Stephan D Fihn
Dados Biográficos
| ID | 5137080 |
|---|---|
| NOME | Stephan D Fihn |
| PRENOMES | Stephan D |
| SOBRENOME | Fihn |
| ASSINATURA | FIHN S D |
| AFILIAÇÕES | University of Washington |
| VERIFICADO | Não |
| TOTAL DE OBRAS | 23 |
| TOTAL DE CITAÇÕES | 15 |
| TOTAL COMO AUTOR | 23 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1986 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2019 |
| ÍNDICE H | 1 |
Response to The Methodological Challenges of Using Veterans Benefits Administration Disability Codes to Ascertain Agent Orange Exposure Among Vietnam Theater Veterans With Service-connected Disabiliti…
Maynard, Charles PhD*,†; Batten, Adam BA‡; Liu, Chuan-Fen PhD*,†; Nelson, Karin MD, MSHS*,†,‡,§; Fihn, Stephan D. MD, MPH†,§ Author Information
The Methodological Challenges of Using Veterans Benefits Administration Disability Codes to Ascertain Agent Orange Exposure Among Vietnam Theater Veterans With Service-connected Disabilities
Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. This timely journal reports on the findings of original investigations into issues related to the research, planning, organization, financing, …
The Burden of Mental Illness Among Veterans
BACKGROUND: Little is known about how Veterans with service-connected conditions use health care provided by the Veterans Health Administration (VHA). OBJECTIVES: To ascertain what proportion of Veterans with service-connected conditions used VHA health care and whether it varied according to type of condition, combined disability rating, age, sex, military rank, or other characteristics and whether there were differences in receipt of inpatient …
A First Look at PCMH Implementation for Minority Veterans
BACKGROUND: Implementation of Patient Aligned Care Teams (PACT), a patient-centered medical home model, has been inconsistent among the >900 primary care facilities in the Veterans Health Administration. OBJECTIVE: Estimate if the degree of PACT implementation at a facility varied with the percentage of minority veteran patients at the facility. RESEARCH DESIGN: Cross-sectional, facility-level analysis of PACT implementation measures in 2012. SUB…
Using a Single Item to Measure Burnout in Primary Care Staff
Prevalence, Comorbidity, and Prognosis of Mental Health Among US Veterans
Objectives. We evaluated the association of mental illnesses with clinical outcomes among US veterans and evaluated the effects of Primary Care–Mental Health Integration (PCMHI). Methods. A total of 4 461 208 veterans were seen in the Veterans Health Administration’s patient-centered medical homes called Patient Aligned Care Teams (PACT) in 2010 and 2011, of whom 1 147 022 had at least 1 diagnosis of depression, posttraumatic stress disorder (PTS…
Association Between Local Area Unemployment Rates and Use of Veterans Affairs Outpatient Health Services
BACKGROUND: Prior research indicates that federal spending on Medicare, Medicaid, and other government health programs accelerated during the Great Recession. OBJECTIVES: To examine whether local unemployment was associated with utilization of Veterans Affairs Health Care System (VA) primary care, specialty care, and mental health services during 2004-2012. RESEARCH DESIGN: We analyzed utilization of VA health services at the clinic level using f…
Patient-Centered Medical Home Implementation and Primary Care Provider Turnover
BACKGROUND: The Veterans Health Administration (VHA) began implementing a patient-centered medical home (PCMH) model of care delivery in April 2010 through its Patient Aligned Care Team (PACT) initiative. PACT represents a substantial system reengineering of VHA primary care and its potential effect on primary care provider (PCP) turnover is an important but unexplored relationship. This study examined the association between a system-wide PCMH i…
Feasibility of Proactive Medical Device Surveillance
BACKGROUND: Timely identification and reporting of medical device problems is critical to postmarket device surveillance programs to maximize patient safety. Cardiac catheterization laboratories are high-device utilization areas well suited for device surveillance. OBJECTIVE: To demonstrate the feasibility of the national VA Clinical Assessment, Reporting, and Tracking (CART) system, embedded in the electronic health record of all 76 VA cardiac c…
Predicting Risk of Hospitalization or Death Among Patients Receiving Primary Care in the Veterans Health Administration
BACKGROUND: Statistical models that identify patients at elevated risk of death or hospitalization have focused on population subsets, such as those with a specific clinical condition or hospitalized patients. Most models have limitations for clinical use. Our objective was to develop models that identified high-risk primary care patients. METHODS: Using the Primary Care Management Module in the Veterans Health Administration (VHA)'s Corporate Da…
Measures of Adherence to Oral Hypoglycemic Agents at the Primary Care Clinic Level
BACKGROUND: Prior research found that in the Veterans Affairs health care system (VA), the proportion of patients adherent to oral hypoglycemic agents varies from 50% to 80% across primary care clinics. This study examined whether variation in patient and facility characteristics determined those differences. METHODS: Retrospective cohort study of 444,418 VA primary care patients with diabetes treated in 559 clinics in fiscal year (FY) 2006-2007.…
Use of Administrative Claims Models to Assess 30-Day Mortality Among Veterans Health Administration Hospitals
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) publicly reports hospital-specific risk-standardized, 30-day, all-cause, mortality rates (RSMRs) for all hospitalizations among fee-for-service Medicare beneficiaries for acute myocardial infarction (AMI), heart failure (HF), and pneumonia at non-Federal hospitals. OBJECTIVE: To examine the performance of the statistical models used by CMS among veterans at least 65 years of age hos…
Health Care Expenditure Prediction With a Single Item, Self-Rated Health Measure
BACKGROUND: Prediction models that identify populations at risk for high health expenditures can guide the management and allocation of financial resources. OBJECTIVE: To compare the ability for identifying individuals at risk for high health expenditures between the single-item assessment of general self-rated health (GSRH), "In general, would you say your health is Excellent, Very Good, Good, Fair, or Poor?," and 3 more complex measures. STUDY …
A Refill Adherence Algorithm for Multiple Short Intervals to Estimate Refill Compliance (ReComp)
BACKGROUND: There are many measures of refill adherence available, but few have been designed or validated for use with repeated measures designs and short observation periods. OBJECTIVE: To design a refill-based adherence algorithm suitable for short observation periods, and compare it to 2 reference measures. METHODS: A single composite algorithm incorporating information on both medication gaps and oversupply was created. Electronic Veterans A…
Predicting Mortality and Healthcare Utilization with a Single Question
Objective. We compared single‐ and multi‐item measures of general self‐rated health (GSRH) to predict mortality and clinical events a large population of veteran patients. Data Source/Study Setting. We analyzed prospective cohort data collected from 21,732 patients as part of the Veterans Affairs Ambulatory Care Quality Improvement Project (ACQUIP), a randomized controlled trial investigating quality‐of‐care interventions. Study Design. We create…
Provider Response to Computer-Based Care Suggestions for Chronic Heart Failure
OBJECTIVES: We sought to assess the responses of providers to recommendations generated by a computer-management system for chronic heart failure (CHF). METHODS: This study is an analysis of primary care providers' responses to evidence-based computer-generated suggestions regarding patients with CHF at one center of a randomized trial. The trial randomized primary care providers from 2 VA Medical Centers to receive care suggestions regarding pat…
Accounting for Deaths in Longitudinal Studies Using the SF-36
BACKGROUND: Commonly used measures such as the Physical Component Scale of the Short Form 36-item health survey (PCS) are undefined at death, limiting longitudinal analyses to survivors, a healthier cohort that cannot be identified prospectively, and that might have had little change in health. One proposed approach is to transform the PCS into the Physical Component Transformed, with Deaths included (PCTD), which is the probability of being heal…
Transforming Self-Rated Health and the SF-36 Scales to Include Death and Improve Interpretability
BACKGROUND: Most measures of health-related quality of life are undefined for people who die. Longitudinal analyses are often limited to a healthier cohort (survivors) that cannot be identified prospectively, and that may have had little change in health. OBJECTIVE: To develop and evaluate methods to transform a single self-rated health item (excellent to poor; EVGGFP) and the physical component score of the SF-36 (PCS) to new variables that incl…
Regional Variations in Health Status
CONTEXT: Knowledge about variations in the health status of patients seeking primary care in different parts of the United States is limited. OBJECTIVE: To examine regional variations in the physical and mental health of patients receiving primary care in the largest integrated health care system in the United States which is operated by the Department of Veteran Affairs (VA). STUDY DESIGN AND SETTING: We performed a mailed, cross sectional surve…
Quality Enhancement Research Initiative in Ischemic Heart Disease
Despite the dramatic fall in ischemic heart disease (IHD) mortality rates over the last 3 decades, it remains the number one cause of death in the United States, and one of the most frequent indications for care by the US Department of Veterans Affairs. National practice guidelines have been developed and disseminated both by societies that specialize in cardiology and within the Veterans Health Administration. Despite these efforts, a substantia…
Variation in the Rate of Cervical Spine Surgery in Washington State
Lack of consensus about the treatment of low back pain is reflected by wide regional variations in lumbar spine surgery rates. Neck pain may be as common as low back pain, but there has been no similar evaluation of regional variation for the surgical treatment of neck pain. This report examines the geographic variation and temporal trends in the rate of cervical spine surgery in Washington state from 1986 through 1989. Using diagnosis and proced…
A General Method of Compliance Assessment Using Centralized Pharmacy Records
The prescription refill records of centralized pharmacies are a potential source of information about patient compliance with long-term medications. We developed a method for assessing compliance in such settings and validated our measures using pharmacy data and clinical information from patients with seizure disorders and hypertension. For patients taking the anticonvulsant medication phenytoin, compliance with the drug correlated significantly…
Association Between Diaphragm use and Urinary Tract Infection
We conducted independent case-control and retrospective cohort investigations to assess the relationship between diaphragm use and urinary tract infection (UTI). In the former, we compared diaphragm use and vaginal flora among 114 women with acute UTI and 85 women with acute urinary tract symptoms and no UTI. In the latter study, we ascertained the incidence of UTI in 192 diaphragm users and 182 women taking oral contraceptives during a mean foll…
Prevalence, Comorbidity, and Prognosis of Mental Health Among US Veterans
Objectives. We evaluated the association of mental illnesses with clinical outcomes among US veterans and evaluated the effects of Primary Care–Mental Health Integration (PCMHI). Methods. A total of 4 461 208 veterans were seen in the Veterans Health Administration’s patient-centered medical homes called Patient Aligned Care Teams (PACT) in 2010 and 2011, of whom 1 147 022 had at least 1 diagnosis of depression, posttraumatic stress disorder (PTS…
Association Between Diaphragm use and Urinary Tract Infection
We conducted independent case-control and retrospective cohort investigations to assess the relationship between diaphragm use and urinary tract infection (UTI). In the former, we compared diaphragm use and vaginal flora among 114 women with acute UTI and 85 women with acute urinary tract symptoms and no UTI. In the latter study, we ascertained the incidence of UTI in 192 diaphragm users and 182 women taking oral contraceptives during a mean foll…
A General Method of Compliance Assessment Using Centralized Pharmacy Records
The prescription refill records of centralized pharmacies are a potential source of information about patient compliance with long-term medications. We developed a method for assessing compliance in such settings and validated our measures using pharmacy data and clinical information from patients with seizure disorders and hypertension. For patients taking the anticonvulsant medication phenytoin, compliance with the drug correlated significantly…
Variation in the Rate of Cervical Spine Surgery in Washington State
Lack of consensus about the treatment of low back pain is reflected by wide regional variations in lumbar spine surgery rates. Neck pain may be as common as low back pain, but there has been no similar evaluation of regional variation for the surgical treatment of neck pain. This report examines the geographic variation and temporal trends in the rate of cervical spine surgery in Washington state from 1986 through 1989. Using diagnosis and proced…
Quality Enhancement Research Initiative in Ischemic Heart Disease
Despite the dramatic fall in ischemic heart disease (IHD) mortality rates over the last 3 decades, it remains the number one cause of death in the United States, and one of the most frequent indications for care by the US Department of Veterans Affairs. National practice guidelines have been developed and disseminated both by societies that specialize in cardiology and within the Veterans Health Administration. Despite these efforts, a substantia…
Transforming Self-Rated Health and the SF-36 Scales to Include Death and Improve Interpretability
BACKGROUND: Most measures of health-related quality of life are undefined for people who die. Longitudinal analyses are often limited to a healthier cohort (survivors) that cannot be identified prospectively, and that may have had little change in health. OBJECTIVE: To develop and evaluate methods to transform a single self-rated health item (excellent to poor; EVGGFP) and the physical component score of the SF-36 (PCS) to new variables that incl…
Regional Variations in Health Status
CONTEXT: Knowledge about variations in the health status of patients seeking primary care in different parts of the United States is limited. OBJECTIVE: To examine regional variations in the physical and mental health of patients receiving primary care in the largest integrated health care system in the United States which is operated by the Department of Veteran Affairs (VA). STUDY DESIGN AND SETTING: We performed a mailed, cross sectional surve…
Accounting for Deaths in Longitudinal Studies Using the SF-36
BACKGROUND: Commonly used measures such as the Physical Component Scale of the Short Form 36-item health survey (PCS) are undefined at death, limiting longitudinal analyses to survivors, a healthier cohort that cannot be identified prospectively, and that might have had little change in health. One proposed approach is to transform the PCS into the Physical Component Transformed, with Deaths included (PCTD), which is the probability of being heal…
Predicting Mortality and Healthcare Utilization with a Single Question
Objective. We compared single‐ and multi‐item measures of general self‐rated health (GSRH) to predict mortality and clinical events a large population of veteran patients. Data Source/Study Setting. We analyzed prospective cohort data collected from 21,732 patients as part of the Veterans Affairs Ambulatory Care Quality Improvement Project (ACQUIP), a randomized controlled trial investigating quality‐of‐care interventions. Study Design. We create…
Provider Response to Computer-Based Care Suggestions for Chronic Heart Failure
OBJECTIVES: We sought to assess the responses of providers to recommendations generated by a computer-management system for chronic heart failure (CHF). METHODS: This study is an analysis of primary care providers' responses to evidence-based computer-generated suggestions regarding patients with CHF at one center of a randomized trial. The trial randomized primary care providers from 2 VA Medical Centers to receive care suggestions regarding pat…
A Refill Adherence Algorithm for Multiple Short Intervals to Estimate Refill Compliance (ReComp)
BACKGROUND: There are many measures of refill adherence available, but few have been designed or validated for use with repeated measures designs and short observation periods. OBJECTIVE: To design a refill-based adherence algorithm suitable for short observation periods, and compare it to 2 reference measures. METHODS: A single composite algorithm incorporating information on both medication gaps and oversupply was created. Electronic Veterans A…
Health Care Expenditure Prediction With a Single Item, Self-Rated Health Measure
BACKGROUND: Prediction models that identify populations at risk for high health expenditures can guide the management and allocation of financial resources. OBJECTIVE: To compare the ability for identifying individuals at risk for high health expenditures between the single-item assessment of general self-rated health (GSRH), "In general, would you say your health is Excellent, Very Good, Good, Fair, or Poor?," and 3 more complex measures. STUDY …
Use of Administrative Claims Models to Assess 30-Day Mortality Among Veterans Health Administration Hospitals
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) publicly reports hospital-specific risk-standardized, 30-day, all-cause, mortality rates (RSMRs) for all hospitalizations among fee-for-service Medicare beneficiaries for acute myocardial infarction (AMI), heart failure (HF), and pneumonia at non-Federal hospitals. OBJECTIVE: To examine the performance of the statistical models used by CMS among veterans at least 65 years of age hos…
Measures of Adherence to Oral Hypoglycemic Agents at the Primary Care Clinic Level
BACKGROUND: Prior research found that in the Veterans Affairs health care system (VA), the proportion of patients adherent to oral hypoglycemic agents varies from 50% to 80% across primary care clinics. This study examined whether variation in patient and facility characteristics determined those differences. METHODS: Retrospective cohort study of 444,418 VA primary care patients with diabetes treated in 559 clinics in fiscal year (FY) 2006-2007.…
Feasibility of Proactive Medical Device Surveillance
BACKGROUND: Timely identification and reporting of medical device problems is critical to postmarket device surveillance programs to maximize patient safety. Cardiac catheterization laboratories are high-device utilization areas well suited for device surveillance. OBJECTIVE: To demonstrate the feasibility of the national VA Clinical Assessment, Reporting, and Tracking (CART) system, embedded in the electronic health record of all 76 VA cardiac c…
Predicting Risk of Hospitalization or Death Among Patients Receiving Primary Care in the Veterans Health Administration
BACKGROUND: Statistical models that identify patients at elevated risk of death or hospitalization have focused on population subsets, such as those with a specific clinical condition or hospitalized patients. Most models have limitations for clinical use. Our objective was to develop models that identified high-risk primary care patients. METHODS: Using the Primary Care Management Module in the Veterans Health Administration (VHA)'s Corporate Da…
Association Between Local Area Unemployment Rates and Use of Veterans Affairs Outpatient Health Services
BACKGROUND: Prior research indicates that federal spending on Medicare, Medicaid, and other government health programs accelerated during the Great Recession. OBJECTIVES: To examine whether local unemployment was associated with utilization of Veterans Affairs Health Care System (VA) primary care, specialty care, and mental health services during 2004-2012. RESEARCH DESIGN: We analyzed utilization of VA health services at the clinic level using f…
Patient-Centered Medical Home Implementation and Primary Care Provider Turnover
BACKGROUND: The Veterans Health Administration (VHA) began implementing a patient-centered medical home (PCMH) model of care delivery in April 2010 through its Patient Aligned Care Team (PACT) initiative. PACT represents a substantial system reengineering of VHA primary care and its potential effect on primary care provider (PCP) turnover is an important but unexplored relationship. This study examined the association between a system-wide PCMH i…
Using a Single Item to Measure Burnout in Primary Care Staff
Prevalence, Comorbidity, and Prognosis of Mental Health Among US Veterans
Objectives. We evaluated the association of mental illnesses with clinical outcomes among US veterans and evaluated the effects of Primary Care–Mental Health Integration (PCMHI). Methods. A total of 4 461 208 veterans were seen in the Veterans Health Administration’s patient-centered medical homes called Patient Aligned Care Teams (PACT) in 2010 and 2011, of whom 1 147 022 had at least 1 diagnosis of depression, posttraumatic stress disorder (PTS…
A First Look at PCMH Implementation for Minority Veterans
BACKGROUND: Implementation of Patient Aligned Care Teams (PACT), a patient-centered medical home model, has been inconsistent among the >900 primary care facilities in the Veterans Health Administration. OBJECTIVE: Estimate if the degree of PACT implementation at a facility varied with the percentage of minority veteran patients at the facility. RESEARCH DESIGN: Cross-sectional, facility-level analysis of PACT implementation measures in 2012. SUB…
The Burden of Mental Illness Among Veterans
BACKGROUND: Little is known about how Veterans with service-connected conditions use health care provided by the Veterans Health Administration (VHA). OBJECTIVES: To ascertain what proportion of Veterans with service-connected conditions used VHA health care and whether it varied according to type of condition, combined disability rating, age, sex, military rank, or other characteristics and whether there were differences in receipt of inpatient …
The Methodological Challenges of Using Veterans Benefits Administration Disability Codes to Ascertain Agent Orange Exposure Among Vietnam Theater Veterans With Service-connected Disabilities
Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. This timely journal reports on the findings of original investigations into issues related to the research, planning, organization, financing, …
Response to The Methodological Challenges of Using Veterans Benefits Administration Disability Codes to Ascertain Agent Orange Exposure Among Vietnam Theater Veterans With Service-connected Disabiliti…
Maynard, Charles PhD*,†; Batten, Adam BA‡; Liu, Chuan-Fen PhD*,†; Nelson, Karin MD, MSHS*,†,‡,§; Fihn, Stephan D. MD, MPH†,§ Author Information
Medicine (22 obras) · Family medicine (11 obras) · Internal Medicine (8 obras) · Internal Medicine (8 obras) · Primary Care and Health Outcomes (8 obras) · Gerontology (7 obras) · Gerontology (7 obras) · Political science (7 obras) · Chronic Disease Management Strategies (6 obras) · Health care (6 obras)