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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.

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Dr Robert Petzel at The King's Fund Annual Conference

  1. 1. Health System Transformation<br />Robert A. Petzel, M.D. | Under Secretary for Health <br />
  2. 2. Veterans Health Administration<br />Budget…………………........................................…..$50 Billion<br />Medical centers………………………………………………..153<br />Outpatient clinics……………………………………..………850<br />Unique patients treated…………………………….…6 Million<br />Outpatient visits……………................................….78 Million<br />Employees………………………………………………...250,000<br />Physicians………………...................................….….....19,000<br />Nurses (RN)………………………………………….…..…45,000<br />Nurse Practitioners………………………………..….……3,500<br />2<br />
  3. 3. What drove the change?<br />A vision for change<br />Structural re-organisation<br />Decentralisation<br />Evidence-based medicine<br />Performance measures<br />Performance management<br />Electronic medical record<br />Integration<br />1<br />2<br />2<br />3<br />4<br />5<br />6<br />7<br />8<br />3<br />
  4. 4. The Transformation Vision1996<br />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. <br />4<br />
  5. 5. 21 Veterans Integrated Service Networks in 1998<br />VISNs are the Funding & Accountability Unit in VA<br />1995: Creating VISNs<br />Objective to transform from a ‘hospital system’ to a ‘health system’<br />From ‘safety net’ to ‘health promotion and disease prevention’<br />5<br />
  6. 6. Sample performance measures 1997<br /> Decrease BDOC by 19%<br /> Increase ambulatory surgery by 20%<br /> Chronic disease index<br /> Prevention index<br /> Implement 12 new clinical practice guidelines<br />✓<br />✓<br />✓<br />✓<br />✓<br />6<br />
  7. 7. Outpatient visits vs BDOC<br />7<br />
  8. 8.
  9. 9. Patient satisfaction<br />VHA has led private sector health care in patient satisfaction.<br />NM = Not Measured <br />Source: http://www.theacsi.org<br />9<br />
  10. 10. Electronic Health Record<br />10<br />
  11. 11. Why is IT a central strategy?<br />Healthcare in the U.S., presents multiple challenges<br />Information<br />1 in 7 hospital admissions occurs because care providers do not have access to previous medical records*<br />12% of physician orders are not executed as written*<br />20% of laboratory tests are requested because previous studies are not accessible*<br />1 in 6.5 hospitalisationsare complicated by drug error<br />1 in 20 outpatient prescriptions<br />*PITAC (President’s Information Technology Advisory Committee, 2004)<br />11<br />
  12. 12. Transformation 2010<br />
  13. 13. Vision<br />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.<br />This care will be delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery and continuous improvement.<br />It will emphasise prevention and population health and contribute to the nation’s well-being through education, research and service in national emergencies.<br />13<br />
  14. 14. Transformational initiatives<br />Patient-aligned care teams – PACT <br />Telemedicine<br />Transparency <br />✓<br />✓<br />✓<br />14<br />
  15. 15. PACT<br />Patient<br />Aligned<br />Care<br />Teams<br />✓<br />✓<br />✓<br />✓<br />‘Changing the paradigm from episodic care to longitudinal engagement’<br />-Robert Jesse, MD<br />15<br />
  16. 16. PACT<br />Patient-centered<br />Team care<br />Continuous improvement<br />Evidence-based, data driven<br />✓<br />✓<br />✓<br />✓<br />16<br />
  17. 17. 12 principles of patient-centered care<br />Honor the veteran’s expectations of safe, high-quality, accessible care.<br />Enhance the quality of human interactions and therapeutic alliances. <br />Solicit and respect the veteran’s values, preferences and needs.<br />Systemise the co-ordination, continuity and integration of care.<br />Empower veterans through information and education.<br />Incorporate nutritional, cultural and nurturing aspects of food.<br />1<br />2<br />3<br />4<br />5<br />6<br />17<br />
  18. 18. 12 principles of patient-centered care<br />continued<br />Provide for physical comfort and pain management.<br />Ensure emotional and spiritual support. <br />Encourage involvement of family and friends.<br />Ensure that architectural layout and design are conductive to health and healing.<br />Introduce creative arts into the healing environment.<br />Support and sustain an engaged workforce as key to providing patient-centered care.<br />7<br />8<br />9<br />10<br />11<br />12<br />18<br />
  19. 19. Team care<br />Everyone is on a team<br />Team members are peers<br />Collaboration<br />Culture of respect<br />✓<br />✓<br />✓<br />✓<br />19<br />
  20. 20. Continuous improvement<br />Data<br />Methodology<br />Time<br />Empowerment<br />✓<br />✓<br />✓<br />✓<br />20<br />
  21. 21. Data-driven and evidence-based<br />Data at point of care about cost, quality, access and satisfaction<br />Practice to the evidence<br />✓<br />✓<br />21<br />
  22. 22. Patient-alignedcare teams<br />PACT: Enhanced Access to Care<br /><ul><li>PACT offers diverse methods of accessing health care:
  23. 23. personal visits
  24. 24. group clinics
  25. 25. telephone conversations
  26. 26. secure messaging through My HealtheVet
  27. 27. web access
  28. 28. telehealth</li></ul>22<br />
  29. 29. Patient-alignedcare teams<br />PACT: Co-ordinatedcare (cont.)<br /><ul><li>PACT co-operates with veterans to plan their overall health with focus on:
  30. 30. personal relationships
  31. 31. patient preferences
  32. 32. open communication and sharing of information
  33. 33. team delivery of holistic care
  34. 34. co-ordination across specialties and settings of care
  35. 35. quality and safety improvements.</li></ul>23<br />
  36. 36. PACT Compass<br />Panel management<br />Outcomes<br />Access<br />Continuity<br />Satisfaction<br />Co-ordination<br />24<br />
  37. 37. PACT Compass<br />25<br />
  38. 38. Transparency<br />26<br />
  39. 39. ASPIRE<br /><ul><li>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. 40. Includes 50 metrics
  41. 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</li></ul>27<br />
  42. 42. LinKS<br />(Linking Knowledge and Systems)<br /><ul><li>Used to identify the performance of each VAMC in relation to all other VAMCs
  43. 43. Contains 45 process and outcomes metrics
  44. 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</li></ul>28<br />
  45. 45. Telemedicine<br />29<br />
  46. 46. Telehealth<br /><ul><li>Telemedicine:
  47. 47. dermatology
  48. 48. ophthalmology
  49. 49. cardiology
  50. 50. pathology
  51. 51. mental health
  52. 52. Telehome Health
  53. 53. eICU</li></ul>30<br />
  54. 54. Telehealth<br /><ul><li>Home telehealth
  55. 55. 50,000 unique patients in FY 2010
  56. 56. Telemedicine
  57. 57. FY 2010
  58. 58. 73,000 unique patients
  59. 59. 165,000 encounters
  60. 60. Mental health
  61. 61. 100,500 unique patients over a four year period
  62. 62. Teleretinal imaging
  63. 63. 155,780 encounters in FY 2010</li></ul>31<br />
  64. 64. What drives the change?<br />A vision for change<br />Structural re-organisation<br />Decentralisation<br />Evidence-based medicine<br />Performance measures<br />Performance management<br />Electronic medical record<br />Integration<br />Constancy of purpose<br />1<br />2<br />3<br />4<br />5<br />6<br />7<br />8<br />9<br />32<br />

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