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12. Reply by Authors

Author

Aguilar Palacios, Diego, primary, Wilson, Brigid, additional, Michael, Patrick, additional, Saarela, Olli, additional, Ascha, Mustafa, additional, Song, Sunah, additional, DeWitt-Foy, Molly E., additional, Lawson, Keith, additional, Barnholtz-Sloan, Jill, additional, Finelli, Antonio, additional, Campbell, Steven C., additional, and Abouassaly, Robert, additional

Published
2022
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16. Additional file 1 of Expanding the definition beyond surveillance criteria reveals a large burden of osteomyelitis caused by group B Streptococcus in the United States Veterans Health Administration

Author

Chengsupanimit, Tayoot, Bej, Taissa A., Wilson, Brigid, Banks, Richard E., Song, Sunah, Briggs, Janet M., Jump, Robin L. P., and Perez, Federico

Abstract

Additional file 1. Supplemental Tables 1-4 detail the International Classofication of Diseases (ICD) and current procedural terminology (CPT) codes as part of case identification.

Published
2022
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23. A Novel Metric for Hospital-Quality in Kidney Cancer Surgery: A Veteran’s Affairs National Health System Validation of Concept

Author

Palacios, Diego Aguilar, primary, Wilson, Brigid, additional, Michael, Patrick, additional, Saarela, Olli, additional, Ascha, Mustafa, additional, Song, Sunah, additional, DeWitt-Foy, Molly E., additional, Lawson, Keith, additional, Barnholtz-Sloan, Jill, additional, Finelli, Antonio, additional, Campbell, Steven C., additional, and Abouassaly, Robert, additional

Published
2021
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36. Reply by Authors

Author

Aguilar Palacios, Diego, primary, Wilson, Brigid, additional, Ascha, Mustafa, additional, Campbell, Rebecca A., additional, Song, Sunah, additional, DeWitt-Foy, Molly E., additional, Campbell, Steven C., additional, and Abouassaly, Robert, additional

Published
2021
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38. Similar Mortality Among United States Veterans With Invasive and Noninvasive Pneumonia due to Group B Streptococcus.

Author

Banks, Richard E, Wilson, Brigid M, Bej, Taissa, Briggs, Janet M, Song, Sunah, Goto, Michihiko, Jump, Robin L P, and Perez, Federico

Subjects
STREPTOCOCCUS agalactiae, STAPHYLOCOCCUS aureus infections, PNEUMONIA, ELECTRONIC health records, VETERANS, NEONATAL sepsis, INFECTION
Abstract

Background The nosology of noninvasive pneumonia due to group B Streptococcus (GBS) is not well defined. This study compared clinical characteristics and outcomes of patients with invasive pneumonia and noninvasive pneumonia caused by GBS. Methods We conducted a retrospective cohort study among Veterans Affairs (VA) healthcare users between 2008 and 2017. Using data from electronic health records, we identified patients who had blood or respiratory cultures that grew GBS and had invasive pneumonia or noninvasive pneumonia. We analyzed patient and infection characteristics associated with all-cause mortality, including among the subset of patients with cultures that were monomicrobial for GBS. Results Among 1791 patients with GBS pneumonia, 646 (36%) cases were invasive and 1145 (64%) were noninvasive. Among those, 535 and 424 cases of invasive and noninvasive pneumonia, respectively, had cultures that were monomicrobial for GBS. All-cause 30-day mortality among those with monomicrobial GBS pneumonia was 15% for both those with invasive and noninvasive disease, respectively. Increasing age, severity of illness, healthcare exposure in the previous 90 days, and polymicrobial infection with Staphylococcus aureus were independently associated with all-cause mortality at 30 days. Conclusions In this large cohort, even when considering cases for which GBS was the only pathogen recovered, >40% of GBS pneumonia cases were noninvasive. All-cause mortality was comparable for invasive and noninvasive pneumonia. These findings suggest that the burden of GBS pneumonia may be greater than previously recognized by surveillance of invasive GBS disease and may inform treatment and prevention efforts. [ABSTRACT FROM AUTHOR]

Published
2022
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39. Association of a geriatric emergency department program with healthcare outcomes among veterans.

Author

Huded, Jill M., Lee, Albert, Song, Sunah, McQuown, Colleen M., Wilson, Brigid M., Smith, Todd I., and Bonomo, Robert A.

Subjects
EVALUATION of medical care, LENGTH of stay in hospitals, HOSPITAL emergency services, SCIENTIFIC observation, EVALUATION of human services programs, GERIATRICS, GERIATRIC assessment, PATIENTS, PRIMARY health care, HOSPITAL admission & discharge, HUMAN services programs, DESCRIPTIVE statistics, VETERANS, METROPOLITAN areas, LONGITUDINAL method, OLD age
Abstract

Background: We aim to describe the outcomes of Geriatric Emergency Room Innovations for Veterans (GERI‐VET), the first comprehensive Veterans Affairs Geriatric ED program. Methods: In this prospective observational cohort study at an urban Veterans Affairs Medical Center ED, participants included Veterans aged 65 years and older treated in the ED from January 7, 2017 to February 29, 2020. Veterans with an Identification of Seniors At Risk (ISAR) score >2 were considered eligible for GERI‐VET, receiving geriatric screens and care coordination in addition to standard ED treatment. The control group included GERI‐VET eligible Veterans who did not receive GERI‐VET care. Propensity score matching was used to compare outcomes in the GERI‐VET group (N = 725) and a matched control group (n = 725). Key measures included ED resource utilization, outpatient referrals, ED admission, and 30‐day admission. Results: In the ED, the GERI‐VET group received more consults to pharmacy (315 [43.4%] vs. 195 [26.9%], p < 0.001) and social work (399 [55.0%] vs. 132 [18.2%], p < 0.001). The GERI‐VET group had higher referral rates to Geriatrics (64 [17.7%] vs. 18 [5.8%], p < 0.001) and Home Based Primary Care (110 [30.4%] vs. 24 [7.8%], p < 0.001). Key outcome measures included lower rates of ED admission (363 [50.1%] vs. 417 [n = 57.5%], p = 0.003) and 30‐day hospital admission (412 [56.8%] vs. 464 [64.0%], p = 0.004) without increasing ED length of stay (5.4 ± 2.2 vs. 5.4 ± 2.6 h, p = 0.85) or 72‐h ED revisits (23 [3.2%] vs. 16 [2.2%], p = 0.25) in the GERI‐VET group. Conclusions: A program designed to screen for geriatric syndromes and coordinate care among at‐risk older Veterans was associated with increased multidisciplinary resource utilization and reduced ED and 30‐day admissions without increasing ED length of stay or re‐visitation. [ABSTRACT FROM AUTHOR]

Published
2022
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45. MP66-10 HOSPITAL-LEVEL QUALITY INDICATORS FOR KIDNEY CANCER SURGERY: A VETERAN’S AFFAIR NATIONAL HEALTH SYSTEM VALIDATION OF CONCEPT

Author

Palacios*, Diego Aguilar, primary, Wilson, Brigid, additional, Saarela, Olli, additional, Ascha, Mustafa, additional, Song, Sunah, additional, DeWitt-Foy, Molly E., additional, Lawson, Keith, additional, Barnholtz-Sloan, Jill, additional, Finelli, Antonio, additional, Campbell, Steven C., additional, and Abouassaly, Robert, additional

Published
2020
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47. Hospital-level quality indicators for kidney cancer surgery: A Veteran’s Affairs national health system validation of concept.

Author

Aguilar Palacios, Diego, primary, Wilson, Brigid, additional, Saarela, Olli, additional, Ascha, Mustafa, additional, Song, Sunah, additional, DeWitt-Foy, Molly Elmer, additional, Lawson, Keith, additional, Barnholtz-Sloan, Jill, additional, Finelli, Antonio, additional, Campbell, Steven, additional, and Abouassaly, Robert, additional

Published
2020
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49. Influence of microbiological culture results on antibiotic choices for veterans with hospital-acquired pneumonia and ventilator-associated pneumonia

Author

Bej, Taissa A., Christian, Robbie L., Sims, Sharanie V., Wilson, Brigid M., Song, Sunah, Akpoji, Ukwen C., Bonomo, Robert A., Perez, Federico, and Jump, Robin L. P.

Abstract

AbstractObjective:We examined the impact of microbiological results from respiratory samples on choice of antibiotic therapy in patients treated for hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP).Design:Four-year retrospective study.Setting:Veterans’ Health Administration (VHA).Patients:VHA patients hospitalized with HAP or VAP and with respiratory cultures between October 1, 2014, and September 30, 2018.Interventions:We compared patients with positive and negative respiratory culture results, assessing changes in antibiotic class and Antibiotic Spectrum Index (ASI) from the day of sample collection (day 0) through day 7.Results:Between October 1, 2014, and September 30, 2018, we identified 5,086 patients with HAP/VAP: 2,952 with positive culture results and 2,134 with negative culture results. All-cause 30-day mortality was 21% for both groups. The mean time from respiratory sample receipt in the laboratory to final respiratory culture result was longer for those with positive (2.9 ± 1.3 days) compared to negative results (2.5 ± 1.3 days; P< .001). The most common pathogens were Staphylococcus aureusand Pseudomonas aeruginosa. Vancomycin and β-lactam/β-lactamase inhibitors were the most commonly prescribed agents. The decrease in the median ASI from 13 to 8 between days 0 and 6 was similar among patients with positive and negative respiratory cultures. Patients with negative cultures were more likely to be off antibiotics from day 3 onward.Conclusions:The results of respiratory cultures had only a small influence on antibiotics used during the treatment of HAP/VAP. The decrease in ASI for both groups suggests the integration of antibiotic stewardship principles, including de-escalation, into the care of patients with HAP/VAP.

Published
2022
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