Ranak B Trivedi

• PhD
• Research Assistant at VA Palo Alto Health Care System & Stanford University

Importance More than 75% of US adults with diabetes do not meet treatment goals. More effective support from family and friends (“supporters”) may improve diabetes management and outcomes. Objective To determine if the Caring Others Increasing Engagement in Patient Aligned Care Teams (CO-IMPACT) intervention improves patient activation, diabetes m...

Background Healthcare fragmentation may lead to adverse consequences and may be amplified among older, sicker patients with mental health (MH) conditions.Objective To determine whether older Veterans with MH conditions have more fragmented outpatient non-MH care, compared with older Veterans with no MH conditions.DesignRetrospective cohort study us...

Objective: To examine outpatient care fragmentation and its association with future hospitalization among patients at high risk for hospitalization. Data sources: Veterans Affairs (VA) and Medicare data. Study design: We conducted a longitudinal study, using logistic regression to examine how outpatient care fragmentation in FY14 (as measured...

Objectives: To assess what patient, family supporter, and call characteristics predicted whether patients completed automated and coach-provided calls in a telehealth diabetes intervention. Study design: A total of 123 adults with type 2 diabetes and high glycated hemoglobin A1c (HbA1c) or blood pressure, enrolled with a family supporter, receiv...

Background Family support for adults’ diabetes care is associated with improved self-management and outcomes, but healthcare providers lack structured ways to engage those supporters.Objective Assess the impact of a patient-supporter diabetes management intervention on supporters’ engagement in patients’ diabetes care, support techniques, and careg...

Objective: Psychotherapy for depression is effective for many veterans, but the relationship between number of treatment sessions and symptom outcomes is not well established. The Dose-Effect model predicts that greater psychotherapeutic dose (total sessions) yields greater symptom improvement with each additional session resulting in smaller sessi...

This study examined the role of autonomy support from adults’ informal health supporters (family or friends) in diabetes-specific health behaviors and health outcomes. Using baseline data from 239 Veterans with type 2 diabetes at risk of complications enrolled in behavioral trial, we examined associations between autonomy support from a support per...

Background Although web-based psychoeducational programs may be an efficient, accessible, and scalable option for improving participant well-being, they seldom are sustained beyond trial publication. Implementation evaluations may help optimize program uptake, but few are performed. When the US Department of Veterans Affairs (VA) launched the web-b...

Introduction: Among adults with type 2 diabetes, low health literacy (HL) is a risk factor for negative health outcomes. Support from family and friends can improve adults’ self-management and health-related outcomes. We examined whether supporters provided unique help to adults with diabetes and low HL, and whether HL was associated with adults’ p...

Objective Heart Failure (HF) care requires substantial care coordination between patients, patients’ informal caregivers, and clinicians, but few studies have examined recommendations from all three perspectives. The objective of this study was to understand and identify shared recommendations to improve HF self-care from the perspective of VA pers...

Importance Women veterans increasingly seek care yet continue to face barriers in the Veterans Health Administration (VA), which predominantly cares for men. Evidence-based collaborative care models can improve patient access to treatment of depression, which is experienced at higher rates by women. While the VA has implemented these care models na...

Background: Patients with diabetes (PWD) often experience diabetes distress which is associated with worse self-management and glycemic control. In contrast, PWD who receive support from family and friends (supporters) have better diabetes outcomes. Purpose: Examine the associations of PWD diabetes distress and supporters’ distress about PWDs’ dia...

Many adults with DM have a family supporter (FS) involved in their care. Informal support has been linked with better DM management and outcomes. We evaluated the effect of a patient and FS engagement intervention on FS roles in DM care, and the impact of those roles on HbA1c. Two-hundred and thirty-nine adult Veterans with type 2 DM and a FS were...

We evaluated the effectiveness of an intervention for patient-family dyads aimed at improving diabetes self-management and outcomes for adults with T2DM (AWD) at risk for complications. AWD were randomized with a family supporter to an intervention vs. usual care for 12 months. The intervention provided dyads: one health coaching session, biweekly...

Background: In the United States, suicide rates are increasing among nearly all age groups. Primary care is a critical setting for suicide prevention, where interventions often rely on identifying mental health conditions as indicators of elevated suicide risk. Objective: Quantify the proportion of suicide decedents within primary care who had n...

Background Premature mortality observed among the mentally ill is largely attributable to chronic illnesses. Veterans seen within Veterans Affairs (VA) have a higher prevalence of mental illness than the general population but there is limited investigation into the common causes of death of Veterans with mental illnesses. Objective To characteriz...

BACKGROUND Although web-based psychoeducational programs may be an efficient, accessible, and scalable option for improving participant well-being, they seldom are sustained beyond trial publication. Implementation evaluations may help optimize program uptake, but few are performed. When the US Department of Veterans Affairs (VA) launched the web-b...

Aiming to increase care access, the national Primary Care-Mental Health Integration (PC-MHI) initiative of the Veterans Health Administration (VHA) embedded specialists, care managers, or both in primary care clinics to collaboratively care for veterans with psychiatric illness. The initiative's effects on health care use and cost patterns were exa...

Objective: This study sought to compare quality of care following medical home implementation among Veterans Health Administration (VHA) primary care patients with and without mental illness. Methods: VHA primary care patients seen between April 2010 and March 2013 whose medical records were reviewed by the VHA External Peer Review Program were...

Background: Heart failure (HF) management requires the participation of patients, their significant others, and clinical providers. Each group may face barriers to HF management that may be unique or may overlap. Objective: The aim of this study was to compare the barriers and facilitators of HF management as perceived by patients, significant o...

Background: It is unknown whether family members or friends (‘supporters’) tailor their assistance to the unique needs of patients with diabetes and low HL. Methods: Surveys were conducted among 239 VA healthcare system patients with type 2 diabetes who were 30-70 years old, had A1c>8% or high blood pressure, did not have dementia or need help with...

Many adults with diabetes have family or friend ‘supporters’ involved in their care. Adult-supporter dyads were recruited to a trial comparing usual care to a 12-month program to engage and train supporters. Potentially eligible patients with T2DM and either HbA1c>8% or high systolic BP were identified via medical records. Patients randomized to th...

Objectives: Informal caregivers who recognize patients’ depressive symptoms can better support self-care and encourage patients to seek treatment. We examined patient-caregiver agreement among patients with heart failure (HF). Our objectives were to (1) identify distinct groups of HF patients and their out-of-home informal caregivers (CarePartners)...

Objectives:: The authors examined whether the rate of preventable hospitalizations among veterans with mental illness changed after implementation of the Department of Veterans Affairs (VA) primary care medical home-Patient Aligned Care Teams (PACT). Methods:: A 12-year retrospective cohort analysis was conducted of data from 9,206,017 veterans...

Background: Most adults with diabetes who are at high risk for complications have family or friends who are involved in their medical and self-care ("family supporters"). These family supporters are an important resource who could be leveraged to improve patients' engagement in their care and patient health outcomes. However, healthcare teams lack...

Introduction The association between disability and cause of death in Veterans with service-connected disabilities has not been studied. The objective of this study was to compare age at death, military service and disability characteristics, including disability rating, and cause of death by year of birth. We also examined cause of death for speci...

We examined the association of mental health staffing and the utilization of primary care/mental health integration (PCMHI) with facility-level variations in adequacy of psychotherapy and antidepressants received by Veterans with new, recurrent, and chronic depression. Greater likelihood of adequate psychotherapy was associated with increased (1) P...

Objective To determine whether the presence of an informal caregiver and the patient’s level of social support are associated with better diabetes self-care among adults with poorly controlled diabetes. Methods Cross-sectional study using baseline data from 253 adults of age 30–70 with poorly controlled diabetes. Participants who reported receivin...

Background Heart failure (HF) is associated with frequent exacerbations and shortened lifespan. Informal caregivers such as significant others often support self-management in patients with HF. However, existing programs that aim to enhance self-management seldom engage informal caregivers or provide tools that can help alleviate caregiver burden o...

Objectives: We evaluated the association of mental illnesses with clinical outcomes among US veterans and evaluated the effects of Primary Care-Mental Health Integration (PCMHI). Methods: A total of 4 461 208 veterans were seen in the Veterans Health Administration's patient-centered medical homes called Patient Aligned Care Teams (PACT) in 2010...

Exclusion criteria are an important determinant of the external validity of treatment research findings, yet the prevalence and impact of exclusion criteria have not been studied systematically. Our objective was to describe prevalent exclusion criteria in treatment research on neurological disorders and to analyze their impact on sample representa...

Mobile health (mHealth) interventions may improve heart failure (HF) self-care, but standard models do not address informal caregivers' needs for information about the patient's status or how the caregiver can help. We evaluated mHealth support for caregivers of HF patients over and above the impact of a standard mHealth approach. We identified 331...

Background Although telephone care management improves depression outcomes, its implementation as a standalone strategy is often not feasible in resource-constrained settings. Moreover, little research has examined the potential role of self-management support from patients’ trusted confidants. Objective To investigate the potential benefits of int...

The purpose of this study was to investigate the potential benefits for medication adherence of integrating a patient-selected support person into an automated diabetes telemonitoring and self-management program, and to determine whether these benefits vary by patients' baseline level of psychological distress. The study was a quasi-experimental pa...

Objectives Post-traumatic stress disorder (PTSD) and depression are both associated with coronary artery disease (CAD) in older adults. It is unclear whether PTSD is associated with CAD among older patients with depression, particularly ethnic/racial minority patients. We examined how PTSD relates to CAD in older depressed patients and how this rel...

Background: Angina and depression are common in ischemic heart disease (IHD), but their association remains understudied. Purpose: This study was conducted in order to evaluate the association of 1 year change in depression with change in patient-reported outcomes of stable angina. Methods: Five hundred sixty-nine stable angina patients comple...

Objectives: To assess whether the relationship between antidepressant adherence and coronary artery disease (CAD) hospitalizations varied between older and younger adults with depression. Design: Retrospective cohort study. Setting: Department of Veterans Affairs outpatient clinics nationwide. Participants: Chronically depressed individuals...

Objective: This study characterized racial-ethnic differences in treatment of veterans with chronic depression by examining antidepressant and psychotherapy use among non-Hispanic black, non-Hispanic white, Hispanic, Asian, and American Indian-Alaska Native (AI/AN) veterans. Methods: Logistic regression models were estimated with data from the U...

Objective: To understand patient participation in interactive voice response (IVR) depression monitoring and self-management support calls and estimate the workload from clinical alerts based on patients' IVR reports. Study design: Observational study from program implementation in 13 community- and university-based primary care practices. Meth...

Given ongoing concerns about high levels of burden reported among some informal caregivers, the goal of this study was to characterize their sociodemographics, health, and well-being. Using cross-sectional data from a large nationally representative survey in the United States (N = 438,712) we identified adults who provided informal care to friends...

Recruitment and retention challenges impede the study of behavioral interventions among patient-support person dyads. To characterize recruitment and retention rates of behavioral interventions involving dyads. Using PRISMA guidelines and with the guidance of a medical librarian, we searched Medline, EMBASE, Cochrane Controlled Trials, PsycInfo, an...

Background A small pre-test study was conducted to ascertain potential harm and anxiety associated with distributing information about possible cancer treatment options at the time of biopsy, prior to knowledge about a definitive cancer diagnosis. Priming men about the availability of multiple options before they have a confirmed diagnosis may be a...

Questions & answers about your prostate.

Young to middle-aged women usually have notably lower rates of cardiovascular disease (CVD) than their male counterparts, but African American women lack this advantage. Their elevated CVD may be influenced by sex differences in associations between depressed mood and CVD risk factors. This cross-sectional study examined whether relations between s...

Objective To characterize diabetes patient engagement and clinician notifications for an mHealth interactive voice response (IVR) service. Design Observational study. Methods For three to six months, VA patients with diabetes received weekly IVR calls assessing health status and self-care along with tailored education. Patients could enroll with...

Background Approximately 2/3 of Veterans admitting to Veterans Health Administration (VHA) facilities present >12 hours after symptom onset of acute myocardial infarction (AMI) (“late presenters”). Veterans admitted to VHA facilities with AMI may delay hospital presentation for different reasons compared to their general population counter parts. D...

Because evidence-based psychotherapies of 12 to 20 sessions can be perceived as too lengthy and time intensive for the treatment of depression in primary care, a number of studies have examined abbreviated psychotherapy protocols. The purpose of this study was to conduct a systematic review and meta-analysis to determine the efficacy of brief psych...

Contributions of informal caregivers to adherence among chronic obstructive pulmonary disease (COPD) patients remain understudied. This study aims to evaluate the association between caregiver presence and adherence to medical recommendations among COPD patients. Three hundred and seventy-four COPD patients were asked whether they had a caregiver....

Recent research has highlighted the positive influence that spouses can have on patient outcomes. It is not clear whether patients and spouses influence each other's well-being reciprocally or whether spousal well-being affects the success of patients' disease management. Our goals were 2-fold: (a) to propose a conceptual framework to examine the r...

The purpose of this study was to assess the impact of changes in symptoms of depression over a 1-year period on subsequent clinical outcomes in heart failure (HF) patients. Emerging evidence shows that clinical depression, which is prevalent among patients with HF, is associated with a poor prognosis. However, it is uncertain how changes in depress...

The individual and societal burden of depressive disorders is widely acknowledged, but treating these disorders remains challenging. Clinical guidelines recommend that both pharmacotherapy and psychotherapy should be considered as first-line treatments. Yet, because primary care settings are often the frontline of treatment, pharmacological treatme...

Resilience has been written about and valued since time immemorial. Its value is transmitted down generations through adages, mythology, anecdotes, and even children’s books. In essence, resilience can be thought of as a process of successfully adapting to maintain or regain emotional well-being in the face of adversity. It does not mean that distr...

To examine the utility of psychotherapy in managing treatment resistant depression. PubMed, PsycInfo, Embase, Cochrane Registry of Controlled Clinical Trials, article bibliographies. Eligible articles had to be in English and include English-speaking adult outpatients from general medical or mental health clinics. Studies had to be randomized clini...

Purpose: We conducted a pilot study to examine the acceptability and psychological burden of providing information about the risks and benefits of potential treatment options to men who are scheduling a biopsy, but do not yet know their results. We hypothesize that engaging men in discussions about differences between high and low risk prostate can...

To determine subtypes of adherence, 636 hypertensive patients (48% White, 34% male) reported adherence to medications, diet, exercise, smoking, and home blood pressure monitoring. A latent class analysis approach was used to identify subgroups that adhere to these five self-management behaviors. Fit statistics suggested two latent classes. The firs...

Elevated depressive symptoms have been linked to poorer prognosis in heart failure (HF) patients. Our objective was to identify coping styles associated with depressive symptoms in HF patients. A total of 222 stable HF patients (32.75% female, 45.4% non-Hispanic black) completed multiple questionnaires. Beck Depression Inventory (BDI) assessed depr...

After menopause, women are at an increased risk of cardiovascular disease. The present study assessed cardiovascular hemodynamics in premenopausal versus postmenopausal women, with a focus on systemic vascular resistance (SVR) at rest and during stress. Sympathetic nervous system activity and cardiovascular adrenergic receptor (AR) function were al...

Health-related knowledge is an important component in the self-management of chronic illnesses. The objective of this study was to more accurately assess racial differences in hypertension knowledge by using a latent variable modeling approach that controlled for sociodemographic factors and accounted for measurement issues in the assessment of hyp...

We were interested in examining the relationship between psychosocial factors and hypertension-related behaviors. We hypothesized that lower emotional well-being and unmarried status would be related to higher BP, poorer medication adherence, greater difficulty adhering to diet and exercise, and current smoking. In a cross-sectional design, 636 hyp...

The recovery phase of the stress response is an individual difference characteristic that may predict cardiovascular risk. The purpose of this study was to examine whether laboratory-based blood pressure (BP) recovery predicts ambulatory BP (ABP). One hundred and eighty-two participants underwent a standard laboratory stress protocol, involving a 2...

To study the effect of donepezil in treating patients with cognitive decline following coronary artery bypass graft (CABG) surgery. Forty-four patients, with at least a 0.5 SD decline at 1 year post-CABG on at least one cognitive domain compared to their pre-CABG baseline score, were randomized to treatment with donepezil (titrated to 10 mg daily)...

Depression is widely recognized as a risk factor in patients with coronary heart disease. However, patients with heart failure (HF) have been less frequently studied, and the effect of depression on prognosis, independent of disease severity, is uncertain. Two hundred four outpatients having a diagnosis of HF, with a ventricular ejection fraction o...

To examine the genetic and/or environmental origin of variation and covariation of perceived stressful life events and two stress-related coping styles, anger expression and John Henryism. Data were available from 306 European American (EA) and 213 African American (AA) twin pairs, including monozygotic and dizygotic of same as well as opposite sex...