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Developing an Internally Validated Veterans Affairs Women Cardiovascular Disease Risk Score Using Veterans Affairs National Electronic Health Records.

ABSTRACT: Background The current American College of Cardiology/American Heart Association women cardiovascular disease (CVD) risk score suboptimally estimates CVD risk for young and minority women in the military. The current study developed an internally validated CVD risk score for women military service members and veterans using the Veterans Affairs (VA) national electronic health records data. Methods and Results The study cohort included 69 574 White, Black, and Hispanic women service members and veterans aged 30 to 79 years in 2007 treated in the VA Health Care System between January 1, 2007 and December 31, 2017 (henceforth, VA women). Stratified by race and ethnicity, the new VA women CVD risk model estimated risk coefficients and 10-year CVD risk using a time-variant covariate Cox model. Harrell C-statistics, calibration plots, and net classification index were used to assess accuracy and prognostic performance of the new VA women CVD risk model. The new internally validated VA women CVD risk score performed better in predicting VA women 10-year atherosclerosis cardiovascular disease risk than the pooled cohort American College of Cardiology/American Heart Association risk score in both accuracy (White Harrell C-statistics, 70% versus 61%; Black, 68% versus 63%) and prognostic performance (White net classification index, 0.31; 95% CI, 0.26-0.33; Black net classification index, 0.06; 95% CI, 0.03-0.09). Conclusions The proposed VA women CVD risk score improves accuracy of the existing American College of Cardiology/American Heart Association CVD risk assessment tool in predicting long-term CVD risk for VA women, particularly in young and racial/ethnic minority women.

SUBMITTER: Jeon-Slaughter H

PROVIDER: S-EPMC8174271 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundHeterogeneity of existing physician burnout studies impairs analyses of longitudinal trends, geographic distribution, and organizational factors impacting physician burnout. The Department of Veterans Affairs (VA) is one of the largest integrated healthcare systems in the USA, offering a unique opportunity to study burnout across VA sites and time.ObjectiveTo characterize longitudinal burnout trends of VA physicians and assess organizational characteristics and geographic distribution associated with physician burnout.DesignLongitudinal study of the VA All Employee Survey during 2013-2017.ParticipantsSelf-identified physicians practicing in one of nine clinical service areas at 140 VA sites nationwide.Main measuresWe identified burnout using a validated definition adapted from the Maslach Burnout Inventory and characterized burnout trends for physicians in different clinical service areas. We used clustering analysis to categorize sites based on their burnout rates over time, and compared organizational characteristics and geographic distribution of high, medium, and low burnout categories.Key resultsWe identified 40,382 physician responses from 140 VA sites. Mean burnout rates across all physicians ranged from 34.3% in 2013 to a high of 39.0% in 2014. Primary care physicians had the highest burnout. High burnout sites were more likely to be rural and non-teaching, have lower complexity (i.e., offer fewer advanced clinical services), and have fewer unique patients per site.ConclusionsVA physician burnout was lower than previously described in many non-VA studies and was relatively stable over time. These findings may be due to unique characteristics of the VA practice environment. Nonetheless, with over a third of VA physicians reporting burnout, organizational interventions are needed. Primary care physicians and those practicing at small, rural sites have higher rates of burnout and may warrant more focused attention. Our results can guide targeted interventions to promote VA physician well-being and inform efforts to address burnout in diverse clinical settings.

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Developing an Internally Validated Veterans Affairs Women Cardiovascular Disease Risk Score Using Veterans Affairs National Electronic Health Records.

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