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How to Facilitate Rehabilitation CareHow to Facilitate Rehabilitation Care
Lucille Beck, PhD
Chief Consultant, Rehabilitation and Prosthetic Services
Veterans Health Administration
Department of Veterans Affairs
VETERANS HEALTH ADMINISTRATION
Photo Courtesy of U.S. Army
Photo Credit: Sgt. Matthew C. Cooley
“The only victor in war is medicine…”“The only victor in war is medicine…”Mayo BrothersMayo Brothers
WWIIWWII
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VETERANS HEALTH ADMINISTRATION
VA MissionVA 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
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VETERANS HEALTH ADMINISTRATION
VA Health CareVA 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
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VETERANS HEALTH ADMINISTRATION
Better Access, Better CareBetter Access, Better Care
Before After
Only HospitalsHospitals
Outpatient ClinicsMobile Clinics
Vet Centers Mobile Vet Centers
My HealtheVet
Hospital System Health System
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VETERANS HEALTH ADMINISTRATION
2121stst Century VA Health Care 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-Focused7
VETERANS HEALTH ADMINISTRATION
The Path to Patient Centered CareThe Path to Patient Centered Care
PastPastVAVA
PresentPresentVAVA
FutureFutureVAVA
“What can I fix?”“How can we help what is
wrong with you?”“How can we help you live the life you want to live?”
Physician Clinical TeamVeteran, Family and Health Care Team
Case-Based Paper Medical Record
Disease-Based Electronic Medical Record
Whole-Person Electronic Health Record
“We’ll address your immediate concern.”
“You have a risky problem, please follow this plan to
improve by your next visit.”
“We can design your personalized health plan to
meet your goals.”
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VETERANS HEALTH ADMINISTRATION
Team CareTeam CareThe New Health Care Work PlaceThe 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
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VETERANS HEALTH ADMINISTRATION
Surgical
Medical
Inpatient - Immediate Transitional/Community
Re-entry – Residential
Transitional/Community
Re-entry - Day Program
Outpatient Care
Neurobehavioral
Supported Living
Vocational
Educational
Day Activity
Support Groups
Skilled Nursing
Total Care
Outpatient Care
Inpatient – Ongoing
Outpatient Care
Evaluation and
Management
Family Support
Case Management
Benefits Management
Medical Information Management
Trauma Care Rehabilitation CommunityReintegration
LifetimeCommunity Care
Integrated HealthcareIntegrated Healthcare
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VETERANS HEALTH ADMINISTRATION
The Spectrum of Rehabilitation NeedsThe Spectrum of Rehabilitation Needs
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TBIAmputation
Chronic Pain
Musculo-skeletal injuries
Visual Deficits
Mental Health
Auditory Problems
Cognitive Problems
Recreation / Leisure
VETERANS HEALTH ADMINISTRATION
Integrated Comprehensive Rehabilitation CareIntegrated Comprehensive Rehabilitation Care
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VETERANS HEALTH ADMINISTRATION
Medical Rehabilitation Services in VAMedical Rehabilitation Services in VA
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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
VETERANS HEALTH ADMINISTRATION 14
National Veterans National Veterans Wheelchair GamesWheelchair Games
National Disabled National Disabled Veterans Sports ClinicsVeterans Sports Clinics
National Veterans National Veterans Golden Age GamesGolden Age Games
National Veterans National Veterans Training, Education, Training, Education,
and Experience (TEE) and Experience (TEE) Golf TournamentGolf Tournament
National Sports Competitions and GamesNational Sports Competitions and Games
Sports and Rehabilitation Services in VASports and Rehabilitation Services in VA
VETERANS HEALTH ADMINISTRATION
• 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
Specialty Rehabilitation Programs in VASpecialty Rehabilitation Programs in VA
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VETERANS HEALTH ADMINISTRATION
Inpatient Rehabilitation TeamInpatient Rehabilitation Team
• Physiatrist • Counseling Psychology
• Rehabilitation Nursing • Neuropsychology
• Speech Language Pathology • Family Therapist
• Occupational Therapy • Social Work/Case Manager
• Physical Therapy • Driver Trainer
• Therapeutic Recreation
Specialist
• Prosthetist/Orthotist
• Hospitalist
• Blind Rehabilitation Specialist • Intensivist
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VETERANS HEALTH ADMINISTRATION
VA Mental Health SystemVA 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 (800-273-8255 Press “1”; Chat Service:
www.veterancrisisline.net)• Public awareness and outreach: www.maketheconnection.net
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VETERANS HEALTH ADMINISTRATION
Rehabilitation ResourcesRehabilitation Resources
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TelehealthProsthetic
LimbsAssistive
Technology
Diagnostic Tools,
Therapies
VA Innovative Initiatives, Technologies and Treatment
VETERANS HEALTH ADMINISTRATION 20
TeleTele--Rehabilitation: Rehabilitation: Making the Connection with the VeteranMaking 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•
VETERANS HEALTH ADMINISTRATION
Assistive Technology:Assistive Technology:Keeping up with the Active VeteranKeeping up with the Active Veteran
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VETERANS HEALTH ADMINISTRATION
Rehabilitation Research:Rehabilitation Research:Translating Research into Medical PracticeTranslating Research into Medical Practice
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• 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
VETERANS HEALTH ADMINISTRATION
Clinical Practice GuidelinesClinical Practice Guidelines
Adopt or adapt, develop, implement, and sustain evidence-based clinical practice guidelines (http://www.healthquality.va.gov/):• 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)
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VETERANS HEALTH ADMINISTRATION
Forward Looking Rehabilitation HealthcareForward 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?
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“To Care For Him Who Shall Have Borne the “To Care For Him Who Shall Have Borne the Battle, And For His Widow and Orphan”Battle, And For His Widow and Orphan”
- Abraham Lincoln
VETERANS HEALTH ADMINISTRATION
VA Rehabilitation PoliciesVA Rehabilitation Policies
http://vaww1.va.gov/vapubs/ Website for access to various policies for VA Rehabilitation programs and services, including:
•Audiology & Speech Pathology:
VHA Handbook 1173.7, Audiology and Speech Devices
VHA Handbook 1170.02, VHA Audiology and Speech-Language Pathology Services
VHA Directive 2008-070, Prescribing Hearing Aids and Eyeglasses
VHA Directive 2006-032, Management of Patients with Swallowing or Feeding Disorders
•Blind Rehabilitation:
VHA Directive 2009-049, Audible Prescription Reading Devices
VHA Handbook 1174.01, Blind Rehabilitation Outpatient Specialist Program Procedures
VHA Handbook 1174.02, Blind Rehabilitation Service National Consultant Procedures
VHA Handbook 1174.03, Visual Impairment Service Team Program Procedures
VHA Handbook 1174.04, Blind Rehabilitation Center Program Procedures
VHA Handbook 1174.05, Outpatient Blind and Vision Rehabilitation Clinic Procedures
VETERANS HEALTH ADMINISTRATION
• Chiropractic Care:VHA Directive 2009-059, Chiropractic Care, November 16, 2009
• Physical Medicine and Rehabilitation:VHA Directive 2012-016, 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 2011-017, Physical Medicine Rehabilitation Outcomes for Acute Stroke, Traumatic Brain Injury, and Lower-Extremity Amputation Patients, March 31, 2011
VHA Handbook 1172.02, Physical Medicine and Rehabilitation Service Transitional Rehabilitation Bed Section, May 14, 2010
VHA Handbook 1172.04, Physical Medicine and Rehabilitation Individualized Rehabilitation and Community Reintegration Care Plan, May 3, 2010
VHA Directive 2010-012, Screening and Evaluation of Possible Traumatic Brain Injury in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans, March 8, 2010
VA Rehabilitation PoliciesVA Rehabilitation Policies
VETERANS HEALTH ADMINISTRATION
• Physical Medicine and Rehabilitation (continued):
VHA Handbook 1173.16, Driver Rehabilitation for Veterans with Disabilities Program, January 4, 2010
VHA Directive 2006-050, Preservation-Amputation Care and Treatment Program, September 14, 2006
VHA Handbook 1172.1, Polytrauma Rehabilitation Procedures, September 22, 2005
VA Rehabilitation PoliciesVA Rehabilitation Policies