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Dr Robert Petzel at The King's Fund Annual Conference

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Dr Robert Petzel, Under Secretary for health, Veterans Health Administration talking at The King's Fund Annual Conference 2010 on transforming health services.

Dr Robert Petzel, Under Secretary for health, Veterans Health Administration talking at The King's Fund Annual Conference 2010 on transforming health services.

Published in: Health & Medicine

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  • 1. Health System Transformation
    Robert A. Petzel, M.D. | Under Secretary for Health
  • 2. Veterans Health Administration
    Budget…………………........................................…..$50 Billion
    Medical centers………………………………………………..153
    Outpatient clinics……………………………………..………850
    Unique patients treated…………………………….…6 Million
    Outpatient visits……………................................….78 Million
    Employees………………………………………………...250,000
    Physicians………………...................................….….....19,000
    Nurses (RN)………………………………………….…..…45,000
    Nurse Practitioners………………………………..….……3,500
    2
  • 3. What drove the change?
    A vision for change
    Structural re-organisation
    Decentralisation
    Evidence-based medicine
    Performance measures
    Performance management
    Electronic medical record
    Integration
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  • 4. The Transformation Vision1996
    The Veterans Health Administration is a comprehensive, integrated health care system that provides excellence in health care value, defined by quality, cost, access and satisfaction. An organisation characterised by accountability and being an employee of choice.
    4
  • 5. 21 Veterans Integrated Service Networks in 1998
    VISNs are the Funding & Accountability Unit in VA
    1995: Creating VISNs
    Objective to transform from a ‘hospital system’ to a ‘health system’
    From ‘safety net’ to ‘health promotion and disease prevention’
    5
  • 6. Sample performance measures 1997
    Decrease BDOC by 19%
    Increase ambulatory surgery by 20%
    Chronic disease index
    Prevention index
    Implement 12 new clinical practice guidelines





    6
  • 7. Outpatient visits vs BDOC
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  • 8.
  • 9. Patient satisfaction
    VHA has led private sector health care in patient satisfaction.
    NM = Not Measured
    Source: http://www.theacsi.org
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  • 10. Electronic Health Record
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  • 11. Why is IT a central strategy?
    Healthcare in the U.S., presents multiple challenges
    Information
    1 in 7 hospital admissions occurs because care providers do not have access to previous medical records*
    12% of physician orders are not executed as written*
    20% of laboratory tests are requested because previous studies are not accessible*
    1 in 6.5 hospitalisationsare complicated by drug error
    1 in 20 outpatient prescriptions
    *PITAC (President’s Information Technology Advisory Committee, 2004)
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  • 12. Transformation 2010
  • 13. Vision
    VHA will continue to be the benchmark of excellence and value in healthcare and benefits by providing exemplary services that are both patient-centered and evidence-based.
    This care will be delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery and continuous improvement.
    It will emphasise prevention and population health and contribute to the nation’s well-being through education, research and service in national emergencies.
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  • 14. Transformational initiatives
    Patient-aligned care teams – PACT
    Telemedicine
    Transparency



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  • 15. PACT
    Patient
    Aligned
    Care
    Teams




    ‘Changing the paradigm from episodic care to longitudinal engagement’
    -Robert Jesse, MD
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  • 16. PACT
    Patient-centered
    Team care
    Continuous improvement
    Evidence-based, data driven




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  • 17. 12 principles of patient-centered care
    Honor the veteran’s expectations of safe, high-quality, accessible care.
    Enhance the quality of human interactions and therapeutic alliances.
    Solicit and respect the veteran’s values, preferences and needs.
    Systemise the co-ordination, continuity and integration of care.
    Empower veterans through information and education.
    Incorporate nutritional, cultural and nurturing aspects of food.
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  • 18. 12 principles of patient-centered care
    continued
    Provide for physical comfort and pain management.
    Ensure emotional and spiritual support.
    Encourage involvement of family and friends.
    Ensure that architectural layout and design are conductive to health and healing.
    Introduce creative arts into the healing environment.
    Support and sustain an engaged workforce as key to providing patient-centered care.
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  • 19. Team care
    Everyone is on a team
    Team members are peers
    Collaboration
    Culture of respect




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  • 20. Continuous improvement
    Data
    Methodology
    Time
    Empowerment




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  • 21. Data-driven and evidence-based
    Data at point of care about cost, quality, access and satisfaction
    Practice to the evidence


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  • 22. Patient-alignedcare teams
    PACT: Enhanced Access to Care
    • PACT offers diverse methods of accessing health care:
    • 23. personal visits
    • 24. group clinics
    • 25. telephone conversations
    • 26. secure messaging through My HealtheVet
    • 27. web access
    • 28. telehealth
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  • 29. Patient-alignedcare teams
    PACT: Co-ordinatedcare (cont.)
    • PACT co-operates with veterans to plan their overall health with focus on:
    • 30. personal relationships
    • 31. patient preferences
    • 32. open communication and sharing of information
    • 33. team delivery of holistic care
    • 34. co-ordination across specialties and settings of care
    • 35. quality and safety improvements.
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  • 36. PACT Compass
    Panel management
    Outcomes
    Access
    Continuity
    Satisfaction
    Co-ordination
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  • 37. PACT Compass
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  • 38. Transparency
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  • 39. ASPIRE
    • Used to track each VAMC’s progress toward meeting the goals that VA aspires to achieve over the next few years (eg: no hospital-acquired infections)
    • 40. Includes 50 metrics
    • 41. Examples: MRSA, VAP, CLAB infection rates, hospital-acquired pressure ulcers, incorrect surgery, risk adjusted, standardised mortality rates for AMI, CHF, pneumonia and all cause re-admission rates
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  • 42. LinKS
    (Linking Knowledge and Systems)
    • Used to identify the performance of each VAMC in relation to all other VAMCs
    • 43. Contains 45 process and outcomes metrics
    • 44. Examples: Standardised mortality ratios for acute care (30 day) and ICU (in hospital & 30 day), and surgery (30 day), AMI, CHF, and pneumonia patients; risk adjusted re-admission rates (AMI, CHF and pneumonia); all cause re-admission rates, ambulatory care sensitive condition hospitalisations, hospital-acquired infections, etc
    28
  • 45. Telemedicine
    29
  • 46. Telehealth
    30
  • 54. Telehealth
    • Home telehealth
    • 55. 50,000 unique patients in FY 2010
    • 56. Telemedicine
    • 57. FY 2010
    • 58. 73,000 unique patients
    • 59. 165,000 encounters
    • 60. Mental health
    • 61. 100,500 unique patients over a four year period
    • 62. Teleretinal imaging
    • 63. 155,780 encounters in FY 2010
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  • 64. What drives the change?
    A vision for change
    Structural re-organisation
    Decentralisation
    Evidence-based medicine
    Performance measures
    Performance management
    Electronic medical record
    Integration
    Constancy of purpose
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