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Office of Rural Health Advisory Committee on Geriatrics and

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Title: Office of Rural Health Advisory Committee on Geriatrics and


1
Office of Rural Health
  • Advisory Committee on Geriatrics and Gerontology
  • April 14, 2011
  • Mary Beth Skupien, Ph.D.
  • Director, Office of Rural Health
  • Office of the Assistant Deputy Under Secretary
    for Health for Policy and Planning
  • Veterans Health Administration

2
ORH Establishment
  • In 2006, Congress created Office of Rural Health
    (ORH) by enacting Public Law 109-461 (also known
    as the Veterans Benefits, Health Care, and
    Information Technology Act of 2006).
  • By March 2007, ORH was established within the
    Office of the Assistant Deputy Under Secretary
    for Health (ADUSH) for Policy and Planning,
    Veterans Health Administration (VHA), Department
    of Veterans Affairs (VA).

2
3
ORH Mission Major Goals
  • ORH Mission
  • Improve access and quality of care for enrolled
    rural and highly rural Veterans by developing
    evidence-based policies and innovative practices
    to support the unique needs of enrolled Veterans
    residing in geographically remote areas.
  • ORH Major Goals
  • Improve access and quality of care for rural and
    highly rural Veterans.
  • Optimize the use of available and emerging
    technologies to enhance services to Veterans
    residing in rural and highly rural areas.
  • Maximize the utilization of existing and emerging
    studies and analyses to impact care delivered to
    rural and highly rural Veterans.
  • Improve availability of education and training
    for VA and non-VA service providers to rural and
    highly rural Veterans.
  • Enhance existing and implement new strategies to
    improve collaboration to increase service options
    for rural and highly rural Veterans.
  • Develop innovative methods to identify, recruit
    and retain medical professionals and requisite
    expertise in rural and highly rural communities.

4
ORH Organizational Structure
ORH Director (SES) Mary Beth Skupien, Ph.D., MS,
RN
Veterans Rural Health Advisory
Committee Chairman James Ahrens
ORH Deputy Director Sheila Warren, MPH, RN
Staff Assistant Alta Jones
Budget Analyst Mike Privman, MHSA
Program Analyst Judy Bowie, MA
Staff Assistant Elmer Clark
Program Analyst Anthony Achampong, MBA, MHSA
Program Analyst Christina White
Program Analyst Serena Chu, Ph.D.
Program Analyst Nancy Maher, Ph.D.
Clinical Liaison Lynn McQueen, DrPH, RN
Health Systems Specialist Katie Dziak, MHSA,, MBA
Veterans Rural Health Resource Centers
VISN Rural Consultants
Part-Time / Collateral Duties 13 Positions
Full-Time 8 Funded
VRHRC-Eastern Director Paul Hoffman, M.D.
VRHRC-Central Director Peter Kaboli, M.D.
VRHRC-Western Director Byron Bair, M.D.
1. Jackie Morales (V9) 2. Sherri Deloof (V11) 3.
Mary OShea (V15) 4. Deanna Jackson-Moore
(V16) 5. Ron Schmidt (V19) 6. Jodie Waters
(V20) 7. Colette Alvarez (V21) 8. Katie Dziak
(V23)
  • 1. Doug Edwards (V1)
  • 2. Christopher Petteys (V2)
  • 3. Bertha Fertil (V3)
  • 4. Anthony Behm (V4)
  • 5. Alvis Hargrove (V5)
  • 6. Talbot Vivian (V6)
  • 7. Kristin Pettey (V7)
  • Pat Ryan (V8)
  • Joe Kohut (V10)
  • Joseph Zimmerman (V12)
  • Shenita Washington (V17)
  • Kenneth Browne (V18)
  • Laurie Traylor (V22)

Contractor Support
5
ORH Resources
  • Veterans Rural Health Resource Centers (VRHRCs)
  • Three regional centers White River Junction, VT
    Iowa City, IA Salt Lake City, UT.
  • Function as field-based clinical laboratories for
    demonstration projects/pilot projects.
  • Serve as rural health experts.
  • Act as educational and clinical repositories.
  • Provide programmatic support to ORH.
  • VISN Rural Consultants (VRCs)
  • Serve as primary interface between ORH and VISN
    rural activities.
  • Develop rural health service plans based on
    VISN-wide needs assessments.
  • Facilitate information sharing across the VISNs.
  • Perform outreach to develop community
    relationships.
  • Veterans Rural Health Advisory Committee (VRHAC)
  • Federal advisory committee to advise the
    Secretary of Veterans Affairs on health care
    issues affecting enrolled Veterans residing in
    rural areas.
  • Evaluate current program activities and identify
    barriers to providing rural health care services.
  • May adopt recommendations to enhance or improve
    VA rural health care services.

6
ORH Funding
  • Fiscal Year 2009

Funding as of August 31, 2010
7
ORH Funding
  • Fiscal Year 2010

Funding as of August 31, 2010
8
Fiscal Year 2011 ORH Funding
  • Fiscal Year 2011-250 Million-Operating
    Plan

9
ORH Accomplishments
  • FY 11- ORH has allocated 22,825,892 to Home
    Based Primary Care initiatives and 3,582,764 to
    GEC.
  • They are very important partners to ORH and we
    support the efforts.
  • The partnership is making a difference in the
    lives of rural Veterans!

10
ORH Accomplishments
  • ORH has executed over 500 million in support of
    over 300 national and local-level rural health
    initiatives and is now working to gather metrics
    and other outcome data for these initiatives.
  • ORH led the VA-Indian Health Service (IHS)
    Memorandum of Understanding (MOU) Work Group and
    activities and updated the current interagency
    MOU from 2003. This was signed October 1, 2010.

11
VA Geriatric Scholars Program A collaboration
of 9 GRECCs to improve care of older Veterans at
rural VA CBOCs
  • Intensive education and on-going educational
    opportunities, practica, mentoring, coaching.
  • Learners since pilot program in FY08 140 staff
    from 109 CBOCs, 21 VISNs, 41 states/territories
  • 76 primary care providers (MD, DO, NP, PA)
  • 8 pharmacists and 16 social workers
  • Evaluation includes Scholars QI projects to
    apply state-of-the-art geriatrics in CBOC setting.

12
Fighting immObility in Rural Veterans with
Exercise and Technology(FOR VETs)
  • 38 of all Veterans live in rural communities
    and 75 of rural Veterans are over 55 years of
    age.
  • Heart disease and stroke rank first and third,
    respectively, as the leading causes of death in
    the United States and are the most frequently
    first-listed diagnosis in VAMCs nationwide.
  • The image of a physically active rural lifestyle
    is no longer accurate.
  • Elderly rural Veterans have an increased risk
    of cardiovascular disease.

12
13
Fighting immObility in Rural Veterans with
Exercise and Technology(FOR VETs)
  • Exercise can fight both cardiovascular disease
    and osteoarthritis.
  • Remotely implemented pilot in-home exercise
    training program.
  • State-of-the-art empirical pre and post testing
    of vascular function, skeletal muscle
    fatigability, mobility, and joint function.

13
14
Providing Rural Veterans Access to Proactive
Memory Services Targeting Wyoming and Southeast
Idaho
  • Collaboration with Pocatello ID and Afton WY
    CBOCs for
  • 1. Phone screening for memory loss
  • 2. Brief cognitive assessment at CBOCs
  • 3. Neurobehavioral exams at CBOCs
  • 4. Comprehensive cognitive assessments
  • 5. Teleneuropsychological assessments
  • 6. Family management education
  • 7. Unified family plan for progressive support

15
Providing Rural Veterans Access to Proactive
Memory Services Targeting Wyoming and Southeast
Idaho
  • Collaborative cognitive specialty team to serve
    Veterans has been established at St. Johns
    Hospital in Jackson, WY
  • Team includes cognitive specialist physician,
    social worker/health educator, nurse also trained
    as a neuropsychology technician, and outreach
    coordinator
  • Since May 2010, 81 Veterans identified for
    program enrollment
  • 50 Veterans from Idaho and Wyoming have received
    114 units of services
  • Services provided Comprehensive cognitive
    assessments, neurobehavioral examinations,
    neuropsychological testing, health education for
    Veterans and their families, and proactive social
    work services to develop unified plans of
    progressive support for patient cognitive
    problems
  • Teleneuropsychological assessments for 5 Veterans
  • Reports of assessments have been provided to
    primary care providers, patients and their
    families

16
Advancing Geriatric Education through Quality
Improvement in Rural CBOCs
  • AGE QI is an innovative program of team-based
    education and practice improvement.
  • Three sessions on site, case-based interactive
    teaching QI project planning project
    evaluation. Award 20 AMA PRA Category 1 Credits
  • Participation to date 33 clinics 128 providers
    and 252 clinic staff members with 91 involvement
    rate.
  • Fall risk screening QI program in five Wyoming
    CBOCs successfully meeting gt 90 screening goal.
  • In FY11, expanding to Montana CBOCs.

17
New Initiatives with Office of Rural HealthHome
Based Primary CareFY 09-10
  • Funding Received - 28,540,350
  • HBPC Expansion via 25 CBOCs
  • HBPC Expansion via Indian Health Service and 14
    Reservations
  • Medical Foster Home Expansion 3
  • Geriatrics Scholar Program Expansion

18
Goals of Rural HBPC Initiative
  • Improve Access to Non-Institutional Care in Rural
    Areas via Community Partnerships.
  • Increase Provision of Cost-Effective Long Term
    Care.
  • Respect Veterans Preferences to Remain in a Home
    Setting.
  • Improve Quality and Safety of the Care Provided
    at Home.

19
HBPC Project Goals
  • Bring Interdisciplinary Home Care to Frail
    Medically Compromised Veterans
  • Expand HBPC into Rural Areas
  • Increase Number and Percent of Rural Veterans
    Enrolled in HBPC
  • Expand Services to Native American (NA) Veterans

20
Rural Health and Indian Country
  • Partnership with Indian Health Service and Tribes
  • Expansion of HBPC onto 14 Reservations
  • HBPC Staff to Mentor Tribal Staff
  • Tribes Providing in-kind space, IT, staff
  • GEC and IHS to convene mentoring conference calls
    with projects

21
Successes with HBPC ORH
  • Asheville initiating 2nd Project with Cherokee
    Nation
  • Richmond mobile HBPC van serving 6
    non-federally recognized tribes (concept being
    copied in Prescott AZ)
  • Use of Telehealth equipment to solve manpower
    shortages in rural areas and to reassure Veterans
    and caregivers

22
ORH Field Accomplishments
  • Rural Health Community Low Literacy Program (VISN
    6)
  • Increasing rural Veteran enrollment, MyHealtheVet
    utilization, assessing health literacy levels,
    and improving self health management to over 500
    Veterans.
  • Utuado, Puerto Rico Rural Outreach Clinic (VISN
    8)
  • Provided services to over 200 unique Veterans in
    rural communities. The clinic has received a
    high demand for services and outreach resources.
  • Rural Health Professions Institute (VISN 9)
  • Completed 8 of 9 workshop sessions to over 200
    providers on the complexities of rural health
    care.
  • Received strong enrollment response and positive
    feedback from participants across VISNs.
  • Wilmington, Ohio Outreach Clinic (VISN 10)
  • Since August 2010, the outreach clinic has
    provided primary care, mental health, and
    telehealth services to rural Veterans.

23
ORH Field Accomplishments
  • Northern Michigan (Saginaw) Rural Health
    Transportation Network (VISN 11)
  • Scheduled over 400 transportations for rural
    Veterans to appointments, who on average live 176
    miles away from their appointment locations.
  • Collaborative Discharge Planning for Veterans
    Returning to Rural Areas (VISN 15)
  • Over 80 rural Veterans received discharges from
    psychiatric care to outpatient care as a result
    of collaborative teleconferencing with inpatient
    and outpatient providers.
  • ACCESS Assisting Communities to Collaborate for
    Expanded Soldier Support (VISN 16)
  • Implemented and evaluated programs to enhance
    access for mental health and substance abuse care
    for OEF/OIF Veterans using the latest technology.
  • Completed a Student Veteran Outreach Program
    implementation tool-kit held an orientation in
    August 2010 on education to administrators and
    student services personnel in 4 rural college
    campuses.
  • Veterans Treatment Court (VTC) provided outreach
    services (eligibility evaluations, education, and
    counseling) to rural Veterans, and certified six
    Veterans in the VTC Mentor Program.

24
ORH Field Accomplishments
  • Successful rural services support and expansions,
    including Home-Based Primary Care (HBPC)
    Expansion (VISNs 2, 7, 10, 21 and 22)
  • Enhanced access and expansion of services for
    rural Veterans in Northern Pennsylvania (VISN 2).
  • Implemented HBPC expansion at the Jasper,
    Mississippi community-based outpatient clinic
    (CBOC) resulting in improved access to services
    and decreased emergency room and inpatient stays
    (VISN 7).
  • Expanded optometry and podiatry services to 10
    rural CBOCs (VISN 10).
  • Implemented HBPC on Molokai, Hawaii, resulting in
    increased access to services and completed a town
    hall meeting with rural stakeholders in July
    2010, to discuss service needs (VISN 21).
  • Implemented the Veteran medical motel model,
    Medtel, used to coordinate Veteran health care,
    transportation, and follow-up services (VISN 22).

25
ORH Major Telehealth Projects
  • Successful implementations of Telehealth and
    Tele-specialty services in rural areas (VISNs 1,
    3, 4, 10, 12, 19, 20, and 23)
  • Improved access to care via Care Coordination
    Home Telehealth by implementation of best
    practices for home based primary care geriatric
    services.
  • As of June 2010, completed 150 rural clinical
    video telehealth encounters.
  • Increased access to specialty services for rural
    Veterans through E-consults and telehealth.
  • Developed supported telehealth sub-specialty
    pre- and post-operative services for the most
    rural medical centers for surgery,
    endocrinology, cardiology TBI pain management
    podiatry PTSD mental health/behavioral health
    conditions.
  • Implemented the Tele-audiology pilot program
    TeleMOVE! Program.
  • Established 10 telehealth specialty clinics (VISN
    19).
  • Implemented VISN-wide (15 20) Tele-dermatology
    services reaching over 2,400 Veterans and
    diagnosing over 3,700 conditions.

26
ORH Major Telehealth Projects
  • Implemented a Care Coordination Home Telehealth
    renal project for chronic kidney disease for 20
    Veterans (VISN 23).
  • Implemented Northern Plains PTSD Telehealth
    services on rural reservations.
  • Treatment services used innovative VA Telehealth
    technologies.
  • Currently 14 clinics serving over 11 Tribes in
    Montana, Wyoming, Nevada, North South Dakota,
    and Utah from the Denver VA Medical Center with a
    rural funded psychiatrist.
  • Opening additional PTSD Tele-mental health
    clinics in VISNs 19 23.
  • Implemented a collaborative discharge planning
    model using tele-conferencing serving rural
    Veterans and 100 surveyed reported their health
    care needs were met and barriers to care were
    addressed.
  • Implemented and valuated programs VISN-wide that
    will enhance access for mental health and
    substance abuse care for OEF/OIF Veterans using
    Tele-health technologies.

27
Rural Women Initiatives
  • VISN 5 Women Veterans Health Program
    Conducted women-specific needs assessment. Hired
    3 nurse practitioners to provide clinical,
    training, education, and outreach services to
    rural women Veterans. Evaluate new and expanded
    programs.
  • VISN 6 Rural Women Veterans Health Care Program
    Conducted women-specific needs assessment.
    Trained physicians and nurses to provide services
    to rural women Veterans. Purchased specialized
    OB/GYN equipment for CBOCs.
  • VISN 10 Womens Diagnostic Coordinator Nurse
    coordinates Mammography and Pap tests for all
    Veterans utilizing the Chillicothe VAMC and its 5
    CBOCs. Order, track, and follow-up with the
    community providers.
  • VISN 16 Womens Health Pilot Use biofeedback
    to regulate pain and anxiety.

28
Other Rural Women Veteran Activities
  • Focus on Education activities
  • Collaborate with The Women Veterans Health
    Strategic Health Care Group to provide Rural
    Womens Health programs (e.g., presentation at
    Women Veterans Program Manager Conferences).
  • Participate in regular conference calls with the
    Rural Women Veterans Steering Committee.
  • Partner with VA Health Services Research and
    Development to develop initiatives. Share data in
    order to develop policy recommendations.

29
Priorities of the Office of Rural Health
  • Web-based reporting system developed with all
    projects listed with access for all ORH staff.
  • Monitoring and Tracking all ORH projects
    quarterly.
  • Communications Plan developed for ORH.
  • Strategic Plan Update in FY 2011 with involvement
    of Stakeholders.
  • Increase collaboration communication with
    existing and new partners.
  • Monitor and track the activities of the VA/IHS
    MOU Subgroups.
  • Regular site visits to the field.

30
Priorities of the Office of Rural Health
  • Complete a Comprehensive Needs Assessment of
    Veterans with VRCs VRHRCs participation.
  • Realignment of VRHRCs under ORH (Direct
    Supervision effective 10/1/2010).
  • Collaboration and Education Symposia planned and
    managed by ORH staff (focus Rural Mental Health
    and Barriers to Care).
  • Filled all 12 positions in ORH to strengthen
    infrastructure and field support.
  • Support our partnerships with GEC and HBPC! ?

31
Contact Information
  • For further information please contact
  • Mary Beth Skupien, Ph.D.
  • Director, Office of Rural Health
  • Department of Veterans Affairs
  • Veterans Health Administration
  • 810 Vermont Avenue, NW
  • Washington, DC 20420
  • (202) 461-1884
  • MaryBeth.Skupien_at_va.gov

31
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