Evaluation of a Virtual Tai Chi Program for Older Veterans at Risk of Loneliness or Physical Deconditioning: A Quality Improvement Project.

This Quality Improvement project evaluated the implementation of a virtual Tai Chi program for older Veterans (OVs) at risk of loneliness and/or physical deconditioning. A 12-week Tai Chi course was conducted virtually at three Veterans Affairs sites using VA Video Connect (VVC). Changes in physical function based on the 30-Second Chair Stand (30CST) and loneliness based on the De Jong Gierveld Loneliness Scale (DJGS) were measured, as were the OVs' satisfaction and adherence. Of 109 OVs who enrolled, 74 completed the program with a mean attendance rate of 84%. Completers demonstrated a statistically significant improvement in the 30CST, and those who were moderately or severely lonely at baseline saw a statistically significant improvement in the DJGS. Course evaluations were generally very positive. Results suggest that a virtual Tai Chi program is an effective and very satisfying intervention for OVs at risk of loneliness or physical deconditioning.

Use of Real Time Clinical Video Telehealth to Home by primary care providers within the Veterans Health Administration during the first wave of the COVID-19 pandemic: variability across VA stations and with time.

Objective: Determine the extent to which use of Clinical Video Telehealth to Home (VT2H) for primary care licensed independent practitioner visits (PCLIPVs) varied over time and across the Veterans Health Administration (VA) during the first 18 months of the COVID pandemic, and if there was an association between VT2H usage and VA station characteristics. Materials and Methods: All outpatient encounters (n = 12 143 456) for Veterans (n = 4 373 638) that had VA PCLIPVs during the period of observation were categorized as conducted by VT2H, in-person, or telephone. The change over time in the percentage of total PCLIPVs conducted by VT2H was plotted and associations between VA station characteristics and VT2H usage were analyzed using simple statistics and negative binomial regression. Results: Between March 2020 and mid-August 2020, VT2H visits increased from <2% to 13% of all VA PCLIPVs. However, VT2H usage varied substantively by VA station and declined system-wide to <9% of PCLIPVs by July 2021. VA stations that serve a greater proportion of rural Veterans were found less likely to use VT2H. Discussion: The VA was successful in increasing the use of VT2H for PCLIPVs during the first phase of the COVID pandemic. However, VT2H usage varied by VA station and over time. Beyond rurality, it is unknown what station characteristics may be responsible for the variance in VT2H use. Conclusion: Future investigation is warranted to identify the unique practices employed by VA stations that were most successful in using VT2H for PCLIPVs and whether they can be effectively disseminated to other stations.

Nurse Staffing and Veteran Outcomes in the Veterans Health Administration's Community Living Centers.

BACKGROUND: The demand for nursing care is rising in the long-term care setting. Nurse staffing is a crucial measure linked to health care quality measure outcomes. PURPOSE: To assess for associations between nursing hours per patient day (NHPPD) and outcome measures in the Veterans Health Administration Community Living Centers. METHODS: A retrospective data review of NHPPD and quality measures for 134 community living centers was conducted. Linear regression was used to assess for linear associations between average total NHPPD and 6 quality measures. RESULTS: A significant linear association was found between average total NHPPD and falls with major injury ( P = .02) and help with activities of daily living ( P = .01). No associations were found between nurse staffing and 4 other quality measures. CONCLUSIONS: This study adds to the body of literature regarding the impact of nurse staffing on quality measures.

Rapid conversion of Tai Chi classes from face-to-face to virtual during the COVID-19 pandemic: A quality improvement project.

PURPOSE: The purpose of this quality improvement project was to examine the feasibility of rapidly converting a Tai Chi program for older Veterans from face-to-face to virtual classes. METHODS: Eighteen Veterans attending our face-to-face Tai Chi course were invited to transition to virtual classes. Feasibility was defined as the ability of program staff and participants to successfully connect and complete the initial and subsequent classes by VA Video Connect (VVC) with little to no technical difficulties, participant ability to participate in the course without safety concerns, and favorable feedback from participants and program staff. RESULTS: Nine of 18 Veterans agreed to transition to the virtual program and attended a median (interquartile range) of 11 (4-15) classes; they were younger (62.7 + 11.5 vs. 70.5 + 7.0 years, p < .05) and more likely to have the knowledge and equipment needed to participate (78% vs. 0%, p < .01) than nonparticipants. Tai Chi instructors and participating Veterans reported being able to connect to and complete the classes virtually with only minimal technical problems. No adverse events were reported. Feedback from the instructors and Veterans was positive and included comments on ease of use and enjoyability. CONCLUSION: Results suggest that virtual Tai Chi classes via VVC are feasible for some older Veterans.

An outpatient Tai Chi program: Effects on veterans' functional outcomes.

PURPOSE: To evaluate the effectiveness of an evidence-based 12-week Tai Chi course designed to improve balance and physical function in a population of older veterans. METHODS: Community dwelling veterans of all ages with gait and balance problems were invited to participate in the Tai Chi program. Participants completed the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and the Falls Efficacy Scale-International (FES-I) at baseline and again at the end of the program. Descriptive statistics were used to summarize study participants' characteristics. The change from baseline to the end of the 12-week program was calculated for each of the three primary outcome variables (BBS, TUG, FES-I). RESULTS: Twenty-two veterans, aged 58 years and above, with perceived gait and/or balance issues were enrolled in the program with completion by 11 veterans. Veterans who completed their final assessments showed the BBS, improved significantly (p = 0.004) from baseline to the 12-week assessment. The TUG scores improved by a median of 1.3 s (p = 0.022). There was not a significant change in the FES-I. CONCLUSIONS: Preliminary findings provide evidence of the effectiveness of a 12-week Tai Chi program to improve functional outcomes for older veterans with mild to moderate gait and balance problems.

National and Northern New England Opioid Prescribing Patterns, 2013-2014.

OBJECTIVE: To evaluate current opioid prescribing patterns nationally and regionally across several northern New England states and compare with prescription data on an institutional level over a two-year period, between 2013 and 2014. DESIGN, SETTING, AND SUBJECTS: The IMS Health National Prescription Audit (NPA) database was used to obtain prescription data from US retail pharmacies between 2013 and 2014. METHODS: Our study compared noninjectable opioid dispensing between two time periods: January-June 2013 and July-December 2014. Opioid prescription data were obtained nationally and in New Hampshire, Vermont, Maine, and Massachusetts. Institutional prescription data were supplied by Dartmouth Hitchcock Medical Center (DHMC) and University of Vermont Medical Center (UVMC) pharmacies. RESULTS: There was a 3.4% ( P = 0.81) decrease in opioid prescriptions filled nationally. Among New England states, opioid prescribing decreased in Maine (-5.20%, P = 0.72), Massachusetts (-4.4%, P = 0.78), and Vermont (-2.2%, P = 0.89) but increased in New Hampshire by 1.3% ( P = 0.94). Examination of local institutional opioid utilization revealed a 13.6% decline in prescriptions filled at UVMC, and only a 0.4% decrease at DHMC. CONCLUSIONS: The review of opioid prescriptions filled in 2013-14 suggests that national opioid utilization may be reaching a plateau. Initiatives such as prescription monitoring programs, prescriber opioid education, addiction treatment programs, public addiction awareness, and availability of medical cannabis may play a role in interstate variability of opioid use. National and regional data served as a benchmark for local institutional comparison, laying groundwork for efforts to explore areas where opioids can be prescribed more judiciously.

Expanding American Nurses Association nursing quality indicators to community-based practices.

Continuing its commitment to patient care quality, the American Nurses Association appointed a committee in 1997 to expand nursing-sensitive quality indicators beyond acute care. This article is the final report describing the processes used to identify a core set of community-based quality indicators relevant to nurses across the care continuum and identifies next steps. The indicator categories are (a) change in symptom severity, (b) strength of the therapeutic alliance, (c) utilization of services, (d) client satisfaction, (e) risk reduction, (f) increase in protective factors, and (g) level of function/functional status. Potential indicators requiring further research and development are also described.