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Implementation of the Epilepsy Center of Excellence to improve access to and quality of care--protocol for a mixed methods study.

Pugh MJ, Leykum LK, Lanham HJ, Finley EP, Noël PH, McMillan KK, Pugh JA - Implement Sci (2014)

Bottom Line: Each ECOE consists of a network of regional hubs to which spoke facilities refer Veterans for subspecialty treatment.This four-year comparative case study uses a mixed-methods approach.Moreover, it contributes to implementation science by advancing understanding of the role of RC in the context of a major transformation in the structure of care delivery in a national integrated healthcare system.

View Article: PubMed Central - HTML - PubMed

Affiliation: South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, 7400 Merton Minter BLVD, San Antonio, TX 78229, USA. Maryjo.Pugh2@va.gov.

ABSTRACT

Background: To address the growing problem of epilepsy among aging Veterans and younger Veterans who have experienced a traumatic brain injury (TBI), the Veterans Health Administration (VA) has implemented 16 Epilepsy Centers of Excellence (ECOE) to assure increased access to high quality of care for Veterans with epilepsy. Each ECOE consists of a network of regional hubs to which spoke facilities refer Veterans for subspecialty treatment. The ECOEs are expected to improve access to and quality of epilepsy care through patient care, consultation and education. This study aims to: evaluate the effectiveness of the ECOE structure by describing changes in the quality of and access to care for epilepsy before and after the ECOE initiative using QUality Indicators in Epilepsy Treatment (QUIET Indicators); describe associations between changes in the structure and processes of care and Relational Coordination (RC), a model of task-oriented communication that has been shown to play a role in implementation science; and determine if variations in care are related to levels of RC.

Methods: This four-year comparative case study uses a mixed-methods approach. We will use VA inpatient, outpatient, pharmacy, and chart abstraction data to identify changes in the quality of and access to epilepsy care in the VA between Fiscal Year 2008 and Fiscal Year 2014. Qualitative and survey methods will be used to identify changes in the structure and processes of epilepsy care and RC over the course of the study. We will then link data from the first two objectives to determine the extent to which quality of and access to epilepsy care is associated with RC using multivariable models.

Discussion: This innovative study has the potential to improve understanding of hub-and-spoke model effectiveness, VA epilepsy care, and models of epilepsy specialty care more globally. Moreover, it contributes to implementation science by advancing understanding of the role of RC in the context of a major transformation in the structure of care delivery in a national integrated healthcare system.

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Related in: MedlinePlus

Epilepsy centers of excellence organizational structure.
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Related In: Results  -  Collection

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Figure 1: Epilepsy centers of excellence organizational structure.

Mentions: Mandated by the Veterans Mental Health and Other Care Improvements Act of 2008 (PL110-387), the ECOE is comprised of 16 VA ‘hub’ facilities geographically dispersed in four regions to which ‘spoke’ facilities that lack specialty care and/or necessary diagnostic equipment may refer Veterans for specialty care within their region. Hubs within each region are linked to an accredited medical school and a Polytrauma Rehabilitation Center (PRC), which treats Veterans with TBI who at risk of developing post-traumatic epilepsy (PTE). This hub and spoke network is led by a national director with regional directors overseeing hubs within each region (Figure 1). This network structure was designed to improve access to epilepsy specialty care to Veterans across the country. Ideally, access is improved directly by providing a referral network for Veterans from remote sites and indirectly by providing outreach education and telehealth opportunities for patient consultation.


Implementation of the Epilepsy Center of Excellence to improve access to and quality of care--protocol for a mixed methods study.

Pugh MJ, Leykum LK, Lanham HJ, Finley EP, Noël PH, McMillan KK, Pugh JA - Implement Sci (2014)

Epilepsy centers of excellence organizational structure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4022083&req=5

Figure 1: Epilepsy centers of excellence organizational structure.
Mentions: Mandated by the Veterans Mental Health and Other Care Improvements Act of 2008 (PL110-387), the ECOE is comprised of 16 VA ‘hub’ facilities geographically dispersed in four regions to which ‘spoke’ facilities that lack specialty care and/or necessary diagnostic equipment may refer Veterans for specialty care within their region. Hubs within each region are linked to an accredited medical school and a Polytrauma Rehabilitation Center (PRC), which treats Veterans with TBI who at risk of developing post-traumatic epilepsy (PTE). This hub and spoke network is led by a national director with regional directors overseeing hubs within each region (Figure 1). This network structure was designed to improve access to epilepsy specialty care to Veterans across the country. Ideally, access is improved directly by providing a referral network for Veterans from remote sites and indirectly by providing outreach education and telehealth opportunities for patient consultation.

Bottom Line: Each ECOE consists of a network of regional hubs to which spoke facilities refer Veterans for subspecialty treatment.This four-year comparative case study uses a mixed-methods approach.Moreover, it contributes to implementation science by advancing understanding of the role of RC in the context of a major transformation in the structure of care delivery in a national integrated healthcare system.

View Article: PubMed Central - HTML - PubMed

Affiliation: South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, 7400 Merton Minter BLVD, San Antonio, TX 78229, USA. Maryjo.Pugh2@va.gov.

ABSTRACT

Background: To address the growing problem of epilepsy among aging Veterans and younger Veterans who have experienced a traumatic brain injury (TBI), the Veterans Health Administration (VA) has implemented 16 Epilepsy Centers of Excellence (ECOE) to assure increased access to high quality of care for Veterans with epilepsy. Each ECOE consists of a network of regional hubs to which spoke facilities refer Veterans for subspecialty treatment. The ECOEs are expected to improve access to and quality of epilepsy care through patient care, consultation and education. This study aims to: evaluate the effectiveness of the ECOE structure by describing changes in the quality of and access to care for epilepsy before and after the ECOE initiative using QUality Indicators in Epilepsy Treatment (QUIET Indicators); describe associations between changes in the structure and processes of care and Relational Coordination (RC), a model of task-oriented communication that has been shown to play a role in implementation science; and determine if variations in care are related to levels of RC.

Methods: This four-year comparative case study uses a mixed-methods approach. We will use VA inpatient, outpatient, pharmacy, and chart abstraction data to identify changes in the quality of and access to epilepsy care in the VA between Fiscal Year 2008 and Fiscal Year 2014. Qualitative and survey methods will be used to identify changes in the structure and processes of epilepsy care and RC over the course of the study. We will then link data from the first two objectives to determine the extent to which quality of and access to epilepsy care is associated with RC using multivariable models.

Discussion: This innovative study has the potential to improve understanding of hub-and-spoke model effectiveness, VA epilepsy care, and models of epilepsy specialty care more globally. Moreover, it contributes to implementation science by advancing understanding of the role of RC in the context of a major transformation in the structure of care delivery in a national integrated healthcare system.

Show MeSH
Related in: MedlinePlus