VA Heartland Network

Introduction: Breed-specific legislation (BSL) is intended to restrict or reduce the ownership of selected breeds of dogs within a municipality. These laws frequently aim at ‘bully breeds’ such as the American Pit Bull Terrier and other pure or mixed breeds with similar phenotypic characteristics, which are heavily represented in animal shelters nationwide. This retrospective cohort study investigated differences in outcomes and length of stay (LOS) for legislated dogs versus dogs of other breeds in a managed admission municipal shelter subject to BSL. Methods: Retrospective outcome data from January 1, 2022 through December 31, 2022 were analyzed. The study population included 764 adult dogs of which 118 were legislated breeds. Results: Analysis of the full study population found legislated dogs were more likely to be euthanized (x2(4) = 23.76, p < 0.001) and experience a longer LOS (U = 32858.50, z = -2.385, p = 0.017). Non-legislated breeds were more likely to be adopted (x2(4) = 23.760, p < 0.001). In a weight-matched subset of dogs weighing 14.1–30.6 kg (n = 424, including 339 non-legislated and 85 legislated dogs), there was no longer a significant difference between the groups in the rate of live versus non-live outcomes (X2(1) = 2.022, p = 0.179); however, legislated dogs experienced a significantly longer LOS to adoption (U = 2039.00, Z = -2.04, p = 0.041) and return-to-owner (U = 1725.50, Z = -3.33, p = 0.001) and a reduced likelihood of adoption (x2(3) = 11.454, p = 0.010). Additional analysis performed for 80 dogs whose first outcome was euthanasia revealed non-legislated dogs were significantly more likely to be euthanized for medical reasons than legislated dogs, and there were no significant differences in euthanasia for aggressive behavior or behavioral evidence of poor quality of life (x2(2) = 6.528, p = 0.038). Conclusion: Shelter dogs subject to BSL generally experience barriers to live outcomes. In this shelter, staff endeavored to find live outcomes for these dogs, including transport and reunification. Overturning BSL would support increased live outcomes, including family reunification, for legislated dogs.

BackgroundThe adoption and sustainment of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of three EBPs: (1) a deprescribing approach intended to reduce potentially inappropriate polypharmacy; (2) appropriate dosing and drug selection of direct oral anticoagulants (DOACs); and (3) use of cognitive behavioral therapy as first-line treatment for insomnia before pharmacologic treatment. We describe the design and methods for a harmonized series of cluster-randomized control trials comparing two implementation strategies.MethodsFor each trial, we will recruit 8–12 clinics (24–36 total). All will have access to relevant clinical data to identify patients who may benefit from the target EBP at that clinic and provider. For each trial, clinics will be randomized to one of two implementation strategies to improve the use of the EBPs: (1) individual-level academic detailing (AD) or (2) AD plus the team-based Learn. Engage. Act. Process. (LEAP) quality improvement (QI) learning program. The primary outcomes will be operationalized across the three trials as a patient-level dichotomous response (yes/no) indicating patients with potentially inappropriate medications (PIMs) among those who may benefit from the EBP. This outcome will be computed using month-by-month administrative data. Primary comparison between the two implementation strategies will be analyzed using generalized estimating equations (GEE) with clinic-level monthly (13 to 36 months) percent of PIMs as the dependent variable. Primary comparative endpoint will be at 18 months post-baseline. Each trial will also be analyzed independently.DiscussionMIDAS QUERI trials will focus on fostering sustained use of EBPs that previously had targeted but incomplete implementation. Our implementation approaches are designed to engage frontline clinicians in a dynamic optimization process that integrates the use of actional clinical data and making incremental changes, designed to be feasible within busy clinical settings.Trial registrationClinicalTrials.gov: NCT05065502. Registered October 4, 2021—retrospectively registered.

To provide a summary of the implementation of a virtual academic detailing pilot program at the US Department of Veterans Affairs (VA). In September 2018, VA Pharmacy Benefits Management implemented a virtual academic detailing ("e-Detailing") pilot program across 3 regional networks. Academic detailing involves multifaceted collaborative outreach delivered by trained healthcare clinicians to other clinicians using targeted educational interventions that improve clinical decision-making. Across VA, academic detailing programs are primarily staffed by specially trained clinical pharmacist specialists. Implementation began with an in-person meeting to train academic detailers on using the virtual academic detailing platform (VA Video Connect) and virtual soft skills, which was followed by regular facilitation meetings to address issues and share experiences. During e-Detailing program implementation, coronavirus disease 2019 (COVID-19) emerged, prompting the US Department of Health and Human Services to declare a public health emergency. VA followed with restrictions on nonessential travel for all employees, thus hampering in-person academic detailing activities. Fortunately, e-Detailing provided an alternative channel for academic detailers across VA to continue delivering critical outreach to providers during the pandemic. Qualitative assessment of academic detailers' and providers' perceptions on e-Detailing highlighted the need for local leadership support for e-Detailing and telehealth, the efficiency of virtual compared to in-person visits, and potential time savings resulting from avoidance of long commutes. The timing of e-Detailing implementation during the COVID-19 pandemic illustrates the need and potential for a virtual platform to deliver timely provider outreach.

Heartland Kidney Network developed the Take 5 to Tune In project utilizing the technique of “talking control” to improve communication between staff and patients in the dialysis facility. Face-to-face talking control encounters with a five-minute minimum were conducted with patients from June 1, 2014, through September 30, 2014. Five questions from the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) experience of care survey were used to evaluate the success of the project. Overall, there was an increase of 5 percentage points in the combined rate of positive responses to the five ICH CAHPS questions. Talking control is an effective and simple means to improve dialysis provider communication and patients’ satisfaction with their care.