Tighter budgets and an increasing demand for affordable, convenient health care options are driving a number of innovative research projects at the Iowa City VA Health Care System.
A number of groups within the system are working to implement low-cost, efficient health care practices for veterans across the state and nation.
"We have finite resources, and we have to evaluate what we're doing and see what's cost effective and look at how, over time, we can improve the efficiency of the care we deliver," said Peter Kaboli, director of the Veterans Rural Health Resource Center, Central Region.
The Resource Center, along with the Center for Comprehensive Access and Delivery Research and Evaluation, or CADRE, are in their third year of a five-year, $10 million grant to study how best to provide care to rural veteran populations.
The Iowa City location is one of three VA Health Care Systems throughout the country studying the issue, Kaboli said.
Though research is focused on veterans, the need to provide low-cost services to all populations makes the work particularly significant, said Eli Perencevich, interim director of research at CADRE.
The Resource Center and CADRE are looking at ways to provide access to some specialized services in more clinics and even allowing patients to take some treatment into their own hands and their own homes.
"There are some things we know are a challenge to rural vets. One of those is access to care," Kaboli said. "We're working to understand how big of a challenge that is for veterans and what the implications are for them. We can't bring a clinic to every town, but we're looking at telehealth, resources for telemedicine, equipment in patients' homes and local clinics."
Kaboli said the push for more access and localized services cuts down on costs to taxpayers, allows patients to stay at home longer and can provide patients the same quality of health care in a more convenient way.
"With a fixed budget, you have to find the most cost-effective ways to provide care," Kaboli said. "We want patients to get the care they need. If the best way is for them to call in from home, then why not do it that way?"
The Resource Center and CADRE work hand-in-hand in researching and identifying ways to improve care and then finding the most effective implementation, Perencevich said.
Kaboli pointed to a new mental health service for veterans who are students at Western Illinois University as one example of telehealth put into practice.
The Iowa City VA identified a large veteran population at the school in Macomb, Ill., but determined it was not feasible to locate and staff a clinic there.
Instead, students access VA mental health services by speaking with doctors via video in the student health office.
"It's a real solution for access," Kaboli said. "Students at Western Illinois don't have to drive two hours; they can sit in front of a TV monitor and get help remotely."
Randy Kardon, a professor of ophthalmology and director of the Center for the Prevention and Treatment of Visual Loss, is looking to provide the same services in eye care.
Kardon's center is looking at ways to provide telemedical diagnosis and monitoring of vision problems, he said.
He said the telemedical approach would work for people with a number of eye disorders, including the most common causes of vision loss, such as glaucoma, diabetes and macular degeneration.
"The problem is that it's pretty costly having to come back for repeat visits," he said.
Kardon said new low-cost portable imaging devices that are being developed can take pictures in the back of the eye and will be outfitted with software that can identify diseases.
"It's conceived as a low-cost camera system that could be placed in many easily accessible locations," he said.
Kardon likened it to the blood pressure monitors available at grocery stores and pharmacies.
"It's a way of monitoring a much larger group of people and at a lower cost," Kardon said. "People tested who show abnormal results or worsening would then be referred to an eye doctor."
Kardon said research is being done to compare how receiving an evaluation from a telemedical device might compare to an evaluation from an actual doctor.
"It's an important concern," he said about skepticism surrounding such remote practices. "It can't take the place of a doctor, but we can at least try to set up the system to flag patients who need to be seen the most so they can be prioritized.
"There's a chance that any condition could be undiagnosed by a doctor or a machine. It's all a learning process that is evolving rapidly as technology and new approaches become available."
Iowa City is an ideal place for that learning process to take place because many of those involved in the research know the struggles rural patients face, Perencevich said.
"A lot of the investigators here were born and raised in Iowa," Perencevich said. "They understand some of the challenges associated with rural health."
Perencevich and Kardon said asking the right questions allowed local researchers access to millions in grant money.
The Iowa City VA Center for the Prevention and Treatment of Visual Loss received a $5 million grant to conduct its research and has been able to leverage it into more than $17 million in additional funding, with hopes to top $25 million, Kardon said, noting the five-to-one return on the initial investment by the Department of Veterans Affairs Rehabilitation Research and Development Division.
The Iowa City VA Health System ranks in the top five in terms of funding for research, he said.
"That tells you we've been a very active hotbed of research and successful collaboration of exceptional clinicians and scientists," he said.
The VA also just completed a new multi-million 64,000-square-foot, three-building research complex in November 2010 with more resources and space for projects to expand.
"It gives us a home," Kardon said. "Now we are able to meet regularly and discuss ideas in a central location. We want to come together and interact as much as possible. It came at just the right time for our purposes."
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Autor(en)/Author(s): Emily Schettler
Quelle/Source: Iowa City Press Citizen, 10.03.2011
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