tests of effects on depression care quality, however, are needed. We examined overall quality of depression care and tested whether increasing clinic engagement in Veterans Affairs (VA)'s Primary Care-Mental H…
Engaging African American Veterans with Health Care Access Challenges in a Community Partnered Care Coordination Initiative
Veterans living in underserved areas who have had difficulty accessing VA care have unique perspectives on VA services. Partnering with trusted local community organizations to engage Veterans in their home communities is a promising strategy to inform efforts to improve care access and coordination for vulnerable Veterans
Communication Among Team Members Within the Patient-centered Medical Home and Patient Satisfaction With Providers
BACKGROUND: The Patient-centered Medical Home (PCMH) uses team-based care to improve patient outcomes, including satisfaction. The quality of patients' communication with their primary care providers (PCPs) is a key determinant of patient satisfaction. A shift to team-based care could disrupt the therapeutic relationship between patients and their PCPs and reduce patient satisfaction if communication and coordination among primary care team membe…
Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health‐care System
CONTEXT: There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. METHODS: . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desir…
Challenges with Implementing a Patient-Centered Medical Home Model for Women Veterans
Women Veterans with Depression in Veterans Health Administration Primary Care
Differences in Depression Care for Men and Women among Veterans with and without Psychiatric Comorbidities
Impact of Medical Home Implementation Through Evidence-based Quality Improvement on Utilization and Costs
BACKGROUND: Evidence-based quality improvement (EBQI) methods may facilitate practice redesign for more effective implementation of the patient-centered medical home (PCMH). OBJECTIVE: We assessed changes in health care utilization and costs for patients receiving care from practices using an EBQI approach to implement PCMH and comparison practices over a 5-year period. RESEARCH DESIGN: We used longitudinal, electronic data from patients in 6 pra…
Emotional Exhaustion in Primary Care During Early Implementation of the VA’s Medical Home Transformation
Objective: Transformation of primary care to new patient-centered models requires major changes in healthcare organizations, including interprofessional expectations and organizational policies. Emotional exhaustion (EE) among workers can accompany major organizational change, threatening its success. Yet little guidance exists about the magnitude of associations with EE during primary care transformation. We assessed EE during the initial phase …
VA Health Service Utilization for Homeless and Low-income Veterans
BACKGROUND: The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program-the VA's Housing First effort-is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. OBJECTIVES: We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veteran…
Help-Seeking from Clergy and Spiritual Counselors Among Veterans with Depression and PTSD in Primary Care
Chronic Disease Management for Recently Homeless Veterans
BACKGROUND: Although vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a "digital divide" in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Affairs (VA) HIT-care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the US Department of Ho…
Reducing Costs of Acute Care for Ambulatory Care-sensitive Medical Conditions
BACKGROUND: New patient-centered models of ambulatory care aim to substitute better primary care for preventable acute care within existing primary care practices. This study aims to identify whether mental illness and other characteristics of primary care patients are related to risk for an acute event for an ambulatory care-sensitive condition (ACSC). METHODS: We conducted a 2-year, longitudinal analysis comparing ambulatory care-sensitive admi…
Clinical Inertia in Depression Treatment
OBJECTIVE: To explore reasons for clinical inertia in the management of persistent depression symptoms. RESEARCH DESIGN: We characterized patterns of treatment adjustment in primary care and their relation to the patient's clinical condition by modeling transition to a given treatment "state" conditional on the current state of treatment. We assessed associations of patient, clinician, and practice barriers with adjustment decisions. SUBJECTS: Su…
The Evolution of Changes in Primary Care Delivery Underlying the Veterans Health Administration’s Quality Transformation
Objectives. Suffering from waning demand, poor quality, and reform efforts enabling veterans to “vote with their feet” and leave, the Veterans Health Administration (VA) health care system transformed itself through a series of substantive changes. We examined the evolution of primary care changes underlying VA’s transformation. Methods. We used 3 national organizational surveys from 1993, 1996, and 1999 that measured primary care organization, s…
Balancing Participation and Expertise
In a longitudinal qualitative study, the authors evaluated two health care quality improvement (QI) methods that emphasized either participation (local approach) or expertise (central approach). They followed teams using these approaches to develop depression care QI programs for primary care practices over several years, observing their processes and outcomes and learning about participants' perceptions, beliefs, and experiences. Concordant with…
Determinants of physician unwillingness to offer medical abortion using mifepristone
Primary Care Patients’ Involvement in Decision-Making Is Associated With Improvement in Depression
BACKGROUND: Depression is undertreated in primary care settings. Little research investigates the impact of patient involvement in decisions on guideline-concordant treatment and depression outcomes. OBJECTIVE: The objective of this study was to determine whether patient involvement in decision-making is associated with guideline-concordant care and improvement in depression symptoms. DESIGN: Prospective cohort study. SETTING: Multisite, nationwi…
The Acceptability of Treatment for Depression Among African-American, Hispanic, and White Primary Care Patients
BACKGROUND: Ethnic minority patients are less likely than white patients to receive guideline-concordant care for depression. It is uncertain whether racial and ethnic differences exist in patient beliefs, attitudes, and preferences for treatment. METHODS: A telephone survey was conducted of 829 adult patients (659 non-Hispanic whites, 97 African Americans, 73 Hispanics) recruited from primary care offices across the United States who reported 1 …
Primary Care Practice Management in Rural and Urban Veterans Health Administration Settings
Limited access to specialty care in rural settings may result in more expectations of primary care providers and a higher demand for primary care The authors used survey and administrative data from 1999 from the Veterans Health Administration (vHA) to compare primary care practice management and performance in 19 rural to 103 urban VHA hospitals nationally Rural VHA hospitals me smaller, less likely to be academically affiliated, and had fewer i…
What Patient Population Does Visit-Based Sampling in Primary Care Settings Represent
BACKGROUND: Evaluations of outpatient interventions often rely on consecutive sampling of clinic visitors, and assume that study results generalize to the population of patients cared for. OBJECTIVE: The representativeness of such visit-based sampling compared with the population of patients seen during the same year, in terms of sociodemographic and clinical characteristics of the user groups that visit-based sampling yielded were assessed. METH…
Who is at risk of nondetection of mental health problems in primary care?
Impact of Disseminating Quality Improvement Programs for Depression in Managed Primary Care
CONTEXT: Care of patients with depression in managed primary care settings often fails to meet guideline standards, but the long-term impact of quality improvement (QI) programs for depression care in such settings is unknown. OBJECTIVE: To determine if QI programs in managed care practices for depressed primary care patients improve quality of care, health outcomes, and employment. DESIGN: Randomized controlled trial initiated from June 1996 to …
Balancing Participation and Expertise
In a longitudinal qualitative study, the authors evaluated two health care quality improvement (QI) methods that emphasized either participation (local approach) or expertise (central approach). They followed teams using these approaches to develop depression care QI programs for primary care practices over several years, observing their processes and outcomes and learning about participants' perceptions, beliefs, and experiences. Concordant with…
HMO vs fee-for-service care of older persons with acute myocardial infarction
OBJECTIVES. Health maintenance organizations (HMOs) continue to grow in number and in their enrollment of Medicare recipients. They are also increasingly viewed as organizational structures that might contribute to control of health care costs. Yet little is known about the quality of care that elderly HMO enrollees receive. METHODS. We compared patients from three HMOs to a fee-for-service (FFS) sample that was national in scope. Sickness at adm…
The Evolution of Changes in Primary Care Delivery Underlying the Veterans Health Administration’s Quality Transformation
Objectives. Suffering from waning demand, poor quality, and reform efforts enabling veterans to “vote with their feet” and leave, the Veterans Health Administration (VA) health care system transformed itself through a series of substantive changes. We examined the evolution of primary care changes underlying VA’s transformation. Methods. We used 3 national organizational surveys from 1993, 1996, and 1999 that measured primary care organization, s…
HMO vs fee-for-service care of older persons with acute myocardial infarction
OBJECTIVES. Health maintenance organizations (HMOs) continue to grow in number and in their enrollment of Medicare recipients. They are also increasingly viewed as organizational structures that might contribute to control of health care costs. Yet little is known about the quality of care that elderly HMO enrollees receive. METHODS. We compared patients from three HMOs to a fee-for-service (FFS) sample that was national in scope. Sickness at adm…
Benefits and Obstacles of Health Status Assessment in Ambulatory Settings
In the past decade physicians have identified the need to expand patient assessment to include global function and quality of life. During the same period, the busy clinic has evolved into the location where this assessment seems most appropriate. Integrating functional health assessment into a busy clinical practice is difficult because the necessary steps require time, thought, recording, and follow-up. Attention to the office ecosystem is very…
Health Habit Counseling Amidst Competing Demands
Objective. This study assesses the effects of competing demands, such as poor health habits or new medical problems, on health-habit counseling during a primary care visit. Methods. We surveyed a consecutive sample of 1,259 patients visiting primary care clinicians at an academic VA medical center. Before the visit, patients reported their health status, health habits, and sociodemographics; immediately after the visit, patients reported reasons …
Who is at risk of nondetection of mental health problems in primary care?
Impact of Disseminating Quality Improvement Programs for Depression in Managed Primary Care
CONTEXT: Care of patients with depression in managed primary care settings often fails to meet guideline standards, but the long-term impact of quality improvement (QI) programs for depression care in such settings is unknown. OBJECTIVE: To determine if QI programs in managed care practices for depressed primary care patients improve quality of care, health outcomes, and employment. DESIGN: Randomized controlled trial initiated from June 1996 to …
Structured Implicit Review
BACKGROUND: Nurses' independent decisions about assessment, treatment, and nursing interventions for hospitalized patients are important determinants of quality of care. Physician peer implicit review of medical records has been central to Medicare quality management and is considered the gold standard for reviewing physician care, but peer implicit review of nursing processes of care has not received similar attention. OBJECTIVE: The objective o…
Quality Enhancement Research Initiative in Mental Health
The Veterans Administration (VA) recently introduced its Quality Enhancement Research Initiative (QUERI) to facilitate the translation of best practices into usual clinical care. The Mental Health QUERI (MHQ) was charged with developing strategic plans for major depressive disorder (MDD) and schizophrenia. Twenty percent or more of VA service users are affected by 1 of these 2 disorders, disorders that often have a devastating impact on affected …
From Understanding Health Care Provider Behavior to Improving Health Care
Basic science and health care research provide the evidence base for the scientific practice of medicine. Over the past 2 decades, as increasingly refined tools for improving health and health care have been developed, the health care community has attempted to bridge the gap between available tools and actual health care practices. This gap can be bridged only by influencing health care provider behavior. The VA Quality Enhancement Research Init…
Primary Care Practice Management in Rural and Urban Veterans Health Administration Settings
Limited access to specialty care in rural settings may result in more expectations of primary care providers and a higher demand for primary care The authors used survey and administrative data from 1999 from the Veterans Health Administration (vHA) to compare primary care practice management and performance in 19 rural to 103 urban VHA hospitals nationally Rural VHA hospitals me smaller, less likely to be academically affiliated, and had fewer i…
What Patient Population Does Visit-Based Sampling in Primary Care Settings Represent
BACKGROUND: Evaluations of outpatient interventions often rely on consecutive sampling of clinic visitors, and assume that study results generalize to the population of patients cared for. OBJECTIVE: The representativeness of such visit-based sampling compared with the population of patients seen during the same year, in terms of sociodemographic and clinical characteristics of the user groups that visit-based sampling yielded were assessed. METH…
The Acceptability of Treatment for Depression Among African-American, Hispanic, and White Primary Care Patients
BACKGROUND: Ethnic minority patients are less likely than white patients to receive guideline-concordant care for depression. It is uncertain whether racial and ethnic differences exist in patient beliefs, attitudes, and preferences for treatment. METHODS: A telephone survey was conducted of 829 adult patients (659 non-Hispanic whites, 97 African Americans, 73 Hispanics) recruited from primary care offices across the United States who reported 1 …
Determinants of physician unwillingness to offer medical abortion using mifepristone
Primary Care Patients’ Involvement in Decision-Making Is Associated With Improvement in Depression
BACKGROUND: Depression is undertreated in primary care settings. Little research investigates the impact of patient involvement in decisions on guideline-concordant treatment and depression outcomes. OBJECTIVE: The objective of this study was to determine whether patient involvement in decision-making is associated with guideline-concordant care and improvement in depression symptoms. DESIGN: Prospective cohort study. SETTING: Multisite, nationwi…
The Evolution of Changes in Primary Care Delivery Underlying the Veterans Health Administration’s Quality Transformation
Objectives. Suffering from waning demand, poor quality, and reform efforts enabling veterans to “vote with their feet” and leave, the Veterans Health Administration (VA) health care system transformed itself through a series of substantive changes. We examined the evolution of primary care changes underlying VA’s transformation. Methods. We used 3 national organizational surveys from 1993, 1996, and 1999 that measured primary care organization, s…
Balancing Participation and Expertise
In a longitudinal qualitative study, the authors evaluated two health care quality improvement (QI) methods that emphasized either participation (local approach) or expertise (central approach). They followed teams using these approaches to develop depression care QI programs for primary care practices over several years, observing their processes and outcomes and learning about participants' perceptions, beliefs, and experiences. Concordant with…
Clinical Inertia in Depression Treatment
OBJECTIVE: To explore reasons for clinical inertia in the management of persistent depression symptoms. RESEARCH DESIGN: We characterized patterns of treatment adjustment in primary care and their relation to the patient's clinical condition by modeling transition to a given treatment "state" conditional on the current state of treatment. We assessed associations of patient, clinician, and practice barriers with adjustment decisions. SUBJECTS: Su…
Reducing Costs of Acute Care for Ambulatory Care-sensitive Medical Conditions
BACKGROUND: New patient-centered models of ambulatory care aim to substitute better primary care for preventable acute care within existing primary care practices. This study aims to identify whether mental illness and other characteristics of primary care patients are related to risk for an acute event for an ambulatory care-sensitive condition (ACSC). METHODS: We conducted a 2-year, longitudinal analysis comparing ambulatory care-sensitive admi…
Help-Seeking from Clergy and Spiritual Counselors Among Veterans with Depression and PTSD in Primary Care
Chronic Disease Management for Recently Homeless Veterans
BACKGROUND: Although vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a "digital divide" in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Affairs (VA) HIT-care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the US Department of Ho…
VA Health Service Utilization for Homeless and Low-income Veterans
BACKGROUND: The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program-the VA's Housing First effort-is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. OBJECTIVES: We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veteran…
Emotional Exhaustion in Primary Care During Early Implementation of the VA’s Medical Home Transformation
Objective: Transformation of primary care to new patient-centered models requires major changes in healthcare organizations, including interprofessional expectations and organizational policies. Emotional exhaustion (EE) among workers can accompany major organizational change, threatening its success. Yet little guidance exists about the magnitude of associations with EE during primary care transformation. We assessed EE during the initial phase …
Women Veterans with Depression in Veterans Health Administration Primary Care
Differences in Depression Care for Men and Women among Veterans with and without Psychiatric Comorbidities
Impact of Medical Home Implementation Through Evidence-based Quality Improvement on Utilization and Costs
BACKGROUND: Evidence-based quality improvement (EBQI) methods may facilitate practice redesign for more effective implementation of the patient-centered medical home (PCMH). OBJECTIVE: We assessed changes in health care utilization and costs for patients receiving care from practices using an EBQI approach to implement PCMH and comparison practices over a 5-year period. RESEARCH DESIGN: We used longitudinal, electronic data from patients in 6 pra…
Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health‐care System
CONTEXT: There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. METHODS: . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desir…
Medicine (29 obras) · Family medicine (19 obras) · Health care (17 obras) · Nursing (17 obras) · Primary Care and Health Outcomes (17 obras) · Political science (13 obras) · Primary care (12 obras) · Psychiatry (11 obras) · Mental Health Treatment and Access (10 obras) · Psychology (10 obras)