examine the steps in the investigation of an outbreak in the following scenario:

This data was taken from Hospital Compare about the quality of care (4000 hospitals in the U.S. are in the database). In this journal, evaluate data on four VA Hospitals located in WV. Three diagnoses were selected for comparison from available data on deaths with 30 days.

30 Day Death Rates 2012-2015

Acute Myocardial VA National Congestive Heart NA National Rate Pneumonia VA National Rate

Infarction (AMI) Rate AMI Failure (CHF) (CHF) (PN) (PN)

VA Hospital 1 8.05 9.21 6.05 7.72 8.57 8.64

VA Hospital 2 9.54 9.21 8.08 7.72 11.21 8.64

VA Hospital 3 11.01 9.21 7.07 7.72 9.28 8.64

VA Hospital 4 9.07 9.21 7.31 7.72 8.52 8.64

How do these four hospitals compare by diagnosis to the national rate (e.g. the National VA benchmark). What does the rates tell in this case? What was found from the Case Study #9 that might reflect additional issues in care of Veteran's? Describe the organization of the US Department of Veterans Affairs (VA) and its subunits, including Veteran's Health Administration (VHA). What challenges does the aging of the veteran population pose for VA and VHA? What challenges does the VHA face in attempting to switch from incentivizing hospitaloriented services to incentivizing home and community-based services?