Diffusion of Excellence kicks off with 11 groundbreaking practices

The fourth cohort of VHA employees will start their implementation journey as the Diffusion of Excellence (Diffusion) kicks off its Base Camp on October 23-25 in Orlando, Florida. From the 4th annual VHA Shark Tank Competition at the VHA Innovation Experience in August, 11 finalists, known as Gold Status Fellows (GSF). The GSF’s will connect with their counterparts from other VHA medical centers, dubbed Implementing Facility Fellows (IFF) nationwide to begin replicating the Gold Status practices. Implementing facilities bid time and resources to implement the Gold Status practices and Base Camp is where they will learn to adapt and standardize the practice for implementation across multiple facilities. Once reviewed by VHA leadership and subject matter experts, the most successful practices are diffused throughout VHA’s health care system, for to ensure all Veterans experience the same quality of care no matter which facility they visit.

Diffusion is one of VHA’s most successful initiatives. Since launching in late 2015, Diffusion has produced 36 Gold Status practices which have been replicated 386 times at VHA facilities, positively impact care and lives of more than 97,000 Veterans. These practices helped achieve cost savings of over $27 million while saving more than 10,000 labor hours. With more than 5,000 employees involved in implementing best and promising practices throughout the system, Diffusion is fundamentally changing the Veteran experience, how they receive their care, and the overall quality, value and impact of the care.

At Base Camp, GSFs and IFFs will work together to develop a roadmap for implementing the Gold Status practice at their facility, and accounting for the special challenges they may face including: varying levels of leadership enthusiasm and support, and organizational, regulatory and funding barriers, and more. However, like their predecessors, the current cohort of GSFs and IFFs welcome the challenge, knowing that Gold Status practices help improve and advance clinical care practice for all Veterans because their efforts will lead to one thing: a better health care system for Veterans.

Each team of GSFs and IFFs will be set up for success through pairings with trained experts in implementation from QUERI’s Center for Evaluation and Implementation Resources (CEIR) and project managers. These experts will provide training in implementation science and help them develop implementation plans that will not just pertain to their facilities, but also serve as the foundation for nationwide rollout when ready. VA leadership and health care specialists will join in to guide the GSF and IFF teams to most effectively develop and implement new practices. Finally, previous Fellows will share their experience and insights with the current cohort on the challenges they faced and how they overcame them. By the end of Base Camp, the current cohort will have comprehensive and actionable plans that will allow them to begin implementing their practices at new facilities.

Below are descriptions of the practices and how they will impact Veteran care. To learn more about the practices, be sure to join us from October 23-25 on Facebook and Twitter as we bring you live coverage of this amazing event. See live streams of speakers, demonstrations of practices, and follow along throughout the entire Base Camp on the #VHABaseCamp hashtag.

Access

4-Sight: Automated Eyeglass Ordering for Prosthetics
Gold Status Fellow Name: David Hook, Brian Kaiser, Spencer Mion, Timothy Strebel, Pamela Westbrooks
Gold Status VISN/Facility: VISN 22: Desert Pacific Healthcare Network
Implementing Facilities: Eastern Oklahoma VA Health Care System, Lexington VA Health Care System, South, Texas Veterans Health Care System, Veterans Health Care System of the Ozarks, VISN 12 VA Great Lakes, VISN 19 Rocky Mountain Network
Summary: The practice uses an Excel macro to automate the eyeglass-ordering process, increasing the number of consults closed. Using the macro, nine sites closed 38,888 consults between October 2017 and April 2018, dramatically reducing the number of consults open more than 30 days.

COACH – Caring for Older Adults and Caregivers at Home
Gold Status Fellow Name: Judith Davagnino
Gold Status VISN/Facility: VISN 6, Durham VA Medical Center
Implementing Facility: Tuscaloosa VA Medical Center
Summary: The program provides dementia care to Veterans in their home and offers education in dementia care and resource assistance to the Veteran caregivers. After one year, the program reduced agitated Veteran behaviors by 14 percent, reduced negative caregiver reactions to behaviors by 34 percent, and reduced caregiver burnout.

Hypertension Management via Virtual Visits
Gold Status Fellow Name: Margaret Carrico
Gold Status VISN/Facility: VISN 8, James A. Haley Veterans’ Hospital Primary Care Annex
Implementing Facilities: Gulf Coast Veterans Health Care System, VA Boston Healthcare System
Practice Summary: The practice provides virtual visits allowing Veterans to receive blood pressure check-ins at home, reducing the risk for no-shows and travel expenses for Veterans. The practice resulted in a 94 percent satisfaction rate among Veterans choosing virtual visits over face-to-face visits.

Care Coordination

Advanced Comprehensive Diabetes Care (ACDC)
Gold Status Fellow Name: Matthew Crowley
Gold Status VISN/Facility: VISN 6, Durham VA Medical Center
Implementing Facility: VISN 19 Rocky Mountain Network
Practice Summary: The program is a nurse-administered telemedicine intervention which addresses advanced diabetes, using standard telemonitoring services to deliver diabetes self-management support and clinician-guided medication management. ACDC improved diabetes test results (HbA1c) by an average of 1 percent versus usual care over a six-month period, and by nearly 2 percent among engaged Veterans.

Reducing Chronic Obstructive Pulmonary Disease (COPD) Readmission Rates by Improving Transitions of Care through an Interprofessional Primary Care Team
Gold Status Fellow Name: Edward Portillo
Gold Status VISN/Facility: VISN 12, William S. Middleton Memorial Veterans Hospital
Implementing Facility: Veterans Health Care System of the Ozarks
Practice Summary: The practice uses an action plan to reduce COPD readmissions including interprofessional visits, referrals for pulmonary rehabilitation, tobacco cessation treatment, and optimized medications. Practice data demonstrated a significant reduction in total number of readmissions, with 0 percent of patients in the program readmitted compared to 18.9 percent for standard of care.

Provider Recruitment and Retention in Rural Facilities
Registered Nurse (RN) Stay Interviews: A Nursing Turnover Strategy
Gold Status Fellow Name: Karen Long
Gold Status VISN/Facility: VISN 12, Tomah VA Medical Center
Implementing Facilities: Eastern Oklahoma VA Health Care System, West Texas VA Health Care System
Practice Summary: The practice uses an interview plan with new nursing staff at regular intervals during their first year to assess satisfaction and boost retention. The practice resulted in a 65 percent reduction in RN turnover over five quarters and an improvement of 35 positions in national ranking.

Quality and Safety

Better Health, Lower Cost: How IMPaCT Community Health Workers Can Support Veterans
Gold Status Fellow Name: Judith Long
Gold Status VISN/Facility: VISN 4, Philadelphia VA Medical Center
Implementing Facility: Iowa City VA Health Care System
Practice Summary: The practice provides training to community health workers to prepare them to join a health care team and provide social support to high risk patients. IMPaCT reduced total patient hospital days by nearly ten-fold at six months (13 vs. 138) with persistence of effect at nine months (69 vs. 162 days), and patients were twice as likely to report high-quality primary care.

Getting Hospitalized Veterans Back on Their Feet: The STRIDE Program
Gold Status Fellow Name: Susan Hastings
Gold Status VISN/Facility: VISN 6, Durham VA Medical Center
Implementing Facilities: Martinsburg VA Medical Center, Wm. Jennings Bryan Dorn VA Medical Center
Practice Summary: The program provides hospitalized older Veterans with a gait and balance assessment by a physical therapist followed by supervised walks with a nursing assistant throughout their hospital stay. Program participation resulted in shorter hospital stays for Veterans from 5.7 days to 4.7 days and saved the hospital approximately $1,742 per Veteran that participated in the program.

Utilizing Machine Learning to Audit and Impact Prescription Benefit Decisions
Gold Status Fellow Name: Cory Fominaya
Gold Status VISN/Facility: VISN 7, Ralph H. Johnson VA Medical Center
Implementing Facilities: Memphis VA Medical Center, Tuscaloosa VA Medical Center
Practice Summary: The practice uses a Deep Learning Algorithm to identify and reduce prescription drug billing errors associated with a service connected condition. This practice detected more than two million anomalous records annually.

Veteran Experience

Environmental Management Service (EMS)
Gold Status Fellow Name: Ricardo Rucker
Gold Status VISN/Facility: VISN 20, VA Puget Sound Health Care System
Implementing Facilities: Louis Stokes Cleveland VA Medical Center, Tomah VA Medical Center, VISN 19 Rocky Mountain Network
Practice Summary: The practice provides room cards with QR codes that employees and patients can use to submit concerns or feedback to the EMS team 24 hours a day. The practice improved facility Survey of Healthcare Experiences of Patients (SHEP) by more than 27 percent.

Gerofit – Managing Diseases and Lowering Care Costs with Exercise
Gold Status Fellow Name: Miriam Morey
Gold Status VISN/Facility: VISN 6, Durham VA Medical Center
Implementing Facility: Charlie Norwood VA Medical Center
Practice Summary: The program provides older Veterans with personally tailored exercises. 92 percent of participating Veterans reported high satisfaction with the program and noted that this program often provides them with their “most positive VA experience.” Additionally, the program improved functional status, CV metabolic profile, and reported post-traumatic stress disorder (PTSD) and anxiety symptoms among participating Veterans.