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Rani Elwy, PhD
Rani Elwy, PhD, and Joshua Thorpe, PhD, are each recipients of the 2017 HSR&D Best Research Paper of the Year Award, which honors a single article or collection of articles resulting from one or more HSR&D- or QUERI-funded investigations. Research studies also must involve Veterans, with results that are important to Veterans’ health and care, and to the VA healthcare system.
Published in JAMA Surgery, Dr. Elwy and colleagues’ article, “Surgeons’ Disclosures of Clinical Adverse Events,” describes a study conducted from January 2011 through December 2013 that assessed surgeons’ reports of disclosure of adverse events and aspects of their experiences with the disclosure process. Surgeons (41 men, 21 women) representing 12 specialties at three VA medical centers completed a web-based survey. Most of the surgeons reported using 5 of the 8 recommended disclosure items in their conversations with Veterans and their families, but those who were less likely to apologize to patients, discuss preventability of the adverse event, or discuss how recurrences of the event could have been prevented were more negatively affected by disclosure than others. Dr. Elwy and her colleagues suggest that quality improvement efforts focused on recognizing the association between disclosure and surgeons’ well-being may help sustain open disclosure policies.
Dr. Elwy’s article was one of the top 10 downloaded articles in JAMA Surgery in 2016 and was mentioned in 45 news stories from 20 news outlets, including CBS News and the Washington Post. Further, following an early conference presentation of Dr. Elwy’s study, Dr. Carolyn Clancy, currently VHA Executive in Charge, arranged for a briefing to VA operational leaders to discuss how VA could move disclosure from a risk management perspective to a patient safety perspective, in order to encourage more surgeons (and other clinicians) to follow VA’s “Disclosure of Adverse Events” policy (VHA Handbook 1004.08). Dr. Elwy is part of HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR) in Boston and Bedford, MA.
Joshua Thorpe, PhD
Published in the Annals of Internal Medicine, Dr. Thorpe and colleagues' article “Dual Health Care System Use and High-Risk Prescribing in Patients with Dementia” was chosen for several reasons, including its potential to be impactful both inside and outside VA. David Gifford, MD, MPH, wrote an accompanying editorial, noting “On the surface, the study by Thorpe and colleagues seems to be only about medication prescribing for dementia in the VA system, but it could serve as the basis for an entire medical school course on health policy.” Dr. Thorpe and colleagues used VA and Medicare data to identify nearly 76,000 Veterans with dementia who were enrolled in both healthcare systems from 2007 through 2010. They found that compared with VA-users only, Veterans who used both VA and Medicare (dual-users) had more than double the odds of exposure to potentially unsafe medications, demonstrating that receipt of prescription medications across unconnected care systems increases the risk for unsafe prescribing.
Based on the immediate applicability of this article, senior VA leaders in Geriatrics and Extended Care, Pharmacy Benefits Management (PBM), and the Center for Medication Safety (VA MedSAFE) engaged Dr. Thorpe to fast-track implementation of new approaches to reduce the risk for potentially unsafe prescribing for Veterans. Dr. Thorpe is part of HSR&D’s Center for Health Equity Research and Promotion (CHERP) in Pittsburgh, PA.
HSR&D thanks Drs. Elwy and Thorpe for their outstanding work and contributions to the literature which will help VA improve the safety of Veterans in VA care.
