Spotlight: QUERI Partnership Evaluates the Transformation of VA Specialty Care

December 2013

VA's Office of Specialty Care Services/Office of Specialty Care Transformation (SCS/OSCT) has launched four initiatives to improve access to and delivery of specialty care that are Veteran-centered, team-based, efficient, and evidence-based, including:

1) E-consults: Consultations requested and completed via VA's electronic health record, with the goal of avoiding unnecessary face-to-face specialty visits. 2) Specialty Care Access Network – Extension for Community Health Outcomes (SCAN-ECHO): Real-time tele-video consultations between specialists and primary care providers (PCPs) across outlying clinics. Key goals include increasing the knowledge base of rurally-located PCPs, so they can provide optimal treatment for complex and chronic conditions without referring Veterans to a distant specialty care facility. 3) Specialty Care Neighborhood: Team-based specialty care model, in which teams of specialists engage in proactive and long-term collaboration with primary care in order to provide coordinated, optimal care for Veterans with the greatest specialty care needs. 4) Mini-Residency Program: Training primary care providers for a given condition or specialty, with the goal of expanding the scope of care they can provide onsite.

OSCT and VA/HSR&D's Quality Enhancement Research Initiative have collaborated to fund two Partnered Evaluation Centers to assess the implementation and impacts of these four initiatives. Specifically, the Centers will address these key questions:

• To what extent, and in what manner, has the Specialty Care Initiative been implemented?
• What factors and conditions foster or hinder implementation?
• ·What impact has the initiative had on patient experience, staff, quality of care, and other outcomes?

To answer these questions, the Evaluation Centers collect data from telephone interviews, electronic surveys, and sites visits, as well as utilizing VA administrative data. The Centers will rapidly report key findings so that OSCT can make informed modifications to the initiatives in response to conditions on the ground. This will result in better support for the 21 VISNs (Veterans Integrated Service Networks) located across the country, as they disseminate and implement initiatives to improve specialty care for Veterans.

Findings:

Findings contribute to both Operations and research. For example, findings for SCAN-ECHO showed extremely strong support for the program on the part of providers, but highlighted the need for protected time for PCPs' participation, as well as the importance of leadership engagement at all stages of implementation. Findings for E-Consults highlighted the time that is required to complete the consultation, as well as the importance of involving both primary care and specialty care in template development, thereby informing revisions to the guidance materials provided to the field and a change to the workload credit assigned to E-Consults.

Ultimately, the goal is to produce findings that are useful to both current and future initiatives, and to support program and policy decisions that benefit the health and well-being of Veterans.

Partnership Members:

Operations: Michael Doukas, M.D., Chief Consultant, VA Office of Specialty Care, and Susan Kirsh, M.D., M.P.H., VA Office of Specialty Care Transformation.

QUERI: P. Michael Ho, M.D., Ph.D., David Au, M.D., David Aron, M.D., and Julie Lowery, Ph.D..

Additional Resources:

As HSR&D seeks to promote innovative partnership-oriented research, most notably through the new CREATEs and COINs, the 10 QUERI Centers continue to develop and implement research partnerships that work to improve the health and healthcare of Veterans. For information about QUERI partnerships, visit the Funding Opportunities for Partnered Research webpage, where you also may view QUERI videos featuring successful partnerships.

Office of Specialty Care Transformation (Intranet only) SharePoint site:

If you have intranet access, copy and paste this URL into your browser: http://vaww.infoshare.va.gov/sites/specialtycare/SCSTransformation/default.aspx .

Questions about the HSR&D website? Email the Web Team

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