Mayo Brothers WWII - Ministry of Patriots and Veterans Affairsenglish.mpva.go.kr/upload/files/How to...

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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Patients and FamiliesPatients and Families

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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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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 5

Best Best Care AnywhereCare Anywhere


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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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


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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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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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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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


Integrated Comprehensive Rehabilitation CareIntegrated Comprehensive Rehabilitation Care

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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


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


• 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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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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VHA Polytrauma/TBI System of Care FY2012


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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Rehabilitation ResourcesRehabilitation Resources

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TelehealthProsthetic

LimbsAssistive

Technology

Diagnostic Tools,

Therapies

VA Innovative Initiatives, Technologies and Treatment


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•


Assistive Technology:Assistive Technology:Keeping up with the Active VeteranKeeping up with the Active Veteran

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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


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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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


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


• 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



• 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


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