H ow can h e a l th ca re n e tworks de ve lop po l i cy au ton omy w i t h in an e n v i ron me n t sh ape d by e x te rn a l man date s?

Carla L. Cassidy, CRNP, MSN

Director, Evidence-Based Clinical Practice Guideline Program

Quality Standards and Programs (10A4B)

Washington , DC

Evidence-Based Guidelines Affecting Policy, Practice and Stakeholders

(E-GAPPS)

December 10, 2012

I have no current affiliation or financial arrangement with any grantor or commercial interest that might have direct interest in the

subject matter of this CE program.

Disclosure Statement

The views expressed in the presentation are those of the presenter and do not necessarily

reflect the official policy or position of the Department of Veterans Affairs, Department of

Defense, or the U.S. Government.

About the Veterans Health Administration

• Veterans Health Administration has 8.6M enrollees, serves 6.2M Veterans/year in 152 hospitals, 817 clinics, 300 community living centers

– Affiliations with 124 medical schools• $54 Billion health care budget• Older, sicker, poorer than U.S. pop.

– Half are over 65 yrs, 8.3% female• 24% racial and ethnic minorities

– Likely to grow as minorities make up 1/3 active duty military• National healthcare system

– Responsible for Veterans in every corner of the US• VHA addresses social as well as medical issues

VHA’s vision will continue to be the benchmark of excellence and value in health care and benefits by providing exemplary services that areboth patient‐centered and evidence‐based.

This care will be delivered by engaged, collaborative teams in anintegrated environment that supports learning, discovery andcontinuous improvement.

It will emphasize prevention and population health andcontribute to the Nation’s well‐being through education, researchand service in national emergencies.

Veterans Health Administration Mission & Vision

VHA’s mission is to honor America's Veterans by providing exceptional health care that improves their health and well-being.

Current VA/DoD Guidelines(December, 2012)

Chronic Condition Related Asthma Chronic Heart Failure (CHF) Chronic Kidney Disease (CKD) Chronic Obstructive Pulmonary Disease (COPD) Diabetes Mellitus (DM) Dyslipidemia (LIPIDS) Hypertension (HTN) Ischemic Heart Disease (IHD) Obesity and Overweight (OBE) Tobacco Use (MTU) Mental Health RelatedBipolar Disorder (BD) Major Depressive Disorder (MDD) Post Traumatic Stress Disorder (PTSD) Substance Use Disorder (SUD)

Military Related Biological, Radiation, Chemical, and Blast/Explosion Induced Illnesses Medically Unexplained Symptoms (MUS) Post-Deployment Health (PDH) Pain RelatedPain Lower Back Pain (LBP) Opioid Therapy for Chronic Pain (OT) Post-Operative Pain (POP) Rehabilitation RelatedConcussion/mTBILower Limb Amputation Stroke Rehabilitation Women's Health Pregnancy

External Influences on Guideline Development

Federal Government−Congress−OMB

Veteran Service Group−Professional /Advocacy organizations−Federal Advisory Committees

External Agencies−NCQA−The Joint Commission

Federal Government

Congress

Last year congress initiated process of over 100 bills that affect veteran care:

−Women Veteran health Care Improvement Act−Rural Veteran health Care Improvement Act−Homeless Care−Camp LeJeune

Omnibus Act

Tribal Government Relations

Veteran Advocacy Groups−World War I−World War II−Korean War−Vietnam War

Veteran Family Organizations

Women Advocacy Groups

Veteran Service Groups

External Influences

•The Joint Commission

•NCQA

•CMS

Implications

•Office of Management and Budget Constraints

•Research

•Congressional Mandates

•Global Conflicts