Transcript good things are happening at the va

GOOD THINGS ARE HAPPENING
AT THE VA
Vasilios Papademetriou, MD
Professor of Medicine Georgetown
University
<Vasilios Papademetriou, MD
Disclosure
Ad board: Pfizer, Shire
Speakers bureau: Amgen, AZ
Research support: Astra Zeneca, NIH, VA co-op study group
VA MEDICAL SYSTEM
THE VETERANS HEALTH
ADMINISTRATION
 History - Department of Veterans Affairs (VA )
 The United States has the most comprehensive system of
assistance for Veterans of any nation in the world.
 Roots can be traced back to 1636, when the Pilgrims of Plymouth
Colony were at war with the Pequot Indians. The Pilgrims passed a
law that stated that disabled soldiers would be supported by the
colony.
 In 1776 continental congress, provided pensions to disabled soldiers
 In 1811, the federal government authorized the first domiciliary and
medical facility for Veterans
 in 1917, Congress established a new system of
Veterans benefits.
 In 1921 the first consolidation of federal Veterans
programs took place.
VHA
 Following World War II, Congress enacted
large numbers of new benefits for war Veterans
 1944-World War II GI Bill was signed,
 1988 The VA was elevated to a cabinet-level
executive department by President Ronald Reagan
 1990 President George H. W. Bush renamed it to: The
Department of Veterans Affairs, known as VA.
 1991, the name was changed to the Veterans Health
Administration (VHA ).
 1995-2015 safe, effective, compassionate health care to
all veterans
THE VETERANS HEALTH
ADMINISTRATION TODAY
• 8.8 million patients
• 168 Medical Centers
• 300 Vet Centers,
• 827 Community-based
Outpatient Clinics
(CBOC),
• 135 Community Living
Centers,
• 6 Independent
Outpatient Clinics, and
• 103 Residential
Rehabilitation Centers
The largest Health Care System in the US
21 Veterans Integrated Service Networks
VISNs are the Funding & Accountability Unit in VA
 1995: Creating VISN’s
 Objective to transform
from VA “Hospitals” to a
“Comprehensiv Health
System”
 From “Safety Net” to
“Health Promotion &
Disease Prevention”
 Creating “System-ness”
 VISN Funding
 Performance
Measures
 Electronic Health
Records
IN JANUARY 2002
VISNS 13 AND 14
WERE INTEGRATED AND
RENAMED VISN 23
Main Objective 1995 -2005
 Improvement in Patient care
 Decrease in cost
 Improvement in outcomes
Goals: 2005 – 2015
To establish:
Safe, Effective, Efficient,
Compassionate Health Care
For All Veterans
2006-2016 : Who is “VHA” . . .
Veterans Health Administration
 VHA Today is . . .
 >8.8 million patients, Increased from 2.5 million patients / enrollees in 1995
(+404%)
 ~ 1,400 Sites-of-Care, including 171 medical centers or hospitals, ~900
clinics, 207 counseling centers, & long-term care programs
 ~ $31 Billion budget ?
 ~ 198,500 Employees (~14,500 MD , 59,000 Nurses, 33,000 AHP)
 ~ 10,000 fewer employees than 1995
 Affiliations with 107 Academic Health Care Systems
 Additional 25,000 affiliated MD’s and 35,000 residents & fellows in 14,000 slots
 ~ 90,000 trainees in all disciplines & 1,500 Health Professions Training Affiliations
 Nearly half US health professionals (>65% MDs) have some training in VA
 ~ 150,000 volunteers
 ~ $1.7B Research: Rehab, Health Services, Clinical, Basic
Electronic Medical Records
Integrates Notes, imaging, Pharmacy,
labs, orders etc. Everything related to
Patient care. Truly paperless system.
VA’s Electronic Health
Record
Ross Fletcher
Every medical center has
the Computerized Patient
Record System . . .
Since 1999 instrumental in the
transformation of the VA
Bar-Coded Medication
Administration
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5.85 Sigma Performance
Helped hold per prescription costs virtually constant for 5 years (~2½% / year)
VistA Use
 Documents (Progress Notes, Discharge Summaries, Reports)
 796,000,000…….. +586,000 each workday
 Orders
 1.55 Billion……. ... +916,000 each workday
 Images
 454,000,000……… +633,000 each workday
 Vital Sign Measurements
 977,000,000……… +672,000 each workday
 Medications Administered
with the Bar Code Medication Administration (BCMA) system
 776,000,000……… +599,000 each workday
ELECTRONIC MEDICAL RECORDS
VA INFORMATICS AND COMPUTING
INFRASTRUCTURE (VINCI)
• VINCI is an initiative to improve researchers
access to VA data.
• VINCI welcomes all researchers in the VA
community to explore the environment
and tools available.
• VINCI is a partner with the Corporate Data
Warehouse (CDW) and hosts all data available
through CDW as well as some unique data.
Extracts data from:
• CDW extractions from VistA
• MedSAS in SAS and SQL
• DSS in SAS and SQL
• TIU
• Radiology notes
•
For more information visit VINCI Central Intranet site at:
http://vaww.vinci.med.va.gov/vincicentral/default.aspx
VINCI has a common access point using Remote Desktop Connection
to connect from anywhere within the VA network.
THE VETERANS HEALTH
ADMINISTRATION TODAY
Good things are happening at the VA with
all three pillars of Academic Medicine:
Clinical Medicine
Medical Education
Medical Research
PATIENT CARE
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Comprehensive medical care
Decreased waiting time
Decreased hospital stay
Decreased cost
Met most performance measures.
Medicare
Consumer PI
VA-Cost per patient
GOOD THINGS ARE HAPPENING AT THE VA
HEART FAILURE ADMISSIONS
MEDICAL RESEARCH AT THE VA
 Animal Research
 Biosafety and biosecurity research
 Co-operative studies program: Mission statement
 To advance the health and care of Veterans through cooperative
research studies that produce innovative and effective solutions to
Veteran and national healthcare problems.
 CSP has a clinical research infrastructure that operates under the
management of Central Office in Washington, D.C
 35 active co-op studies
 CSP #474 - Radial Art e r y v s. Saphenous Vein G rafts in Coronary Arte r y Bypass Surgery (Radial Arte r y)
 CSP #592 - Efficacy and Safety of ICD Implantation in the Elderly (PI: Steve Singh)
 CSP #517-FS - ROOBY Trial Extension (Randomized on pump and off pump bypass surgery: Long Term
Follow -up)
 CSP #571—DES vs BM S in vein grafts
 Million Veteran Program (MVP)
MILLION VETERAN PROGRAM (MVP)
 MVP is a national, voluntary research program funded
entirely by the Department of Veterans Affairs Office of
Research & Development.
 The goal of MVP is to partner with Veterans receiving
their care in the VA Healthcare System to study how genes
affect health.
 MVP will build one of the world's largest medical databases
by safely collecting blood samples and health information
from one million Veteran volunteers.
 Data collected from MVP will be stored anonymously for
research on diseases like diabetes and cancer and heart
disease
 As of August 2016, MVP has enrolled over 530,000
participants, largest genetic study in the world
MILLION VETERAN PROGRAM (MVP)
 The program is entering the next phase of making these data
available , first to VA invest igators with plans for expanding in the
future to non -VA investigators , for genomic and epidemiological
studies that will inform health care delivery.
Genetics of Cardio-Metabolic Diseases in the
VA Population
Pharmacogenomics of Risk Factors and
Therapies Outcomes of Kidney Disease
Dr. Philip Tsao at the VA Palo Alto Health Care
System and Dr. Kyong-Mi Chang at the
Philadelphia VA Medical Center will lead a study
to explore the role of genetics in obesity,
diabetes, and abnormal lipid levels (namely,
cholesterol and triglycerides), as drivers of heart
disease. This project will help more thoroughly
understand underlying causes of cardiometabolic
disease and develop new therapies that are safe,
effective, and personalized.
Dr. Adriana Hung at the VA Tennessee Valley
Healthcare System will lead a study focusing on
how genes affect the risk and progression of
kidney disease, one goal is to examine how
patients with diabetes—who often develop kidney
problems—respond differently to the drug
metformin, the standard first-line treatment for
diabetes, based on their genetic profile. The
project will also look at the genetics of
hypertension, a major risk factor for kidney
disease.
Cardiovascular Disease Risk Factors, Prevalent Dr. Peter Wilson at the Atlanta VA Medical Center
Cardiovascular Disease and Genetics in the
and Dr. Kelly Cho at the Boston VA Healthcare
Million Veteran Program
System will lead an effort probing the genes that
influence how obesity and lipid levels affect heart
risk. Using MVP data, this study will also look at
whether these genetic factors differ among
African Americans and Hispanics.
Genetics of Cardio-Metabolic
Diseases in the VA Population
Pharmacogenomics of Risk Factors
and Outcomes of Kidney Disease
Cardiovascular Disease Risk Factors,
Cardiovascular Disease and Genetics
HYPERTENSION
ED D Freis
VA Co-op studies
1972: VA co-op study
Moderate HTN
1967: Va co-op
Severe HTN
1980s:
VA monotherapy
2000s:
ALLHAT
ACCORD
2015:
SPRINT
Hypertension treatment and control saves lives
MORE THAN 75% CONTROL RATES
Fletcher et al..AHA 2016
CARDIOLOGY PROCEDURES IN 2016
 78 cath labs
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39,735 coronary angiographies
12,305 PCIs
6,902 CABGs
1,783 peripheral angiographies
8,452 right heart caths
GOOD THINGS ARE
HAPPENING AT THE VA
 Electrophysiology:
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554 permanent pacemakers,
501 temporary wires
297 ICDs
217 ablation procedures
193 Bive+ICDs
 Structural:280 procedures
 71 valvulaplasties
 17 pfo closures
GOOD THINGS ARE HAPPENING
IN CARDIOLOGY AT THE VA