Improving Health Care for Veterans

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Brenda ShafferBy Brenda Shaffer, DNP, RN-BC, NE-BC

In 2010, the Department of Veterans Affairs (VA) transformed traditional care to a patient-centric model of care. Teams known as Patient Aligned Care Teams (PACT) with focus on the person rather than the disease were formed to provide timely and coordinated care ensuring that the patients’ wants, needs and preferences are at the core of decision-making. This practice change has enhanced the patient experience by involving veterans in medical decision making and self-management. As a result, PACT has allowed patients to take on more active roles in managing their health care. 

During 2013, a symposium was held to determine what veterans liked and disliked about this new type of patient-care delivery. Veterans and team members gathered together to discuss the transformation of care. Veterans expressed that they appreciated having a consistent health care team that included the same provider, care manager, Licensed Practical Nurse (LPN) or Health Care Technician (HCT) and medical support assistant. However, they expressed that they wanted to spend more time with their providers during visits in order to discuss their health concerns.

Following the meetings, PACT teams gathered to review the veterans’ requests. Consequently, it was decided that phone calls made prior to scheduled appointments would result in several potential benefits to patient visits. One is that the calls would allow more time to be spent face to face with the veterans’ providers. The calls would be made by members of the patients’ PACTs who would ask questions based on clinical reminders related to individual health concerns. As a result, veterans would feel comfortable providing information to staff members that they know. Secondly, the calls would act as reminders of appointments for the veterans, who may have forgotten about the visits. 

Phone calls made prior to scheduled times were initiated on April 29, 2013, with LPNs and HCTs making the calls. This initiative required them to change practice allowing for enough time in their schedules to make calls. The staff members were challenged to contact veterans when telephone numbers were not always accurate. They found that often several calls to the veterans were required in order to successfully reach the patients. The percentage of veterans who are successfully called prior to their scheduled appointments is approximately 49%.

Prevention calls have become a sustained practice at VA Pittsburgh Healthcare System. Pre-visit calls have improved various measures that PACT teams are evaluated on. For example, telephone access to patients by PACT staff is considered an effective component of patient-centered care. Since inception of prevention calls, the percentage of telephone care has continued to improve to a high of 38.4% of patient encounters. Additionally, access to available appointments for other veterans has occurred when a veteran who has been contacted via the telephone cannot make his appointment. 

 As requested by veterans, pre-visit calls have allowed more time spent with providers. Instead of utilizing an average of fifteen to twenty minutes to complete clinical reminders during PACT visits with LPNs or HCTs, these visits have been reduced to five to ten minutes of clinical reminders, permitting substantially more time spent with providers resulting in more time to fully participate in medical decisions with their providers. Additionally, providers and patients have had the opportunity to form partnerships in order to develop treatment plans that lead to improved adherence by the veterans. This change has involved the transformation of the practices of team members who now focus on veterans’ goals and needs facilitating for veterans to take on more active roles in managing their health care. 

Brenda Shaffer is the associate chief nurse for primary care at VA Pittsburgh Healthcare System. She has been a nurse for almost 34 years and a VAPHS employee for almost 27 years. Learn more about health care for Veterans at www.pittsburgh.va.gov.