Developing Community Partnerships

December 11, 2014

Lorna Oldson BSN

Brenda L. Hart MSN

Salem VAMC Rural Health

The Salem VA Medical Center• Since 1934, Salem VAMC has been

improving the health of the men and women who have so proudly served our Nation. Services are available to more than 112,500 Veterans living in a 26-county area of southwestern Virginia.

• In addition to our main facility in Salem, we offer services in five community-based outpatient clinics (CBOCs). These clinics are located in Danville, Lynchburg, Staunton, Tazewell, and Wytheville, Virginia.

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What Area do we cover?

Salem VAMC Rural Health Team provides services to the Counties highlighted in yellow. Salem VAMC is the blue star, and our 5 CBOCs are the red stars: Danville, Lynchburg, Staunton, Tazewell, and Wytheville.

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About Rural Veterans• The Veterans Health Administration (VHA)

provides comprehensive healthcare services to approximately 8.9 million of the 22 million United States Veterans. U.S. soldiers in recent conflicts are increasingly drawn from rural areas and, therefore, rural VA users are growing proportionate to urban VA users. Youths living in the most sparsely populated zip codes are 22 percent more likely to join the Army, with an opposite trend in cities. Regionally, most enlistees come from the South (40 percent) and West (24 percent).

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History• The Rural Health Team was established in 2010 to do

outreach to assist Veterans with enrollment into the VA healthcare system.

• The Rural Health Team had to go where Veterans “hung out” such as gun shows, fairs, festivals and the community events.

• Partnerships were formed within Salem’s 26 county catchment area to include (not limited to)

– Virginia Wounded Warriors Program

– VFW’s

– American Legions

– DAV’s

– Community Service Boards

• 2014 goals changed to develop community partnerships with other healthcare providers and to expand health education in rural communities.

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What Do We Do?

• Outreach - Our Rural Health Team goes out to where the Veterans are to share information with them:– General Information about VA Services and

Resources for Veterans– Enrollment/Vesting– Patient Education

• Networking• Health Education

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Program Description• The VISN 6 Needs Assessment

documents that 53% of our Veterans are rural or highly rural and face complex challenges in accessing health care including health/wellness information. Despite their eligibility, many are unable to participate in consistent VA care or education because of their distance from the nearest VA facility and lack of reliable transportation options.

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Program Description• As per ORH Issue Brief #9, 2011,

healthcare quality suffers when Rural Veterans can’t access appropriate healthcare (in particular mental health services), preventive care or education. A 2011 study by ORH, VISN 6 RH and the VISN 6 MIRECC, found that 56% of community providers fail to ask patients if they are Veterans and only 29% of community providers feel knowledgeable about how to refer a Veteran to VA.

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Program Description• These disconnects must be overcome if

Rural Veterans are to receive efficient, effective care. While care coordination between VA and local health care practices can deliver comprehensive, high quality care, these critical relationships are often underdeveloped in rural areas. Improving care coordination by enhancing communication is a crucial requirement in improving health outcomes.

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Program Objectives1) Develop community partnerships to

improve public perception of VA and provide information related to services and benefits available to Veterans.

2) Identify Veterans who are receiving dual care or community care only and make them aware of VA services and programs they may need but cannot receive appropriately in the community (i.e. mental health services for TBI, PTSD, MST, etc.) 10

Program Objectives

3) Provide chronic disease education programs to Veterans in rural communities to teach Veterans how to better self-management of these diseases.– According to VHA databases, 56.22 % of

VISN 6’s Veterans suffer from diabetes, 62.29% from heart disease, 55.95% from hypertension and, 56.75% are tobacco users.

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Salem RH FY14 Goals

• Teach 184 educational sessions

• Teach 375 Veterans

• Vest 375 Veterans

• Contact 90 community partners

• Identify Veterans with dual care

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Problem

• The Rural Health Team found out fast that in order to get into some of the very rural areas you needed a contact that the community trusted.

• The Rural Health Team partnered with the Virginia Wounded Warriors to reach into these communities.

• As partnerships grew many barriers were identified to include:– Poor communication– Poor knowledge of VA services– How to contact the VAMC– Who to contact at the VAMC

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Challenges

• Developing trust within rural communities• Creativity to reach out to community

providers• Remote access in highly rural areas• Participation• Advertisement

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Plan• As an effort to remove these barriers the

Rural Health Team met with the Virginia Wounded Warriors representatives in Salem’s catchment area to discuss how we could all work together to break down these barriers.

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DO• We all met to discuss why and how to break

down these barriers. This started in April 2013.

• We each determined what information we needed from community partners to set this in motion.

• These meetings resulted in a plan to co-sponsor a conference at the Salem VAMC for community partners located within Salem’s 26 county catchment area.

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Study• One in three Veterans who are enrolled in the VA

health care system resides in rural areas.• It is a Rural Health Initiative to ensure that all

Veterans in rural areas receive the health care they need and deserve.

• Individuals living in rural areas have traditionally been underserved with regard to health care access. The reasons are multiple and varied but mainly stem from the need to travel long distances for health care, lack of public transportation, lack of insurance, lack of specialized care and an inadequate number of health care providers working in rural areas.

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Act• The Rural Health Team and the Virginia Wounded

Warriors talked frequently to community partners to determine why we all couldn’t work together. We gathered all the information and we all felt it would be worth the effort to plan a conference.

• The conference was called “Working With Community Partners to Serve Veterans”

• The date was set for 2-26-14.• The next step was for the Rural Health Team to

met with Salem’s Leadership to move forward with this project.

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Act• The Rural Health Team met with Dr. Lapuz, our medical

center director.

• Topics were discussed and who would be best to present on these topics.

• Dr. Lapuz suggested to offer CME’s to help entice community partners to come to the conference.

• Advertisements for the conference included development of a flyer with details and a registration form.

• The flyer was emailed and/or mailed to all community partners within Salem’s 26 county catchment area (over 350 emails/letters were sent).

• Phone calls (over 200) were also made to community partners.

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Topics of Concern

• Post Traumatic Stress

Disorder (PTSD)

• Traumatic Brian Injury

(TBI)

• OEF/OIF/OND Program

• Home Based Primary Care

• Telehealth/Community

Health

• Crisis Intervention

• The Homeless Program

• Women’s Health

• Enrollment and Eligibility

• Veterans Benefits

• Transportation

• MyHealtheVet

• Pharmacy

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Invitations

• Physicians• Nurse Practitioners• Physician Assistants• Social Workers

• Nurses

• Life centers

• Lead Safe House• Correctional centers

• Virginia Employment Services

• Rehabilitation Centers• Hospice

• State Mental Health Agencies

• Health Departments• Social Services

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Data• The conference was held on 2-26-14.• Presenters deliberated all the services available to

our Nation’s Veterans along with the VA’s commitment to identifying and breaking down the barriers in communication between the VA and community entities.

• Contact names and phone numbers were distributed for each department to simplify future communication.

• 70 participants were in attendance.• Evaluations provided great feedback for future

projects.

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Educational Challenges

• Finding rural locations to host health education classes.

• Establishing trust and credibility within rural communities.

• We needed to offer something in the community that held value and that they could get excited about.

• Sufficient quantity of educational material.

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Problem

• We were established and teaching diabetic education at several VFWs, but not elsewhere.

• We needed 184 educational sessions to meet FY14 goals for our program.

• We needed educational materials to hand out to class participants.

• We needed advertisement.

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Plan

• We contacted additional veterans service groups such as American Legion, Vet Centers, and other VFWs.

• We sent emails with an introduction to the Rural Health Team and a list of classes that we offered.

• We asked potential sites what topics that they might be interested in & were flexible about days & times.

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Plan

• We asked current contacts if they had any suggestion as to potential class sites.

• We contacted churches.

• We contacted YMCAs

• We contacted senior centers & retirement communities.

• We contacted libraries.

• We offered classes to veterans and members of the community.

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• We decided to offer the “Friends & Families” CPR classes without cost

to the participants.

• Everyone who attended a class took home a free kit(inflatable manikin, DVD, etc.) to practice with at home.

• We developed flyers for distribution within the facility and neighborhood.

• We asked local newspapers to publish information about our free classes.

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Do

Act

• We initially offered “Friends & Families” CPR classes to establish our value and credibility within the community.

• We then offered our diabetes series.

• From there we offered our general health topics.

• The director of each library would talk to others within that system and that would lead to other classes.

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ACT

• Once class was scheduled, I emailed each site several days in advance to confirm that we would be there, time and date.

• I followed up each class with a thank you email and a list of other class offerings.

• I called each class site and asked what they thought of the class and discussed other class offerings that they might be interested in. 29

Study

• Sites wanted to see for themselves that our classes would be well attended and well received by the class participants.

• Class participants asked for additional class topics and we were invited back.

• Potential sites now call us to request particular classes.

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FY14 DataWe taught 184 educational sessions. There were 631 veterans and 1078 non veterans receiving education within the community.

We formed partnerships with:

•15 libraries

•3 VFW Posts

•3 Veteran Service Organizations

•2 YMCAs

•5 Senior Centers31

Location of Classes

• Community Service Boards (CSB)

• Churches• YMCA• VFWs• American Legion• Libraries• RAM house• Vet Center

• Salem Senior Center• Vinton Senior Center• Carriage Hill

Retirement• Bethel Ridge Assisted

Living• Brandon Oaks• PRRC• Rotary Field-Stuart

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Educational Topics

• AHA Friends & Family CPR

• Alzheimer’s & Other Dementia

• Athlete’s Foot• Anxiety• Cataracts• CHF• COPD• Depression

• Elder Care• Fibromyalgia• GERD• Glaucoma• Gout• Heart Attacks• Insomnia• Nonalcoholic Fatty

Liver Disease

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Educational Classes

• Osteoarthritis• Osteoporosis• Panic Attacks• PTSD• Shingles• Sleep Apnea• Stroke• Thyroid Disorders• Weight Management

• Most popular: Diabetes

– Pre-diabetes– Managing your

diabetes– Complications of

diabetes– Medication

management

– Blood pressure management

– Nutrition and diabetes– Diabetes self care

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Teaching Models and Tools• Fat, Salt, and Sugar Tubes (Can

Visually See How Much Fat, Salt & Sugar in Specific Foods)

• Dietary Fat Tubes (How Much Fat in Food of Various Fast Food Restaurants)

• DVD – Fast Food Survival Guide• Male & female reproductive

Systems• Lung (normal tissue)• Smoker’s lung damaged by

emphysema and chronic bronchitis/COPD, and cancer

• Prostate• Why Prostate Exams Can Save

Your Life• Diabetic Foot• Consequences of Diabetes• Breast Care/Lump location

• Heart Disease (Normal Heart, Heart with Myocardial Infarction, Heart with Congestive Heart Failure, and Heart with Thrombus)

• Heart with Congestive Heart Failure

• Death of an Artery(Clear artery, Build up of plaque, Reduced blood flow, 70% blockage, complete blockage)

• Death of a lung (normal lung, emphysema, lung cancer)

• Skin Pathology• Consequences of High Blood

Pressure• A Guide to Contraceptives• My Pyramid (Steps to a Healthier

You) 35

Teaching Methods

• Group Discussions• Q & A at end of all classes• Hands on• Copies/Handouts• Power Point• Educational Brochures• Individual CPR manikins to take home• Games

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FY15 Education Goals

• 184 educational sessions

• Partner with MOVE(weight loss program) coordinator to bring MOVE into the rural communities .

• Have at least 375 veterans participating in our health education classes

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What is MOVE?• The VA serves over six million veterans of

whom about 77% are overweight or obese. Approximately 38% are obese. The MOVE! program is the largest and most comprehensive weight management and physical activity program associated with a medical care system in the United States.

• MOVE helps patients lose weight, keep it off and improve their health.

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MOVE Goals• Promotes personal responsibility and

personal empowerment to improve health

• Improvement in health status

• Decrease/delay onset and/or occurrence of weight-related chronic diseases

• Improvement in quality of life

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Features

• Focus on health and wellness through healthy eating, physical activity and behavior change

• Evidence-based, stepped-care model

• Lifetime/Lifestyle focus

• Population-based

• Health and Well-being emphasis

• Self-management support program

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Features• Same-day enrollment

• Patient determined intensity of treatment in Primary Care

• Achievable goals

• Individually tailored program with frequent review

• Focus on health and wellness through healthy eating, physical activity and behavior change

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Features

• Focus on weight loss maintenance

• Comprehensive/multidisciplinary content: behavior, nutrition and physical activity

• Website patient and clinician resources

• National online staff training

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Plan• We have met with our MOVE coordinator

to get her assistance and permission to offer MOVE in the community.

• Our MOVE coordinator will supply us with class outlines, power pints and other materials to do the classes

• We have a medical clinic in Laurel Fork, VA interested in being the first site.

• To be continued…..

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VLER Health• VLER Health is a program that shares

certain parts of the veterans medical record between the Department od veterans’ Affairs (VA) , Department of Defense (DoD), and non-VA health care providers. This will allow VA and non-VA providers to make informed decisions about veteran health care because the shared information provides a more complete health record.

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PRRC• We also formed partnerships within the

VAMC in order to provide health education to rural veterans who come in for our day treatment programs.

• We taught over 64 health education classes to rural veterans in the PRRC classroom in FY14.

• We are continuing our classes in PRRC for the year 2015.

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Community Partners• We continue our goal of making contacts

with private providers within rural communities.

• Our goal fro FY15 is to contact at least 901 private providers to talk to them about:

• VA services available and who might qualify.

• Contact information for the different departments and services. 46

Community Partners

• Going out into the rural communities and talking face to face to private providers (or their nurse manager/office manager) on their home turf.

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Rural Health Team Collaboration Groups

• National level: NRHA

• VISN level: 6 and 9

• State level: 31

• Community level: 44

• Facility level: 9

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Advertisement

• Salem’s Internet Website www.salem.va.gov (Events Calendar)

• Just the Facts newsletter

• News Releases and Flyers (Radio, TV, Newspaper)

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StatisticsFY2011 FY2012 FY2013 FY2014

Events 206 87 40 20

Applications 123 129 39 108

Vested/Enrollment 150 1752 846 1056

Veterans / Male Encountered 831 1912 508 1322

Veterans/ Female Encountered 69 98 23 22

Family Members/Others 852 2121 839 4397

Education Materials 3029 3203 1428 4587

Blood Pressure 354 486 56 47

Health Education Classes ? 36 48 184

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Successes  Goals Completed

Educational sessions 184 219

Vets receiving ed 375 631Caregivers

receiving ed NA 1078Vets vested 375 1056Community

contacts 90 94

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Successes

• The Rural Health Program was very successful due to several factors:• Station support:

• Primary Care Leadership

• QUAD members

• The RH team:• Brenda L. Hart RN

• Lorna Oldson RN

• Lois Lail LPN

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Milestone• The Rural Health Team conference:

“Developing Community Partnerships”

presented on 2-26-14 with 70 attendees.

• The number of collaborations that have established: – National level: NRHA– VISN level: 6 and 9– State level: 31– Community level: 44– Facility level: 9

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Unforeseen Outcomes

• Contacted by the Metropolitan Property Management Organization to provide health education classes at 5 of its facilities.

• Contacted by other facilities (such as the libraries and other VSOs) to provide health education classes in their communities.

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Looking Forward FY 15

• Teach 184 educational sessions

• Teach 375 Veterans

• Vest 354 Veterans

• Contact 90 community partners

• Identify Veterans with dual care

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Sources

• Office of Rural Health (ORH)

• www.ruralhealth.va.gov

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Rural America

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Questions/Comments/ Discussion

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