Karin M. Nelson
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View article: Population-Level Health Intervention and Primary Care Quality for Veterans
Population-Level Health Intervention and Primary Care Quality for Veterans Open
Importance The COVID-19 pandemic caused substantial disruptions to primary care, potentially impacting quality of care for chronic conditions. The Veterans Health Administration (VHA) implemented the Preventive Health Inventory (PHI) initi…
View article: Relationship between neighborhood walkability, perceived neighborhood features, and depression among treatment-seeking veterans
Relationship between neighborhood walkability, perceived neighborhood features, and depression among treatment-seeking veterans Open
A population health perspective in mental health shifts attention from interventions delivered at the individual level to broad determinants, such as neighborhood characteristics, that impact the mental health of communities. The walkabili…
View article: “Navigating Healthcare and Social Interactions: The Impact of Multidrug-Resistant Bacteria on Wound Patients”– a qualitative study
“Navigating Healthcare and Social Interactions: The Impact of Multidrug-Resistant Bacteria on Wound Patients”– a qualitative study Open
Background Multidrug-resistant bacteria are a growing global health concern, fueled by antibiotic misuse and poor hygiene. Wound carriers face increased infection risks, as compromised skin becomes vulnerable to bacterial colonization. Har…
View article: Measuring Primary Care Productivity in the Era of Interprofessional Team Care: Stakeholder, Scoping Review, and Implementation Perspectives
Measuring Primary Care Productivity in the Era of Interprofessional Team Care: Stakeholder, Scoping Review, and Implementation Perspectives Open
Policy Points The economics and outcomes of modern primary care are substantially driven by investment in interprofessional clinical team members aimed at delivering complex, population health–oriented care. Neither interprofessional prima…
View article: High Users of Primary Care Secure Messaging in the Veterans Health Administration
High Users of Primary Care Secure Messaging in the Veterans Health Administration Open
A small percentage of veterans exchange a disproportionate share of total secure messages. Most high users of secure messaging do not use other primary care or emergency department services at the same high frequency as secure messaging. H…
View article: Early Implementation of a Regional Telehealth Contingency Staffing Program and Primary Care Quality in the Veterans Health Administration: Evidence from the Clinical Resource Hub program
Early Implementation of a Regional Telehealth Contingency Staffing Program and Primary Care Quality in the Veterans Health Administration: Evidence from the Clinical Resource Hub program Open
Background The Veterans Health Administration (VHA) launched the Clinical Resource Hub (CRH) program to address primary care staffing deficits and improve access. Objective To determine if the quality of primary care at clinics that use CR…
View article: An approach to evaluating the impact of virtual specialty care: the Veterans Health Administration’s clinical resource hub as case study
An approach to evaluating the impact of virtual specialty care: the Veterans Health Administration’s clinical resource hub as case study Open
Objectives Telemedicine for specialty medical care is evolving from a COVID-19 pandemic-era requirement to an option for patients and clinicians alike, requiring evidence to guide optimal use of virtual specialty care. Heterogeneity across…
View article: A partner‐informed approach to prioritizing social risks for research in a learning health system
A partner‐informed approach to prioritizing social risks for research in a learning health system Open
Objective To prioritize social risks (individual‐level social and economic conditions) that may influence a person's health for inclusion in a national survey of Veterans Affairs (VA) healthcare system patients. Data Sources and Study Sett…
View article: National Telehealth Contingency Staffing Program and Primary Care Quality in the VHA
National Telehealth Contingency Staffing Program and Primary Care Quality in the VHA Open
Importance The Veterans Health Administration (VHA) launched the Clinical Resource Hub (CRH), a national telehealth contingency staffing program, to address primary care staffing shortages and improve veteran access to primary care. How th…
View article: Electronic Health Record Time Allocation Among Primary Care Clinicians at the Veterans Health Administration Using Virtual Observations
Electronic Health Record Time Allocation Among Primary Care Clinicians at the Veterans Health Administration Using Virtual Observations Open
View article: Burnout and Turnover Among Veterans Health Administration Primary Care Providers From Fiscal Years 2017–2021
Burnout and Turnover Among Veterans Health Administration Primary Care Providers From Fiscal Years 2017–2021 Open
Objectives: We examined how individual-level turnover among Veterans Health Administration primary care providers (PCPs) from fiscal years 2017 to 2021 was associated with health care system-level burnout and turnover intent. Background: B…
View article: Primary Care Telehealth Initiation and Engagement Among Veterans at High Risk, 2019-2022
Primary Care Telehealth Initiation and Engagement Among Veterans at High Risk, 2019-2022 Open
Importance During the COVID-19 pandemic, the Veterans Health Administration (VHA) expanded telehealth infrastructure. Understanding telehealth initiation and sustained engagement could inform future resource allocation for high-need popula…
View article: Evaluating equity in a national virtual care management intervention: Delivery and outcomes by race/ethnicity among Veterans with hypertension and diabetes
Evaluating equity in a national virtual care management intervention: Delivery and outcomes by race/ethnicity among Veterans with hypertension and diabetes Open
Objective To evaluate whether the Preventive Health Inventory (PHI)—a virtual care management intervention addressing hypertension and diabetes management implemented nationally in the Veterans Health Administration (VHA)—was delivered equ…
View article: “Veteran to Veteran, There's Automatically a Trust”: A Qualitative Study of Veterans’ Experiences in a Peer Health-Coaching Program for Hypertension
“Veteran to Veteran, There's Automatically a Trust”: A Qualitative Study of Veterans’ Experiences in a Peer Health-Coaching Program for Hypertension Open
This study was registered at Clinicaltrial.gov with the identifier NCT02697422.
View article: Assessing and Improving Productivity in Primary Care: Proof of Concept Results for a Novel Value-Based Metric
Assessing and Improving Productivity in Primary Care: Proof of Concept Results for a Novel Value-Based Metric Open
View article: Factors Associated With Use of the Preventive Health Inventory in US Veterans
Factors Associated With Use of the Preventive Health Inventory in US Veterans Open
Importance The COVID-19 pandemic caused significant declines in the quality of preventive and chronic disease care. The Veterans Health Administration (VHA) used the Preventive Health Inventory (PHI), a multicomponent care management inter…
View article: Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic
Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic Open
Background The COVID-19 pandemic involved a rapid change to the working conditions of all healthcare workers (HCW), including those in primary care. Organizational responses to the pandemic, including a shift to virtual care, changes in st…
View article: Automated Opt-Out vs Opt-In Patient Outreach Strategies for Breast Cancer Screening
Automated Opt-Out vs Opt-In Patient Outreach Strategies for Breast Cancer Screening Open
Importance Optimal strategies for population-based outreach for breast cancer screening remain unknown. Objective To evaluate the effect on breast cancer screening of an opt-out automatic mammography referral strategy compared with an opt-…
View article: Associations Between Primary Care Providers and Staff-Reported Access Management Challenges and Patient Perceptions of Access
Associations Between Primary Care Providers and Staff-Reported Access Management Challenges and Patient Perceptions of Access Open
View article: Learning from national implementation of the Veterans Affairs Clinical Resource Hub (CRH) program for improving access to care: protocol for a six year evaluation
Learning from national implementation of the Veterans Affairs Clinical Resource Hub (CRH) program for improving access to care: protocol for a six year evaluation Open
View article: Associations Between Social Risks and Primary Care Utilization Among Medically Complex Veterans
Associations Between Social Risks and Primary Care Utilization Among Medically Complex Veterans Open
View article: Effect of a Peer Health Coaching Intervention on Clinical Outcomes Among US Veterans With Cardiovascular Risks
Effect of a Peer Health Coaching Intervention on Clinical Outcomes Among US Veterans With Cardiovascular Risks Open
Importance Although cardiovascular disease (CVD) is the leading cause of death in the US, CVD risk factors remain suboptimally controlled. Objective To test the effectiveness of a home-visit, peer health coaching intervention to improve he…
View article: The Clinical Resource Hub Initiative
The Clinical Resource Hub Initiative Open
Health care systems face challenges providing accessible health care across geographically disparate sites. The Veterans Health Administration (VHA) developed regional telemedicine service focusing initially on primary care and mental heal…
View article: Changes in Primary Care Quality Associated With Implementation of the Veterans Health Administration Preventive Health Inventory
Changes in Primary Care Quality Associated With Implementation of the Veterans Health Administration Preventive Health Inventory Open
Importance The COVID-19 pandemic caused significant disruptions in primary care delivery. The Veterans Health Administration (VHA) launched the Preventive Health Inventory (PHI) program—a multicomponent care management intervention, includ…
View article: Adapting a Telephone-Based, Dyadic Self-management Program to Be Delivered Over the Web: Methodology and Usability Testing
Adapting a Telephone-Based, Dyadic Self-management Program to Be Delivered Over the Web: Methodology and Usability Testing Open
Background The COVID-19 pandemic has amplified the need for web-based behavioral interventions to support individuals who are diagnosed with chronic conditions and their informal caregivers. However, most interventions focus on patient out…
View article: Patient Enrollment Growth and Burnout in Primary Care at the Veterans Health Administration
Patient Enrollment Growth and Burnout in Primary Care at the Veterans Health Administration Open
View article: Primary Care Provider Experience With Proactive E-Consults to Improve COPD Outcomes and Access to Specialty Care
Primary Care Provider Experience With Proactive E-Consults to Improve COPD Outcomes and Access to Specialty Care Open
This evaluation indicates that a proactive e-consult intervention can be deployed to collaboratively manage the health of populations with COPD in a way that is acceptable, appropriate, and feasible for primary care. Lessons learned from t…
View article: Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative Study
Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative Study Open
Primary care physicians perceive patient values, health priorities and goals, and preferences as influential during clinical decision-making for complex patients with multimorbidity. Participants used concrete strategies to negotiate align…
View article: Implementation of a mailed faecal immunochemical test programme for colorectal cancer screening among Veterans
Implementation of a mailed faecal immunochemical test programme for colorectal cancer screening among Veterans Open
Background Screening for colorectal cancer (CRC) with faecal immunochemical test (FIT) is effective at reducing CRC mortality. Unfortunately, the COVID-19 pandemic has been associated with deferred care, especially screening for CRC. Aim W…
View article: Adapting a Telephone-Based, Dyadic Self-management Program to Be Delivered Over the Web: Methodology and Usability Testing (Preprint)
Adapting a Telephone-Based, Dyadic Self-management Program to Be Delivered Over the Web: Methodology and Usability Testing (Preprint) Open
BACKGROUND The COVID-19 pandemic has amplified the need for web-based behavioral interventions to support individuals who are diagnosed with chronic conditions and their informal caregivers. However, most interventions focus on patient ou…