Health Services Research & Development

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FORUM - Translating research into quality health care for Veterans

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Dialogue

FORUM Editors, Karen Bossi and Margaret Trinity, recently sat down with Robert McDivitt, Director of the VA Ann Arbor Healthcare System (VAAAHS) and Acting VISN 11 Network Director, to explore the topic of access—what access means in the context of the health care Veterans receive, as well as successes and challenges that VA Ann Arbor Healthcare System has experienced around access to care for Veterans.

For the past 35 years, I've worked in a variety of positions across six medical centers and three corporate assignments within the VA health care system. I am also a Veteran and view access issues from a patient perspective.

Across VA, I've witnessed an evolution from a system that once focused on inpatient care to a system focused on outpatient care, then primary care, and now, health and wellness in partnership with Veterans. The focus has shifted to providing care when it is needed by Veterans and where Veterans are located. Today, Veterans have access to care on a real time basis via smartphones. And most Veterans have experienced at least one virtual encounter—whether telehealth, videoconferencing technology, or an e-consult. At the facility level, I have seen a pronounced increase in telephone communications between clinicians and Veterans. So, in fact, VA is a leader in access to care, although it has not always been portrayed as such.

Over the last few years, the VAAAHS has focused on increasing capacity in both its primary care and specialty care clinics, which led us to hire an additional 60 clinicians as a result of implementation of the Choice Act. One of our priorities has been to expand evening and weekend clinics. As a result, we've seen a 10 percent increase in outpatient visits from FY 14 to FY 15.

We've also worked hard to improve wait times for specialty care referrals. One example is the endoscopy clinic, where in the past we had hundreds of Veterans on the wait list for an appointment. Today, we do not have any Veterans on the electronic wait list and, for routine screening, we are well within the 30-day guideline for securing an appointment. To accomplish these improvements in access, we expanded staffing in the endoscopy clinic, and we also redesigned clinic workflow. The next phase is for us to expand the physical space within the endoscopy clinic itself.

Another prime example is improved access to dermatology consults. We now have a teledermatology initiative whereby our outpatient clinics have dermatoscopes so that images can be forwarded to University of Michigan faculty physician and a diagnosis provided within 48 hours. This is just one example of a telemedicine technology that VA has aggressively rolled out in the last decade.

Looking ahead, one of our strategic goals is to roll out the Patient-Aligned Care Team (PACT) concept in several specialty clinics. We feel that the PACT concept has been successful in primary care in terms of surrounding Veterans with a team of providers, and using communication tools that do not necessarily require the Veteran to physically travel to the clinic. We anticipate translating the successes that we saw in primary care PACT into specialty care.

Our job is working in partnership with Veterans. At VAAAHS, we are continuously engaged in a conversation with the Veterans we serve. We involve Veterans in myriad ways across our facilities. We recently designed a new Veterans Welcome Center and we have Veterans who serve on our governing board. We've conducted several Veteran Tele-Townhalls via Facebook with hundreds of Veterans in virtual attendance. Last year, VAAAHS conducted a Tele-Townhall with a congressional representative who was available to answer questions, much like a call in radio show; we had 700 Veterans participating. The Facebook Townhall has become an important listening post for us.

As a health care executive, my goal is to take evidence-based research results and implement them in a way that works in a given environment. The excellent work undertaken by HSR&D researchers in the area of access as well as many other critical topics has allowed facility leaders such as myself to roll out best clinical practices from health system to health system and from VISN to VISN.

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