VHA RURAL OUTREACH CLINIC ELKO, NEVADA

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1 VHA RURAL OUTREACH CLINIC ELKO, NEVADA BRIAN WESTFIELD, MSN, NP-c ASSOCIATE DIRECTOR, PATIENT CARE SERVICES VA SALT LAKE CITY HEALTHCARE SYSTEM Veterans Health Administration (VHA) HISTORY VHA is a system of medical centers politically located throughout the nation Centralized care Benefits tied to inpatient care Mid-1990 s VHA began transition to primary care-driven system VHA TRANSITION Legislation and regulation changed to encourage primary care Community Based Outpatient Clinic (CBOC) concept established. CBOCs located in population centers away from medical centers. CBOCs provide primary care M-F Some specialty services added VHA CARES REPORT CARES REPORT 2004 Address the realignment of services to best serve veteran populations Communities identified for CBOCs Elko, Nevada not on list but at top of those communities that were not included Energized the veterans and citizens CBOC LIMITATIONS Do not meet needs of veterans in rural and highly rural communities Not cost effective for smaller populations Are free-standing clinics like any other private clinic Lacks an effective relationship with the community 1

2 Office of Rural Health (ORH) PL , December 2006, directed DVA to establish an office of rural health Improve access and quality of care for enrolled veterans in rural areas Primary care, mental health and long-term care Several additional bills provided additional guidance on intent of law ORH General themes in the initiative: Research activity Partnering with community clinics or entities Use of TeleHealth technologies Partnering with IHS Kara Hawthorne, Director of VHA ORH ELKO, NEVADA Population 16,900 - Vet pop 4800 Located in North Eastern Nevada in Great Basin Ranching and mining Small commercial district, hospital, Community College with a few 4-year programs Located 250 miles west of SLC, 290 miles east of Reno Elko Healthcare Services Elko medical service in transition with new hospital and medical building Community leaders wanted more than one option for medical care Establishment of the Nevada Health Center Clinic (Community Clinic) Also desired health services for the veteran population Elko Healthcare Services Early VASLCHCS Leadership met with Elko community leaders April 2004 Townhall meeting Coordinating group including county commissioners, college president, dept chairs, veteran representatives, city officials, sporadic medical comm reps Ongoing communication with congressional delegation 2

3 VASLCHCS agreed to do what we could given no authority or resources VASLCHCS committed to three point plan DAV Van Service Local access to labs Telehealth primary care DAV van service 3 days one week alternating with 2 days the next week Coordinating clinic schedules HOPTEL Helpful but not community-based service Lab Draw Station Extend our contract with LabCorp to allow for local collection of specimens Processed in Reno, Nevada and results transmitted to VASLCHCS Another small step to providing VA services Telehealth (TH) Clinic Objectives: Provide interim visits using TH Provider in SLC and veteran in Elko Annual face-to-face in SLC If provider feels need for face-to-face would be in SLC Still had an issue of space and support for community-based services TEACH Grant Innovative affiliations Three-way affiliation with Great Basin College (GBC), University of Utah, VASLCHCS $50,000 annual funding for three years Grant Funding Support nursing faculty position at Great Basin College Department of Nursing Faculty and students staff the Elko Virtual Clinic Provides support for veterans using technology Clinical experience for nursing students 3

4 Additional VASLCHCS funding Sharing agreement with University of Utah College of Nursing (CON) VASLCHCS supports 0.5 NP faculty position CON provides 0.5 NP for clinical support VASLCHCS is clinical site for NP students NP students/faculty collaborate with GBC faculty/students to provide TH care. Space lease with GBC TEACH Grant Intent met through innovative relationship with three institutions Outcome: GBC students get valuable learning experience CON NP students get TH experience Elko veterans have access to some real community-based VA care Other activities Community partners continue to meet Congressional delegation remains interested VASLCHCS on GBC curriculum committee VASLCHCS does analysis for CBOC for Elko CBOC-approved sites released by VHA Nevada Congressional delegation requests meeting the VHA VHA designates the Elko experiment as an Outreach Clinic July 2007 VASLCHCS now has the authority to provide services in Elko, Nevada Still cannot support CBOC Develop alternative model for VA services Where is this delivery model today? October 24, 2007 started on-site visits by NP MOU with Nevada Health Center Clinic for exam room space December 19, 2007 started on-site MH care January 2008 converted faculty position to VA staff position Transferred home telehealth care to Elko Clinic RN Upgraded TH technology which will allow for TH Mental Health services 4

5 Transferred home telehealth care to Elko Clinic RN Upgraded TH technology which will allow for TH Mental Health services Mobile Teleretinal Imaging Teledermatology RN Case Management 5 days per week FUTURE As enrollment increases will add clinic days TH and on-site Community-based pharmacy agreement Community-based access to imaging Urgent care services New space Add specialty TH services as available SLC-based clinical studio Framework of success Partnership Community Leadership VASLCHCS responsiveness ORH Initiative VHA ORH has looked at the Elko Model Similar and new models will be developed to meet the needs of veterans in rural and highly rural communities Keys to Success Partnerships Telehealth technologies Questions? 5