The American Hospital Association has awarded a Citation of Honor to the Veterans Health Administration for building and expanding the infrastructure to provide palliative and end-of-life care services to Veterans throughout the country and working with community-based providers to complement its services.
VHA exemplifies the best in health care, providing compassionate care and helping patients and families facing complex health challenges, according to the American Hospital Association.
In 2002, nearly a third of VA’s medical centers were making no referrals to community hospices, and most centers had no palliative care team. Today, VA has a wide-ranging, innovative palliative care program that builds on the nation’s largest integrated health system’s advanced information technology capabilities and culture of performance improvement to care for Veterans with serious illness and their families.
Each of the VA’s 21 regions has a palliative care program manager and clinical champion, and each of its 152 medical centers has an interdisciplinary palliative care team. All are supported by three national quality centers.
“The program began with a small nucleus of committed people,” says Scott T. Shreve, National Director, VA Hospice and Palliative Care, “and grew by focusing on what worked rather than what didn’t. We identified regional champions and we gave them the resources to really make things happen.”
It’s about proactively meeting the needs of an individual patient.
Because Veterans also receive care from community providers, it’s not enough to change the VA system itself. Ensuring non-VA providers understand the special problems faced by Veterans at the end of life — such as when traumatic memories from combat come to light — is critical. Through the VA’s collaboration with the National Hospice and Palliative Care Organization, the We Honor Veterans program creates collaborative models to increase all Veterans’ access to community hospice and palliative services designed to meet their needs.
A powerful tool for internal improvement is the nationwide Bereaved Family Survey, which offers leaders of VA’s 21 regional networks feedback on how end-of-life care services are satisfying families. Mary Zuccaro, who oversees VA palliative and hospice services in northern California, northwest Nevada and Hawaii, depends on those metrics to “take the temperature” of the program.
“I look through it for themes of where did we make a difference and where did we miss the boat. I disseminate that through all our programs.”
The VA program focuses on both technology and simple human kindness. The Care Assessment Need score, for instance, is a robust predictive model that scans the electronic medical record to identify Veterans “at-risk” for needing supportive services rather than waiting for a clinician to notice the need.
The VA Medical Foster Home program is a lower tech solution to keep Veterans out of nursing homes. In this program, families “adopt” a seriously ill Veteran under the close watch of VA clinicians.
“The future for VA is proactive, personalized and patient-driven care,” says Dr. Madhulika Agarwal, Deputy Under Secretary for Health Policy and Services for the Veterans Health Administration. “It’s about proactively meeting the needs of an individual patient, which is based on their preferences and their goals. That is what our focus needs to be.”