While Secretary of Veterans Affairs Eric Shinseki has made expanding access to care one of his three major themes, VA has had a continuous focus on expanding access to care for decades. Given the influx of new veterans and the growing needs of special populations (e.g., rural, homeless, women), the study and improvement of healthcare access needs to be a key focus of HSR&D. Further, as healthcare shifts from a primarily face-to-face episodic care paradigm to expanded communication and access, there remains a need for continued focus on measuring access as well as expanding access with innovative care models to all veterans. The CREATE focus for the Center will be hospital-associated infections (HAI), a major threat to patient safety The most significant HAI, methicillin-resistant Staphylococcus aureus (MRSA), is the focus of a VA-wide MRSA Initiative and yet is still found on 13% of admitted Veterans, twice the national average. Three key factors may explain high levels of HAI in VA: 1) hand-hygiene compliance is suboptimal, 2) frequent movement of colonized/infected patients between acute-care and community-living center settings, and 3) current efforts to prevent transmission do not address endogenous infections (i.e., infections that arise in patients already colonized on admission) It is in this context that CADRE seeks COIN funding to advance its missions for understanding and expanding access to care (Goal 1, Focused Area) and preventing HAIs (Goal 2, Focused Area - CREATE). Goal 1 will focus on access to care with a particular focus on rural veterans, specialty care, and women's health services. Areas of innovative expertise include tele-health, tele-ICU, and understanding the impact of dual-use with non- VA care. Key operational partners include the Office of Rural Health and the e-Health QUERI. Goal 2 will focus on evaluating interventions targeting the prevention of HAI through the use of vertical (i.e., pathogen specific) and horizontal (i.e., pathogen non-specific) interventions. These efforts will be supported through partnerships with the VA Office of Public Health including the Center for Occupation Health and Infection Control along with VA's National Infectious Diseases Service. CADRE will also expand and support innovative health services research in several additional areas including women's health, substance abuse, mental health, and comparative effectiveness research (Goal 3). CADRE will continue its success in supporting mentored, career- development opportunities (Goal 4) and promoting cross-medical center collaborations in VA (Goal 5). CADRE will be led by two accomplished scientists, Eli Perencevich and Peter Kaboli, whose leadership in HAI prevention and rural access provide experience and the necessary connections with VA operations to undertake important partner-oriented health services research in the proposed Focused Areas.
Improving veterans' access to high quality care is a major priority in VA. The Center for Comprehensive Access & Delivery Research and Evaluation (CADRE) seeks COIN funding to advance its mission of identify ways to improve access to high quality primary and specialty care services for veterans. While VA seeks to provide the highest quality and safest care possible, occasionally veterans develop infections while they are in the hospital. These infections can be caused by 'superbugs', like methicillin-resistant Staphylococcus aureus (MRSA), and can lead to longer hospitals stays or even death. The Center seeks to develop and test ways to prevent these infections in hospitals, community living centers and in outpatient settings so that veterans receive the safest care possible. The Center will also study ways to improve care for women veterans, find ways to assist veterans quitting smoking, and complete studies to determine which treatments are most effective; a science called 'comparative-effectiveness research.'
| Stewart, Kenda R; Stewart, Greg L; Lampman, Michelle et al. (2015) Implications of the Patient-Centered Medical Home for Nursing Practice. J Nurs Adm 45:569-74 |
