BACKGROUND/RATIONALE:
VA primary care staff nationwide have been reorganized into "Patient Aligned Care Teams" (PACTs) in order to provide high quality management of Veterans with chronic conditions. Yet, prior research has found that many male Veterans at risk for a common chronic condition, osteoporosis (OP), are neither identified with the gold standard test for OP known as DXA, nor treated with medications. The research proposed in this application directly addresses this problem through three related studies.

OBJECTIVE(S):
The overarching goal is to identify and mitigate existing barriers to PACT-based DXA testing in high risk men. This goal will be accomplished through three related studies, whose aims include: 1) to evaluate DXA testing rates among male Veterans at high risk for osteoporosis; 2) to identify factors influencing PACT-based DXA testing of high risk men; and 3) to work with VA clinical and operations staff to develop and pilot test a PACT-based intervention to improve DXA testing.

METHODS:
Statistical methods and qualitative techniques will be used to analyze: 1) VA and Medicare claims data for older male Veterans; and 2) qualitative data collected from VA health care providers and operational leadership.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The research will: 1) address known knowledge gaps by quantifying the number of male Veterans at high risk of osteoporosis who have not been identified by a clinician; and 2) partner with VA clinical and operations staff to design and test an intervention to improve OP care. By leveraging administrative data to improve osteoporosis care, the research has the potential to reduce the considerable morbidity associated with this condition and to establish VA as a national leader in primary care- based management of geriatric chronic conditions.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX001542-01A1
Link: https://reporter.nih.gov/project-details/8865812

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PUBLICATIONS:

Journal Articles

1. Van Tiem JM, Steffen MJA, Seaman AT, Miller K, Wardyn SE, Richards CC, Solimeo SL. Attitudes toward bone health among rural-dwelling veterans identified as at risk of fracture: a qualitative analysis. JBMR plus. 2021 Jun 1; 5(6):e10501. [view]
2. Seaman AT, Steffen MJA, Van Tiem JM, Wardyn S, Santana X, Miller KL, Solimeo SL. Cultivating across "pockets of excellence": challenges to sustaining efforts to improve osteoporosis care. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2022 Jan 1; 33(1):139-147. [view]
3. Miller KL, Steffen MJ, McCoy KD, Cannon G, Seaman AT, Anderson ZL, Patel S, Green J, Wardyn S, Solimeo SL. Delivering fracture prevention services to rural US veterans through telemedicine: a process evaluation. Archives of osteoporosis. 2021 Feb 10; 16(1):27. [view]
4. Miller KL, Mccoy K, Richards C, Seaman A, Solimeo SL. Engagement in Primary Prevention Program among Rural Veterans With Osteoporosis Risk. JBMR plus. 2022 Oct 1; 6(10):e10682. [view]
5. Van Tiem JM, Friberg JE, Cunningham Goedken C, Pineles L, Schacht Reisinger H, Morgan DJ, Solimeo SL. Environmental service workers as potential designers of infection control policy in long-term care settings. American journal of infection control. 2020 Apr 1; 48(4):398-402. [view]
6. Solimeo SL, Lund BC, McCoy KD, Sarrazin MV, Hoffman R. Factors Associated with Osteoporosis Management Among Veterans Who Received Androgen Deprivation Therapy for Prostate Cancer. Journal of general internal medicine. 2021 Oct 1; 36(10):3270-3272. [view]
7. Solimeo SL, Ono SS, Stewart KR, Lampman MA, Rosenthal GE, Stewart GL. Gatekeepers as Care Providers: The Care Work of Patient-centered Medical Home Clerical Staff. Medical Anthropology Quarterly. 2017 Mar 1; 31(1):97-114. [view]
8. Sullivan JL, Shin MH, Adjognon OL, Shay K, Harvey K, Intrator O, Yaksic E, Moye J, Solimeo S. Geriatric Patient-Aligned Care Teams in Department of Veterans Affairs: How Are They Structured?. Geriatrics (Basel, Switzerland). 2018 Sep 1; 3(3):46. [view]
9. Shin MH, Montano AL, Adjognon OL, Harvey KLL, Solimeo SL, Sullivan JL. Identification of Implementation Strategies Using the CFIR-ERIC Matching Tool to Mitigate Barriers in a Primary Care Model for Older Veterans. The Gerontologist. 2023 Mar 21; 63(3):439-450. [view]
10. Sullivan JL, Eisenstein R, Price T, Solimeo S, Shay K. Implementation of the Geriatric Patient-Aligned Care Team Model in the Veterans Health Administration (VA). Journal of the American Board of Family Medicine : JABFM. 2018 May 1; 31(3):456-465. [view]
11. Solimeo SL, Stewart KR, Stewart GL, Rosenthal G. Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers. Healthcare (Amsterdam, Netherlands). 2014 Dec 1; 2(4):245-50. [view]
12. Stewart KR, Stewart GL, Lampman M, Wakefield B, Rosenthal G, Solimeo SL. Implications of the Patient-Centered Medical Home for Nursing Practice. The Journal of nursing administration. 2015 Nov 1; 45(11):569-74. [view]
13. Edmonds SW, Cram P, Lu X, Roblin DW, Wright NC, Saag KG, Solimeo SL, PAADRN Investigators. Improving bone mineral density reporting to patients with an illustration of personal fracture risk. BMC medical informatics and decision making. 2014 Nov 25; 14:101. [view]
14. Seaman AT, Steffen M, Doo T, Healy HS, Solimeo SL. Metasynthesis of Patient Attitudes Toward Bone Densitometry. Journal of general internal medicine. 2018 Oct 1; 33(10):1796-1804. [view]
15. Patterson BJ, Solimeo SL, Stewart KR, Rosenthal GE, Kaboli PJ, Lund BC. Perceptions of pharmacists' integration into patient-centered medical home teams. Research in social & administrative pharmacy : RSAP. 2015 Jan 1; 11(1):85-95. [view]
16. Solimeo SL, Nguyen VT, Edmonds SW, Lou Y, Roblin DW, Saag KG, Cram P, Wolinsky FD. Sex differences in osteoporosis self-efficacy among community-residing older adults presenting for DXA. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2019 May 1; 30(5):1033-1041. [view]
17. Solimeo SL, Stewart GL, Rosenthal GE. The Critical Role of Clerks in the Patient-Centered Medical Home. Annals of Family Medicine. 2016 Jul 1; 14(4):377-9. [view]
18. Solimeo SL, Ono SS, Lampman MA, Paez MB, Stewart GL. The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran's health administration. Journal of Interprofessional Care. 2015 Jan 1; 29(1):26-33. [view]
19. Edmonds SW, Solimeo SL, Nguyen VT, Wright NC, Roblin DW, Saag KG, Cram P. Understanding Preferences for Osteoporosis Information to Develop an Osteoporosis Patient Education Brochure. The Permanente journal. 2016 Nov 18; 21. [view]
20. Solimeo SL, Steffen MJA, Gardner EE, Adjognon O, Shin MH, Moye J, Sullivan JL. Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams. Journal of the American Geriatrics Society. 2020 Sep 1; 68(9):2006-2014. [view]

Journal Other

1. Solimeo SL. Capsule commentary on Zuchowski et al., challenges in referral communication between VHA primary care and specialty care. Journal of general internal medicine. 2015 Mar 1; 30(3):344. [view]

Online News Media Articles

1. Solimeo S. Clerical Staff Serve Critical Role on Patient-Centered Care Team. Annals of Family Medicine Research [Internet]. 2016 Aug 31. Available from: http://www.aafp.org/news/practice-professional-issues/20160831pcmhclerks.html. [view]
2. Solimeo S. Clerks - The Unsung Heroes of Primary Care? VA anthropologists study clerks' underappreciated role in medical practices. VA Research Currents [Internet]. 2016 Sep 13. Available from: http://www.research.va.gov/currents/0916-2.cfm. [view]

Reports

1. Sullivan JL, Adjognon O, Shin M, Steffen M, Moye JA, Solimeo S. Report 2: GeriPACT Program Implementation and Organizational Factors Associated with GeriPACT Functioning and Performance. Boston: CHOIR; 2018 Mar 29. 25 p. [view]

HSR&D or QUERI Articles

1. Lampman L, Solimeo SL, Stewart G, Stockdale SE. Enhancing PACT Implementation Through Qualitative Research. FORUM: Translating Research Into Quality Health Care for Veterans. 2017 Jun 1; 2017(Spring): 5. [view]

Conference Presentations

1. Reeves C, Stewart GL, Crawford E, Astrove S, Solimeo S. Adapting to Team Membership Change: Exploring the Effects of Membership Change Event Characteristics on Team Performance Trajectories. Paper presented at: Academy of Management Annual Meeting; 2015 Aug 11; Vancouver, Canada. [view]
2. Solimeo S, McCoy K, Rosenthal GE, Vaughan-Sarrazin MS. Association of VA Medical Homes with Osteoporosis Detection in Male Veterans with Hip Fracture. Poster session presented at: Gerontological Society of America Annual Scientific Meeting; 2015 Nov 21; Orlando, FL. [view]
3. Solimeo S, Ono SS, Stewart K, Lampman MA, Rosenthal GE, Stewart GL. Exploring the Invisible Role of Administrative Associates in Patient Aligned Care Teams (PACTs). Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 11; Philadelphia, PA. [view]
4. Solimeo S. Going beyond “boys will be boys”: Moving the needle on the understanding of male gender role performance and health in later life. Paper presented at: Gerontological Society of America Annual Scientific Meeting; 2015 Nov 20; Orlando, FL. [view]
5. Solimeo S. Technical Considerations for Designing Qualitative Observational Research. Paper presented at: Gerontological Society of America Annual Scientific Meeting; 2015 Nov 18; Orlando, FL. [view]
6. Stewart GL, Astrove S, Reeves C, Crawford E, Solimeo S. Those with the Most Toys Find it Hardest to Share: Leadership and Structural Empowerment in Teams. Paper presented at: Academy of Management Annual Meeting; 2015 Aug 10; Vancouver, Canada. [view]

DRA: Aging, Older Veterans' Health and Care, Health Systems, Musculoskeletal Disorders
DRE: Treatment - Implementation
Keywords: Effectiveness
MeSH Terms: none