Adaptation of Lean Six Sigma Methodologies for the Evaluation of Veterans Choice Program at 3 Urban Veterans Affairs Medical Centers.

OBJECTIVE: The Veterans Health Administration (VHA) is adapting to meet the changing needs of our Veterans. VHA leaders are promoting quality improvement strategies including Lean Six Sigma (LSS). This study used LSS tools to evaluate the Veterans Choice Program (VCP), a program that aims to improve access to health care services for eligible Veterans by expanding health care options to non-VHA providers. RESEARCH DESIGN: LSS was utilized to assess the current process and efficiency patterns of the VCP at 3 VHA Medical Centers. LSS techniques were used to assess data obtained through semistructured interviews with Veterans, staff, and providers to describe and evaluate the VCP process by identifying wastes and defects. RESULTS: The LSS methodology facilitated the process of targeting priorities for improvement and constructing suggestions to close identified gaps and inefficiencies. Identified key process wastes included inefficient exchange of clinical information between stakeholders in and outside of the VHA; poor dissemination of VCP programmatic information; shortages of VCP-participating providers; duplication of appointments; declines in care coordination; and lack of program adaptability to local processes. Recommendations for improvement were formulated using LSS. CONCLUSIONS: This evaluation illustrates how LSS can be utilized to assess a nationally mandated health care program. By focusing on stakeholder, staff, and Veteran perspectives, process defects in the VCP were identified and improvement recommendations were made. However, the current LSS language used is not intuitive in health care and similar applications of LSS may consider using new language and goals adapted specifically for health care.

Preclerkship Medical Students' Use of Third-Party Learning Resources.

Importance: Undergraduate medical education increasingly relies on asynchronous, virtual learning; and medical educators have observed students engaging in self-directed learning outside of their institutional curriculum using widely available third-party resources. If medical educators better understand how students are learning, they may uncover novel opportunities to improve preclerkship education. Objective: To explore how and why preclerkship medical students use third-party learning resources. Design, Setting, and Participants: This qualitative study recruited second-year medical students from 7 public and private allopathic US medical schools and conducted 7 virtual focus groups (1 per institution) from September 2022 to January 2023, exploring how and why students use third-party resources. Data were iteratively analyzed in parallel with focus groups using constructivist grounded theory methodology. Data analysis was performed from October 2022 to February 2023. Results: Fifty-eight second-year US medical students who had used a third-party resource at least once participated; 36 (61%) identified as women; 13 (23%) identified as Asian, 6 (11%) as Black, 30 (53%) as White, 6 (11%) as multiracial, and 4 (7%) as other; 6 (10%) identified as Hispanic, Latino, or Spanish origin, and 52 (90%) identified as non-Hispanic, Latino, or Spanish origin; 48 (83%) were aged 23 to 25 years. Participants described engaging in a cyclical process of deciding whether and how to use third-party resources. Four broad themes were identified: (1) hearing about resources, (2) selecting resources, (3) using resources, and (4) tensions and possible solutions. Participants largely heard about third-party resources from peers and turned to resources out of dissatisfaction with some aspect of their medical school curriculum. Students used resources in various ways that were user-dependent and context-dependent. Participants endorsed multiple benefits over their in-house curricula, particularly efficiency, clarity, and concision. Tensions included navigating resource drawbacks and the perception of an antagonistic relationship between medical schools and third-party resources. Participants suggested that medical schools examine the resources, recommend specific ones, integrate them into the curriculum, and subsidize their cost. Conclusions and Relevance: In this qualitative study of preclerkship medical student use of third-party resources, participants perceived that the resources had numerous benefits for learning and suggested that medical schools should more formally acknowledge and integrate their use.

Topical and systemic GLP-1R agonist administration both rescue retinal ganglion cells in hypertensive glaucoma.

Glaucomatous neurodegeneration, a blinding disease affecting millions worldwide, has a need for the exploration of new and effective therapies. Previously, the glucagon-like peptide-1 receptor (GLP-1R) agonist NLY01 was shown to reduce microglia/macrophage activation, rescuing retinal ganglion cells after IOP elevation in an animal model of glaucoma. GLP-1R agonist use is also associated with a reduced risk for glaucoma in patients with diabetes. In this study, we demonstrate that several commercially available GLP-1R agonists, administered either systemically or topically, hold protective potential in a mouse model of hypertensive glaucoma. Further, the resulting neuroprotection likely occurs through the same pathways previously shown for NLY01. This work contributes to a growing body of evidence suggesting that GLP-1R agonists represent a viable therapeutic option for glaucoma.