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In the Spotlight

VA Uses Technology to Provide Rural Veterans Greater Access to Specialty Care Services

SCAN Echo sites map - no specific detailThe Department of Veterans Affairs has announced that it is expanding access to specialty care and services for Veterans in rural or under-served areas as part of an enhanced three-pronged approach. This includes use of facilities, programs and technology to improve patient care and increase knowledge and skills of primary care teams as a component of workforce development. In June 2011, VA initiated Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) to increase access to specialty care services for Veterans in rural and medically under-served areas through the use of videoconferencing equipment.

VA SCAN-ECHO Specialty Care Centers (hubs) continue to expand participants (spokes) across all networks (see map), particularly in rural areas in conjunction with the Office of Rural Health (ORH). To date, over 600 community based outpatient clinics (CBOCs) have participated, which has doubled over the past year. In addition, 3,600 consults have been placed and used as case presentations. Care delivery has been evaluated by the Specialty Care Evaluation Center, a VA Health Services Research and Development (HSR & D)-funded center working to support a quantitative and qualitative evaluation of this program. Plans for FY15 include further expansion of SCAN-ECHO participation in non-hub networks as well as collaborations with the Office of Mental Health for Substance Use and Geriatrics and Extended Care Services (GECS) for Palliative Care.

SCAN-ECHO, originally modeled after University of New Mexico’s (UNM’s) Project ECHO but modified to accommodate the Veterans Health Administration’s (VHA’s) unique organizational structure, provides ongoing mentoring using case-based learning between specialist teams and Patient Aligned Care Teams (PACTs). Primary care providers (PCPs) present a patient’s case using multi site videotelconferencing equipment. Providers then take information back to the patient for discussion and collaborative decision making. The specialty care team collaborates, culminating in a recommended treatment plan. In addition to case presentations, formal clinical education is provided.

“The Department of Veterans Affairs is reaching out to Veterans in innovative new ways to improve access to our specialty care programs to Veterans regardless of where they live,” said VA Secretary Eric Shinseki. SCAN-ECHO originated with specialty care teams in diabetes, chronic pain management, Hepatitis-C, and heart failure. Since 2011, the list has expanded to include: chronic kidney disease, emphysema, gastroenterology, pre-operative evaluation, transplant medicine, women’s health/gynecology, palliative care, and vascular surgery. A master schedule of the clinics currently offered throughout the nation is available upon request. In addition, the VHA Office of Rural Health has supported new primary care teams with pilot funding for their participation.

Eleven VHA medical facilities currently serve as SCAN-ECHO Centers: VA Connecticut Healthcare System, West Haven, Conn.; Hunter Holmes McGuire VA Medical Center, Richmond, Va.; Salem VA Medical Center, Salem, Va.; Louis Stokes VA Medical Center, Cleveland, Ohio; VA Ann Arbor Healthcare System, Ann Arbor, Mich.; New Mexico VA Healthcare System, Albuquerque, N.M.; VA Eastern Colorado Healthcare System, Denver, Colo.; Portland VA Medical Center, Portland, Ore.; San Francisco VA Medical Center; and Veterans Integrated Service Network (VISN) 22 (services split between VA Greater Los Angeles Healthcare System and VA San Diego Healthcare System).

Results currently include: improved care delivery for patients with chronic pain whose providers have participated in pain SCAN-ECHO, improved process and initiation of Hepatitis-C treatment for providers participating in Hepatitis-C SCAN-ECHO, and promising early results in heart failure for guideline adherent recommendations. Other evaluations, such as those in pre-operative care and vascular medicine SCAN-ECHO, have shown an increase in care at CBOCs which translates into patients not needing to drive sometimes hundreds of miles to see a specialist. As a result, patients are experiencing improved access to care by having some specialty services delivered in CBOCs. Expansion in mental health, palliative care, and molecular oncology are anticipated in FY 15. For further information, contact vhaocststaff@va.gov.