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2015 HSR&D/QUERI National Conference Abstract

3188 — Hepatitis C System Redesign in an Era of Transformation

Morgan TR, VA Long Beach Healthcare System; Park A, NE Veterans Engineering Resource Center; Lukesh W, NE Veterans Engineering Resource Center; Yakovchenko V, QUERI; Gonzalez R, VA Long Beach Healthcare System; Knott A, Office of Public Health, HHPHP; Rongey C, Office of Public Health, HHPHP; Chartier M, Office of Public Health, HHPHP; Ross D, Office of Public Health, HHPHP; Schlosser J, VISN 1 Improvement Resource Office

Advances in treatment for patients with Hepatitis C (HCV) and an increased demand for treatment present the opportunity to improve healthcare delivery in all steps of the continuum of care (screening, linkage to specialty care, evaluation, and treatment). The Department of Veterans Affairs (VA), Veterans Health Administration (VHA) has undertaken a national system redesign effort to improve access and quality of care for all Veterans with HCV in VHA.

We utilized principles of lean management and organizational science as the basis for a system-wide program. VISN (Veterans Integrated Service Network) representatives received training in the aforementioned principles to develop HCV quality improvement initiatives to increase access and quality of HCV care. Each VISN was invited to submit a proposal in support of an interdisciplinary Hepatitis C Innovation Team (HIT), comprised of clinicians, system redesign, pharmacists, support staff and health informatics.

21 VISNs participated in face-to-face workshops and developed process mapping to identify gaps in care delivery. While process maps differed by VISN, key steps of the care continuum were identified as consistent themes. Team representatives estimated their current capacity to manage and treat HCV, identified opportunities for improvement, and defined metrics to monitor change. As estimates for capacity to deliver HCV care were highly variable, a greater need for capacity modeling emerged. To monitor HCV care system-wide, VISNs began development of leading and lagging measures to capture changes in care outcomes. 20 VISNs submitted a HIT proposal for redesigning HCV care.

Through mentorship and hands-on training, we are creating a learning organization and system-wide focus on continuous quality improvement. VHA clinicians and staff are supported through the HIT collaborative to apply lean management and organizational science principles, promoting the use of best practices within and across VISNs. This includes a focus on population health management and transforming the generalist-specialist interface as we move into a new era in HCV treatment.

This ongoing national effort aligns with VA's transformation to improve Veterans' access to care. Lessons learned will be summarized and translated to other chronic diseases in need of system redesign.