Providing medical care to Veterans, with more than 1,700 hospitals
The Department of Veterans Affairs (VA) operates the largest integrated health care system in the United States, paying for and providing medical care to Veterans, with more than 1,700 hospitals, clinics, community living centers, domiciliaries, readjustment counseling centers, and other facilities. These VA facilities are organized into 1 of the 18 Veterans Integrated Services Networks (VISNs) by geographic location and each VISN has its own administrative hierarchy. Consider below the VA’s mission and values (http://www.va.gov):
Mission
To fulfill President Lincoln’s promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.
Core Values
VA’s five core values underscore the obligations inherent in VA’s mission: Integrity, Commitment, Advocacy, Respect, and Excellence. The core values define “who we are,” our culture, and how we care for veterans and eligible beneficiaries. Our values are more than just words – they affect outcomes in our daily interactions with Veterans and eligible beneficiaries and with each other. Taking the first letter of each word—Integrity, Commitment, Advocacy, Respect, Excellence—creates a powerful acronym, “I CARE,” that reminds each VA employee of the importance of their role in this Department. These core values come together as five promises we make as individuals and as an organization to those we serve.
Integrity: Act with high moral principle. Adhere to the highest professional standards. Maintain the trust and confidence of all with whom I engage.
Commitment: Work diligently to serve Veterans and other beneficiaries. Be driven by an earnest belief in VA’s mission. Fulfill my individual responsibilities and organizational responsibilities.
Advocacy: Be truly Veteran-centric by identifying, fully considering, and appropriately advancing the interests of Veterans and other beneficiaries.
Respect: Treat all those I serve and with whom I work with dignity and respect. Show respect to earn it.
Excellence: Strive for the highest quality and continuous improvement. Be thoughtful and decisive in leadership, accountable for my actions, willing to admit mistakes, and rigorous in correcting them.
However, at various times, critics have expressed concerns about the substandard care provided by the VA and the resulting negative press created pressure on the VA to do better. As a response, the VA has launched transformation efforts to address its quality gaps over the last decade, with significant internal restructuring of the care delivery system, including changes in delivery models (e.g., primary care teams, service lines), adoption of new technologies (e.g., computerized patient record system [CPRS]), and management strategies (e.g., guideline implementation, performance audit/feedback) (Jha et al., 2003). The VA also created nationally centralized data repositories in quality and utilization to support these efforts (Chou et al., 2015). These organizational changes in the aggregate have demonstrated positive associations with substantial gains in VA quality over time.
Moreover, VA funded a number of research and operational projects that focused on improving care quality for certain high-cost conditions, such as cardiovascular disease, diabetes mellitus, major depressive disorder, etc. In particular, Dr. Matthew Bidwell Goetz, the Chief of Infectious Diseases at the Greater Los Angeles VA Health Care System, implemented a project to improve routine HIV screening across multiple VISNs in areas where rates of HIV were on the rise (Goetz et al., 2013, 2015). Although medical advances have significantly improved the survival and quality of life of those who are infected with HIV, the rates of infection continue to be a major problem for some regions of the United States. As recently as 2015, the Centers for Disease Control and Prevention (CDC, 2016) estimated that southern states accounted for approximately 44 percent of all people living with an HIV diagnosis, despite making up only about one-third (37 percent) of the national population (Figure 1). By region, rates of HIV diagnoses per 100,000 adults and adolescents were 16.8 in the South, 11.6 in the Northeast, 9.8 in the West, and 7.6 in the Midwest.
Figure. . . . . NOTE 0 People by State Rates of HIV diagnoses per 100.000 people. 10 0-109 200-29 9 210 0 Details SOURCE: Adapted from CDC (2016). Diagnosis of HIV Infection in the United States and Depe ndent Areas, 2015. HIV Surveillance Report.
Research evidence has shown that identifying and treating asymptomatic HIV-infected individuals can be highly cost-effective with vast reduction in morbidity and mortality (Goetz et al., 2015). However, full treatment benefits are not being realized, as many HIV-infected persons tend to be unaware of their disease status. Both provider and patient factors factors (e.g., low prioritization, time required for counseling, and poor accountability) as well as organizational barriers (e.g., lack of leadership support, poor information sharing) may have impeded disease identification and treatment.
Within the VA, despite frequent opportunities to achieve early diagnosis, the number of VA patients with documented risk factors for HIV infection who have been tested remains lower than ideal. The VA, in fact, changed its HIV screening policy from risk-based to routine. The Multi-VISN Quality Improvement Project for HIV was launched to develop an exportable intervention for increasing HIV testing rates across a number of VISNs. To measure the effectiveness of various components of the intervention, the project set up a natural experiment to compare the amount of support/resources delivered to individual VA facilities: three sites that were supported by a national team, seven sites that were supported by their respective local teams, and four facilities that served as control sites. The national team provided assistance to the sites with
(1)
a context-specific, computerized clinical reminder for HIV testing of individual patients;
(2)
audit/feedback consisted of a retrospective summary of provider-specific HIV screening rates of at-risk patients;
(3)
provider activation via established academic detailing and social marketing methodology; and
(4)
tools and resources to facilitate organizational change to remove barriers to HIV testing.
Sites supported by local teams received only audit-feedback reports. At the control sites, it was “business as usual.”
Findings from the project showed significant increases in HIV testing rates following the implementation of the interventions (Figure 2). In particular, patients receiving care from facilities where resources were provided by either the national or local team reported higher likelihood of getting tested, compared to their counterparts at control facilities (Goetz et al., 2013). At the end of the study, it was demonstrated that routine HIV testing proved to be cost-effective, especially among persons younger than 65 years (Goetz et al., 2015).
Figure 2. Changes in HIV Testing Rate Pre-Post Intervention Yearly HIV Testing Rate Pre- / Post-Intervention Program implementation increases HIV testing rates two-threefold at all sites . . . . . NOTE Intervention Year Control Site A Site B Site C Site D Site E Details
Questions
Please review the VA mission and values. Does the Multi-VISN QI Project for HIV support VA’s mission and values? If so, how? If not, why not and how can the project align better with the VA mission and values?
What are the factors that may have led to the results achieved by the Multi-VISN QI Project for HIV?
Apply one of the analytic tools to assess if the Multi-VISN Project for HIV creates mission advantage for the VA.
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.
