The Heller School for Social Policy and Management

RC in the VA

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Projects

As part of the RC in the VA project, five VA projects have been provided with funds in support of their projects. Projects include:

CONCERT

Primary Investigators: Christine W. Hartmann & Lynn Snow - Bedford VAMC & Tuscaloosa VAMC

Project Manager: Valerie Clark

CONCERT is conducting a 4-month Learning Intensive for the 32 VA Community Living Centers (CLCs) who could most benefit from this highly participative quality improvement opportunity. The learning intensive has 3 goals: a) provide immediate assistance to improve quality measures, 2) develop long-term skills and systems for continuous improvement, 3) establish a CLC-based high involvement quality improvement system. A leadership team consisting of the medical director, chief nurse, quality manager, and resident assessment coordinator work together to learn, apply, and take back to their CLC staff a process for rapid and sustained improvement. Attendees are assigned tasks to objectively evaluate the current state of their CLCs and implement improvement interventions. The learning intensive focuses on skill building in four areas: high-involvement leadership, highly-effective relational communication infrastructures, supporting Veterans’ highest practicable well-being through individualized care practices, and rapid cycle quality improvement that involves the front-line staff closest to the Veteran. 

Engaging Veterans Seeking Service-Connection Payments in Pain Treatment

Primary Investigators: Steve Martino and Marc Rosen - West Haven

Project Manager: Christina Lazar

The theoretical framework for implementation of SBIRT-PM in a hub-and-spoke model is Relational Coordination. VACHS counselor will provide SBIRT-PM by phone to Veterans in all 8 VISN1 medical centers (and related CBOCs). SBIRT-PM aims to engage Veterans seeking MSD-related C&P claims in multi-modal pain care and, if relevant, plans for reducing risky substance or medication use. Counselors will have 4 calls over 12 weeks with the Veterans. After each call, they will largely be informing primary care nurse managers working within PACTs of the Veterans’ interests in pain and substance use care (e.g., modalities they want to pursue) and, as needed, problem-solve and provide case management support to help the Veterans navigate the different VA healthcare systems.  Our counselors must work with the PACTs because their primary care providers place consults for services the Veterans may become motivated to try via SBIRT-PM counseling.  We believe the quality of communication and collaboration between our counselors and site PACTs and, within site, between C&P, eligibility, PACTs, and pain service providers will be predictive of the extent to which Veterans engage in multi-modal pain care and experience reductions in pain (and risky substance use for those who have this comorbidity).  Clearly, information will need to flow effectively between members of the hub-and-spoke sites for the Veterans’ care to be timely, coordinated and appropriate.


In this study, we will first explore how relationships among C&P, Eligibility, clinical and administrative staff involved in pain care are coordinated at the sites during site visits and baseline semi-structured qualitative interviews early in the preparatory phase. Informed by what stakeholders tell us, we will then work to build Relational Coordination within our hub-and spoke network to deliver SBIRT-PM.

We have proposed to use the Relational Coordination Survey to examine how C&P, Eligibility, clinical and
administrative staff involved in pain care communicate with each other about the treatment needs of compensation-seeking Veterans along seven dimensions (frequency, timeliness, and accuracy of communication, problem-solving, shared goals, shared knowledge, mutual respect). Using the survey, respondents indicate the frequency in which each dimension exists in their setting on a 5-point scale (1 = never, to 5 =constantly). The mean of the individual scores serves as the overall RC score for each dimension within each spoke site. Based on the results of the survey and the stakeholder interviews, we will use this information to further develop our implementation of the hub and spoke SBIRT-PM project approach.

Resources

Podcast

Heather Gilmartin (Investigator and Nurse Scientist at the Denver/Seattle Center of Innovation, part of the Department of Veterans Affairs) is interviewed about her work using relational coordination in care coordination within the VA, the RC in the VA project and recommendations for how others can get involved and use relational coordination in their work.

Visual Abstract. Download PDF here.

RC in the VA Visual Abstract