Health Services Research & Development

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ESP Reports in Progress

ESP ReportsESP Topic NominationESP Reports in Progress

The following reports are under development at one of the four ESP sites. If you would like to provide comments about the topic under development, serve as a peer reviewer for the draft report, or know the timeline for completion, please contact the ESP Coordinating Center.

To review the most up-to-date protocols, please visit the PROSPERO website. Protocol registration numbers for an individual project can be found along with the brief abstract for the project, below.



The Effectiveness of Remote Triage

Key Questions

KQ1a: For adults, what are the effects of remote triage on patient satisfaction, health care utilization, case resolution, cost, and patient safety?

KQ1b: What is the impact of remote triage by different modalities (eg, telephone, video, web, SMS)?

KQ2: What are the identified best practices that impact the planning, execution, and evaluation of remote triage for adults seeking clinical care advice in a large-scale health system such as the VA?

KQ3: What are the types of outcomes used to assess the impact of remote triage?

PICOTS

Population(s): KQ1 & KQ2: Adults 18 years of age and older, and their families and caregivers

KQ2 ONLY: Stakeholders involved in the uptake, management, and implementation of remote triage services (eg, nurses, administrators, organizational leadership)

Interventions: Remote triage services as defined by the following: Pertaining to the initial assessment and management of acute, undifferentiated, unscheduled care initiated by patient or family member from a distance focused on a clinical care issue.

Comparator:
KQ1: Usual care/standard of care, waitlist control, other active comparator-focused (eg, in-person care)

KQ 2 and KQ3: No comparator required

Outcome(s):
KQ1: Patient satisfaction, case resolution, patient safety, health care utilization, cost

KQ 2: Best practices for remote triage system (eg, insights into personnel, processes, and technologies needed to stand up a remote triage; implications for what works well and what does not in conducting remote triage)

KQ3: Outcomes used to assess remote triage from papers identified in KQ 1 and KQ2

Study design:
KQ1: EPOC study designs: randomized controlled studies (RCT), non-randomized controlled studies, controlled before-after studies, interrupted time-series studies or repeated measures studies

KQ2: EPOC study designs as well as prospective cohort and case-control if the n is greater than 100, qualitative studies, surveys, systematic reviews, organizational case studies, case series, and guidelines

General Search Strategy

We will conduct a primary search from 2000 to the current date of MEDLINE® (via PubMed®), and CINAHL. We will use a combination of MeSH keywords and selected free-text terms to search titles and abstracts. To ensure completeness, search strategies will be developed in consultation with an expert librarian.

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Title Interventions to Prevent or Delay Long-term Placement in Nursing Homes for Adults with Physical or Cognitive Impairments

PROSPERO registration: CRD42018116198

Background/Objectives of Review

This review will be used by the VA Caregiver Support Program, the VA Office of Patient Experience, and the Choose Home Moonshot Workgroup to inform the work of the VA Secretary’s Choose Home Moonshot Initiative. The Moonshot aims to enhance policies and practices nationwide to optimize the ability of Veterans in VA to remain in their own homes if that is their desired setting of care. Specifically, this review will provide a critical appraisal of the available evidence on the effectiveness of various interventions designed to delay nursing home placement among adults with functional or cognitive impairments who are currently living at home.

Key Questions

KQ1: What are the modifiable risk factors that lead to long-term placement in nursing homes?

KQ2: What is the effectiveness of home- and community-based interventions, and group homes or medical foster homes, for preventing or delaying long-term placement in nursing homes?

KQ3: Which characteristics of adults with impairments moderate the effectiveness of home- and community-based interventions, group homes, or medical foster homes in preventing or delaying long-term placement in nursing homes?

PICOTS

Population(s): Adults, Veterans and non-Veterans, with physical or cognitive impairments (due to older age or frailty, dementia, TBI, and/or PTSD)

Interventions: Diverse and complex home- and community-based interventions:

  • Home-based primary care, outpatient geriatric assessment and case management
  • Outpatient or home-based rehabilitation, nursing services, or other medical care
  • Physical activity or exercise (not as part of rehabilitation program)
  • In-home assistance with non-healthcare activities (home aides, home repair, etc)
  • Caregiver interventions
  • Respite care
  • Adult day clinics
  • Community health workers, friendly visits
  • Nutritional programs (Meals on Wheels, congregant dining, grocery delivery, etc)
  • Transportation and mobility services
  • Assistive technologies
  • Alternative housing with range of services (assisted living or group homes, medical foster homes, etc)
  • Financial support and benefits (caregiver stipends, Cash and Counseling, etc)

Comparator: Usual care or other intervention

Outcome(s): Long-term placement in nursing home, function, quality of life, hospitalizations, cost, mortality, harms

General Search Strategy

We will search MEDLINE, Sociological Abstracts, PsycINFO, CINAHL, Embase, PROSPERO, Turning Research Into Practice (TRIP), the Cochrane Database of Systematic Reviews (CDSR), Joanna Briggs Institute Database, Agency for Healthcare Research and Quality Evidence-based Practice Center reports, and VA ESP reports.

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Evidence Map of Arts and Humanities Programs: Arts Program

Background/Objectives of Review

The proposed ESP evidence synthesis will be used to guide the use of arts and humanities to improve Veteran health in the VHA. OPCC&CT leadership will use the findings to inform clinical practice and policy, and to develop guidance on the best use of arts and humanities in Veteran health care. We will also host an interactive evidence map on the ESP site to present findings from the evidence map.

Key Questions

We will develop an evidence map for art therapy,which allows us to visually depict the distribution of evidence available to provide an overview of art therapy that describes the volume, nature, and characteristics of research in this area.

PICOTS

Population(s): Any health condition

Interventions: Art therapy

Comparator: Any

Outcome(s): Patient health outcomes

Setting: Any healthcare-related setting

General Search Strategy

We conducted broad searches from database inception through May 5, 2018 using terms related to art therapy in two databases: PubMed and PsycINFO.

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Robotic-assisted Surgery in Urology

Background/Objectives of Review

The National Surgery Office would use the findings of this evidence review to inform planning for existing VHA robotic-assisted surgery programs as well as new program proposals and community care referrals.

Key Questions

KQ1: What is the clinical effectiveness of robotic-assisted surgery compared to open surgery or conventional laparoscopic surgery for urologic procedures including partial nephrectomy and cystectomy?

KQ2: What is the cost-effectiveness of robotic-assisted surgery compared to open surgery or conventional laparoscopic surgery for urologic procedures including partial nephrectomy and cystectomy?

PICOTS

Population(s): Adults undergoing urologic surgery including partial nephrectomy and cystectomy, cancer/tumor indication

Interventions: Robotic-assisted surgery

Comparator: Open surgery or conventional laparoscopic surgery

Outcome(s): Perioperative (including LOS, GFR, complications, warm ischemia time, EBL, proc length), cost, quality of life, short term oncologic (eg, surgical margin, LN yield), long-term oncologic (<1yr, 1-3 years, >= 3years)

General Search Strategy

We conducted broad searches from database inception through October 22, 2018 using terms relating to “robotic surgery” or “cystectomy” or “nephrectomy” in three databases: PubMed, Embase, and Cochrane.

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Aromatherapy and Essential Oils

Background/Objectives of Review

The evidence map will be used by the Integrative Health Coordinating Center, Patient-Centered Care & Cultural Transformation, and Pharmacy Benefits Management Services to determine the evidence base for providing aromatherapy to Veterans to support Veteran health and to inform future research and identify gaps in practice.

Key Questions

What evidence is available on the effectiveness of aromatherapy or essential oils for health-related conditions?

PICOTS

Population(s): Adults (18+), including pregnant and postpartum women, receiving an intervention of interest. Children and adolescents are excluded.

Interventions: Include: Essential oil preparations that are inhaled, topically applied, or oral rinses that do not contain alcohol or other antiseptic ingredients.

Exclude: Essential oil preparations that are ingested or consumed; preparations where essential oils are combined with another drug or active ingredient; preparations intended for mucosal absorption in areas other than nasal/oral (eg, enema); oral rinses that contain antiseptic ingredients, such as Listerine containing 27% alcohol.

Comparator: Any

Outcome(s): Primary symptoms

Secondary outcomes (anxiety, depression, or mental health outcomes that are not primary to a diagnosis; sleep; etc)

Global health outcomes (eg, quality of life, activities of daily living, mobility, social functioning, employment)

Harms

Setting: All settings

General Search Strategy

Search strategies will be developed in consultation with a research librarian, and will be peer reviewed by a second research librarian using the instrument for Peer Review of Search Strategies. We will conduct a review of the literature by systematically searching, reviewing, and analyzing the scientific evidence as it pertains to the research questions. To identify relevant systematic reviews/meta-analyses, we will begin by searching Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE, Ovid PsycINFO, CINAHL, Epistomonikos, and Ovid EBM Reviews Cochrane Database of Systematic Reviews (CDSR, DARE, HTA, Cochrane CENTRAL, etc.). We will search all available years of publication from database inception (1946 for Ovid MEDLINE®) through January 2019. To identify additional reviews, we will review the bibliographies of relevant reviews of reviews, search the review registry Prospero for completed reviews, and query subject matter experts.

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One-to-One Observation

Background/Objectives of Review

The findings from this evidence synthesis will be used by the falls expert panel for decisions on whether to add patient sitters or one-to-one observation interventions to the patient safety assessment tool (PSAT) for falls. Additionally, NCPS will use the findings to determine if patient sitters should be a recommended intervention in the Falls Toolkit.

Key Questions

KQ1: What is the effectiveness of patient sitters (one-to-one observation, patient safety companions, etc) for reducing falls?

KQ2: What is the effectiveness of patient sitters (one-to-one observation, patient safety companions, etc) for reducing suicide or self-harm?

KQ3: What is the effectiveness of patient sitters (one-to-one observation, patient safety companions, etc) for reducing wandering?

KQ4: What is the cost effectiveness of one-to-one observations compared to usual care for patients at risk of falls, suicide, or wandering?

PICOTS

Population(s): Adults

Interventions: One-to-one patient observations (patient sitters, safety companions, formal observation, etc)

Comparator: Any

Outcome(s): Falls, falls with harm or fall related injury, wandering, amount of sitter use, costs

Setting: Inpatient

General Search Strategy

We will procure literature from these sources: Web of Science, PubMed, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Trials, PsycINFO.

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Panel Size

Key Questions

KQ1: How should panel size be determined for a primary care provider? What is the optimal size of a patient panel in primary care? Is there evidence to suggest that MD, NP and PAs should have different panel sizes? Is there evidence from large health systems in terms of setting and maintaining panel sizes?

KQ2: Should primary care panel sizes be risk adjusted for patient complexity? If yes, how should risk adjustment be accomplished?

PICOTS

Population(s): Adults

Comparator: Any comparison of differences in panel sizes in primary care

Outcome(s): Risk adjustment used to determine primary care panel sizes, clinical quality, cost, access, equity, patient experience/satisfaction

Setting: Primary care

General Search Strategy

We will procure literature from Web of Science and PubMed.

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Gadolinium Agents for Patients with CKD

Background/Objectives of Review

The Nephrology Field Advisory Committee (FAC) provides independent advice to VA Specialty Care Services (SCS) on clinical policy and program development. The mission of the FAC is to provide National VA Renal program oversight, forward field concerns, assist in distributing information to the field, and serve as a resource to other VACO program offices.

This review will directly guide the FAC’s recommendations for development of national and local policies on Class 2 and Class 3 gadolinium use, the need for laboratory screening, and the need for informed consent prior to contrast administration for MRI scans.

Key Questions

KQ1: When exposed to macrocyclic or newer linear gadolinium-based contrast agents, what is the incidence of nephrogenic systemic fibrosis among:

  1. a) All patients?
  2. b) Patients with acute or chronic kidney disease?
  3. c) Patients with key risk factors for kidney disease (such as diabetes and hypertension)?

KQ2: When compared to older linear gadolinium-based agents, what is the relative risk of nephrogenic systemic fibrosis due to exposure to macrocyclic or newer linear gadolinium-based contrast agents among:

  1. a) All patients?
  2. b) Patients with acute or chronic kidney disease?
  3. c) Patients with key risk factors for kidney disease (such as diabetes and hypertension)?

PICOTS

Population(s): Adults, children, and autopsy

Interventions: ACR Class II gadolinium-based contrast agents: Gadoteridol (Prohance), Gadobenate dimeglumine, gadobenic acid (MultiHance),Gadobutrol (Gadavist, Gadovist, Gadograf), Gadoterate meglumine, Gadoteric acid (Dotarem, Clariscan, Artirem)

ACR Class III: Gadoxetate disodium (Eovist, Primovist)

We will also include Class I gadolinium agents when compared to Class II or III agents.

Comparator: Any or no comparators

Outcome(s): Nephrogenic systemic fibrosis (including “NSF” and nephrogenic fibrosing dermopathy (either confirmed or suspected cases; cases associated with multiple types of gadolinium agents or multiple doses also acceptable)

Setting: Gadolinium agents administered for any reason, outpatient or inpatient, in any country

General Search Strategy

We will conduct a primary search from inception to the current date of MEDLINE® (via PubMed®), Embase, Cochrane Register of Controlled Trials, and Web of Science. We will use a combination of MeSH keywords and selected free-text terms to search titles and abstracts. To ensure completeness, search strategies will be developed in consultation with an expert librarian. We will also hand search key references for relevant citations that may not be captured by our database search. Depending on the depth of the peer-reviewed literature, we may also search for case reports of NSF among patients exposed to newer gadolinium agents in the FDA (FAERS) database.

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Deprescribing for Older Veterans

Key Questions

KQ1: What are the effectiveness, comparative effectiveness, and harms of deprescribing interventions among adults age 65 and older?

KQ1a: What are the identified elements/components that contribute the most to the effectiveness of deprescribing interventions?

KQ1b: Do the effectiveness, comparative effectiveness, and harms of deprescribing interventions vary by patient population, provider factors, or setting?

KQ2: What are the identified facilitators and barriers that impact the implementation of deprescribing interventions within large-scale health systems such as the VA?

PICOTS

Population(s): Individuals age 65 years and older

Interventions: Deprescribing intervention

Comparator: Any (to include usual care or a different intervention)

Outcome(s): Patient-Centered Outcomes: quality of life, mortality, hospitalizations, acute care encounters, falls, delirium; functional status (physical and/or cognitive), adverse drug withdrawal events

Intermediate Outcomes: total number of medications discontinued, number of medications with dosage decreased, number of medications with schedule simplified, number of inappropriate medications discontinued, adherence to medications, types of medications, cost

Setting: Any health care setting

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