|
|
|
Share this email with your colleagues to make sure they get the latest VHA IE news: SUBSCRIBE
|
|
|
 |
When the pandemic hit, the US health care system saw unprecedented levels of delayed appointments. Most elective appointments were paused, and care was prioritized for emergencies and COVID operations. To continue meeting Veteran health care needs, VA immediately expanded the use of telehealth. VA’s most common telehealth tool is VA Video Connect, VA’s secure videoconferencing app. However, telehealth comes with some limitations.
Dr. Nichol Salvo is a podiatrist at the Atlanta VA Medical Center, Deputy Director for VHA’s National Podiatry Program, and 2024 Senior Innovation Fellow with VHA Innovation Ecosystem. For podiatrists, who are responsible for treating problems that affect the feet and lower legs, telehealth doesn’t allow full examination of potential foot issues. Those exams are critical for determining a patient’s risk for amputation.
VA’s PAVE, or Prevention of Amputation in Veterans Everywhere, program has been in place for nearly 30 years and is designed to reduce overall amputation rates and reduce the amputation levels performed, such as a toe, foot, or lower leg. PAVE establishes that any Veteran with a past medical history that might increase the risk of amputation requires an annual foot exam.
As the pandemic evolved, podiatrists became increasingly concerned about at-risk Veterans developing symptoms that needed sudden treatment. Dr. Salvo recognized the need for a creative approach to reach patients and minimize the negative impact of delayed care. The High-risk Eye and Limb Preservation Program (HELPP) was developed to provide an eye and foot exam, labs, vitals intake, and general health assessment. The foot exam was performed by a nurse, while a podiatrist supervised via video to identify foot care needs.
|
 |
|
The HELPP intermediate care technicians, or ICTs, now perform basic foot exams and care at VA outpatient clinics, working towards HELPP’s mission of preserving limbs and keeping Veterans walking. Eligible Veterans were also enrolled in the Remote Temperature Monitoring program to monitor their risk for lower limb amputation.
Since starting in 2020 at the Atlanta VA, HELPP has completed over 5,500 visits and allowed more high-risk Veterans to receive care. It has decreased podiatry related community care costs, expanded access to care, and improved health outcomes for Veterans.
As a Senior Innovation Fellow, Dr. Salvo's mission is to establish HELPP as a model of care that can be used across VA, providing basic foot care to Veterans at increased risk for amputation, improving access and timeliness of care, and preventing amputation.
|
The Exchange is a monthly VHA IE panel event where innovators across the VA come together to share their perspectives. On February 15th, The Exchange discussion explored the impactful contributions of Kimberly Church, MS, Dr. Indra Sandal, Dr. Lindsay Riegler, and Dr. Joe Geraci in addressing crucial aspects of Veterans' health, ranging from transportation barriers to mental health challenges, digital health, and age-friendly care principles.
Breaking Barriers in Veterans' Transportation
Dr. Indra Sandal, the National Lead for VHA-Uber Health Connect Initiative, and Chief of Innovation at the James A. Haley Veterans' Hospital in Tampa, FL, brings a passion for engaging Veterans in the innovation lifecycle. The success of the VISN 9 & 15 pilot and its subsequent expansion to 68 VA hospitals showcases the positive outcomes of these initiatives. Reflecting on her impact, Dr. Sandal said: “I’m not an MD so I thought maybe I wouldn’t be able to make an impact, but there is the innovation side at VA that presented that opportunity. In my role as an Entrepreneur in Residence Fellow, I realized you don’t have to be an MD to make an impact.”
Telehealth Innovations for Veterans' Well-Being
Dr. Lindsay Riegler, an Innovation Specialist and Speech-Language Pathologist at the Cincinnati VA Medical Center, delves into the realm of telehealth to address the challenges Veterans face in accessing timely care. Collaborating within VA, Dr. Riegler focuses on building a collaborative environment that anticipates future challenges. Her emphasis on remote temperature monitoring is just one facet of a broader strategy to build a resilient system that can adapt to emerging health care needs. Dr. Riegler's advice underscores the importance of persistence and resource utilization.
Precision Medicine and Suicide Prevention for Modern Warriors
Dr. Joe Geraci, a U.S. Army Veteran with a background in clinical psychology and a passion for precision medicine, discusses the prevention of Veteran suicides. As a licensed psychologist and Director of the Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), Dr. Geraci sheds light on the alarming rise in suicide rates among Veterans, particularly those age 18-34. His focus on the Veteran Sponsorship Initiative recognizes the need for a support system for Veterans during their transition to civilian life. “Veterans need someone to guide them through the process of readjusting,” Dr. Geraci said. “Support from within communities are incredibly important because that’s where sponsors live. The best people for them to work with are those who they look to as a mentor.”
Age-Friendly Principles and Holistic Care
Kimberly Church, from the Department of Veterans Affairs Office of Geriatrics and Extended Care, emphasizes age-friendly principles in health care, recognizing the unique needs of older Veterans. The collaboration with the Institute for Healthcare Improvement (IHI) has led to the development of age-friendly health systems using the "4Ms": What Matters, Medications, Mentation, and Mobility. The creation of an action community, supported by a grant from IHI, signifies the commitment of the VA to become the largest age-friendly health network in the US. With 186 centers participating in the first action committee, the VA is rapidly progressing toward providing holistic care for older Veterans.
The collective efforts of Dr. Indra Sandal, Dr. Lindsay Riegler, Dr. Joe Geraci, and Kimberly Church exemplify the commitment of health care professionals in addressing the diverse challenges faced by Veterans. From overcoming transportation barriers to enhancing mental health support and ensuring age-friendly care, these innovations underscore the transformative potential of collaborative and persistent efforts in Veterans' health care. As we navigate the complexities of health care innovation, these initiatives serve as beacons of hope for a future where veterans receive the comprehensive and timely care they rightfully deserve.
|
|
Approximately 7,000 Veterans have psychogenic non-epileptic seizures (PNES), a functional neurological disorder that presents with neurologic symptoms associated with underlying psychological issues/stressors and neural network dysfunction. Treatment options for these Veterans are limited due to lack of training and education opportunities. To address this issue, W. Curt LaFrance, Jr., MD, MPH, neurologist and psychiatrist at VA Providence Healthcare System, and his team created the VA Mind Brain Program. The national program uses online TMS courses as well as virtual group lectures and individual training to educate and train clinicians across the VA to improve the knowledge and care of Veterans with PNES and other neuropsychiatric diagnoses.
VA Mind Brain Program (MBP) also connects mental health and neurology clinicians with researchers to optimize diagnosis and treatment for neuropsychiatric conditions. MBP staff train clinicians to use neuro-behavioral therapy (NBT), an evidence-based, whole-person, time-limited psychotherapy. In sites with NBT-trained clinicians, Veterans with PNES and related disorders receive coordinated care and treatment options for their symptoms. NBT has been shown to reduce seizures, depression, and anxiety, and improve function and quality of life. The VA MBP continues to improve access to mental health care for Veterans across the nation.
VA Mind Brain Program launched in 2021 through VA Neurology Program Office and has trained clinicians nationwide in 10 VA facilities. Presently, four additional VA facilities across the nation are establishing local clinics where NBT is being offered.
|
A recent study published by VHA IE’s Diffusion of Excellence (Diffusion) and VA Quality Enhancement Research Initiative revealed that Diffusion’s process to identify, replicate, and spread innovative practices across VHA is sustainable. Diffusion identifies frontline employee innovations through the annual VHA Shark Tank Competition. The study evaluated the first eight competitions from 2016 to 2022, highlighting that the program received over 3,000 applications, identified 88 winning practices, and contributed to 1,440 practice adoptions at new VA sites.
|
|
|
|
|
