Lucille Beck, PhD Chief Consultant, Rehabilitation and Prosthetic Services Veterans Health Administration Department of Veterans Affairs

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1 How to Facilitate Rehabilitation Care Lucille Beck, PhD Chief Consultant, Rehabilitation and Prosthetic Services Veterans Health Administration Department of Veterans Affairs

2 The only victor in war is medicine Mayo Brothers WWII Photo Courtesy of U.S. Army Photo Credit: Sgt. Matthew C. Cooley 1

3 Patients and Families 2

4 VA Mission To serve America's Veterans and their families with dignity and compassion and to be their principal advocate in ensuring that they receive the care, support and recognition earned in service to this Nation. VHA core missions: Health Care Graduate Medical Education Research Emergency Preparedness 3

5 VA Health Care Honor America's Veterans by providing exceptional health care that improves their health and well-being The largest integrated health care system in US: 152 hospitals 135 community living centers 209 veterans counseling centers 807 community based outpatient clinics (CBOC) VHA manages the largest medical education program in the U.S, partnering with 107 medical schools, 55 dental schools and 1,200 other schools Over 109,000 health care professionals in over 40 professions train in a VA facility each year 4

6 Best Care Anywhere 5

7 Better Access, Better Care Before Hospital System After Health System Only Hospitals Hospitals Outpatient Clinics Mobile Clinics Vet Centers Mobile Vet Centers My HealtheVet 6

8 21 st Century VA Health Care People Centric Honor and Serve Veterans and Their Families Embrace VA Core Values of Compassion, Integrity, Respect, and Commitment Engage, Inspire, and Empower Employees Results Driven Ensure Improved Access for All Veterans Provide High-Quality Care and Exceptional Client Relationship Management Leverage Technology and Adapt Business Processes with Agility Demonstrate Leadership, Accountability, and Effective Results Forward Looking Communicate Widely and Effectively and Conduct Systematic Outreach and Collaboration Anticipate Veterans Needs and Be Pro-Active in Meeting Them Develop a VA Culture that Is Forward Looking, Innovative, and Veteran-Focused 7

9 The Path to Patient Centered Care Past VA What can I fix? Physician Case-Based Paper Medical Record We ll address your immediate concern. Present VA How can we help what is wrong with you? Clinical Team Disease-Based Electronic Medical Record You have a risky problem, please follow this plan to improve by your next visit. Future VA How can we help you live the life you want to live? Veteran, Family and Health Care Team Whole-Person Electronic Health Record We can design your personalized health plan to meet your goals. 8

10 Team Care The New Health Care Work Place Work is done in teams Team members regard each other as peers Teams are empowered Teams have data about cost, quality, satisfaction and access Teams use a continuous improvement process Teams have time Teams work collaboratively 9

11 Integrated Healthcare Trauma Care Rehabilitation Community Reintegration Lifetime Community Care Surgical Inpatient - Immediate Transitional/Community Re-entry Residential Supported Living Vocational Educational Medical Inpatient Ongoing Outpatient Care Evaluation and Management Transitional/Community Re-entry - Day Program Outpatient Care Neurobehavioral Day Activity Support Groups Skilled Nursing Total Care Outpatient Care Family Support Case Management Benefits Management Medical Information Management 10

12 The Spectrum of Rehabilitation Needs Amputation TBI Mental Health Chronic Pain Cognitive Problems Visual Deficits Musculo -skeletal injuries Auditory Problems Recreation / Leisure 11

13 Integrated Comprehensive Rehabilitation Care 12

14 Medical Rehabilitation Services in VA Provide high quality, comprehensive, state-of-the-art clinical services to Veterans with disorders of hearing, balance, speech, language, cognition, voice, and swallowing Provide treatment and services for all blind and visually impaired Veterans and Servicemembers with deficits and in need of rehabilitation training and / or devices Deliver evidence-based care to restore functional ability, reduce pain, prevent disability, and improve quality of life to those with physical impairments or disabilities 13

15 Sports and Rehabilitation Services in VA National Veterans Wheelchair Games National Disabled Veterans Sports Clinics National Veterans Golden Age Games National Veterans Training, Education, and Experience (TEE) Golf Tournament National Sports Competitions and Games 14

16 Specialty Rehabilitation Programs in VA Acute Inpatient Rehabilitation Emerging Consciousness Program Transitional Rehabilitation Program Outpatient Rehabilitation Programs Assistive Technology Labs Amputation System of Care Blind Rehabilitation Spinal Cord Injury and Disorders Tele-rehabilitation Drivers Training 15

17 Inpatient Rehabilitation Team Physiatrist Rehabilitation Nursing Speech Language Pathology Occupational Therapy Physical Therapy Therapeutic Recreation Specialist Counseling Psychology Neuropsychology Family Therapist Social Work/Case Manager Driver Trainer Prosthetist/Orthotist Hospitalist Blind Rehabilitation Specialist Intensivist 16

18 VHA Polytrauma/TBI System of Care FY

19 VA Mental Health System Multiple ways of delivering mental health care in Medical Centers and CBOCs Treatment provided in Specialty Mental Health Settings: Outpatient clinics: Interdisciplinary team coordination of care Specialty Outpatient Post traumatic stress disorder (PTSD) Substance Use Disorders Residential Rehabilitation Treatment Programs Inpatient mental health care Mental health integrated in Physical Health Settings: Primary care/mental Health integration Long term care and end-of-life care Physical Rehabilitation Interdisciplinary medical specialty clinics Vet Centers and Mobile Vet Centers VA s Veteran Crisis Line ( Press 1 ; Chat Service: Public awareness and outreach: 18

20 Rehabilitation Resources VA Innovative Initiatives, Technologies and Treatment Telehealth Prosthetic Limbs Assistive Technology Diagnostic Tools, Therapies 19

21 Tele-Rehabilitation: Making the Connection with the Veteran Using telehealth technology between specialized regional rehabilitation centers and community based clinics to: Evaluate possible traumatic brain injury Provide consultative amputation care services 20

22 Assistive Technology: Keeping up with the Active Veteran 21

23 Rehabilitation Research: Translating Research into Medical Practice Polytrauma and Blast-Related Injuries Quality Enhancement Research Initiative (QUERI) Evaluate newly developing technologies and integrate technologies to support functional independence (e.g., DEKA Arm; Genium Knee) Validate effectiveness and expand capacity of rehabilitation services Assess new paradigms for patient treatment and management to: Enhance systems of care Advance evidence-based, outcomes-driven diagnostic tools, and clinical practice 22

24 Clinical Practice Guidelines Adopt or adapt, develop, implement, and sustain evidence-based clinical practice guidelines ( Rehabilitation of Lower Limb Amputation (2008) Management of Concussion-mild Traumatic Brain Injury (mtbi) (2009) Management of Substance Use Disorder (SUD) (2009) Management of Major Depressive Disorder (MDD) (2009) Management of Opioid Therapy (OT) for Chronic Pain (2010) Management of Stroke Rehabilitation (2010) Management of Traumatic Stress Disorder and Acute Stress Reaction (2010) 23

25 Forward Looking Rehabilitation Healthcare Scientific and technological advancements Revolutionary computerized prosthetic devices Self management supported with computer / smartphone apps ands other monitoring devices Telehealth Long term sequelae of severe, complex injuries when, how long, and what type of therapy to provide? 24

26 To Care For Him Who Shall Have Borne the Battle, And For His Widow and Orphan - Abraham Lincoln

27 VA Rehabilitation Policies Website for access to various policies for VA Rehabilitation programs and services, including: Audiology & Speech Pathology: VHA Handbook , Audiology and Speech Devices VHA Handbook , VHA Audiology and Speech-Language Pathology Services VHA Directive , Prescribing Hearing Aids and Eyeglasses VHA Directive , Management of Patients with Swallowing or Feeding Disorders Blind Rehabilitation: VHA Directive , Audible Prescription Reading Devices VHA Handbook , Blind Rehabilitation Outpatient Specialist Program Procedures VHA Handbook , Blind Rehabilitation Service National Consultant Procedures VHA Handbook , Visual Impairment Service Team Program Procedures VHA Handbook , Blind Rehabilitation Center Program Procedures VHA Handbook , Outpatient Blind and Vision Rehabilitation Clinic Procedures

28 VA Rehabilitation Policies Chiropractic Care: VHA Directive , Chiropractic Care, November 16, 2009 Physical Medicine and Rehabilitation: VHA Directive , Documentation of Kinesiotherapy Services in Department of Veterans Affairs Community Living Centers in the Resident Assessment Instrument Minimum Data Set, May 9, 2012 VHA Directive , Physical Medicine Rehabilitation Outcomes for Acute Stroke, Traumatic Brain Injury, and Lower-Extremity Amputation Patients, March 31, 2011 VHA Handbook , Physical Medicine and Rehabilitation Service Transitional Rehabilitation Bed Section, May 14, 2010 VHA Handbook , Physical Medicine and Rehabilitation Individualized Rehabilitation and Community Reintegration Care Plan, May 3, 2010 VHA Directive , Screening and Evaluation of Possible Traumatic Brain Injury in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans, March 8, 2010

29 VA Rehabilitation Policies Physical Medicine and Rehabilitation (continued): VHA Handbook , Driver Rehabilitation for Veterans with Disabilities Program, January 4, 2010 VHA Directive , Preservation-Amputation Care and Treatment Program, September 14, 2006 VHA Handbook , Polytrauma Rehabilitation Procedures, September 22, 2005