Ensuring timely access to high-quality care for all veterans is a key component of the VA’s mission, yet veterans in rural areas often face challenges in obtaining high-quality emergency care, which can lead to poor health outcomes.
To combat this issue, the Department of Veterans Affairs Veterans Health Administration Office of Rural Health has established an Emergency Medicine Analytics Team (EMAT) to improve the acute-care experience for rural veterans.
The initiative is co-directed by Michael Ward, M.D., Ph.D., vice chair and professor of emergency medicine and biomedical informatics at Vanderbilt University Medical Center, and Anita Vashi, M.D., from the Center for Innovation to Implementation at the Palo Alto VA Medical Center. The team has two main priorities: Improving access to acute services and enhancing the quality of emergency care.
“More than four out of five rural veterans lack access to a VA emergency department or urgent-care facility,” Ward said. “The VA is spending over $500 million per month on non-VA emergency care, which is not a viable fiscal strategy in the long run.”
Dissecting the Unmet Need
Ward questions the efficiency of how the VA’s financial resources are used to provide emergency care services to veterans in the community.
Much of the care veterans receive in acute settings may not actually be urgent, but rather related to common conditions that could be better managed, Ward explained.
“Common presentations, like viral infections or stomach upset, don’t necessarily require medical intervention,” Ward said. “Veterans often visit the nearest emergency room, where they receive care that is not evidence-based, later coming back to the VA to manage complications of inappropriate treatment.”
“The process is flawed, inefficient and must be improved.”
He added: “The process is flawed, inefficient and sometimes unsafe. It must be improved.”
The Emergency Medicine Analytics Team will begin by evaluating virtual programs and community care utilization, as well as evidence-based risk stratification and prescribing quality for common conditions.
Specifically, it will evaluate telemedicine and the quality of prescribing, which could help expand access to high-quality acute services for veterans in rural areas.
Focusing on Three Strategic Priorities
As the initiative matures, it will focus on three strategic areas:
- Evaluation, including assessments of quality, safety, utilization, cost and patient experience.
- Innovation development, focusing on new tools, processes and pilot interventions.
- Dissemination of effective practices, interventions, programs and policies.
Ward’s long-term vision is to enhance the quality and accessibility of emergency care for veterans across the country, which includes disseminating the most important findings to the broader medical community.
“With any new intervention, you have to understand how it can be used to improve quality of care, save costs or adapt policies and programs,” Ward said.
Laying Groundwork for Change
The work of the analytics team and, more broadly, the Office of Rural Health aligns with the VA’s priority of becoming a learning health-care system, which combines institution‐specific data generation and evaluation with a broader context to improve all facets of care, including lowering the cost.
To achieve cost reductions, Ward highlights the importance of successfully scaling up evidence-based interventions and continually monitoring their impact.
“The EMAT is a key step to build a framework for future change.”
“Spending $500 million a month isn’t sustainable,” he said. “And when you don’t have the physical infrastructure for patients to simply go to the nearest VA where there isn’t one, you can’t easily solve the problem.”
“The EMAT is a key step to build a framework for future change.”
